Core Competency Domain Three

Interprofessional Communication

Tujuan dari Inter Professional Education adalah untuk membantu siswa belajar
bagaimana bekerja sebagai bagian dari sebuah tim pelayanan kesehatan Inter Professional
Collaborative yang efektif. Pada tahun 2011, IPEC (Inter Professional Education
Collaborative) mengeluarkan empat domain kompetensi inti yang saling terkait untuk Inter
Professional Education. Kompetensi Inter Professional Education ini dikembangkan untuk
lebih mempersiapkan siswa profesi kesehatan untuk bekerja sama dengan baik untuk
memenuhi tujuan bersama dari memberikan keamanan yang berkualitas tinggi, perawatan
kesehatan yang berpusat pada pasien.
Domain kompetensi ketiga berisi tentang bagaimana berkomunikasi dengan pasien,
keluarga, komunitas, dan profesi kesehatan yang lain, dengan cara yang responsif dan
bertanggung jawab yang mendukung pendekatan tim untuk pemeliharaan kesehatan dan
pengobatan penyakit.
The scenario centers around Ella, a 78 year old woman who, in collaboration with her health
care team, had decided to stop further cancer treatments and transition solely to palliative
medicine and symptom management control.
Ella has been working with her inter-professional collaborative team for two years. Her
daughter Karen lives out of town and is not supportive of the decision. Her daughter is visiting
her mother for the purposes of reversing her mother's decision and resuming chemotherapy.
Let's meet the team members.
In addition to Ella -- our patient -- and her daughter Karen, there is Dr. Young, the oncologist
who specialized in breast cancer, Jose, the oncology clinical nurse specialist an advanced
practice nurse who works with cancer patients to manage symptoms. Andrea, the oncology
social worker with advanced training in palliative care and psychosocial oncology, and Dr. Lee,
the oncology pharmacist with experience in palliative care.
If you want to know more about the roles on this team, watch videos one and two in this series.
We're going to listen in on the family conference and then examine how some of the sub
competencies related to the interprofessional education communication competency apply.
---
Thank you everyone for coming today. We're here to talk together as a team about Ella's
decision to end her chemotherapy treatments and focus solely on supportive and palliative
care at this time. I know Karen has expressed some concern about her mother's decision.
Ella, would you like to tell us more about your decision?
Sure. Basically, I've chosen to stop any further treatment for my cancer. I've thought long and
hard about this, and I feel that it is the right thing for me to do. I'm tired of treatment and I want
to focus on enjoying the rest of the time that I have left.
I understand your decision Ella. I just want to remind you though that there are some newly
novel experimental treatments including mTOR inhibitors for your specific disease that show
promise and that you would be a candidate for. I know we discussed this already, but are you
sure you don't want to give one of these treatments to try?
MTor? What's that? What does that mean for my mom? Does it mean we only have
experimental treatments left?
It is an experimental treatment that could impact her cancer, but it may not -- which is why it
is experimental. It could also make her feel worse and that is why it is ultimately your choice,
Ella. Dr.Young, could you tell us what mTOR is?
Of course, I'm sorry. mTOR is shorthand for a type or class of drug that can be used for cancer.
Am I right, Dr. Lee? Is there anything you'd like to add?
Yes that's correct. mTOR is a type of drug used when treating cancer, but what we don't know
is how it will impact your mother's type of cancer. I'm sorry for the confusion Terry, does that
help?
Yes, but it sounds like you're all talking about giving up. Mom, why have you stop fighting so
aggressively? I don't want you to go. We need to do everything possible right now.
Karen, I don't want to take it. The side effects are horrible. It's not how I want to spend the rest
of my time. Dr. Lee, can you explain to Karen about the side effects?
While it may slow the rate of your mother's cancer, it won't cure it. And it can cause severe
side effects such as loss of appetite, fatigue,diarrhea or pneumonia.
Karen I think it's important that you know that I'm not giving up. I'm simply coming to terms
with the situation. It's easy for you to say, "Let's try something new. There's a new experimental
drug. Let's keep going. Let's do everything possible." But the cancer is an experience I hope
you never have to go through. I love you so much and you know I love you. And a part of me
will always be with you. But these treatments – I know this team that I have here, they're going
to take care of me. They're going to abide by my wishes. And so to answer your question
Dr.Young, I am sure about this decision. Thank you for the reminder of the experimental drugs.
I've thought long and hard and I am very comfortable with my decision.
Ella and I have also had several conversations with Jose, the past few weeks, about palliative
care which focuses on symptom management and quality of life. We've also talked about
experimental treatments such as mTOR, and we have all reviewed the pros and cons of these
treatments as a team, and that includes your mother.
