Narrator: This podcast is intended to support UK healthcare

professionals with education.

The information provided in this podcast is not a substitute for professional

medical advice or treatment, and patients are encouraged to consult healthcare

providers, including nurses, for any medical questions they may have.

or concerns.

Hannah: Welcome to stoma and continence conversations from Coloplast Professional

where healthcare professionals and experts by experience discuss the latest

hot topics in the worlds of stoma, continence care and specialist practice.

I'm Hannah Patterson.

I've worked in specialist care and I'm currently the ostomy care associate

education manager at Coloplast.

This time we're talking about powering specialist care and the magic of

interprofessional collaboration.

Now, today is one of the special podcasts that you may remember I

spoke about a few weeks ago, and I am once again joined by Paul and Emma.

Hi both, how are you?

Paul: Hello!

You had us back!

We got invited back, Em.

Hannah: I know.

I'd be like, you behaved last time, I'll have you back again.

So, we are back.

Paul: Well, it's lovely to be back, thank you.

Hannah: And it is lovely to have you both back.

Now, as I said in the title, we're looking at specialist care again, as

I said, go back at the start of the series, we're doing some special podcasts

about specialist care this time around.

And this one is looking at the magic of interprofessional collaboration.

Now I'm going to start off.

With what might be a very obvious question, but not potentially a very

easy question, how would you define interprofessional collaboration?

Paul, I'm going to go with you for this one.

Paul: Defining interprofessional, that's a difficult one, isn't it?

It's the ability and the understanding to improve patient care and outcomes

by utilizing all the resources at your disposal, I think is probably

the easiest way I would describe it.

And because specialist practice, again, like I said, in the last episode,

the hints in the title specialist, we are, we specialize in our individual.

Speciality, and only by utilizing interpersonal relationships.

Are we able to actually improve, uh, patient outcomes?

Hannah: Now, Emma, I don't think you've probably got much to add to that.

I think you're probably feeling very relieved that I came to Paul for that one.

But is there anything you would like to add to that?

Emma: I think, yeah, I think we pool our expertise with other, Healthcare

professionals as well to ensure that actually you're, you're able to

improve patient outcomes that way.

So, yeah,

Hannah: fantastic.

Now, you touched on it briefly within there, Emma.

So I am going to come to you and ask you this one.

Sorry.

It's because you said patients in there.

So how does having that interprofessional collaboration benefit patients?

What is the benefit for patients?

Emma: So I think by working together, collaborating with others, we can

have better communication, we can um, have efficient decision making, we

can look at the patient holistically.

So yeah, I think that's probably how we can help outcomes.

Hannah: And what would you say on that, Paul?

Paul: Very similar.

I would kind of add to one of the things that all nurses

say is, I haven't got time.

You know, I haven't got time to do this.

I don't know where to start, all those sorts of things.

And I think with specialist practice, what you're able to

do is not reinvent the wheel.

So if you can utilize the resources and tools that somebody else has

got and actually just, you know, tweak them to match your service.

It's a win.

Hannah: Yeah.

And it is almost interprofessional.

You're looking at your MDTs, things like that.

So looking at then from, so we've looked at the patient's side of things.

So what would then be the benefit for the workplace as a whole?

How would that then, interprofessional collaboration benefit the workplace?

Paul: Again, it's, It is, it's almost a case of think about what the hospital or

the care setting would be like without it.

It's almost answering the question by saying I want to change the question

and say imagine what a hospital or a care environment would be like if

you didn't have Into, you know, that, that interpersonal interprofessional

connection, that interpersonal relationship, it's using all those

people at your discretion, all those people thinking outside the box,

we cannot do our job without it.

And part of the specialist role spot, the specialist practice role

is actually having an understanding.

Of that wider picture, understanding other roles, interpreting those

roles and actually say, no, I need that little bit of speciality.

I need that.

And I need that.

It's a vital part of being a specialist nurse is actually understanding.

I don't know everything and having that interpersonal relationship, those

interpersonal discussions, that ability to care for somebody completely holistically.

is only possible through the utilization of that interpersonal,

professional relationship and teamwork.

Hannah: Yeah, it's almost like cogs in a wheel, isn't it, that you're not going

to get the next phase of the system moving along without the cogs earlier on.

Emma: Just talking about that, it reminded me of a couple of

patients that I had within my role.

Um, obviously teaching intermittent self catheterization, looking at

urology, um, patients in general, but a lot of my patients had MS.

And actually, the way I had and worked collaboratively with the MS nurses and

the continence teams, we were able to give that patient the best possible care

because we, we spoke to each other, we, we talked to each other, we worked together.

