Skilled compassionate staff work in effective teams
Knowledge and skills in care of older patients, particularly those with
cognitive impairment, were seen as important for all hospital staff.
“Even from the people who work in the ward who are going to handle an
older person, who are going to transfer an older person; how are they
going to deal with an older person if he has dementia when he needs to
move from A to B or he needs to have his meds? So everyone needs to have
some sort of training.” P17, geriatrician, academic
Compassion was identified as an important attribute in caring for older
people. Experiential learning could enhance compassion, while entrenched
ageism, lack of knowledge and mentorship, negative experiences and
competing values and demands could erode it.
“I do think that people start with a degree [of compassion] and it
can be eroded over time, through experiences of lack of
interdisciplinary teamwork, you know, lack of what they see as being
important, not being valued.” P3, nurse, manager
“They probably don’t think about it… It’s so easy when you work
in that environment all the time. You become immune to what goes on” P9
nurse, clinician
Teamwork was discussed as a critical component of care of older
inpatients. Respondents identified value and challenges working in
multidisciplinary teams (MDT). Good teamwork provided opportunities for
sharing information, prioritising workload, mutual learning and peer
support.
“Different people bring the different skill mix to the
situation…. I actually love the interaction of the team because
it really allows us to talk about the aspects of the older person care
in a really MDT approach. We know the view of the doctors, the doctors
are able to learn the view of ours and I believe that we learn from each
other.” P10, AHP, clinician
However, when multiple team members were involved in care there was a
risk of overwhelming patients and families with poorly coordinated
interactions. Within teams, professional silos could limit communication
of important information, create duplication, and prevent individual
providers taking responsibility beyond a limited scope.
“I would hear the nutrition assistant or the dietitian come around to
the patient…just saying ‘how’d you go with your [breakfast]
this morning’. And I thought, what a missed opportunity, because the
nurse was there, you didn’t ask the nurse, you walked straight past
them.” P3, nurse, manager
“I think nurses are very quick to go ‘this is not something I know a
lot about so I’ll flick it off sooner than I really need to because I
know that there’s somebody more expert in that.”’ P12, nurse, academic
Important enablers for promoting effective teamwork included
face-to-face meetings, working together over time to develop trust and
shared values, and open discussion of role boundaries.
“[These medical staff] don’t have any rapport with the allied
health team… in comparison to teams that might meet three time a week
so you’ve got a bit of rapport. You get to understand how they work, and
they get to understand how you work… I think with teams that
don’t meet and don’t really know each other, that’s really difficult.”
P1, AHP, clinician