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A reflective account of the experience of working in an interprofessional

learning set.

Throughout this paper, a reflective model will be used to explore the importance of
teamwork by mapping the experiences of members of a group project to other scenarios
in a health and social care setting. The use of reflection will show how teams can
improve productivity and solve problems by reflecting on their own experiences. A Kings
fund project suggests that where multi-professional teams work together, patient
satisfaction is higher. (Improving NHS culture: teamwork, 2015) To truly put the
patients needs first, these multi-professional teams need to not just be willing to work
together but to be able to work effectively.
When good teamwork doesnt happen, it can have devastating effects on service users.
As early as 1984, fatalities were known to be caused by staff failing to work together
effectively for the interests of their patients. (Kennedy, 2001) These early failings are
being repeated, the Mid Staffordshire public inquiry showed the public that closed
communication and a lack of confidence amongst professionals was still preventing best
practice from taking place. (Francis, 2013) By making reflective account writing a
requirement for revalidation, the Nursing and Midwifery Council (NMC) are ensuring that
within the inter-professional teams, nurses can reflect upon practice and have the
confidence needed to promote change.
By completing a reflection, team members for the presentation can explore the
implications of group work in practice and develop skills that can be used when out in a
clinical setting. I will use Gibbs (1988) reflective model which outlined several stages,
from describing an experience to evaluating it and creating an action plan for future
practice.
For the Concepts of Interprofessional and Collaborative Practice module, one of the
assignments was to prepare a presentation based on a given scenario looking at
service user perspectives of the healthcare system. The following will reflect on how
well our group, consisting of eight members from several nursing disciplines, worked
together to fulfil the aims of the assignment.
Upon learning of the size of the group, there was some apprehension as previous
experiences of group work hadnt always been positive. Ringelmann (1913) found that
when several people were asked to pull on a rope, they each became less productive
than with fewer people doing the task. So being in a large group, we expected to have
some issues with productivity. After further research, a study (Levinger and Peckham
1974) showed that the effect was curvilinear and that increasing a group size beyond
two or three had a negligible effect.
In a health and social care setting, groups could be much larger or smaller than ours so
by experiencing a large interprofessional group in a class setting it may better prepare
the group for experiences out in practice.
Due to some initial confusion about the aims of the assignment the group didnt become
particularly active until a few weeks before the presentation date. This meant we had to
work quickly to ensure all the work was completed to a high standard and on time. The
fact that the work was completed supports the idea that teams need solid project
direction (McQuerry 2010) as it was only after we had come together and agreed on a
shared goal that good work started to happen.
Despite the initial fear that group work would be difficult, it soon became clear that all
members of the team were committed to the task. There were a few occasions when
arranging to meet as a whole group were difficult and this was sometimes a common
source of annoyance to the group but every member found time to give some
contribution to the project, even if some devoted more time than others.
Because of my initial reservations about completing the project, the fact that every
member was somewhat proactive gave encouragement and motivated me and others to
complete work. This meant that the final presentation came together very quickly as the
group moved past the storming phase of team development.
The storming stage is part of Tuckmans REFERENCE TUCKMAN model of team
development which begins with forming, followed by storming, norming, performing and
then adjourning. By understanding these various stages of development, a team can be
comfortable with their situation whilst working to move the team into the next stage.
When our team was in the forming stage, conflict was minimal and members felt
anxious about working together and about contributing to the group. Knowing that this is
a necessary stage to become comfortable with each other and establish team roles
enabled us to move through the stages, resolve any conflicts that arose in the storming
stage and move into the norming stage where we could work more effectively to pursue
a common goal.
Despite, I think, never reaching the most productive stage, the performing stage, the
project went relatively smoothly and by the deadline, a well-structured presentation had
been developed. Although this may have been down to large contributions from just a
few of the team members.
The members of the group who knew each other prior to being placed in the learning
set quickly bonded further and we met several times almost like a sub-group. In this
smaller team, there may have been some hostility towards the others for not being as
involved but equally, they could have felt excluded because some of us were already
comfortable with each other.
A 2014 study showed that ostracism is a more harmful workplace experience than
harassment. (OReilly et al, 2014) Some of my frustrations about other team members
not participating as much as I would have liked could be down to my own faults. In
future team projects, it would be important to be inclusive of all members and to make
sure that I myself was fully immersed in the team.
For good teamwork to take place its members must have regular and frequent
interactions with one another. (Martin, 2010) In the sub-group that formed, we were
trying to ensure that these regular interactions took place but we could have put more
emphasis on having the entire group available to meet before deciding on a plan.
It was during the first two stages of team development that the roles of members of the
group started to show. In the storming phase, peoples personalities begin to be
revealed. These personality traits can reveal what type of role a person can take in a
group. Belbin (1993) explores the ways in which personalities can dictate which role a
person plays in a team.
During our second semester, we got to explore which roles we would be assigned using
Belbins personality assessment. Given that our group was late to start working on the
assignment we found out our roles before we had done much work. This may have put
pressure on some members of the group to fulfil their personality roles but I found my
result to be quite fitting and didnt change how I acted to fit into the role.
In our project our individual objectives in the team were all the same, to research and
form a presentation about one topic. In other teams, such as the multidisciplinary teams
found in health and social care settings, people have distinct functions to carry out.
Even in teams of the same discipline the roles wont always be the same. In these
cases, it may be useful to determine team roles based on personality tests as people
could then be matched to a task that best suits them. In most cases, someone would be
assigned a task without a thought to the role that would suit them most so they may not
be as effective as someone else in that role. REFERENCEBELBIN?
During the personality assessments, I found myself to be a shaper. Belbin (1993)
describes this role as someone who challenges others and can thrive on pressure.
Whilst I see some similarities with myself I think it would take time to become
comfortable enough in a group to start showing these traits. Perhaps we would have
worked more effectively and started working sooner if myself and others had shown
more confidence.
Confidence can be a huge factor in establishing roles in teams and in allowing teams to
work efficiently. Early research into peer pressure as a solution to inactive members of a
team found that if team members are in a position where they will be punished for low
productivity then each member of the team will encourage the entire group to do well.
(Kandel and Lazear, 1992)
More recently, a 2011 paper suggests that individuals might abstain from free-riding in
teams if they hold the level of their skill in high regard. (Rullire et al, 2011) Here it may
be important not only to have confidence in yourself but also to be able to project that
on to others. By being inclusive to other team members and receptive of their ideas it
may boost their confidence. With this confidence boost comes a raised team output
according the same 2011 study.
In a healthcare setting having this conviction for your own skills is doubly important. Not
only could it boost the productivity of the multi-disciplinary team but also it enables
professionals to speak out about issues they are concerned about. This takes us back
to the mid Staffordshire enquiry where a lack of confident communication lay at the
heart of the trusts issues.
Whilst the events leading to the enquiry into hospitals such as Bristol and the Mid
Staffordshire trust are complex and numerous, they could still have been prevented if
health care professionals were aware of the importance of communication and team
work. By evaluating our performance in the learning set, we can start our careers with
the ability to avoid negative outcomes by looking at what went wrong in our presentation
group and taking preventative measures.
Alongside reflection, other tools can be used to identify behaviour that will best
contribute to effective teamwork. Amongst healthcare students in Australia, a self
assessment tool was developed for the students to use after performing in an
emergency scenario. The report found that with good information sharing and support
comes effective team coordination. REFERENCE
By using such tools and by writing reflective accounts, it is possible to gain a greater
self awareness of how you perform within a team. Whilst personality models may
attempt to define what role you play with regards to how work is completed. It can
sometimes take reflection to understand how well you interact with others and how your
role within a team can affect relationships with other team members.
MOVE POSITION? Within our learning set, there was one member of the group who I
think could be an implementer in Belbin's collection of roles. REFERENCE This role
suggests a stubbornness which at first made me somewhat hostile towards that team
member. Through shallow reflection it would be easy to say that I would prefer not to
work with this person again but by exploring their personality and by evaluating how well
the team eventually worked I can say that they helped give us the initial push needed to
set the team to effective work.
The majority of the presentation had to be completed in time outside timetabled
sessions. This meant a great deal of trust was needed between team members, first in
that people would honour their commitments of meetings the group and secondly that
they would take time individually to carry out work for the project.
Due to a number of people in the group having to commute to get to university, our
designated meeting place, it meant they sometimes couldn't attend meetings because
of the distance. Others had family commitments and found it difficult to find time in their
schedules to attend meetings at relatively short notice.
This could have led to a lot of conflict within the group as those who made it to the
group sessions regularly may be angered by the perceived lack of effort from other
team members. However with our learning set, we were lucky to have team members
who overcame these barriers in different ways. Whilst they may not be able to attend
meetings they still did their own research and sent the information to other group
members if possible or pooled resources during the weekly seminars.
In a health and social care setting, whilst people may always be present during work
hours and not expected to partake in multi-disciplinary meetings, they may be distracted
by out of work matters. In the sense, working in our learning sets has shown us that
there are ways around such issues.

