CLINICAL FEATURE

KEYWORDS Interprofessional teamwork / Patient-centred care / Collaboration / Ethics / Communication / Documentation

Provenance and Peer review: Unsolicited contribution; Peer reviewed; Accepted for publication January 2013.

Interprofessional collaborative
teamwork facilitates patient
centred care:
a student practitioner’s perspective
by Mark Osbiston
Correspondence address: Student Operating Department Practitioner, Edge Hill University, Faculty of Health and Social Care, Armstrong House, Manchester Technology Centre,
Broncaster Road, Manchester, M1 7ED. Email: [email protected]

Interprofessional teamwork and collaboration are essential for facilitating perioperative patient
centred care. Operating department practitioners (ODPs) and nurses are registered professional
‘practitioner’ members of the perioperative team. Standards of conduct, communication skills,
ethical principles and confidentiality legislation associated with documented patient information
underpin and guide perioperative practitioner practice. This article will discuss, from a student’s
theoretical and practice experience perspective, the registered professional ‘practitioner’ role in
the context of the interprofessional team.

Introduction Perioperative Practice (AfPP) and to Code: Standards of Conduct, Performance

redefine its membership to include nurses and Ethics for Nurses and Midwives
Persons requiring surgery will become and ODPs (AfPP 2013). In this article (NMC 2008). These documents attempt
a patient on a perioperative journey the term ‘practitioner’ will represent to translate ethical ideas into a set of
through an operating department, and will both the professional groups with which expectations reflecting each professional
make transitions between pre, intra and I have practiced in the perioperative practice interaction and may also have
postoperative environments (Manley et al environment. Using new academic ‘accompanying documents’ that elaborate
2011). Patients arriving for surgery can be knowledge, understanding and practice them more fully (Reel & Hutching 2007
either sedated or anaesthetised and are placement experience examples, I will p143). The document Standards of
therefore rendered temporarily vulnerable, discuss my perspective of the perioperative Proficiency: Operating Department Practice
and due to a fear of the unknown, patients ‘practitioner’ role in the context of the (HCPC 2008b) is an accompanying HCPC
may present in a range of emotional interprofessional perioperative team. Topics publication which contains standards to
states. Despite vulnerability status and covered include: practitioner professional ensure that practitioners work safely and
emotional state, patients have the right registration/regulation and intrinsic roles, effectively; it sets the minimum standards
to be treated and cared for with respect, IPT working and associated advantages to necessary to protect the public.
equality, privacy and without compromising the patient, relationship of ethical principles
dignity, values or autonomy. Perioperative to IPT practice, and essential modes and Registration imposes a need to practice
procedures and care are provided and skills of communication. as an autonomous and accountable
facilitated by a multidisciplinary team professional in partnership with other
(MDT) collaborating as an interprofessional
team (IPT) of healthcare professionals.
Professional standards professionals. Consequently a legal duty
of care exists to the patient and a need to
Operating department practitioners (ODPs) The title Operating Department Practitioner promote and protect their best interests in
and nurses are registered autonomous is protected by law (Health Professions all aspects of care including maintaining
and independent professional members of Order HMSO 2001). Healthcare confidentiality of patients’ personal,
the IPT practicing in all three areas of the professionals using this title are registered sensitive and health information (HMSO
perioperative environment. with and regulated by a statutory regulator, 1998). Standards also protect practitioners,
the Health and Care Professions Council by highlighting the need to practice within
According to Wicker and Ferbrache (2010) (HCPC). The HCPC maintains a register limits of education, training and experience.
two groups of registered professionals of practitioners meeting the published This protects practitioners against claims
now practice in the role of perioperative Standards of Conduct, Performance and of negligence and deregistration by
practitioner: ODPs and nurses. The overlap Ethics (HCPC 2008a). Nurses are registered patients and regulators who can hold them
in roles led the National Association of with and regulated by the Nursing and accountable for poor practice/omissions
Theatre Nurses (NATN) to change its Midwifery Council (NMC) and follow The which have caused harm or professional
name, in 2005, to the Association for disrepute (Griffith & Tengnah 2010).

