The Role of the Multidisciplinary Teams in Mental Health Nursing Essay

The decision-making process related to the treatment of patients with complex conditions is the responsibility of multidisciplinary teams. However, to make the correct decisions for individual patients, the hospitals need to ensure the active participation of all their members at the meetings. Hence, the purpose of this paper is to reveal the leadership and management patterns in nursing in the context of inter-professional working applicable to the chosen case. It also seeks to examine the current policies related to the treatment of oropharyngeal dysphagia in the UK as well as the role of multidisciplinary teams in improving the condition of such patients.

One of the principal concepts used in nursing is leadership, which is essential in terms of the case study (see Appendix A). Its importance is defined by the lack of leaders among nurses due to the absence of the required qualities (Cabral et al., 2019). However, to successfully participate in multidisciplinary team meetings, specific leadership skills are essential as they also contribute to the creation of good relationships with other team members (Fast and Rankin, 2017). Senior nurses play a significant role in the successful execution of delegated tasks by monitoring the actions of other nurses (Van Hecke, 2019). Hence, the ability to be a leader in the decision-making process related to the treatment of the patient with oropharyngeal dysphagia would contribute to its better outcome through enhanced cooperation of medical personnel.

The concept of leadership is complemented by the proper management of human resources at multidisciplinary team meetings. It allows the participants to provide high-quality services for the patient as it is crucial for her safety (Orton et al., 2019). Moreover, the effectiveness of the management of the personnel correlates with the effectiveness of the whole treatment and the decrease in time the patient would spend at the hospital (Orton et al., 2019). Hence, nurses should participate actively as they must encourage teams to overcome the arising challenges connected to the patient’s behavior (Nobbs, 2018). Their participation at all management levels is one of the critical factors of the consequent success of the chosen treatment (Cabral et al., 2019). Therefore, proper management would improve the experience of both nurses and the patient.

The combination of leadership and management allows medical personnel to achieve better results in treatment. Hence, the motivation of the multidisciplinary team members, together with effective coordination of available resources, is the best approach in terms of developing a strategy of medical assistance (Cummings et al., 2018). The choice of management style would also be conditional upon organisational goals (Rubio and Picardo, 2017). As for leadership skills, they include strategic thinking and the ability to make decisions and assume responsibility for the hospital’s nursing units (Cabral et al., 2019). However, in order to succeed, it is vital to consider the patient’s needs and opinions towards the issue (Cardiff et al., 2018). Therefore, the person-centred approach would be an excellent complement to the chosen strategy treatment and allow medical staff to achieve better results.

To implement the approach, which includes the concepts of leadership and management at the multidisciplinary team meeting, it is essential to consider various theories related to them. The primary theory applicable to the case is Fiedler’s contingency theory, and it highlights the importance of the choice of leadership style for the achievement of specific objectives (Rubio and Picardo, 2017). Hence, it would be necessary to match the patient’s condition and the chosen therapy (see Appendix A) with a suitable leadership style. This approach would allow creating the conditions for the delivery of care (Mororó et al., 2017). In this way, the leadership qualities of personnel would contribute to a better outcome.

Another management theory applicable to the case is the theory X and Y of Douglas McGregor. It represents the idea of a combination of the opposite methods. Thus, the authoritative approach with strict supervision is mixed with the use of specific soft tools such as motivation of team members intended to increase their productivity (Rubio and Picardo, 2017). This theory contributes to the proper distribution of tasks between the participants (Management of inpatient oro-pharyngeal dysphagia policy, 2019). Its implementation would allow medical personnel to benefit from the existing mechanisms of control over nurses and other specialists and motivate them to participate in the process.

As the essential task of multidisciplinary team work is to ensure the participation of all its members, the applicable leadership models would be focused on combining their efforts. The example of such a model is transformational leadership, which requires the presence of a charismatic leader who motivates others to achieve the common goal (McCay, Lyles and Larkey, 2018). The fundamental component of this model is the mutual respect of all members of the multidisciplinary team, which allows providing high-quality medical services shared between specialists (Fast and Rankin, 2017). This approach suits the case of the patient with oropharyngeal dysphagia.