ACTION PLAN
Based on some of the perceived failings I feel our group made, in a future team project I
would want to be a confident figure within the team from day one without being seen to
be taking over. By engaging early with all the team members, we could have an early
discussion about our objectives and how to achieve them. From my experience within
the inter-professional learning set, having that clear goal is essential for productivity.
Being a student nurse, it is easy to feel subpar to those around you when out on
placement. If a doctor asks information about a patient I always find myself directing
them to the nurse in charge of that patient, even if I am also looking after them. By
learning to be more confident in situations such as the group presentation, I hope to be
able to transfer that into the clinical setting.
If I can learn to confidently respond to requests, such as those from doctors, working
relationships can be built and I could then feel comfortable asking questions and raising
concerns within the team. To ensure this occurs I will have to be vigilant in not taking the
easy option in situations, such as diverting questions onto other members of staff.
In group work such as the presentation we had to create, it is perhaps easier to become
familiarised with the content of the piece. Lone research can be undertaken and shared
between the group at a slower pace. In the clinical setting, I need to continue to be
proactive in learning about my patients and the diverse types of treatments we provide
so that I gain as much from the experience as I can.
By immersing myself in the multi-disciplinary team I can learn how each member of the
team contributes to the care of the patients so in the future I can be better prepared to
contribute myself. After seeing how important effective communication within the inter-
professional teams is, I want to qualify as a nurse with all the skills needed to be able to
immediately take up a role in the team to ensure patients are provided with the best
possible care.
In ur project our working roles in the team were all quite similar, to research and form
and a presentation about one topic. In other teams, such as the multidisciplinary teams
found in health and social care settings, people may have different functions to carry
out. Even in teams of the same discipline the roles wont always be the same. In these
cases it may be useful to determine team roles based on personality tests as people
could then be matched to a task that best suits them. In most cases someone would be
assigned a task without a thought to the role that would suit them most so they may not
be as effective as someone else in that role. FIND A REFERENCE

CONCLUSION