UNIVERSIDAD DE ZAMBOANGA

MAIN CAMPUS, DON TORIBIO ST., TETUAN, ZAMBOANGA CITY

INTER-PROFESSIONAL CARE MAPS

Interprofessional care refers to care provided by a team of healthcare professionals with overlapping
expertise and an appreciation for the unique contribution of other team members as partners in achieving
a common goal.

Teams are generally organized to achieve specific programmatic goals. Primary health care teams may
work with patients/clients, families, communities, stakeholders and others to achieve patient and/or
population health goals. In order for an interprofessional primary health care team to function effectively,
the team’s purpose and goals should be clearly understood and agreed upon by all members. These goals
– whether short or long-term – also need to be feasible, because the interprofessional team may function
in a variety of settings and the team membership, types and intensity of services provided, and overall
goals may vary.

An interprofessional team developing care plans for patients/clients must be able to approach care in a
holistic manner, considering the needs of the patient/client in a broad manner, and considering how
different, yet pertinent information fits together.
STEPS IN ASSESSING PATIENTS NEED
Handling a complex case requires team members to consider the patient/client’s medical, emotional,
social, environmental, and economic needs. Using the grid and the questions provided below, team
members can consider the holistic (biopsychosocial) needs of the patient and their situation. In developing
an interprofessional care plan, the team needs to identify the expected activities and the responsibility of
each team member (e.g. initiation, follow-up, and reporting
results).

Considering the patient/client’s medical, emotional, social, environmental and economic needs, answer
each of the following questions:
1. What is the overarching goal? At least three perspectives need to be considered and reconciled:
▪ patient/client
▪ his/her family
▪ team
2. What are the patient/client’s problems? (e.g. medical, emotional, social, environmental and
economic).
3. What is the impact of each problem on the patient/client’s health?
4. What strengths and resources does the patient/client have or can be mobilized to deal with each
problem?
5. What additional information is needed to adequately define the problem or its implications?
6. What is the plan of care? (What needs to be done; who will do it; when will it happen?)
7. What priority should be assigned to each problem? How important is its effect on the overarching
problem?
8. What outcomes should be expected for each problem? (e.g. expressed in measurable terms,
appropriate time to look for the outcome

DEVELOPMENT OF PROCESS MODEL AND CLINICAL SCENARIOS

Process model contains the concept types identified from our validated clinical scenarios and are
displayed in a cyclical process. These concept types are: Health Concerns, Goals, Decisions, Interventions,
Assessments and Evaluations. Importantly, the patient is at the center of the process model in
collaboration with clinicians and family/care partners as an intentional indication that everyone can play
an active role at each step in the care process. As a concrete example, the broad term Health Concern
includes any concern from the patient and family/care partner as well as types of diagnoses, such as
medical diagnoses and nursing diagnoses.
HOW CAN NURSES IMPROVE INTERPROFESSIONAL
Providing the best hospital experience for patients requires coordination and communication between all
providers involved in a patient’s care. This cooperative approach is referred to as interprofessional
collaboration, and its goal is to help doctors and nurses work together to administer the highest quality
care. Interprofessional collaboration fosters trust and respect between all healthcare providers and
encourages the practice of treating nurses as equals with physicians.

How nurses can collaborate across disciplines to ensure each healthcare professional’s expertise and
experience are applied in the most effective way possible:
Encourage Participation in Other Departments’ Training
While every healthcare professional attends training sessions specific to their discipline nurses should
make an effort to sit in on other departments’ classes so they can have more insight into other roles at
the hospital. This can also help nurses better empathize with the challenges their colleagues in other
disciplines face, which can strengthen bonds between providers. Being able to assess a situation with
multiple viewpoints allows nurses to make better care decisions.

Promote Multidisciplinary Rounds

Multidisciplinary rounds offer a simple way to improve communication between departments. Nurses
should encourage their staff to take advantage of these opportunities to ask questions, get clarification
and discuss patient goals with other providers. Multidisciplinary rounds are a perfect example of
interprofessional collaboration as they allow every team member to hold discussions and share crucial
information about each patient’s plan of care. They ensure each provider is on the same page regarding
what is best for the patient.

