"Never look down on anybody unless you're helping them up." Jesse Jackson
How many hours do you spend at work? Do you find them productive? Have you ever noticed how your interprofessional collaboration impacts the productivity of your day? Studies actually show that ineffective team dynamics actually put patients at risk, it also affects the level of job satisfaction among nurses and this also impacts their retention within an organization. We may think that it is a current problem but it isn't. In a study done in 2002, It was estimated that 41% of hospital nurses were dissatisfied with their jobs, and 22% planned to leave them in less than one year (among nurses younger than 30, this figure was 33%).The strongest reasons cited for respondents’included discontentment with being overworked, staffing cutbacks, increased caseloads, increased non–patient care duties, little to no concerns about care quality, verbal abuse, and lack of administrative concern." Some of us may be quick to dismiss it as a dated article but are these not the same issues we are grappling with now. For anyone interested please view this article here nurse-physician relationship. Within Africa, very few studies have been done on this. This is quite unfortunate because day in day out, we experience different scenarios that highlight how the interplay of the role of the different professions affects the clinical outcomes for patients.
On a personal level am appreciating how this current Covid 19 is bringing so many things to light. For instance, have you noticed how many webinars currently are inter collaborative efforts? We are finally coming around to the idea that for us to attempt controlling this pandemic we need to generate synergistic relationships. It became quite clear from the start of the pandemic that one profession cannot succeed without the other. Over the years there has existed a lot of friction between the nursing field and the medical field but slowly things are changing. Hopefully, there will come a time when it will be in the distant past. So have you ever consciously looked into why our team dynamics sometimes fall below par? Well, I did, and here is what I came across.Firstly I noticed it was an area where little volumes of data within Africa exist. That I deduced maybe as a result of the provision of patient-centered care being a new or relatively new concept in the majority of health institutions. If interested read this document and draw your own conclusions people-centered health care. Secondly, this patient-centered care due to the expenses inculcated in the implementation of the policies and services has mostly been taken up by the private health sector. Why? because within the public health sector how will these costs be transferred to the patients/clients and services still be provided at a subsidized cost. How will accountability be achieved yet every day we wake up to new corruption scandals? Anyway, before I digress much further let me get back to my core topic for the day.
- The nurses' role not being clearly understood and this leads to nurses being perceived as professionals who should just receive orders and not question them,
- Nurses being considered to lack the clinical expertise as "their level of education is lower than that of medical doctors."
- Stressful work environments that lead to fatigue due to excess workload, inadequate time frame,
- Authoritative positions only being held by the medical doctors
- Provision of clinical suggestions that are not scientifically based.
Before everyone is up in arms those are some conclusions from this one study in which you can view here the status of nurse-doctor collaboration. We all, however, can conduct more studies and generate to this pool of resources, and maybe the conclusions may vary.
What are some of the ways you have participated in abetting or terminating the interprofessional drift? Who suffers. Let us look into it;
During my clinical rotations as a student, I had gone for my operating theatre placement. On this particular day, I had scrubbed in for a partial hip replacement surgery now most people know how frustrating it can get when the surgeon attempts to place back the head of the femur with the prosthetic ball. Sometimes it is not easy and this was one such case. He got frustrated and within no time tension built up rapidly and soon instruments were being tossed over people's heads with the claim that all the instruments were dysfunctional.No one said nothing, some of us walked out the room not to return. The patient was under spinal anesthesia and could hear everything. A surgery that would have taken about two hours ended up taking four hours. It eventually ended successfully but let us examine the events.1. The patient received more dosages for the anesthetics than necessary. This predisposed him to a greater risk for adverse drug reactions.
2. There was exposure to preventable psychological trauma to the patient and staff present. As a patient can you imagine being in an operating table and having your caregivers argue? You will be unsure of the quality of care being provided to you. For the caregivers, our safety was threatened. Our reaction was not the best but we soon learned from it.
3 This situation resulted in increased costs for the patient. We know that theatre charges in most organizations are calculated at a specific rate per hour. He was in for an extra two hours as the team was being gathered again to continue.
Another example would be when a nurse doesn't wish to confirm a dosage for a drug like Gentamycin in an infant and administers the stated dose. Let us assume it was an overdose and we end up with the infant developing drug-induced kidney injury. Who suffers at the end of it? Something needs to be done. Great progress is happening to mend the drift but we need to expedite it. It is possible and we are already on the right path.
Try and think of a time when interprofessional harmony aided in the quick recovery for a patient. Or when it bailed you out of a situation that would have culminated in a court case. What about on those days when this harmony created such a peaceful work environment that it aided in your peak productivity. Wouldnt it be nice if it was the set standard everywhere? Each of us can play their role in making it a reality for example;1.Nurses
- Encourage participation in other departments’ training- This may help nurses better empathize with the challenges their colleagues in other disciplines face.