I'm out.

Gave me a huge amount of job satisfaction, actually.

So, yeah, I think that it can, it can also almost help with sort of

that exhort, that exhaustion when you think, Oh, I've done this, I've done

that, I've done this, what's next.

But actually, if you look further than your own service and you work

with other professionals, they can say, Oh, did you know this?

Or did you know that?

And I think it can just help boost that confidence, doesn't it?

Hannah: Yeah, absolutely.

Now, you mentioned a bit there, Emma, about examples there.

So thinking of, and I'm going to ask you first, Paul, is there any

example you've got from when you were working within the hospital setting?

How, how collaboration, you know, interprofessional collaboration really did

benefit maybe a patient, the workplace?

Have you got any particular thing you can call back on for that?

Paul: Yeah, not, not that I could, I could do an entire podcast series just

giving you examples of when this is, um, when that's happened and I'll, I'll

give you two hopefully quite quick ones.

I'll put the emphasis on hopefully one is an obvious one.

And one is a much less obvious one.

The obvious one is I was asked to initiate, um, distal limb feeding.

Thank you.

And it wasn't chime re infusion, it was distal limb feeding

and it was an elemental feed.

And I don't know anybody who knows about elemental feeds, but they're really

greasy, they're greasy and they're slimy.

And I was okay, you know, I was confident with, with, um, distal limb feeding.

So I was happy with my practice and my ability to actually do it.

But I had this problem where the feeding tube, And the giving set

inside the bag kept on disconnecting.

And for anybody who's ever done distal limb feeding.

You haven't got a lot of room in there anyway.

It is in a tight, a tight environment.

It's a horrible, you know, fiddly and all those sorts of things.

And obviously, you know, to part this distal in feeding, we'd had the greater

the, the, the bigger MDT approach.

So we had the nutritionist, the gastroenterologists, the

dieticians, et cetera, et cetera.

And.

These tubes kept on coming apart.

And it was, I just spoke to me, me and the gastroenterologist nurse.

She said, you know what?

I have this problem all the time with peg feeding with different feeds when

there's different feeds are really greasy.

And it was through that communication where we both said, we're both having

Similar problems, and it was like so both of us got together and right.

If you do that, I'll do this.

You do that.

So basically, it was a case of one patient brought two nurses

together who didn't have a clue.

You know, we're both having the same problem in different situations,

and I think it probably took three hours of us working together.

pooling our knowledge, pooling our understanding.

And, and we basically found out and she contacted some of her old colleagues.

I contacted some of mine and together we came up with this.

There's this lovely little rubber connection that was

like a loop that connected both ends and it was elasticated.

It was fantastic work to dream.

And it was that interface, you know, so it wasn't anything

groundbreaking or anything like that.

It was a tiny little bit of care that would just change the lives of.

Nurses and patients.

And the other one very, very quick is I was citing a patient

and we talk about nutritionists.

We talk about dietitians, we talk about gastroenterologists, we

talk about continence nursing, all these sorts of things.

But it's also that thing of understanding other professions as well.

I remember I was citing somebody and this poor lady, she'd lost a child

in very early infancy and she had a tattoo of his footprint on her tummy

and where the site, what the perfect, and she didn't, you know, she had lots

of other scars and that sort of thing, but where the stoma really needed to

go if she was going to have one was directly or very close to this footprint.

And she was actually at the point of declining surgery because there

was a potential stoma being formed.

And it was like, no, this is my memory of my child.

And again, it's that thinking outside the box, it's that specialist practice.

And I can't, I was racking my brains.

And I actually started speaking to Tattooists, professional

Tattooists and that sort of thing.

So I got medical illustration to come in because medical illustration, they are

fantastic at medical grade photography.

So they had measurements, they had everything, and they took about 50 photos

of this tattoo, and I got the tattooist to come in and the tattooist said.

Yeah, no trouble at all.

He looked at it.

He took drawings.

He did little things like that.

And he said, I will be able to perfectly mirror if it goes through that tattoo.

I will move it somewhere.

And he said, and I'll do it for free.

He said, so if it's needed, I will do it.

And we had this big file of photos, measurements and everything for that.

And so it's that thing.

It's not just yeah.

So when we talk about interprofessional relationships and communication and

thing, it's that thing of being able to go actually medical illustrations, fantastic.

They're experts in their job, but getting somebody out and, and

it's that communication and that lady went to theater, luckily

enough, she didn't need a stoma.

So all of that, that was six hours on camera and I were

Hannah: before that.

Yeah, that's

Paul: six, that's six, eight hours of work.

