Week 4-INTERPROFESSIONAL RELATIONSHIPS & PROFESSIONAL BOUNDARIES

Interprofessional Relationship

• Collaboration between different healthcare practitioners (MLT, physician, nurse, medical lab personnel)

• who share information and work together to enable optimal outcomes for the patient

• Quality and quantity of the interpersonal exchanges increases. This relationships grows stronger and matures

Contact

where you see, hear and observe the person/s. This is followed by interactions where you exchange preliminary information

Involvement

• A sense of being connected with the person/s try to learn more about the person by disclosing information

Intimacy

• The contact and involvement which make up the relationship

• results in you and the person/s becoming close colleagues/friends.

Deterioration of Interprofessional Relationships

Relationship/bond weakens or deteriorates

First Phase: Deterioration of Interprofessional Relationships

• Intrapersonal dissatisfaction

• where you have negative feelings/interactions to the individual

Second Phase: Deterioration of Interprofessional Relationships

• Interpersonal dissatisfaction

• where you withdraw (two types non verbal and verbal)and grow further apart

  • minimum communication

    • exchange fewer messages, awkward silences

Non-verbal withdrawal

• keep a distance from the person in case your temper flares

• Or to say something that you will regret,

• no eye contact

• no acknowledgement of the person

Verbal Withdrawal

refuse to talk or listen to the individual which includes work related information

Third Phase: Deterioration of Interprofessional Relationships

• Decline in Self-disclosure:

  • Self-disclosure and work related information between you and the person becomes non-existent

Fourth Phase: Deterioration of Interprofessional Relationships

• Deception

  • As the relationship breaks down, this can take the form of lies or complaints about the individual

Fifth Phase: Deterioration of Interprofessional Relationships

• Negative versus Positive Messages

  • Negative messages increase, positive messages decrease, individual/s you once praised, now you criticize them

Repair Stage - Internally

(Repairing Interprofessional Relationships)

• you analyze what went wrong,

• is it a mis-communication or perception issue

• am I the problem

• Consider options of repairing the relationship.

  • Meet with the individual, talk about feelings

  • hear what each one has to say

  • both parties should agree to change behaviors or expectations.

Repair Stage - Externally

(Repairing Interprofessional Relationships)

• an external individual (Human Resources) is present and arbitrates the situation, the parties discuss the problem,

• each person must be willing to resolve the issues.

  • Negotiate sign anagreement regarding changes in behavior and attitude.

Dissolution Stage

(Repairing Interprofessional Relationships)

• Last stage in the relationship model

• when both parties are not willing to resolve the problem,

• the relationship dissolves with one or both parties leaving the organization

Relationship Attraction Theory

• people form relationships on the basis of attraction.

Relationship built on

• Similarity Principles

  • where people who act and think like you

    are the ones you form friendships and relationships

• Proximity Principles

  • people who live and work close to you are

    the ones how become friends as you have many opportunities to interact with them

Assumption of the Rules Theory

• relationships in workplace are held together by adherence to certain rules.

• When the rules are broken, the relationship may deteriorate or dissolve

• If you know what the rules are you will be able to develop and maintain the relationships

Workplace Rules:

• Dress Code

• Code of Conduct

• Hours of work, breaks

• Absenteeism and Lateness

• Safety, workplace violence, harassment

Workplace romances

• caution when entering or considering such relationships

• can be

  • an ideal place to meet potential partners, because you are working together,

  • improve work satisfaction

  • lead to poor work performance

• Causes your colleagues to be very uncomfortable, can generate destructive gossips

• advised not to have romances with their colleagues

  • In some workplace, such relationships result in one of the individuals being transferred out of the Department

Professional Boundaries

• It is the Lab Technician and not the patient who is responsible for establishing and maintaining boundaries

• Do not enter into a friendship or romantic or sexual relationship with patient

• Do not give or receive gifts from patients

• Do not engage in activities that may result in inappropriate financial or personal benefit to oneself or a loss to the patient

• Careful about socializing with patients/clients or former patients/clients

• Maintain the same boundaries with the patient’s family and friends

how to maintain this

• Disclose limited amount of information about you or your family

• Do not communicate with a patient in ways that may be perceived as demeaning, seductive, insulting, disrespectful or humiliating

• Help colleagues to maintain professional boundaries and report on boundary violations that you have witnessed or observed