Keep the Focus on the Patient

Traditionally, there has been a hospital hierarchy with physicians at the top and nurses on a lower tier.
Therefore, it can be difficult to institute a paradigm shift where nurses are on the same level as doctors,
particularly with clinicians who have been practicing for many years. However, a physician’s main priority
is giving their patients the best quality care and interprofessional collaboration facilitates this. If you
meet resistance when introducing interprofessional collaboration, remind providers that the goal of the
approach is to ensure patient satisfaction and a positive hospital experience.

When carried out correctly, interprofessional collaboration can lead to better outcomes and
improved patient safety. The approach allows nurses to take advantage of not only their own skills and
experience but also the expertise of every healthcare provider. Since nurses usually spend the most time
with patients, they can share what they’ve learned with doctors and develop the best plan of care for
each individual patient. When nurses and doctors work together as equals, it becomes easier to create a
connected, supportive hospital environment.

HOW WILL INTER-PROFESSIONAL CARE WORK?

Prepared By:

ELLA B. ALBURO
THE DYING CHILD
The nursing role is to assist the child and family to cope with the experience in such a way that it
will promote growth rather than destroy family integrity and emotional well-being. Recognize the Stages of
Dying Evidence Base Kubler-Ross, E. (1997). On death and dying.New York: Schribner.
1. Be aware that dying children, their families, and the staff will all progress through these stages, not
necessarily at the same time.
2. Children experience the stages with much variation. They tend to pass more quickly through the stages
and may merge some of these stages.
3. The nursing goal is to accept the child and his family at whatever stage they are experiencing, not to
push them through the stages.
4. Understand the meaning of illness and death at various stages of growth and development (see Stages
in the Development of a Child’s Concept of Death).
5. Be aware of other factors that influence a child’s personal concept of death. Of particular importance are:
a) The amount and type of direct exposure a child has had to death.
b) Cultural values, beliefs, and patterns of bereavement.
c) Religious beliefs about death and an afterlife.
6. Meet with the parents separately from the child and discuss their wishes regarding dissemination of
information to their child.
Communicate with the Child about Death
Research indicates that children generally can cope with more than adults will allow and that children
appreciate the opportunity to know and understand what is happening to them. It is important that the
child’s questions be answered simply, but truthfully, and that they be based on the child’s particularlevel of
understanding. The following responses have been suggested by Easson in The Dying Child: The
Management of the Child or Adolescent Who is Dyingand may be useful as a guide:
Preschool-Age Child
1. When the child at this age is comfortable enough to ask questions about illness, questions should be
answered. When death is anticipated at some future time and the child asks, “Am I going to die?” a
response might be, “We will all die someday, but you are not going to die today or tomorrow.”
2. When death is imminent and the child asks, “Am I going to die?” the response might be, “Yes, you are
going to die, but we will take care of you and stay with you.”
3. When the child asks, “Will it hurt?” the response should be truthful and factual.
4. Death may be described as a form of sleep—a sleep where the child will be secure in the love of those
around him or her. However, some children may fear sleep as the result of this type of explanation.
Anesthesia is sometimes called a “special sleep” so it is not currently recommended to refer to death as
“sleep.”
5. Parents can express to the child the fact that they do not want the child to go and that they will miss the
child very much; they feel sad, too, that they are1 going to be separated.

