Ce reprezinta o abordare interdisciplinara in realizarea programului kinetic?

Omul este o fiinta complexa, fapt care ridica o serie de provocari in actul recuperator.In prezent, acesta trebuie vazut din mai multe perspective, printre acestea regasindu-se arii precum pshihologia, medicina, religia si sprijinul comunitatii locale. Numai luand in considerare toate aceste aspecte putem asigura un act recuperator de calitate in urma caruia pacientii sa se poata integra usor in societate. De asemenea, s-a dovedit ca o abordare interdisciplinara asigura rezultate mult mai bune decat o abordare unidirectionala. Un prim avantaj al unei abordari interdisciplinare in cadrul kentoterapiei este reprezentat de posibilitatea sporita de depistare a problemelor de sanatate in stadiul incipient. Acest lucru este posibil prin colaborarea specialistilor din diverse arii ale societatii, care pot observa din timp problemele de sanatate ale persoanelor cu care interactioneaza si le pot ghida catre un specialist care poate incepe tratamentul profilactic sau propriu-zis. Din punct de vedere profilactic, kinetoterapeutul poate evalua starea de sanatate a pacientului si il poate indruma care un medic specialist, alaturi de care va incerca sa asigure un tratament de calitate pacientului. De asemenea, pe durata tratamentului pacientul are nevoie de sprijin emotional pentru a putea trece mai usor peste situatia dificila cu care se confrunta. Acest sprijin este asigurat, de cele mai multe ori, de familie si prieteni, care ajuta pacientul sa fie optimist si sa depaseasca momentul. Acest sprijin poate veni si din partea unui pshiholog care sa evalueze periodic starea pshica a pacientului, precum si sa-l motiveze in procesul recuperator, deoarece un aspect foarte important in acest demers il are motivatia pacientului pentru a se vindeca. Pe plan international, termenul de echipa interdisciplinara a luat amploare in ultimii 20 de ani. Acesta a aparut din nevoia de eficientizare a actelor medicale, precum si din considerente economice. Abordarea interdisciplinara a aparut ca necesitate de imbunatatire a tratamentelor oferite de metodele clasice existente la momentul respectiv. In acest proces, sistemele medicale au trecut prin modelul medical, multidisciplinar si interdisciplinar, iar in acest sens exista o tendinta de abordare a unui model transdisciplinar. Modelul initial, medical, este constitutit dintr-o echipa simpla, formata din medicasistent-kinetoterapeut. In aceasta echipa, medicul controleaza intreaga echipa, precum si actiunile celorlalti membri. Comunicarea in cadrul acestui tip de echipa se realizeaza doar pe verticala, deoarece exista o structurare ierarhica care de cele mai multe ori impiedica exprimarea punctelor de vedere ale celorlalti membri. Sheehan, Robertson si Ormond(2007) au observat ca prin acest mod de lucru apar de multe ori neintelegeri in cadrul echipei, deoarece intreg tratamentul se invarte in jurul modului in care medicul decide sa intervina. Prin urmare, aceasta abordare nu este la fel de eficienta in comparatie cu celelalte modele. Abordarea multidisciplinara a aparut din nevoia de a eficientiza actul terapeutic si pune in centrul ariei de interes pacientul. In vederea tratamentului, acesta beneficiaza de ajutor din partea a diversi specialisti, precum medicul, asistentii, nutritionist, pshiholog, kinetoterapeut, servicii sociale si terapie ocupationala. Chiar daca acest mod de abordare a tratamentului abordeaza intr-un mod mult mai amplu dificultatile cu care se confrunta pacientii se confrunta cu o lipsa de comunicare laterala intre specialisti, deoarece acestia nu colaboreaza intre ei pentru a decide ce este in avantajul pacientului si sa isi imparta sarcinile care ar duce la eficientizarea tratamentului. Comunicarea se realizaeza predominant vertical, fiind dictata de pacient.

