Post on 29-Nov-2014
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Palliative Care as a Model for Interdisciplinary
Consult in Clinical EthicsAndi Chatburn, DO, MA
Providence Health Care, Spokane WAMedical Director for EthicsPalliative Care Physician
#ASBH14 October 17, 2014 10:45-12:15 PM Rm 300A
Disclosures
None!
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Objectives
Describe the Palliative Care model for Interdisciplinary Team (IDT) consultation
Apply the IDT model for consultation to Clinical Ethics Consultations
Applications
Utilize the IDT model for consultation in sample role-play scenarios
Reflect on experience utilizing the IDT model for Clinical Ethics Consultation (CEC)
Social Worke
rPhysicia
n
Chaplain
Ethicist Nurse Educator
Optimal Care
Characteristics of an IDT
Interdisciplinary teamwork- provides increase complexity of skills and knowledge needed to provide comprehensive care.
No single professional can meet all the complex needs
Value of an IDT
Shared Goal of a Palliative care IDT: identify and manage suffering among patients and families
Team members are interdependent, meaning they cannot relieve total pain (i.e., spiritual, emotional, physical, psychological) unilaterally, but must rely on teamwork
Adapted from capcsd.org
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
Adapted from capcsd.org
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
Pharmacist
Music Therapist
Dignity Therapy
Child Life Specialist
Art Therapist
Psychologist
Teams with multiple disciplines
Interdisciplinary Team- a group of health care professionals from diverse fields who work in a coordinated fashion toward a common goal for the patient
http://medical-dictionary.thefreedictionary.com
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
ONE GOAL
Paired Consult IDT
Social worker
Nurse
Physician
Nurse Physician
Physician
Social Worker
Chaplain Nurse
Teams with multiple disciplines
Intraprofessional team: a team of professionals who are all from the same profession, such as three physical therapists collaborating on the same case.
http://medical-dictionary.thefreedictionary.com
Patient & Caregiver
Physician
Physician
Physician
Teams with multiple disciplines
Multidisciplinary team: a team of professionals including representatives of different disciplines who coordinate the contributions of each profession, which are not considered to overlap, in order to improve patient care
http://medical-dictionary.thefreedictionary.com
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
Teams with multiple disciplines
Transdisciplinary team: a team composed of members of a number of different professions cooperating across disciplines to improve patient care.
http://medical-dictionary.thefreedictionary.com
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
ONE GOAL
Physician
ONE GOAL
Patient & Caregiver
Patient & Caregiver
The Five Dysfunctions of a Team
Lencioni, Patrick. The Five Dysfunctions of a Team. Jossey-Bass (April 11, 2002)
Inattention to Results
Avoidance of Accountability
Lack of Commitment
Fear of Conflict
Absence of Trust
Healthy Teams
Value diverse professional perspectives
Promote a safe working environment
Equal power structure
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Patient & Caregiver
Nurse
Speech Therapist & PT/OT
Physician
Chaplain
Social Worker
Dietician
ONE GOAL
Benefits of an IDT
Listens to patient story from diverse perspectives
Improve Patient Centered Care
Promote patient dignity, autonomy
Creative ways to promote beneficence
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
The combined perspectives of
IDT members are much more likely to meet the
complex needs patients and
their families than
any individual provider
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Characteristics of Effective Teams
Agree on a common set of
principles, goals,
and measurable objectives
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Characteristics of Effective Teams
Depend on and expect that
competent individual members
represent their discipline’s
current practice standards
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Characteristics of Effective Teams
Share the responsibility for
team functioning
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Characteristics of Effective Teams
Provide ongoing feedback in
team interaction, leadership,
communication, and conflict resolution
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
Team Interdependency
High level of interdependence consistently enhances team performance
Effective teams recognize, honor and use the expertise of each member of the team
Evaluate how each discipline can contribute to the goal
Recognize the need for role definition and role flexibility
Wood, G, T Campbell. UNIPAC 5, Fourth Ed. Communication and Teamwork. Ed. C. Porter Storey, Jr., 2012, AAHPM.
UNIPAC 5 p83 … resource 252
Trust
Creative Commons
Team decision making process
Orientation
Discussion
Decision Making
ImplementationForsyth DR. Group Dynamics, found in UNIPAC 5
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How can this be applied to
Clinical Ethics Consults?
Ethics Consult
Philosopher
Speech Therapist
Physician
Minister
Social Worker
Nurse
Committee Consult
Paired Ethics Consult IDT
Philosopher Nurse
Physician Social worker
MinisterSpeech
Therapist
Physician
Minister
Nurse
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Role Play: Organize
yourselves into a three person
IDT
Social Worke
rPhysicia
n
Chaplain
Ethicist Nurse Educator
Case #1
Cases are Confidential
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Group Reflections
Social Worke
rPhysicia
n
Chaplain
Ethicist Nurse Educator
Case #2
Cases are Confidential
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Group Reflections