Another option is the ethical leadership theory, which requires the inclusion of ethics in the work of team leaders. They are supposed to consider the interests of all actors in the matter, meanwhile demonstrating the essential leadership qualities, such as integrity and honesty (Jambawo, 2018). This approach is also typical for patients with mental issues. It corresponds to the necessity to engage medical personnel at all levels in the decision-making process (Thusini and Mingay, 2019). In the case of ethical leadership, both leaders and followers are valued, and their needs are respected.

The use of the mentioned theories and models is possible with the adoption of a uniform leadership style. As the patient, Alice is suffering from oropharyngeal dysphagia (see Appendix A), which is a complex condition that might result in further complications, the leadership style should be complex as well. Hence, the employment of distributed leadership corresponds to the case due to the opportunity to delegate the tasks to various specialists (Beirne, 2017). It also allows eliminating possible risks of incivility between nurses (Kaiser, 2017). Such an innovative approach would contribute to the mutual understanding between all team members and the clear vision of one’s responsibilities.

Distributed leadership is beneficial in terms of consideration of all the activities and interrelations between the members of a multidisciplinary team. It allows them not only to distribute the tasks among the participants but also to pay attention to the existing leadership roles in the organisation (Feng et al., 2017). It is critical for maintaining the high quality of medical services and ensuring the best outcome possible for the health status of a patient (Sfantou et al., 2017). These benefits are conditional upon the recognition of available talent in the organisation and the tasks, which correspond to the team members (Beirne, 2017). Hence, distributed leadership would be the best option for the multidisciplinary team considering the case of Alice.

As for the management, it should combine the theories mentioned above and benefit from the increase in cooperation they provide. The implementation of the theory X and Y proposed by Douglas McGregor would ensure higher flexibility of the existing relationships between the medical personnel in the organisation (Rubio and Picardo, 2017). The idea of task distribution included in this theory provides for the active participation of all team members. Together with Fiedler’s contingency theory, it would create more opportunities to express the opinions of the medical personnel. The implementation of distributed leadership complements these theories, and the type of management employed for finding a solution for the patient would be described as democratic.

The condition of Alice is characterised by a delayed swallow and significant signs of post swallow residue and aspiration (see Appendix A). It requires the medical interventions of various specialists and makes a multidisciplinary team the best option for the treatment of this patient (Dziewas et al., 2017). The current policies of the UK distinguish the roles and responsibilities for all of the team members (Management of inpatient oro-pharyngeal dysphagia policy, 2019). Thus, the executives in the team would be the medical director and chief nurse, whose task is to distribute the responsibilities among the participants.

In addition to the personnel responsible for such distribution, it is necessary to monitor the compliance of other members with the course of action. It would be the responsibility of clinical managers and directors as well as heads of service and ward sisters (Management of inpatient oro-pharyngeal dysphagia policy, 2019). They would be able to eliminate the conflicts resulting from different opinions of the multidisciplinary team members regarding the chosen treatment (Rubio and Picardo, 2017). In this way, the unanimity of all medical personnel at different levels will be reached.

The principal tasks related to the work with Alice should be distributed between other specialists in the hospital. The registered nursing staff contributes to the success of the treatment by timely conducting the required screening of the patient to reveal the tendencies in her condition (Management of inpatient oro-pharyngeal dysphagia policy, 2019). This task is extremely important due to the possibility of further complications.

These complications are conditional upon the limited functionality of the patient’s body. Further issues might result from the improper coordination of the work of the oral cavity and pharynx muscles (Sasegbon and Hamdy, 2017). The nurses should also make decisions considering the necessity of changes in Alice’s nutrition and hydration to avoid the risk feeding leading to pneumonia and, consequently, death of the patient (McHutchison et al., 2018). From all the foregoing, it is clear that registered screening nurses play a significant role in the prevention of further complications.

Another category of specialists involved in the treatment process is various speech and language therapists ensuring the suitability of the chosen strategy for Alice. Their responsibilities include the timely assessments of the therapy results, the provision of Alice’s family with current information on her state, as well as training of other healthcare professionals involved in the process (Management of inpatient oro-pharyngeal dysphagia policy, 2019). The importance of speech and language therapists and managers is defined by the necessity to coordinate all the actions of the multidisciplinary team for a better outcome (McGinnis et al., 2018). The participation of all the members of the multidisciplinary team mentioned above would allow decreasing the time Alice would spend at the hospital and ensuring her safety during the treatment.