Abordarea interdisciplinara vine sa rezolve aceasta problema. Acest model de organizare a echipei de specialisti isi propune sa se axeze pe comunicarea laterala intre specialisti, care vor analiza si decide impreuna cele mai eficiente metode te tratare a bolnavului. Pacientul va comunica in continuare vertical cu specialistii, dar acestia vor forma un totunitar menit sa eficientizeze actul terapeutic. O astfel de echipa interdisciplinara este formata din medicul specialist, kinetoterapeut, pshiholog, nutritionist,asistent, nutritionist, asistent social, precum si un specialist in reeducare verbala si terapie ocupationala. Recent, din considerente preporderent economice, conceptul de echipa interdisciplinara tinde sa evolueza catre transdiciplinaritate. In acest caz, specialistii din diverse arii sunt nevoiti sa cunoasca si atributele altor membrii ai echipei. Acest proces este bun doar din punct de vedere al costurilor, deoarece calitatea tratamentului este diminuata de lipsa de aprofundare in domeniu a specialistilor din diverse arii, acestia fiind nevoiti sa dobandeasca si cunostintele celorlalti membri. Modelul interdisciplinar, desi cel mai eficient din punct de vedere al calitatii tratamentului, ridica o serie de provocari in randul specialistilor. Acestia trebuie sa poata lucra in echipa, sa fie capabili sa rezolve conflictele ce pot aparea intre acestia, precum si sa respecte munca celorlalti membrii implicati in tratarea pacientului. Cel mai important aspect al unei echipe interdisciplinare este reprezentat de comunicare. Specialistii din diverse arii trebuie sa aiba un limbaj cat mai accesibil in cadrul echipei, deoarece limbajul de specialitate specific unei arii nu poate fi inteles de ceilalti membri. In acest sens, specialistii trebuie sa fie toleranti cu ceilalti membrii si sa actioneze in interesul pacientului. Interdisciplinary collaboration, patient education The importance of interdisciplinary involvement by the total health care team is central to effective patient care and is an area of JCAHO focus. Although some agencies have achieve excellent interdisciplinary collaboration, lack of communication among disciplines often creates barriers. Inadequate communication can lead to disagreements over turf and an inability to collaborate, both between individuals and in team conferences. Patients are often baffled by various team members who repeat instructions already taught by someone else. The need to move patients through the health care system in an effective and cost-effective way means that nurses and other health care professionals must learn ways of providing patient teaching collaboratively. Because of nursings continuous and visible presence at the patients side, nurses are in the unique position to provide leadership for patient education and to capitalize on the strengths of each discipline for the patients ultimate benefit. Understanding the significant contributions that other health care professionals can make to patient teaching is an important part of the nurses knowledge base. To do this, the nurse needs an accurate understanding of the expertise of each member of the team. Physicians help patients understand the health care problem and the treatment plan. Physicians report that they depend on nurses to help reinforce the teaching they do. Nurses are often asked follow up questions by patients and families, especially when physician explanations are not in terms the patient understands or when patients and families have additional questions. Collaboration with physicians increases with good communication and

effective documentation. Physical therapists teach patients and families about mobility and how to perform functional activities safely. Occupational therapy teaching focuses on how to make adaptations that enable patients to be as independent as possible in activities of daily living. Physical and occupational therapists depend on nurses to educate patients about their disease condition and to reinforce instructions they give, particularly regarding carrying through with positioning, transfers, and the use of adaptive devices. Nurses active participation in formal team meetings and informal meetings on patient units or by telephone maximizes the contributions of both disciplines. Dietitians teach patients and families about therapeutic diets. They assess the patients usual dietary patterns and plan with the patient and family how the customary diet can be modified to achieve health management goals. Dieticians depend on nurses to reinforce the importance of following the dietary plan and providing feedback about patient participation. Pharmacists teach patients how drugs work in their bodies, what the medications are for, why its important to take them, how to store them, and how to avoid drug interactions with other medications and food. Pharmacists often depend on nurses to reinforce information they have given patients. Social workers serve as an important liaison between the hospital staff and the community. Social workers coordinate referrals to many different agencies and resources, and provide emotional support to patients and families. The efforts of social workers are maximized when nurses are able to provide specific information about the patients home situation. In well-functioning interdisciplinary teams, team members view nurses as their eyes and ears- to provide feedback about patient participation, to share information that may help team members plan and adjust goals, and to reinforce and follow through with teaching they have provided. In turn, nurse members of top performing teams communicate superbly, both orally and in writing. They keep communication channels open, are active participants in team conferences, and provide excellent and current progress notes about patient teaching results so that other team members are kept continuously informed. Effective teams often cite specific characteristics that allow them to work well together. Some of the characteristics of effective interdisciplinary teams include:

Good communication, both verbal and written, facilitated by planning meetings, patient care conferences, telephone consultation, good documentation, and the willingness to go out of the way to make sure communication takes place Mutual respect among disciplines, recognizing respective areas of expertise, knowing ones limits, and teaching each other A desire to work as a team and recognition of a common goal

Who are members of an interdisciplinary team? What is their role?

Depending on an individual's age and disability, the exact composition of the interdisciplinary team will vary. An interdisciplinary team consists of the family and professionals who are engaged in supporting the individual. The team typically includes at minimum the individual with severe communication disabilities, a family member or guardian, a speech-language pathologist, and a teacher (general or special education). Other members may include, but are not limited to, an occupational therapist, physical therapist, general education and/or special education teacher, direct care staff, employer/job coach, psychologist, and social worker.

The ideal interdisciplinary service delivery model requires that participants share a common perspective on communication. This shared perspective should include a broad understanding of communication including that it is a shared social skill and that it have effects on other people, and can be nonspoken or spoken and nonsymbolic or symbolic The role of the interdisciplinary team is to work cooperatively to provide discipline-specific assessment and intervention, although some cross-disciplinary activity may occur as team members collaborate in the delivery of communication services and supports. They discuss their findings and activities to seek consensus and to develop goals and plans as a team.

Sometimes members of the team may differ about the recommended communication intervention approach for an individual. In these cases, professionals should be guided by the scope of practice and the evidence base. The team must work together to resolve their differences and build consensus so that that individual receives the communication services and supports he or she needs. Sometimes the team may want to seek outside consultation when the team remains divided about an intervention approach or recognizes it doesn't have the requisite expertise represented within the group.