- Promote multidisciplinary rounds- This provides avenues for asking questions, seeking clarification, and discussing patient goals with other providers.
- Keep the focus on the patient - Remind providers that the goal of the approach is to ensure patient satisfaction.
- Be bolder in explaining our evidence-based suggestions.
- Be okay with being uncomfortable. Respect is never demanded it is earned.
For an in-depth elucidation on some of the above points please review the documents below
Role of the health facility administrators and teaching facilities
- Generate staff training programs for interprofessional education- This enhances communication by encouraging discussion of shared cases and provision of immediate feedback.
- Interprofessional curriculum development and delivery - eg At Tribhuvan University’s Maharajgunj Nursing Campus in Nepal, the curriculum on newborn care was updated at a workshop that included nursing and medical faculty. Participants worked together to identify the essential components of a new curriculum. They found that the nursing faculty were more knowledgeable and skilled in areas like essential newborn care while the medical faculty were more knowledgeable and skilled in advanced care.
For more examples of how organizations can effect this please view the following document Framework for action on interprofessional education & collaborative practice. 2010.
“Our sexuality affects everything we do, and everything affects our sexuality. The same is true of our spirituality -that which is most deeply meaningful to us. We can deny both. But denying them does not mean they are not both alive in every breath and heartbeat of life.”
A couple of years ago while on a nightshift a middle-aged woman dashed through the ER door screaming that her daughter had been raped. My colleague and I quickly rushed to the vehicle on the driveway and tried to assist the daughter out of the vehicle. We managed to do so and got her to the examination couch. I was so confused about it all. It was still very unclear on exactly what I should do but my colleague had more experience in handling such delicate cases and guided me through it. We tried to make her as comfortable as possible but upon examination, things suddenly were not adding up. Something was just off. The more we conducted our assessment the more my intuition kept telling me that something was amiss. To keep both parties calm I said nothing and when all samples were collected the treatment process was initiated. A few days later when the police got actively involved new information was disclosed. There was no rape ordeal that had happened but rather she had learned she was pregnant a few weeks prior and had informed her boyfriend who denied impregnating her. Without having appropriate information she had assumed that if she reported being raped. The emergency treatment would terminate her pregnancy without her parents' knowledge. She didn't have full knowledge of what really goes on. At the time she was only 18 years old and had just started campus.
One Saturday while in triage there developed sudden flooding of a foul smell. As I tried to identify the source a young lady walked in. She appeared to be in significant pain but she didn't wish to fully divulge information yet. On enquiring further about her last menstrual cycle she dismissed it as they tend to be irregular and had no recollection of the date. Her presenting complaints were diarrhea and mild abdominal pain. On physical examination she was pyrexic at 38.50Cand tachycardic at 122beats per minute her skin appeared flushed. While in the doctors' room further examination revealed she had had a septic abortion which had resulted in retained products of conception and the infection was so bad that it had created a vesicovaginal fistula hence the foul smell, her cervix was injured and the infection had infiltrated and obstructed her fallopian tubes. The attending gynecologist informed her that future conception was not fully guaranteed if she did not get properly treated. She had no insurance and she wasn't ready for full disclosure to her family. She denied ever being pregnant to her father who had come to check up on her when she informed him she is in hospital. He paid only for what was done in the ER and requested a transfer to a different facility. She was only twenty years old.
These two examples are our sisters, daughters, friends, and grandchildren so if we say sexuality doesn't affect us we kid ourselves. It can be as simple as our reproductive health affecting our generalized physical health. For instance, if a young man develops an STI which is untreated and developed late-stage symptoms of syphilis later on in life. He will be quickly diagnosed as psychotic without it being quickly linked to the late-stage presentation of syphilis. The reason it can be untreated for so long is because whenever he experiences symptoms he cannot phantom visiting a health facility to be mocked by the attending caregiver. Adolescents and young adults are a sensitive age group.
Did you know that in 2017 the MOHkenya had obtained data that showed that "one in five girls began having children by the age of 19 years and only about 2% of teenage mothers finally go back to school?" You can view it here, 
Examination of different studies show that huge figures later translate to 
To try to mitigate this we should participate in it. How?
As we continue promoting healths lets not act as if sexual health is a very separate entity. When one digs dipper one realizes just how big a role it plays in all aspects of our lives. In our daily interaction with our patients' let us keep in mind that, "Sexual health is more than freedom from sexual disease or disorders. Sexual health is non-exploitive and respectful of self and others. Sexual health is dependent upon an individual's well-being and sense of self-esteem. Sexual health requires trust, honesty, and communication."