The training of the medical staff focused on dealing with such a condition as oropharyngeal dysphagia is crucial for the wellbeing of the patient and her quality of life. The organisational factors related to hospital procedures and included in such training would decrease the risks for Alice as this condition tends to develop into aspiration pneumonia, the second leading cause of death in the country (Attrill et al., 2018). If the medical personnel can timely identify, assess, and manage the people with oropharyngeal dysphagia, the results of the treatment will be better (Management of inpatient oro-pharyngeal dysphagia policy, 2019). It explains the usefulness of a multidisciplinary team approach in the case of this condition.

There is a lot of specificities that need to be considered while making decisions on the treatment suitable for Alice, and the cooperation of various specialists would be beneficial in this case. To avoid potential harm, a thorough examination of the patient in all of the possible aspects is needed. Thus, for example, the UK recommendations include information on the medications suitable for the treatment of oropharyngeal dysphagia (Wright, Smithard, and Griffith, 2020). However, their choice, compatibility with other methods, and the dosage are defined on a case-by-case basis. This circumstance also reflects the usefulness of patient-centred care in the case of Alice (McGinnis et al., 2018). Hence, the participation of all members of the multidisciplinary team would allow making the correct choice of treatment methods with orientation on Alice’s needs.

The role of a multidisciplinary team is not limited by a set of measures intended to maintain and improve the quality of life of Alice. One of its principal objectives refers to the task of decreasing the risk of readmission to the hospital due to the development of such conditions as chest infection or pneumonia (Duncan et al., 2019). It is vital in the case of the patient as she already demonstrated the warning symptoms such as weight loss (Dysphagia, 2018). The situation highlights the necessity of the interventions of a multidisciplinary team to eliminate the risks of malnutrition. In the case of Alice, it would also be necessary for the medical personnel to inform her about the possible consequences of food refusal.

The proper management of patients with oropharyngeal dysphagia is a challenging task for a multidisciplinary team of medical specialists. The initial prescription of treatment is insufficient in terms of improving the condition of patients like Alice. The complex measures also include regularity of meetings for the purpose of reassessing the changes in the patient’s state after implementing the screening, evaluation, and treatment for further decision-making (McGinnis et al., 2018). In the case of the emergence of other symptoms indicating the worsening of Alice’s condition, it would be necessary to re-evaluate the chosen strategy of treatment (Duncan et al., 2019). Therefore, the Interprofessional approach is the most flexible and efficient one for the patient.

Taking into account the information given above, it can be concluded that the only possible option to find a proper treatment for Alice is the creation of a multidisciplinary team of medical specialists. It is defined by the existing risk of poor nutritional status of the patient resulting from her behaviour (Dziewas et al., 2017). Moreover, the researchers proved that such an approach is extremely efficient in the case of patients with oropharyngeal dysphagia like Alice (Mata et al., 2018). They are less likely to seek additional treatment after the end of the prescribed therapy (Mata et al., 2018). Thus, the multidisciplinary practice provides for better results in the case of oropharyngeal dysphagia and, therefore, would be beneficial for Alice.

The coordination of actions of the multidisciplinary team members requires the creation of positive relationships between the medical specialists as well as with the patient. The principal objective is to achieve a mutual understanding between the nurses and Alice in accordance with the theory of patient-centred care (McGinnis et al., 2018). It leads to the necessity to implement the relationship theory, which highlights the significance of caring and orientation on the other team members and their prevalence over the traditional hierarchical roles in the organisation (Cardiff, McCormack and McCance, 2018). This approach is known as relational leadership, and it provides the opportunity to find a balance between the objectives and the people’s opinions.

As can be seen from the description given above, this type of leadership promotes the creation of positive relationships that are important for Interprofessional cooperation. The understanding of the common purpose by all of the members of the multidisciplinary teams with consideration of Alice’s view of her condition would allow achieving the agreement on further actions (Cleary et al., 2018). However, in order to implement this type of leadership, it is necessary to ensure support from all of the team members for the improved outcome (Cummings et al., 2018). Therefore, the task for the medical personnel is to involve Alice in the discussion by demonstrating respect to her opinion.

Once the agreement between the nurses and the patient is reached, it is possible to demonstrate the shared vision of the team of specialists on the possible ways of overcoming the emerging issues. The higher the support of all participants is, the better the outcome of the treatment for Alice would be (McCay, Lyles, and Larkey, 2018). This conclusion shows the importance of building connections for implementing the leadership role in the context of an organisation (Pappas and McCauley, 2018). The process of shared decision-making in the case of the patient who refuses to eat the prescribed food would be a good opportunity to demonstrate respect for her choice and negotiate the ways to improve her condition.