But.

If I hadn't have done that six hours of work, she wouldn't have done it.

And I bet Emma's got goosebumps.

Yeah, it is.

And even now I'm welling up thinking about it because I can remember the

passion in this lady's voice and the way this tattooist just came

in and went, yeah, I won't charge.

Just let me know.

I'll do it.

Hannah: Emma, are you ready for me to come to you and ask you if you've got

any, what do you need a moment right now?

I need

Emma: you to come with a mascara warning.

And it's like, Oh my God, I'm so overwhelmed.

That's such, Oh my God, that's so amazing.

But that just, that, there you go.

There's your job satisfaction right there.

Yeah, but yeah, I know.

I mean, you know, I don't, I can't, I can't really top that.

Sorry.

Hannah: Collar Plus Professional offers a lot of educational

material for specialists, nurses and healthcare professionals.

Visit collarplusprofessional.

co.

uk to find out more.

So now I'm going to go on to a slightly different question here and I can

feel this may be a can of worms that might well spew open all over the

show but hopefully it's going to be less emotional than the last question.

Thanks for that Paul.

How can Communication be improved within multidisciplinary teams.

Now, what viewers can't see, I'm actually hiding under the table right now.

Viewers, listen and see right now.

I'm hiding under the table when I come to these pair with this

question because I'm fully prepared.

I say, can of worms opening.

Uh, Ember, I'm going to come to you first at this one simply

because I'm going to make Mr.

Russell Roberts be patient just a little bit longer because I

know this is something that he would be desperate to talk about.

Emma: So how to improve communication?

I think this is this is not just into the collaborative working.

I think this can be for anybody, really.

And I think it's awareness.

I think you have to be aware of your cultural, the cultural differences.

Um, I think you have to be aware of communication barriers,

understanding, hierarchy, roles within the group, the collaborations.

And you have to be a really good active listening.

And I think you have to be quite emotionally intelligent as well,

because if you're anything like me, um, when I was collaborating with

certain, um, members of teams, um, if I felt quite passionate about a service

or the patients, I, I could feel.

the, the, the, the passion inside me.

And it would sometimes come out the wrong way.

So I had to, I had to learn how to, how to reel that in.

So I think it's just that it's, it's awareness of who you're

collaborating with, knowing about them and knowing about their service,

because making assumptions about.

services can give you that preconception and you go into a,

into a meeting or go into a, some sort of collaborative setting.

And you, you know, it can, it can impact that meeting.

Hannah: It's almost having a pre bias to what you think is going

on in that situation, isn't it?

That's a really, really good point.

And I think we've all probably been guilty of that within the hospital say, well, so

and so, why can't so and so just do that?

Emma: Yeah, exactly.

We, I mean, I've, I've got some, uh, an example of, you know, when you're,

when you're working in an acute hospital, you've obviously, you, you

know, who's in your, in your area and who's in the hospital who you can go

to, but what about in the community?

Who do you need to collaborate with in the community to actually

improve things for the patients?

coming from the hospital, maybe into the, into the community setting.

And if you've had a bad experience because that community team didn't

see that patient or we didn't send a patient home with a discharge

letter, you, it's that, it's that, it's that two way thing, isn't it?

There might be those preconceptions of, of services.

So yeah, I think communication is, it's just, it's, it's huge.

It's just finding those.

Processes really, and sort of protocols and patient records, those wonderful

electronic patient records, why can't we all use the same system?

would be too easy,

Hannah: too easy

Paul: for me as well.

I would say it starts with you as a nurse and at the heart of

nursing is documentation, and I think a lot of the times nurses.

We can be our own worst enemy, and I talk a lot about fragmentary language.

And this goes whether it's written documentation or you speak into someone.

Fragmentary language is the language that doesn't mean anything.

What does better mean?

What does improved mean?

What does read mean?

Or when you, you know, and again, Emma, I'm thinking, you know, what will, you

know, it's that thing of being able to say, passed a good volume of urine.

Well, what does past a good volume of urine actually mean when you look

at other professions, they don't have this fragmentary language.

They don't have language that can be interpreted by different

people in different ways.

My idea of red, the red peristomal area is going to be different

to the next stoma nurses.

It's going to be different to the next and that sort of thing.

So yeah.

Sometimes we are our own worst enemy, and I'm not going to go

on about validated tools at all.

But again, that's what they're there for.

Medics use them.

Physios use them.

Everybody uses these validated tools to unify communication.

And if you are talking to other members of the wider MDT,

listen to how they communicate.

Listen to what they actually say.

And make it factual.

