Introduction
This essay explores the nursing responsibilities and multidisciplinary team (MDT) collaboration involved in the care of Lillian Moore, a 77-year-old woman who recently suffered an ischaemic stroke affecting her left side. Lillian presents with moderate hemiparesis, expressive aphasia, and anxiety, alongside a medical history of atrial fibrillation and chronic kidney disease (Stage 3). Her social situation, living alone in a second-floor flat with limited family support, raises concerns about her independence post-discharge, particularly regarding medication management and finances. This essay will address two key areas: firstly, nursing responsibilities in terms of accountability, leadership, and ethical challenges, and their impact on patient outcomes; secondly, the role of MDT collaboration, focusing on communication, team roles, and patient safety. By examining these elements, the essay aims to highlight the complexities of providing holistic care in a clinical setting while ensuring Lillian’s safety and well-being.
Nursing Responsibilities: Accountability, Leadership, and Ethical Challenges
Nursing responsibilities are central to ensuring high-quality patient care, and in Lillian’s case, they encompass accountability, leadership, and the navigation of ethical dilemmas. Accountability in nursing refers to the obligation to answer for one’s actions and decisions, aligning with professional standards such as those outlined by the Nursing and Midwifery Council (NMC) Code (NMC, 2018). For Lillian, nurses must ensure accurate documentation of her care, including her mobility needs (e.g., use of a standing hoist) and communication difficulties due to expressive aphasia. Failure to document or communicate these needs effectively could lead to inadequate care delivery, compromising patient outcomes such as delayed recovery or increased risk of falls (Royal College of Nursing, 2020). Therefore, nurses must consistently uphold accountability by maintaining clear records and reporting concerns during handovers, directly impacting the continuity of Lillian’s care.
Leadership is another critical nursing responsibility, particularly in coordinating care for patients with complex needs. Nurses often act as advocates, ensuring that patients like Lillian, who struggle with communication, have their needs and preferences represented in care planning (Ellis, 2019). For instance, Lillian’s anxiety and low mood may hinder her engagement with rehabilitation. A nurse demonstrating leadership might initiate referrals to mental health specialists or occupational therapists, fostering a proactive approach to her emotional and physical recovery. Moreover, leadership involves guiding junior staff or students in understanding the nuances of stroke care, such as the importance of patient-centered communication strategies to address expressive aphasia (Barr and Dowding, 2019). Such actions can enhance team performance, ultimately improving Lillian’s rehabilitation outcomes by ensuring a cohesive and responsive care environment.
Ethical challenges also significantly influence nursing practice and patient outcomes in Lillian’s scenario. One prominent concern is her financial autonomy, given her statement that her grandson manages her cash card, coupled with the absence of a recorded Power of Attorney. This situation raises potential safeguarding issues, as nurses have a duty to protect vulnerable patients from exploitation (NMC, 2018). According to Dimond (2015), nurses must balance respect for patient autonomy with the obligation to act in their best interests, which may involve initiating a safeguarding referral if financial abuse is suspected. This ethical dilemma is complex, as Lillian may trust her grandson, yet her impaired decision-making capacity post-stroke could render her vulnerable. Addressing this requires sensitive communication, potentially involving social workers to assess the situation, and could prevent financial harm, thereby safeguarding her well-being post-discharge. Furthermore, ethical considerations around informed consent are pertinent, as Lillian’s aphasia may impede her ability to fully understand treatment plans. Nurses must employ adapted communication tools, such as visual aids, to ensure she can participate in decisions (Stroke Association, 2019), directly supporting positive outcomes like increased patient satisfaction and adherence to care plans.
In summary, nursing responsibilities in accountability, leadership, and ethical decision-making are pivotal in shaping Lillian’s care trajectory. By maintaining rigorous standards, advocating for her needs, and navigating ethical complexities, nurses can mitigate risks, enhance recovery, and ensure her safety, demonstrating the profound impact of these roles on patient outcomes.
