Monday, May 10, 2010

MDT dynamics

What happened?

I had been working with a patient, who was admitted from home after having a fall and came into hospital with a UTI.

I had completed a SAP with her, and reviewed her pre and current occ performance and decided to see her after the weekend to organise a h/v due to her hx of falls and her decline in mobility.

I had documented this in the notes and then attended the MDT mtg on Monday. When the doctor talked about this patient he really had no idea about this patient (her background, falls hx, and how she was managing).

He said I think we need to look at rehab for this lady. I spoke up by saying “I don’t think she is far off her baseline/preadmission occ performance I mentioned that I had planned to do a home visit with this patient early week to assess her safety at home.. But I was not listened to. The doctor asked the “us” (looking at the PT) to review her ?appropriate for rehab.

The next day, I reviewed the notes and the PT had not analysed the plan. i.e. had not mentioned if she was appropriate or not for rehab. I asked the PT how her session went with the patient.

She replied “you were right she is much better this week, probably not appropriate for rehab as yes I think this is how she was before she came in”. I wondered to myself – well why didn’t you document that.

I documented the discussion and met with the patient to get her perspective of being ready for going home, she agreed she was ready and also gave consent for a f/u home visit one day post to ensure she was in a safe environment.

My reflection on this:

I felt I wasn’t being listened to in the MDT with regards to the OT perspective and plan.

I realise one of my roles is “discharge planner” however, I felt in this situation that I was the co-ordinator between PT, and OT – almost summarising the input and sorting the plan for discharge. I felt like I was going over and beyond to sort this lady out – for a few reasons

The medical team didn’t listen to me re: my input and plans from OT perspective

The PT’s analysis wasn’t clear.

How could I have dealt with this better? What will I do next time?

I could have asked the PT to document her view of ?appropriate for rehab as asked in the MDT, however I think it was still appropriate to document that we had that discussion.

I could have talked to the medical team post MDT re: the OT plan

I could have provided feedback to the MDT i.e. The OT and PT had been working with the patient, and that if we felt necessary we would talk to them about rehab appropriateness.

Basically I wanted to say that I felt undermined and that my input was irrelevant – Maybe I should have said that to the Dr/Consultant – knowing that perhaps that could have had a negative impact on OT

Cultural Safety

Yesterday I attended a cultural safety, ethics and rehab presentation which sparked a few reflections on my current practice.

The phrase power relationship - applys alot to working in an acute medical ward where health professionals are seen as having more power over their patients.
This doesnt settle well with me. I wish to relflect and explore whether I as a professional impose power on my patients.

Also I am aware of an article from the NZJOT titled "Cultural Safety, Kawa Whakaruruhau: An occupational therapy perspective". This article really reinforces what the speaker (an occupational therapist) was emphasising

a) the importance of being aware, sensitive and safe in attitude and behaviour

b) the importances of understanding yourself (as a person and professional)and the systems in which they work and live towards cultural competence

c)not ignoring sociopolitical and power relationships that margalinise so many groups in society

I guess what I am trying to say is that being culturally safe is more than knowing about values and beliefs and customs of spectific cultures.
Its about...
Ot's understanding themselves (identify, attitudes, values, beliefs) and how those influence their working relationship with others in context of family, social and work groups. Its also involves broader terms of sociopolitical understandings (impact of poverty on occupation)
Overall an understanding of the person, environment and occupation are all important for cultural safety.

So how can I ensure I am practicing in a culturally safe manner?

a) not forcing a value system on a client
b)exposing the client to a range of possibilites
c) the client is the one who makes the choice
d) being open to the clients ideas, feelings and thoughts - and being open to repsonding to them