The importance of the multi-disciplinary team (MDT) and how they work with the client to promote independence

For this reflection I will be using the Gibbs reflective cycle (1988) to demonstrate how members of the multi-disciplinary team worked together to achieve a positive client outcome.

I will use the Gibbs model which incorporates the following: description, feelings, evaluation, analysis, conclusion and action plan (Gibbs 1988). This model facilitates critical thoughts, linking theory to practice and allows my personal feelings and opinions to be reflected upon.

This reflection will discuss the importance of the multi-disciplinary team (MDT) and how they work with the client to promote independence.
The MDT within the mental health environment generally comprised of psychiatrist, clinical psychologists, nurses, occupational therapists and social workers, but other therapists such as family therapists, psychotherapists, dietician and counsellors mat also become involved in the care of the client (Perkins &Repper 1998).

Multidisciplinary involvement is important within mental health nursing as people with mental health problems have multiple needs, so a variety of expertise is required to meet the needs of these people (Darby et al 1999).
Ovretveit, (1993) defined the MDT as a group of practitioners with a wide variety of professional training who regularly meet to provide a service to clients.
Throughout this reflection, the clients name and clinical setting will not be disclosed as this would breach confidentiality (NMC 2004). For this reason the client will be referred to as ‘Martin’.

The first stage of Gibbs (1988) model of reflection requires a description of events.
Martin is a 45 year old male, who is currently at a mental health rehabilitation unit as he suffers from paranoia schizophrenia. Paranoia results in episodes of delusions which can be accompanied by hallucinations, perception disturbances and auditory variety (BBC 2006). Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by expressions of reality or by impairments in perceptions (BBC 2006).
Martin was brought into the rehabilitation unit as he suffered from chronic delusions, which caused him to behave irrationally and destructive. Before he was admitted into hospital, he was causing danger to himself and others by setting objects on fire and was very paranoid about objects in the kitchen. He felt that the instruments in the kitchen were dangerous and always commented on the cooker and oven being broken. This resulted in him being unable to prepare himself food and eating fast food meals everyday.
After spending 2 weeks in a mental health hospital he was transferred to a rehabilitation unit, which he had currently been in for a month.
The MDT had to work together so Martin was able to overcome his fear of the kitchen and able him to become independent.

I had the opportunity to observe a MDT meeting and participated in the discussion about Martin. Throughout Martin’s time in the rehabilitation unit, many of the MDT members individually spent time with him.
The consultant discussed with him any medical problems Martin may be having and gave Martin a description of the medication he had been prescribed and why it was essential they were taken (Kirby et al .2004)
The psychiatrist discussed with him how he was dealing with the paranoia schizophrenia and gave Martin a better overlook of his overall life and what he would be able to achieve if he focused on trying to prepare meals. The psychiatrist allowed Martin to discuss his feelings openly and concentrated on whether his perception of cooking had changed over the month he had been in the rehabilitation unit.

The occupational therapist also worked with Martin. The main role of the occupational therapist is helping individuals with everyday tasks to promote and maintain their independence and reduce the risk of relapse (Burke 2006). The occupation therapist guided and supervised Martin with his cooking which also gave them a chance to bond and communicate, while preparing their meals (Taylor et al 2001).
The dietician was also notified about Martins lack of ability to prepare food. The dietician explained the risk of poor nutrition and what affects it could have on Martin.

The social workers main duty was to help Martin cope with the environmental aspect of his life, by giving him and his family information about the ways to support him while in rehabilitation and when he returns home. The social worker also advised Martin to attend cooking groups so he could gain confidence in cooking. The social workers also encouraged Martin to join more social events/groups which would encourage social integration (Thompson 2006).

I am now going to enter into the second stage of Gibbs (1988) model of reflection, which is a discussion about my thoughts and feelings.I felt very comfortable and accepted within the MDT meeting. The atmosphere was friendly and relaxed and the MDT discussed Martin’s progress. I felt quite nervous in contributing to the MDT discussion but felt as though I was Martins advocate and was speaking out on his behalf, as I had gained a strong bond with him. The MDT listened to my opinions and asked further questions on how I felt he was progressing. The MDT communicated well with each other and had Martin’s best interest in mind at all times. The discussions about Martin were held until the best outcome was achieved for him. This demonstrated the benefits and importance of communication within a team and how all contributions within meetings should be valued (Perkins & Repper 1998). I found it extremely interesting to see a MDT in action and witness the teamwork between different disciplines.