• If one has to care for family or friends, transfer the care to another professional

• Nicknames or terms of endearments: Avoid using “honey” or ‘love”, always address by “Mr., Mrs. or Miss”

Interviewee – Patient, Care-giver, Family, Parent

• the patient is the primary source of information

• if a patient is critically ill/unconscious, mentally impaired or very young and cannot effectively communicate, then the interview is with the family members

• Parents of young children, adult children with dementia parents, or the spouse (mentally incapable husband or wife) are involved in the interview

• Family accompany a patient, oversee and participate when an interview or procedure is being done, disclose information, ask many questions and observe what is being done

Interview Settings and Types of Questions

• can occur face to face where facial expressions, eye contact and body language are observed

• Over the phone where the tone of voice, accents, pace of speech and words spoken by both the patient and healthcare professional are used to interpret attitude and to develop impressions.

• Closed questions are designed to elicit short focused responses

• Open-ended questions often begin with who, what, where, when, how and why and help to establish relationships

  • Questions we want to ask

Interviewing Guidelines

• Call the patient by name, refer to the patient formally

• Introduce yourself and your role

• Show concern, a warm, caring facial expression, convey an attitude of competence and professionalism, the right attire and attitude will put the patient at ease

• Face or sit opposite the patient, about arm’s length from the patient, maintain a relaxed but attentive posture

• Be non-judgmental, do not pass judgment or condemn a patient for lifestyle or healthcare practices/beliefs

• Use short simple questions and statements

• Give the patient time to answer the question fully before going on to next question

• Listen attentively, respond with interest, paraphrase or ask for clarification

Patient – Centered Interviewing – Lab Technician

Step 1- (Intent is to establish a rapport with the patient and create an environment where the patient is comfortable to provide information)

1) Welcome and greet the patient

2) Use the patient’s name

3) Introduce self and identify your specific role

4) Ensure the patient’s privacy

5) Remove barriers to communication

6) Ensure the patient’s comfort and put the patient at ease

7) Ask the patient to provide their name, date of birth or check the

arm-band

8) Indicate to the patient the time it will take to do the procedure

(5-8 minutes)

Step 2 (Adapting your interview to specific situations)

Silent patient

 Confused patient

 Patient with impaired capacity

 Talkative patient

 Angry or disruptive patient

 The patient with low literacy

 The deaf or hard or hard of hearing patient

 The blind patient

 Patient seeking personal advice

Adapting to silent patient

• Periods of silence can be uncomfortable.

• Patients are silent as they collect their thoughts, remember details or decide whether you can be trusted with certain information.

• During silence, watch the patient closely for non-verbal cues

Adapting to Talkative Patient:

• Can be a problem as you have limited time.

• Give the patient 5-8 minutes to talk and then redirect the patient as to why you are here

Adapt to Confused or Disruptive or Angry Patient (Delirium or Dementia)

• patient is

  confused, angry, disoriented, delusional, disruptive. manner is distant or inappropriate.

• Interaction:

  • Stay calm, keep your posture relaxed and avoid being confrontational.

  • Do not say to a disruptive patient to lower his/her voice, try to understand what they are saying

  • Approach the patient from the front, call the patient by name, respect the patient’s personal space and observe the reaction as you get closer

  • If you sense the situation will get worse, leave the room and ask the nurse for assistance

Adapt to Patient with Impaired Capacity

Ask the nurse if the patient understands information related to health or has decision-making capacity

Adapt to Visual Impairment patient

• Greet and speak directly to the patient

• Tell the patient that you will be touching them and describe the procedure

• Inform the patient when you have completed the procedure and will be leaving the room

• Never touch or distract service eye dog (Out-patient Clinics)

Adapt to deafness and Hearing Loss of patientr 

• Greet and speak directly to the patient

• Gain the patient’s attention and speak clearly and in a normal tone of voice

  • ask for feedback if tone is okay

• Supplement verbal information with visual aids or gestures or write the message

Professional Code of Conduct

Values/ Code of Conduct:

1) Patient-Centered care

2) Teamwork

3) Collaboration

4) Respect, Courtesy, Professionalism and Diversity

5) We treat each other with respect when we provide care

6) We are accountable for our actions

7) We are polite, courteous and professional in our interactions

8) We acknowledge each person’s role, profession and contribution

9) We respect confidentiality of personal information

10)We apologize for our mistakes and learn from them