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Interprofessional teamwork can be defined as interactions between two or more

members of different professional disciplines

Evidence based practitioner which facilitates the progression of surgical role defined by their respective standards
knowledge procedures. of practice, and must communicate this
scope of practice to others (MacDonald et
Professional knowledge and skills must Interprofessional teamwork al 2010).
be kept up to date, and must incorporate
evidence based practice, ensuring fitness Reel and Hutchings (2007 p141) In the anaesthetic practitioner’s role I have
to practise. Practitioners need to be honest reminded the IPT that patients are ‘key discussed with anaesthetists and surgeons
about highlighting deficiencies in their team members’, with values, beliefs and the positioning of a patient’s arm on an arm
knowledge. intrinsic decision-making ability that may board. This incorporated knowledge and
influence their behaviour, ethical views understanding relating to patient anatomy
Evidence based practitioner knowledge may and preferences. Therefore another role and monitoring. The anaesthetist needed
be used to influence practice while working of all practitioners is to use the knowledge to ensure access to and maintenance
in collaboration with other professionals and understanding of patient’s rights to of invasive blood pressure monitoring. I
(HPC 2008a, NMC 2008) and this impacts provide emotional and physical support to explained to the surgeon why the arm board
on the interprofessional team members patients before, during and after procedures was needed and assisted in its positioning,
who may also be held to account when (HCPC 2008b, NMC 2008). For example avoiding damage to the patient’s brachial
patient harm occurs. Therefore a legal in the anaesthetic practitioner role I have plexus nerve. The IPT discussion facilitated
and professional obligation exists, for interacted with anaesthetists and surgeons integrity, surgical access and vulnerable
healthcare professionals to ensure that to identify patient anxiety and stress while patient advocacy.
team members are up to date with practice receiving them into IPT care.
knowledge. Knowledge of the HCPC and Kenward and Kenward (2011) highlighted
NMC standards, education, training and Confirmation of identification, procedure that knowledge of the role of others permits
experience are applied by practitioners in and site marking is also the responsibility the challenging of poor or unsafe practice
each of the three areas of perioperative of all practitioners (AfPP 2007). Hence in that may undermine patient values and
practice: anaesthetic, circulating/scrub the anaesthetic and scrub practitioner’s positive outcomes. Interprofessional
and recovery while working with the role I have confirmed patient identification, teamwork/collaboration between MDT
perioperative IPT (HCPC 2008b). procedure and site marking using verbal members must be an advantage to patients,
communication skills with the patient at for it facilitates decision making in their
Perioperative IPT members include reception and in theatre with anaesthetists best interests. It must include systematic
anaesthetists, surgeons, and anaesthetic, and surgeons. A practitioner’s role is to work reflection on practice using the principles of
circulating and scrub practitioners. interactively with patients, surgeons and ethics (Asselin 2011).
Anaesthetists and surgeons are registered anaesthetists to facilitate interprofessional
teamwork (Reel & Hutchings 2007).
medical professionals with specific roles, Ethical practice
for example: the administration and
maintenance of patients’ anaesthesia Interprofessional teamwork can be The principle of ethics requires
and performance of patients’ surgical defined as interactions between two or professionals to be concerned with the
procedures respectively. Each profession more members of different professional systematic examination of problems
uses monitoring or therapeutic medical disciplines. Reel and Hutchings (2007) to decide what to do for the best or to
devices, for example anaesthetic machines argued that the term ‘interprofessional’ decide if an action/practice is right or
and surgical instruments (RCA 2010, RCSE contradicts the notion of an autonomous wrong. Practitioners must practise within
2008). and independent practitioner. However the ethical principles highlighted by their
Hawley (2007a) suggested that profession (HCPC 2008b, NMC 2008). Four
An important role of practitioners is to interprofessional implies learning from main principles are used to guide ethical
use their knowledge and skills to prepare and about other professional roles to practice: autonomy, beneficence, non-
essential medical equipment, to anticipate, facilitate collaborative teamwork and is maleficence and justice (Griffith & Tengnah
support and meet the needs of surgeons essential for patient centred care. The 2010).
and anaesthetists, and to facilitate the interaction and collaboration of two or more
performance of procedures on patients. autonomous independent professionals, Autonomy is the principle that allows
For example, under supervision I have using knowledge of the other’s role patients, with capacity, to make an informed
supported the anaesthetist by checking to facilitate patient centred care, is and uncoerced decision and includes
anaesthetic machines before induction of therefore a more complete definition of the right to refuse or withdraw consent
anaesthesia and by passing a laryngoscope interprofessional teamwork. Each person (Griffith & Tengnah 2010). For example I
and endotracheal tube to facilitate (professional and patient) has a definite have participated in a discussion, involving
intubation. Similarly when acting as scrub role in an interprofessional team, possesses a surgeon, anaesthetist and patient to
practitioner I have used safe handling knowledge and hence has respect for the facilitate the autonomous decision to
techniques when passing instruments role of others. Each profession has their consent for patient controlled epidural
and sharps in response to surgeons’ own standard of ethical practice and each analgesia (PCEA) as an alternative to
requests, also anticipating their needs IPT member must follow and act within the patient controlled analgesia (PCA).