Evaluation is the third stage of the Gibbs (1988) model of reflection and gives an account of the importance of MDT. There are many positive aspects of this particular MDT as they all worked well together as a team with the same goal in mind. The team discussed the different options available and all the problems that may arise. The MDT have to consider the current state of a client and if the change in lifestyle would benefit him in the long-term. The advantage of a multidisciplinary team approach is that all professionals work together by collecting the facts and by bringing information together, to obtain a complete view of the possible problems of each individual patient. In doing this they are able to make sure that the appropriate range of treatment is given (Onyett 2003).The MDT can have a large impact on the client’s life and can change their long-term way of living.
Although, one of the major disadvantages of the MDT is that they work individually, therefore there can be a lack of direction, unclear goals and poor leader ship (Darby et al 1999) if effective communication between the team is not achieved. This could affect the care Martin given and postpone his discharge from the rehabilitation unit.
Essential communication is vital in MDT as it allows the team to gain an understanding of how the client is coping and if the transfer from the mental health hospital to the rehabilitation unit benefited him.

Stage four of Gibbs(1988) is an analysis of the event. If I had not given my opinion on Martin’s care, he may not have benefited from the MDT as much as he did. Contributing in Martins care meant that I was able to inform the other members of the MDT about his progress. I felt I did this well as I gave a description of his emotional state and how he was progressing with preparing food in the kitchen. The MDT appreciated me speaking about Martin, as they were able to identify new targets for him to achieve, so he would constantly be working towards reaching independence.

In conclusion, stage five of the Gibbs (1988) models, it is clear to see from the MDT meeting that effective leadership and good communication between members of the team is vital to ensure there is a clear understanding of Martin’s outcomes (Taylor 2001). The MDT has to be equipped with all the information to overcome Martin’s individual problems (Taylor 2001). The team working together forms the basis of mental health nursing and can influence the success or failure of the care and treatment that Martin may receive (Kirby 2004). The MDT has the potential to achieve positive outcomes for Martin, and give him the opportunity to reach independence.

The final stage of Gibbs (1988) model is the action plan. If I found myself in this type of situation again, I would be more confident in discussing about the clients and their needs thus participating more within the MDT meeting. I have learnt from this situation that good teamwork and communication between each other is vital (Taylor 2001). I have gained a better understanding of the multidisciplinary team, and how the outcomes of these meetings can affect Martin and his family’s quality of life, which will help me to think very carefully about the decisions I make concerning client care in the future.

References

BBC ,2006, Schizophrenia, BBC news, Available from:[Online]:
http://news.bbc.co.uk/go/pr/fr/-/hi/health/medical_notes/1079451.stm
[Accessed: 20th August 06]

Burke.L, 2006, Occupational therapists, [Online] Accessed from: http://www.occupationaltherapists.com/
[Accessed: 2nd September 06]

Darby, S. Marr, J. Crump, A Scurfield, M (1999) Older People, Nursing & Mental Health. Oxford: Buterworth-Heinemann.

Gibbs.G 1988, Learning by doing. A guide to teaching and learning methods, oxford polytechnic, Oxford

Kirby.S, Hart.D,Cross.D,Mitchell.G, 2004, Mental health nursing: Competencies for practice, Palgrave, Hampshire

Nursing&Midwifery Council, 2004, NMC Code Of Professional Practice: Standards for conduct, performance and ethics, United Kingdom

Onyett, S. (2003) Teamworking in Mental Health. Bristol: Palgrave Macmillan.

Ovretveit, J. (1993) Co-ordinating Community Care: multidisciplinary teams and care management. Buckingham. Open University Press.

Perkins, R. Repper, J. (1998) Dilemmas in Community Mental Health. Oxon: Radcliff Medical Press Ltd.

Taylor.C, Lilis.C, Lemone.P, 2001, Fundamentals of nursing: the art and science of nursing care, 4th edn, Lippincott, Philadelphia

Thompson.N, 2006 , Anti-discriminatory practice 4nd edn. Palgrave Macmillan, Basingstoke

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