Multidisciplinary Team Collaboration: Roles, Communication, and Patient Safety
Collaboration within a multidisciplinary team is essential for delivering comprehensive care to patients with complex conditions like Lillian’s. The MDT typically includes nurses, physiotherapists, occupational therapists, speech and language therapists (SLTs), social workers, and medical staff, each contributing unique expertise to address her multifaceted needs (NHS England, 2019). For instance, physiotherapists focus on improving Lillian’s hemiparesis through tailored exercises, while SLTs target her expressive aphasia with communication strategies. Nurses, often acting as the central point of contact, coordinate these interventions, ensuring that each team member’s input aligns with Lillian’s overall care plan. This collaborative approach is crucial for holistic care, as fragmented efforts could lead to inconsistent treatment, potentially delaying recovery or compromising safety (Goodwin et al., 2017).
Effective communication is the cornerstone of MDT collaboration and directly impacts patient safety. In Lillian’s case, her mobility limitations and communication challenges necessitate clear information-sharing to prevent adverse events, such as falls during transfers. Regular MDT meetings and shared care records facilitate this by ensuring that all professionals are updated on her progress and limitations (e.g., her reliance on a standing hoist) (Reeves et al., 2017). However, communication barriers can arise, particularly when team members work across different shifts or departments. For example, if a physiotherapist’s recommendation for a specific mobility aid is not communicated to nursing staff, Lillian could be at risk of injury. Implementing structured communication tools, such as the SBAR (Situation, Background, Assessment, Recommendation) framework, can mitigate these risks by standardizing information exchange (NHS Institute for Innovation and Improvement, 2010). By enhancing clarity and consistency, such tools safeguard patient well-being and promote seamless care delivery.
Team roles within the MDT must also be clearly defined to optimize collaboration and ensure patient safety. Role ambiguity can lead to duplicated efforts or overlooked responsibilities, particularly in discharge planning for Lillian, given her limited independence and social support. Social workers play a vital role in assessing her home environment and arranging support services, such as home care for personal needs and meal preparation, while occupational therapists evaluate her ability to manage daily tasks (Stroke Association, 2019). Nurses, meanwhile, contribute by monitoring her adherence to medications like Apixaban, essential for preventing further strokes due to her atrial fibrillation. A shared understanding of these roles, reinforced through regular team discussions, prevents gaps in care and ensures that Lillian’s transition to home is safe and supported (Goodwin et al., 2017). Indeed, effective role delineation can reduce readmission risks, a critical concern for stroke survivors.
Collaboration also extends to involving Lillian and her family in care decisions, enhancing patient-centered outcomes. Given her intermittent family support, engaging her grandson (where appropriate and safeguarded) in discharge planning could provide additional resources for her care. However, this must be balanced with safeguarding considerations, as previously discussed. MDT collaboration ensures that all perspectives—clinical, social, and personal—are integrated into a cohesive plan, ultimately prioritizing Lillian’s safety and dignity (NHS England, 2019). Therefore, a well-coordinated MDT approach not only addresses immediate clinical needs but also supports long-term recovery and independence.
Conclusion
In conclusion, the care of Lillian Moore following her ischaemic stroke underscores the critical importance of nursing responsibilities and MDT collaboration in achieving positive patient outcomes. Nurses play a pivotal role through accountability, leadership, and ethical decision-making, ensuring that Lillian’s complex needs—ranging from mobility limitations to potential safeguarding concerns—are addressed with diligence and compassion. These responsibilities directly influence her safety, recovery, and emotional well-being. Simultaneously, MDT collaboration, underpinned by effective communication and clearly defined roles, is essential for delivering holistic care and preventing adverse events. By integrating the expertise of various professionals and prioritizing patient safety, the MDT facilitates a comprehensive approach to Lillian’s rehabilitation and discharge planning. The implications of these findings highlight the need for ongoing training in ethical practice and interprofessional communication within healthcare settings, ensuring that vulnerable patients like Lillian receive the coordinated, high-quality care they deserve.
References
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- Reeves, S., Xyrichis, A. and Zwarenstein, M. (2017) Teamwork, Collaboration, Coordination, and Networking: Why We Need to Distinguish between Different Types of Interprofessional Practice. Journal of Interprofessional Care, 32(1), pp. 1-3.
- Royal College of Nursing (RCN) (2020) Principles of Nursing Practice. London: RCN.
- Stroke Association (2019) State of the Nation: Stroke Statistics. London: Stroke Association.