Ella, we are here to support you in any way that we can and will come up with a care plan
together that makes the most sense to you. By having your whole team working together, we'll
be able to come up with a treatment plan that fits you.
I have a great YouTube video that can help you understand what to expect from palliative
care. I've shared it with your mother and she's found it very helpful. If you'd like, I can share
with you later, Karen.
I would like to see it when we're done here.
Of course.
I can see that you have a really supportive team around you, and you're going to receive good
care even if they won't cure you. But I can also see how my mom made this decision after
speaking with her health care team and weighing all the options. It's hard for me. I don't like
it. I feel sad and helpless, but I'm very glad that you have such an involved team.
And we'll work on a care plan as a team and we'll reevaluate it regularly. We're here to continue
to support you, Ella. Please do not hesitate to let us know how we are doing and if we need
to do anything different. We will want to make sure the plan of care is up to date in the
electronic health record so that there is no confusion, even if none of us is available
We will have to schedule routine CBCs regularly to monitor for immunosuppression.
CBCs? Immunosuppression... That sounds serious. Is something going on that you haven't
told me yet?
No, I'm sorry. I didn't mean to slip into medical jargon. A CBC is a routine blood test that we
do to check on your mother's ability to protect herself from infection. The medication that we
gave her to destroy the cancer cells also has a side effect of destroying white blood cells,
which our bodies make to protect us from germs. It's a very common problem that people
who've had Ella's treatment have.
Is there anything else that needs to be discussed in today's meeting that hasn't been covered?
No I'm good.
Me too.
I think we're just about done here.
Ella, Karen, are there any other topics you would like to discuss at this time?
No, I think that's it. I thank you all.
I feel so at ease knowing that you're my team and that you will respect and listen to my wishes
and for right now that's... that's the best thing that we can have. I thank you.
----
Pengarahan singkat di akhir pertemuan tim adalah salah satu cara untuk memberikan
umpan balik yang membangun kepada orang lain tentang kinerja mereka di tim - salah satu
sub kompetensi untuk komunikasi antarprofesional. Ini juga dapat meningkatkan kerja tim,
yang merupakan kompetensi Interprofessional Collaborative Practice terakhir. Penggunaan
pengarahan singkat menggambarkan sub kompetensi - CC5 - memberikan umpan balik yang
tepat waktu, sensitif, dan instruktif kepada orang lain tentang kinerja mereka di tim, merespons
dengan hormat sebagai anggota tim terhadap umpan balik dari orang lain.
----
So what we're going on in our meeting went? What could he have done differently?
Overall I thought the family meeting went well.
Nice job, everyone.
I forgot about the patient with my mention of the drug class. I sometimes assume that patients
know this.
Jose, could you not apologize after me? I felt bad already.
You're right, I'm sorry. I'm not sure why I apologized as well. I thought maybe I had missed a
meeting where the mTOR class was discussed previously.
Understandable.
I brought up the question to articulate what I thought Karen I was wondering about. I'm glad
she spoke up so we could make sure she wasn't confused or worrying about that too. I'll follow
up with Karen about some of the feelings she brought up.
Yeah, I'm glad she spoke up too. Sometimes I forget that everyone doesn't think in the
acronyms that we use daily. I can't believe I used the term CBC and immunosuppression right
after we just finished clarifying what mTOR was. I really need to be better about avoiding
medical jargon when patients and families are around.
You know it's an easy mistake to make, but I'm sure if Karen hadn't spoken up, someone on
the team would have caught it and clarified what was said.
Yeah I hope so. I mean just another example of it takes a village. Agreed I'm really glad we
have a team in place for places like Ella. It used to be a lot harder to get all of the patients'
needs met when you thought you were the only one in charge of their care.
Thanks Jose, for encouraging this debriefing. You know, there are always things that we can
do better as a team.
-----
Domain kompetensi ketiga berisi tentang bagaimana berkomunikasi dengan pasien,
keluarga, komunitas, dan profesi kesehatan yang lain, dengan cara yang responsif dan
bertanggung jawab yang mendukung pendekatan tim untuk pemeliharaan kesehatan dan
pengobatan penyakit.
Ketika kita melihat sub kompetensi interprofessional communications khusus, sub
kompetensi satu (1) : memilih alat dan teknik komunikasi yang efektif termasuk sistem
informasi dan teknologi komunikasi untuk memfasilitasi diskusi dan interaksi yang
meningkatkan fungsi tim. Sebagai contoh, alat komunikasi yang efektif adalah video YouTube
untuk pendidikan pasien dan memperbarui catatan kesehatan elektronik. Keduanya adalah
alat komunikasi yang menggunakan teknologi untuk meningkatkan komunikasi dengan pasien
dan tim perawatan kesehatan.