May 2013 / Volume 23 / Issue 5 / ISSN 1750-4589 111

CLINICAL FEATURE

Interprofessional collaborative teamwork facilitates patient centred

care: a student practitioner’s perspective
Continued

Beneficence is the principle of actively between two or more persons. Dickson a lesion from the scalp of an anxious patient
doing of good to protect patients from harm and Hargie (2006) suggested that verbal in a procedure which incorporated local
(Hawley 2007b). For example, when acting communication uses open and closed anaesthetic and sedation.
in the anaesthetic practitioner’s role, I have questioning to encourage individuals to talk
incorporated aseptic non touch technique and to obtain factual information. Bostrom Written communication
preparing equipment while supporting (2006) highlighted that the use of active Written communication is the use of hand
anaesthetist, anaesthetist assistant and listening skills, making eye contact, listening written or typed documents/checklists
patient to facilitate inserting and securing without activity, and repeating back to facilitate confirming, exchanging and
an epidural catheter, hence minimising the paraphrased responses, are essential to recording of information between two or
risk of infection. understanding information transfer. These more individuals. Documentation utilised
ensure correct exchange and retention of in the perioperative environment includes:
Non-maleficence is the principle of obtained information and instruction. consent forms, patient/World Health
actively preventing harm, by oneself or Organisation (WHO) preoperative checklists,
others, from occurring to patients (Hawley Hamlin (2005) highlighted that having and perioperative care plans (Pirie 2011).
2007b). For example, when acting in the English as a second language and deafness The primary purpose of documentation is to
anaesthetic practitioner’s role, I followed an can be barriers to effective communication. facilitate and record a patient’s procedure
anaesthetist’s instructions while supporting For example, as suggested by Hughes and care. The use of abbreviations in
a patient’s shoulders and using simple and Mardell (2009), I have observed an documentation is considered to be a
terms to reassure a patient, facilitating anaesthetist and anaesthetic practitioner barrier to communication and must be
the safe insertion of a tuohy needle and allowing the use of hearing aids or avoided. Documented details and checklists
reducing the risk of dural puncture. an interpreter to ensure that patients facilitate safe patient transitions and
understand verbal instructions, and this hence continuity of care. For example, the
Justice is the principle of treating patients has facilitated cannulation and induction of patient’s safe transition from anaesthetic
and IPT members with equality and respect anaesthesia. room into the surgical theatre is facilitated
for their rights, without discrimination by the IPT incorporating the use of the time-
against, for example sex, age, race or Acting as scrub practitioner, I used verbal out section of the WHO checklist (Reid &
beliefs; this includes access to treatment communication and active listening skills Clarke 2009 p338).
and care (Griffith & Tengnah 2010). For when interacting with anaesthetists,
example the surgeon, anaesthetist and I surgeons and other practitioners during In the circulating practitioner’s role, before
supported and did not discriminate against preoperative team briefs. This facilitated the initial surgical incision, I have utilised
a female ethnic minority patient accessing the team’s understanding of patient the WHO checklist verbally to confirm the
and receiving either PCA or PCEA. requirements, safety issues and specific patient’s identity, the surgical procedure
equipment needs before procedures and the surgical site with anaesthetists,
Integration of the four ethical principles into started, hence preventing communication surgeons and scrub practitioners. Hence the
collaborative practice is facilitated by IPT failures and poor patient outcomes (Lingard WHO Surgical Safety Checklist facilitates
interaction using effective modes and skills et al 2008). collaborative IPT communication, with the
of communication (Reel & Hutchings 2007). express purpose of ensuring that the correct
Non-verbal communication procedure is carried out on the correct
Communication skills Non-verbal communication is the use of patient at the correct site (Lingard et al
language not incorporating spoken words, 2008).
Communication is a fundamental skill in for example written text/notes, body
effective IPT interaction and facilitates language, hand signals, facial expression Collectively, patient’s forms, plans
the exchange of information between the and eye contact to convey understanding and checklists used to provide safe
patient and practitioner, and between and meaning. Non-verbal communication is continuity of care will become medical
the practitioner and other IPT members just as important as verbal communication healthcare records and are, potentially,
(Suter et al 2009). All IPT members use during information exchange and facilitates legal documents. Documentation
communication skills to seek, exchange and identification of patient anxiety (RCA 2010). needs to be accurate, concise, legible,
use information to ensure safe and effective All IPT members and practitioners need to contemporaneous, signed and dated, with
practice. Modes of communication can be use verbal and non-verbal skills to explain straight lines drawn through mistakes to
verbal, non-verbal, written or electronic. procedures to patients in order to reduce prevent barriers to communication.
Each mode possesses its own barriers anxiety and other emotional states (HPC
to effective information exchange and 2008b, NMC 2008). Griffith and Tengnah (2010) highlighted
necessitates legal confidentiality protection that documents which record any aspect
(Hamlin 2005). For example, acting in the anaesthetic of patient care may be used as evidence
practitioner’s role I utilised non-verbal in a court of law or before a regulatory
Verbal communication communication, pointing at required body. Perioperative records therefore need
Verbal communication is the use of oral equipment and nodding head confirmation to be sufficiently detailed to demonstrate
language to convey, confirm and exchange between surgeon, anaesthetist and theatre that healthcare professionals have
concise, relevant and timely information practitioners. This facilitated the removal of discharged their duty of care to the patient.