The employment of the existing leadership models and management theories described above would be beneficial for me as a qualified nurse. The principal challenge is the acquisition of specific leadership qualities that would allow me to make correct choices considering the conditions of patients. However, it is not limited by the traditional approach to leadership, which is authoritative in nature (Rubio and Picardo, 2017). What is more important, a qualified nurse should be able to promote the correct decisions in such a way that it takes into account the opinion of the patient (McGinnis et al., 2018). Hence, the responsibility of a nurse is to find the approach that would allow coordinating her actions with the needs of patients.

The information on the work of multidisciplinary teams with the use of specific leadership and management techniques is critical for my future career as a mental health nurse. From the case of Alice, I learnt about the importance of collaboration in the context of the treatment of patients with complex issues. The example of the successful application of theories and models related to the work of multidisciplinary teams would contribute to my professional success as a mental health nurse in the future. This experience also allowed me to expand my knowledge of the common practices of multidisciplinary teams and demonstrated the necessity to develop leadership skills. Such skills would contribute to the creation of positive relationships with my colleagues and patients as well as their families.

However, not all the experience of medical personnel and their patients can be characterised as positive. The organisation of work at hospitals and its proper management is significantly influenced by the human factor, which sometimes leads to malfunction of the healthcare system. Thus, for example, serious concerns about the quality of nursing in the UK were demonstrated by the Francis report (Bradshaw, 2017). According to it, the nurses failed to provide the required services to their patients and ignored their obligations. This case demonstrates the behaviour of nurses who lack compassion, which is an essential part of soft leadership skills. The report also presents the recommendations for improvements corresponding to the leadership theories mentioned above to ensure the proper quality of nursing care.

In conclusion, the case of Alice, a patient with oropharyngeal dysphagia who refuses to follow the doctor’s prescriptions, requires the implementation of complex measures. It is a clear example of the situation that can be solved only with the intervention of a multidisciplinary team of medical specialists. The distribution of tasks among the hospital personnel at different levels, together with the employment of relational leadership style and democratic management would allow improving the condition of Alice. The evidence from numerous studies proves the efficiency of multidisciplinary teams of medical specialists in terms of the creation of positive relationships for a better outcome of the treatment. Thus, the principal condition of their successful work is the inclusion of both patients and all team members in the process and the collaborative development of solutions.