School-Age Child
1. Responses to the school-age child’s questions about death should be answered truthfully. The child
looks for support from those he trusts.
2. The school-age child should be given a simple explanation of his diagnosis and its meaning; the child
should also receive an explanation of all treatments and procedures.
3. The child should be given no specific time in terms of days or months because each individual and each
illness is different.
4. When the school-age child asks, “Am I going to die?” and death is inevitable, the child should be told the
truth. The school-age child has the emotional ability to look to parents and those he trusts for comfort and
support.
5. The school-age child believes in his parents. The child should be allowed to die in the comfort and
security of his family.
6. The school-age child knows death means final separation and knows what will be missed. The child
must be allowed to mourn this loss. The dying child may be sad and bitter and demonstrate aggressive
behavior. The child must be allowed the opportunity to verbalize this if able to do so.
Adolescent
1. The adolescent should be given an explanation of his illness and all necessary treatment and
procedures.
2. The adolescent feels deprived and reasonably resentful regarding his illness because he wants to live
and reach fulfillment.
3. As death approaches, the adolescent becomes emotionally closer to his family.
4. The adolescent should be allowed to maintain emotional defenses—including absolute denial. The
adolescent willindicate by questions what kind of answers are desired.
5. If the adolescent states, “I am not going to die,” he is pleading for support. Be truthful and state, “No, you
are not going to die right now.”
6. The adolescent may ask, “How long do I have to live?” Adolescents are able to face reality more directly
and can tolerate more direct answers. No absolute time should be given because that blocks all hope. If an
adolescent has what is felt to be a prognosis of approximately 3 months, the response might be, “People
with an illness like yours may die in 3 to 6 months, but some may live much longer.”
Support Parents’ Adaptation to Child’s Death
1. Develop a care plan that includes this approach:
a) The primary responsibility for communicating with the parents should be designated to one nurse.
b) Information regarding the parents’ concerns should be communicated to all staff members and
should beincluded in the patient’s care plan.
2. Accept parental feelings about the child’s anticipated death, and help parents deal with these feelings.
a) It is not unusual for parents to reach the point of wishing the child dead and to experience guilt and
selfblame because of this thought.
b) The parents may withdraw emotional attachments to the child if the process of dying is lengthy. This
occurs because the parents complete most of the mourning process before the child reaches
biologic death. They may relate to the child as if he were already dead.
3. Provide anticipatory guidance regarding the child’s actual death and immediate decisions and
responsibilities afterward.
a. Describe what the death will probably be like and how to know when it is imminent. This is
necessary to dispel the horrifying fantasies that many parents have. Reassure the parents
that all measures will be taken to keep the child comfortable at the time of death. (Note
certain diseases, despite appropriate medical interventions, may cause an uncomfortable or
painful death. Parents should be promised complete comfort for their child only if this
expectation is realistic.)
 b. Clarify the parents’ wishes about being present at the child’s death, and respect their
desires. See if they want to hold the child—before, during, or after the death.
c. If appropriate, allow the parents to discuss their feelings about issues such as autopsy and
organ donation in order that they may make appropriate decisions. Do not make them feel
guilty if they do not consent.
d. If necessary, assist the parents to think about funeral arrangements.
4. Be aware of factors that affect the family’s capacity to cope with fatal illness, especially social and
cultural features of the family system, previous experiences with death, present stage of family
development, and resources available to them.
5. Contact the appropriate clergy if the family desires. Contact other extended family members for support if
they wish.
6. During final hours, do not leave the family alone, unlessthey request it.
7. Encourage parents and siblings to share their thoughts with the dying child.
8. Provide information on bereavement support groups, usually available through hospital or church.
Stages in the Development of a Child’s Concept of Death

Child up to age 3
At this stage, the child cannot comprehend the relationship of life to death because the child has not
developed the concept of infinite time.
The child fears separation from protecting and comforting adults.
The child perceives death as a reversible act.

Preschool child
At this age, the child has no real understanding of the meaning of death; the child feels safe and secure
with parents.
The child may view death as something that happens to others.
The child may interpret the separation that occurs with hospitalization as punishment; the painful tests and
procedures that the child is subjected to support this idea.
The child may become depressed because of not being able to correct these wrongdoings and regain the
grace of adults.
The concept may be connected with magical thoughts of mystery.

School-age child
The child at this age sees death as the cessation of life; child understands that he or she is alive and can
become “not alive”; child fears dying.
The child differentiates death from sleep. Unlike sleep, the horror of death is in pain, progressive
mutilation, and mystery.
The child is vulnerable to guilt feelings related to death because of difficulty in differentiating death wishes
and the actual event.
The child believes death may be caused by angry feelings or bad thoughts.
The child learns the meaning of death from own personal experiences, such as the death of pets, family
members, and public figures.
Television and movies have contributed to the concept of death and understanding of the meaning of
illness. There may be more knowledge in the meaning of the diagnosis and an awareness that death may
occur violently.

Adolescent
The adolescent comprehends the permanence of death as the adult does, although the adolescent may
not comprehend death as an event occurring to persons close to self.
The adolescent wants to live–sees death as thwarting pursuit of goals: independence, success,
achievement, physical improvement, and self-image.
The adolescent fears death before fulfillment.
The adolescent may become depressed and resentful because of bodily changes that may occur,
dependency, and the loss of social environment.
The adolescent may feel isolated and rejected because adolescent friends may withdraw when
faced with impending death of a friend.
The adolescent may express rage, bitterness, and resentment; especially resents the fact that fate is to
die.