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In summary, no one single professional meets all of a perioperative patient’s

needs and this necessitates collaboration (Suter et al 2009)

Patients have the right to privacy and all References MacDonald BM, Bally JM, Ferguson LM et al 2010
documented information must remain Knowledge of the professional role of others: A key
Asselin ME 2011 Using reflection strategies to interprofessional competency Nursing in Practice
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on a need-to-know basis only; this includes RN-to BSN student experience Journal of Nursing
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care: principle of nursing practice Nursing
Association for Perioperative Practice 2007 Standard 25 (31) 35-7
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standards of conduct, performance and ethics for
that is recorded, stored and exchanged Association for Perioperative Practice 2013 About nurses and midwives Available from:
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using knowledge of other professionals’
roles to interact within a perioperative Health and Care Professions Council 2008b About the author
team. Practitioners use the principles of Standards of proficiency: operating department
practitioners London, HCPC Available from: Mark Osbiston
ethics and communication skills to facilitate www.hcpc-uk.org/publications/standards [Accessed BSc(Hons)
interactive, interprofessional decision- February 2013]
Student Operating Department Practitioner,
making and collaboration. Edge Hill University, Faculty of Health and Social
Her Majesty’s Stationery Office 1998 Data
protection Act 1998 London, HMSO Available from: Care, Manchester/Seconded Student Operating
Practitioners first use autonomous www.legislation.gov.uk/ukpga/1998/29/contents Department Practitioner The Christie NHS
Foundation Trust, Surgical Theatre Department,
collaboration with patients to confirm [Accessed February 2013]
Manchester
their identification, the surgical procedure Her Majesty’s Stationery Office 2001 Health
and site, and to identify emotional states professions order London, HMSO Available from: No competing interests declared
with the aim of reducing anxiety. Next, www.legislation.gov.uk/uksi/2002/254/contents/
practitioners use interactive collaboration made [Accessed February 2013] Members can search all issues of the BJPN/JPP
published since 1998 and download articles free of
with IPT members to facilitate safe Hughes SJ, Mardell A 2009 Oxford handbook of charge at www.afpp.org.uk.
transitions and infection-free procedures, perioperative practice Oxford, Oxford University Access is also available to non-members who pay a
on the correct surgical sites, during a Press small fee for each article download.
patient’s perioperative journey. Kenward L, Kenward L 2011 Promoting
interprofessional care in the perioperative
A combination of my theoretical knowledge environment Nursing Standard 25 (41) 35-9
and the understanding gained in Lingard L, Regehr G, Beverley O et al 2008
conjunction with my practice experience, Evaluation of a preoperative checklist and
has given me the perspective that team briefing among surgeons, nurses, and
interprofessional collaborative teamwork anaesthesiologists to reduce failures in
communication Archives of Surgery 143 (1) 12-17
facilitates patient-centred care.

May 2013 / Volume 23 / Issue 5 / ISSN 1750-4589 113

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