Yes, as nurses, we are, and it's an emotional profession.

We are fantastic at words.

But are we always using the correct ones?

So it's the how, but also the what, you know, so give

detail, but not spurious detail.

You know, you wouldn't ever write.

Someone came in and their BP was proper low.

Their pulse was banging on a bit.

No, if you know, Yeah,

Hannah: they

Paul: looked a bit warm, you know, you could fry an egg on their forehead.

No, you would write BP 80 over 40 pulse 110 temperature

38.

1.

You know, you would give data.

So when we're talking about patients and we talked about conditions, why is nurses?

I'm not saying at all.

So I don't think I'm doing that.

But it's that thing of.

Think about what you are saying.

You can use a lot fewer words and make a greater impact.

And if you're using fewer words, people will listen to them more.

It's a lot easier to remember 20 words than it is 120 words.

Hannah: So I'm going to add a little bit to what you said there, and I

think it's almost people realizing the importance of what you're asking as well.

And it's something that, and it's leaning towards what you said

there with Emma about past a good amount of urine, how much is good.

And also realizing that importance of actually we need those exact measurements.

I mean, I could, I've lost track of the amount of times that I'd gone to a ward

asking for a fluid balance with a patient with a stoma, and we're getting the.

Bag emptied, or even worse, bowels open, written down.

So, yeah, it's, it's that importance of actually that interpersonal

collaboration, other people realizing why we need that information.

It's not just because we're being awkward.

It's actually people going, no, we need this.

This is why it's important.

It's not just because we want to be awkward and make your lives trickier.

It's to actually make everybody's lives easier.

And I can almost imagine you and Like both Emma and Porno nodding, like furious

little nodding dogs, as I've said that.

Paul: It is, it's true.

And the other example I always use is back in the day when you could, when you

used to write on a TPR chart, you know, my question would be, would you ever

Just rather than actually documenting what the patient's observations

was, would you just write, OBS fine?

Because that's the equivalent.

Writing past urine in toilet or bag emptied, you might as well

write on a TPR chart, OBS stable.

You would never write that on a TPR chart.

And again, when I do things like the high output masterclass, It is something

again, whoever can come up with this result to answer this question.

How do we promote the importance of a adequately and appropriately

completed fluent balance chart?

You're going to be a very, very rich person.

Because it's incredibly simple, but simple doesn't mean that

it's not vitally important.

Emma: Exactly.

It's one of my bugbears in life.

I was like, we need to know the output.

We need to know how much volume has gone.

You know, if this patient's diuresing, for example, you know, what do

we need to replace them with?

So yeah, if someone, if someone comes up with a, with a way to fill it in,

I'll be, I'll be, they'll be very rich.

Paul: And the thing is, the hints in the title, fluid balance.

Chart, you know, so if you put input.

To make it balance, you need output.

And if you've got output to make it balance, you need input.

Yeah.

I know we're laughing when we're doing it, but anybody out there, you know,

and again, I'm sure there's other specialist nurses looking at this now

and other nurses, let's not disrespect a lot of a lot of the generalist

nurses who are saying, Oh my God.

Yes, this is a bug bed.

This is an issue.

So don't just think you're on your own out there, people.

You know, it is nationally, if not internationally, a problem

is fluid balance chart, and it's such a vital component.

Hannah: Absolutely.

And I think we can especially appreciate by our two specialities.

You know, ISC for you, Emma.

all about the waterworks.

And for us with stoma care, especially, you know, you mentioned

it there, Paul, high output.

It's, it's a fluid output.

I mean, you guys say the amount of times I'd see bag emptied or like bowels open.

Uh, well, I'm really glad that patient managed to have their bowels open

when they've had half of them removed.

It's quite a talent.

Thank you so much both of you again for joining me.

A really good conversation again.

I'm really enjoying these sort of new podcasts really, a go of

a different conversation really.

And as much as anything, it's almost, I feel like it's almost

like a semi counseling session with sympathizers with each other and

with everything we've gone through.

It's a bit cathartic in a way.

I quite like it.

Oh, I'm gutted it's over.

I was like, is it over already?

Paul: Can we come back and do another one?

Hannah: Do you know what?

You've behaved yourselves again.

I think we might just let you back again.

So yeah, watch this space guys.

There will be another one coming up and To everyone listening,

we'll see you on the next podcast.

Thanks everyone.

Bye.

Thank you for listening.

To see more of the wide variety of education we offer, please

visit colourplusprofessional.

co.

uk.

See you next time.

Narrator: Stoma and Consonants Conversations is a Vibrant Sound Media

production for Colourplus Professional.