SFM - Interprofessional Relationships Flashcards
How many doctors are there in Australia? How many nurses?
50,000 doctors, 220,000 nurses (595 Nurse Practitioners)
2.What’s the difference between a nurse and a midwife? (More than one may be correct)
A. Nurses have more years of training than midwives.
B. Midwives have more years of training than nurses.
C. Midwifery training is by convention only offered to women
D. Midwives can prescribe medications
E. Nurses, but not midwives, can perform immunisations
F. Midwives have registration specific to antenatal, postnatal and birthing care.
ANSWER: F
A and B are wrong because they are too broad as statements. Exam-clever students will recognise that by the Rules of MCQs one or neither of these questions has to be correct; and any response that has a global statement that implies “always” is usually incorrect. You can enter midwifery through a direct course (3 yrs) or as a postgraduate course after a nursing degree (total of 3 years for nursing + 12-18 months for the postgrad diploma). So sometimes nurses and midwives have the same number of years of training as each other, and sometimes midwives have more years of training.
C is incorrect because midwifery is open to both men and women – not to allow this is against the law.
D is incorrect because nurses can’t prescribe medications (see answer below about nurse practitioners, who can).
E is incorrect because they can both immunise. Midwives only immunise in the post-partum period, so they’re generally only giving the birth Hepatitis B vaccine in children born to Hepatitis B-affected mothers.
F is the basis for registration of midwives.
3.What’s the difference between a doctor and a nurse practitioner? (more than one may be correct)
A. Doctors can order MRIs but nurse practitioners can’t.
B. Nurse practitioners cannot prescribe new generation antipsychotics or drugs of dependence.
C. Nothing. Nurse practitioners can undertake anything a doctor can do.
D. Nurse practitioners cannot claim items of service on the Medicare Benefits Schedule
E. Nurse practitioners’ work is bounded by approved protocols of practice.
ANSWER: E.
Nurse practitioners are advanced clinical nurses who have undertaken further training and are registered by state nursing bodies. They have to follow approved clinical guidelines (Here is an example of the clinical guidelines for Nurse Practitioners in NSW: http://www.nnnet.gov.au/downloads/mythbusters_np.pdf ) This structure extends to the pharmaceuticals they can prescribe and the tests they can order. Doctors practise under looser conditions of practice and thus are able to construct more flexible and complex patient management plans. Arguably, doctors are also more likely to be unsafe because of the lack of approved guidelines they have to practise to. Learn more about nurse practitioners here http://www.nnnet.gov.au/downloads/mythbusters_np.pdf
A is wrong because in theory a nurse practitioner can order an MRI if this is part of their approved guidelines. This will therefore vary from state to state.
B is wrong for the same reasons. This doesn’t mean that all nurse practitioners can and do provide these medications. It will depend on whether they can make the case that they should be able to include these in their guidelines and prescribing pharmacopoeia.
C is wrong because doctors have far more latitude and individual control over their prescribing and ordering and management decisions about patients. Nurse practitioners cannot do advanced procedures such as colonoscopies in Australia (NB: nurse practitioners have been demonstrated to be as good as specialist doctors in screening colonoscopies in Europe; this may be an area for future expansion in our country too).
D is wrong because there are Medicare items for consultations by nurse practitioners. The rebates are considerably lower than those available for GPs. Private general practices tend not to hire nurse practitioners for this reason, as it is hard to build a sustainable business model around them. Most nurse practitioners are employed in the public sector.
4.Exercise physiology is such a new health care profession that it has its own journal chronicling their progress “Professionalization of Exercise Physiology”.[1] What are the steps which exercise physiology must take to demonstrate that it is a health care profession? (more than one may be correct)
A. Demonstrate that there is a field of specialised knowledge underlying their discipline?
B. Have a training program so that entry into the discipline is moderated and limited
C. Demonstrate how their discipline can be distinguished from orthoptics.
D. Demonstrate that there is a demand for exercise physiologists among patients
E. Begin prescribing medication or ordering tests
ANSWER: A and B.
Professions are (1) underpinned by specialised knowledge,(2) transmit the specialised knowledge through specialised training and (3) have defined boundaries of knowledge and practice which enable them to be distinguished from other professions.
A is correct. The underlying field of specialised knowledge is exercise science. Exercise science, the field of knowledge, has a longer history than exercise physiology, the health discipline. One of the concerns of the editor of Professionalization of Exercise Physiology is that professionals have to move from regarding themselves as primarily scientists to being health care professionals.
B. is correct. There now are many courses around the current on exercise physiology which enable people to be trained in the science and practice of exercise physiology. Exercise physiologists must now do the training and become registered with their own professional body.
C. is not correct. It is true that exercise physiology must have defined boundaries, but the health professions with shared similiarities that it must define itself are: personal fitness trainers, and physiotherapy. Orthoptists are “eye healthcare professionals who are trained in the assessment and treatment of patients with eye disorders”[1] Exercise physiology is not likely to be confused with orthoptics, so boundary defining strategies are unnecessary.
D is not correct. This is a question related to marketing, not professionalization. It Is not necessary that the public need or require the discipline for it become a profession; nor is it necessary that the health profession be capable of curing people.
E is not correct. Many health professions neither prescribe medications nor order tests
5.Janet has end-stage renal failure due to contracting an infection when working overseas. She attends dialysis twice a week in the community. Who’s likely to be engaged in her care?
Renal physician, GP, dialysis nurse, nurse in general practice, social worker. Possibly, psychologist (most dialysis patients are exhausted, and even if she is depressed she may not have the energy to receive psychological therapy), pharmacist (a good pharmacist will be able to advise her on the safety of medications, and ensure that she never runs out), occupational therapist (may need home fitted out with aids as she is weak).
For exam-anxious students: To pass this, you would need to have recognised the specialist, the GP and nurses as critical, and list at least a few other allied health workers and why they might become involved.
What challenges can be faced when providing multidisciplinary care? (3)
Not co-located. Could co-locate them, or provide Pt support to get between (e.g. transport), or locate care in the home where possible.
Communication difficulties - Create patient-held record/shared notes, or link electronic systems to be able to see each others notes.
Financial costs to patient - Financial support - band together to advocate for increased centrelink etc.
- You’re the Minister of Health. You know that newly graduated doctors, nurses and physios in hospitals aren’t very good at working with each other. In fact, the doctors tend to regard the nurses as rule-bound and unscientific, the nurses tend to regard the doctors as technocrats who can’t see the patient in front of them, and each regards the physiotherapist as someone who comes in when told and shows the patient how to walk or does chest physiotherapy.
Give three reasons why they may not work together, and list an approach that might help overcome this, with an example of this approach.
Ignorance about other profession - create opportunities to learn from each other/work together (unify training programs, exposure to each other)
Lack of good communication - share patient records.
Battles over leadership - Connect team structures - woke collaboratively and early on.
Organisational complexity - find ways to collaborate between teams, don’t extend the complexity.