Reference List

1. Attrill, S. et al. (2018) ‘Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review,’ BMC health services research, 18(1), pp.594-611. doi:10.1186/s12913-018-3376-3
2. Beirne, M. (2017) ‘The reforming appeal of distributed leadership,’ British Journal of Healthcare Management, 23(6), pp.262-270. doi:10.12968/bjhc.2017.23.6.262
3. Bradshaw, A. (2017) ‘What is a nurse? The Francis report and the historic voice of nursing.’ Nursing Inquiry, 24(4), e12190. doi:10.1111/nin.12190
4. Cabral, A., Oram, C. and Allum, S. (2019) ‘Developing nursing leadership talent—views from the NHS nursing leadership for south‐east England,’ Journal of nursing management, 27(1), pp.75-83. doi:10.1111/jonm.12650
5. Cardiff, S., McCormack, B. and McCance, T. (2018) ‘Person‐centred leadership: a relational approach to leadership derived through action research,’ Journal of clinical nursing, 27(15-16), pp.3056-3069. doi:10.1111/jocn.14492
6. Cleary, S. et al. (2018) ‘Enabling relational leadership in primary healthcare settings: lessons from the DIALHS collaboration,’ Health policy and planning, 33(suppl_2), pp. ii65-ii74. doi:10.1093/heapol/czx135
7. Cummings, G.G. et al. (2018) ‘Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review,’ International Journal of Nursing Studies, 85, pp.19-60. doi:10.1016/j.ijnurstu.2018.04.016
8. Duncan, S. et al. (2019) ‘Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis,’ Systematic Reviews, 8(1), pp. 1-8. doi:10.1186/s13643-019-1196-0
9. Dysphagia (swallowing problems) (2018) Web.
10. Dziewas, R. et al. (2017) ‘Recognizing the importance of dysphagia: stumbling blocks and stepping stones in the twenty-first century,’ Clinical Interventions in Aging, 11, pp. 189-208. doi:10.2147/cia.s97481
11. Fast, O. and Rankin, J. (2017) ‘Rationing nurses: realities, practicalities, and nursing leadership theories,’ Nursing Inquiry, 25(2), p. e12227. doi:10.1111/nin.12227
12. Feng, Y. et al. (2017) ‘Rethinking distributed leadership: dimensions, antecedents, and team effectiveness,’ Leadership & Organization Development Journal, 38(2), pp. 284-302. doi: 10.1108/LODJ-07-2015-0147
13. Jambawo, S. (2018) ‘Transformational leadership and ethical leadership: their significance in the mental healthcare system,’ British Journal of Nursing, 27(17), pp. 998–1001. doi:10.12968/bjon.2018.27.17.998
14. Kaiser, J.A. (2017) ‘The relationship between leadership style and nurse‐to‐nurse incivility: turning the lens inward,’ Journal of Nursing Management, 25(2), pp.110-118. doi:10.1111/jonm.12447
15. Management of inpatient oro-pharyngeal dysphagia policy(2019) Web.
16. Mata, M.D. et al. (2018) ‘Integral management oropharyngeal dysphagia,’ Annals of Physical and Rehabilitation Medicine, 61, pp.e506-e507. doi:10.1016/j.rehab.2018.05.1179
17. McCay, R., Lyles, A.A. and Larkey, L. (2018) ‘Nurse leadership style, nurse satisfaction, and patient satisfaction: a systematic review,’ Journal of nursing care quality, 33(4), pp.361-367. doi:10.1097/NCQ.0000000000000317
18. McGinnis, C. M. et al. (2018) ‘Dysphagia: Interprofessional management, impact, and patient-centred care,’ Nutrition in Clinical Practice, 34(1), pp. 80-95. doi:10.1002/ncp.10239
19. McHutchison, L. et al. (2018) ‘Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia,’ Australasian journal on ageing, 37(4), pp.E120-E126. doi:10.1111/ajag.12562
20. Mororó, D. D. et al. (2017) ‘Concept analysis of nursing care management in the hospital context,’ Acta Paulista de Enfermagem, 30(3), pp. 323–332. doi:10.1590/1982-0194201700043
21. Nobbs, A. (2018) ‘How nurse leadership has evolved,’ British Journal of Nursing, 27(16), p. 935. doi:10.12968/bjon.2018.27.16.935
22. Orton, M. L. et al. (2019) ‘Nursing management matters for registered nurses with a PhD working in clinical practice,’ Journal of nursing management, 27(5), pp. 955-962. doi:10.1111/jonm.12750
23. Pappas, S. and McCauley, L. (2018) ‘Nursing integration and innovation across a multisystem enterprise,’ Nursing administration quarterly, 42(1), pp.54-61. doi:10.1097/NAQ.0000000000000265
24. Rubio, M.A.E. and Picardo, R.L. (2017) ‘Leadership, management and conflict management styles among nurse middle managers’, University of the Visayas-Journal of Research, 11(1), pp.105-112. doi:10.5281/zenodo.2471097
25. Sasegbon, A. and Hamdy, S. (2017) ‘The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia,’ Neurogastroenterology & Motility, 29(11), p.e13100. doi:10.1111/nmo.13100
26. Sfantou, D. et al. (2017) ‘Importance of leadership style towards quality of care measures in healthcare settings: a systematic review,’ Healthcare, 5(4), p. 73-89. doi:10.3390/healthcare5040073
27. Thusini, S. and Mingay, J. (2019) ‘Models of leadership and their implications for nursing practice,’ British Journal of Nursing, 28(6), pp. 356–360. doi:10.12968/bjon.2019.28.6.356
28. Van Hecke, A. et al. (2019) ‘Leadership in nursing and midwifery: activities and associated competencies of advanced practice nurses and midwives,’ Journal of Nursing Management, 27(6), pp. 1261-1274. doi:10.1111/jonm.12808
29. Wright, D.J., Smithard, D.G. and Griffith, R. (2020) ‘Optimising medicines administration for patients with dysphagia in hospital: Medical or nursing responsibility?’, Geriatrics, 5(1), pp. 9-18. doi:10.3390/geriatrics5010009