TeamSTEPPS, yang merupakan singkatan dari strategi tim dan alat untuk meningkatkan
kinerja dan keselamatan pasien (Strategies and Tools to Enhance Performance and Patient
Safety), adalah sistem kerja tim berbasis bukti nasional untuk meningkatkan keterampilan
komunikasi dan kerja tim di antara para profesional perawatan kesehatan. Salah satu alat
komunikasi yang digunakan dari tim STEPPS adalah teknik yang disebut pemeriksaan
kembali yang menggunakan komunikasi loop tertutup untuk memastikan bahwa informasi
yang disampaikan oleh pengirim dipahami oleh penerima sebagaimana dimaksud. Pada
dasarnya, teknik ini bermakna saat seseorang mengulangi pesan pengirim dan
mengonfirmasi pesan itu sehingga pesan dapat diterima dengan benar.
Sub kompetensi interprofessional communications dua (2) : mengatur dan
mengkomunikasikan informasi dengan pasien, keluarga, dan anggota tim perawatan
kesehatan dalam bentuk yang dapat dimengerti, menghindari terminologi disiplin khusus bila
memungkinkan. Kompetensi ini akan mengharuskan anggota tim mengklarifikasi istilah yang
tidak dikenal satu sama lain untuk meningkatkan pemahaman bersama. Disiplin yang berbeda
sering kali memiliki istilah berbeda untuk hal yang sama. Saat berkomunikasi dengan pasien
dan keluarga, profesi kesehatan harus menghindari pemakaian kosa kata yang mengandung
terminolodi medis yang tidak dipahami pasien dan keluarga. Profesi kesehatan dituntut
mampu menjelaskan maksud dari istilah-istilah dengan menggunakan berbagai cara, baik
video, diagram, gambar, cerita, analogi, dan lain sebagainya.
 Sub kompetensi interprofessional communications tiga (3) : ungkapkan pengetahuan dan
pendapat seseorang kepada anggota tim yang terlibat dalam perawatan pasien dengan
keyakinan, kejelasan, dan rasa hormat, untuk memastikan pemahaman bersama tentang
informasi dan keputusan perawatan dan perawatan.
Sub kompetensi interprofessional communications empat (4) : mendengarkan secara aktif
mendorong gagasan dan pendapat anggota tim lainnya.
Sub kompetensi interprofessional communications enam (6) : gunakan bahasa hormat
yang sesuai untuk situasi sulit yang diberikan, percakapan krusial, atau konflik
antarprofesional.
Dalam situasi yang sulit, setiap anggota tim harus saling mendengarkan dengan aktif dan
menggunakan kata-kata yang sopan. Sebagai contoh, memberikan kesempatan kepada
anggota tim yang memiliki bidang yang sesuai dengan topik yang sedang di bahas untuk
menyampaikan pendapatnya adalah salah satu apliaksi dari sub kompetensi tiga (3). Saat
mempersilahkan anggota tim untuk menyampaikan pendapatnya, kata-kata yang digunakan
harus sopan dan penuh rasa hormat. Gunakan bahasa yang hormat untuk situasi sulit saat
terjadi konfilk antar anggota tim.
Sub kompetensi interprofessional communications tujuh (7) : mengenali bagaimana
keunikan sendiri, termasuk tingkat pengalaman, keahlian, budaya, kekuasaan, dan hierarki
dalam tim perawatan kesehatan berkontribusi pada komunikasi yang efektif, resolusi konflik,
dan hubungan kerja antarprofesional yang positif. Subkompetensi ini paling baik dipenuhi
melalui refleksi diri, pertimbangan matang tentang bagaimana variabel-variabel ini
memengaruhi komunikasi profesional seseorang.
Terakhir, sub kompetensi interprofessional communications delapan (8) :
mengkomunikasikan secara konsisten pentingnya kerja tim dan perawatan yang berpusat
pada pasien dan masyarakat. Dalam sebuah tim pelayanan kesehatan, pasien,kelauarga, dan
masyarakat harus menjadi pusat dari tim. Harus diingat, bahwa pasien, keluarga, dan
masyarakat ikut serta dalam tim sebagai anggota yang menjadi pusat pelayanan. Hal ini harus
selalu dikomunikasikan dalam tim agar tujuan utama dari tim pelayanan kesehatan Inter
Professional Collaborative yang efektif dapat tercapai.