Policy Analysis

1
??? ??.?.?.???? ??. ?????????? ?????????????????
????? ?????????????????????
????????????????
Multidisciplinary VS Interdisciplinary
2
Older persons are generally having multiple
diseases increasing complexity and scope of
problems
3
Comprehensive patient care often involves
trying to solve problems which are beyond the
scope of expertise and training of any one
provider.
4
Especially in long-term care settings, health
care professionals work together as a team to
meet the needs of the older adults.
5
Care of older adult is generally accepted to be
an interdisciplinary team project

• The older adult does not belong to medicine,
  nursing, physiotherapy, or any other disciplines.

6
?????????

• ????????????????????????????????????????
• ??????????????????????????????????????????
• ????????????????????????????????
  ??????????????????????????????????????????????????
  ?????????????
• ?????????????????????????????????????????
• ?????????????????????????????????????????
• ?????????????????????????????????????
  ?????????????????????
• ??????????????????????????????????????????????????
  ???????????????????

7
??????????

• ?????????????????????????????????????????
  ????????????????????????
• ???????????????????????????????????????????
  ???????????????????
• ???????????????????????????????????

8
How do teams work together?
9
"a team is a small number of consistent people
committed to a relevant shared purpose, with
common performance goals, complementary and
overlapping skills, and a common approach to
their work. Team members hold themselves mutually
accountable, team results are outcomes."
Team
Lorimer Manion (1996)
10
Health Care Team

• ??? Interdisciplinary team ???????????????????????
  ???????????????????????????????? formal
  informal ???????????????????
• 
  (Walsh, 1994)

????????????????????? ??????????????????????
?????????????????????????????????????????????
(Bond Bond, 1994)
11
?????????????????????? ???????????? ??????
balance responsibilities

• Values
• Knowledge
• Skills
• Goal about patient

Majority opinion (more expert opinion, unanimity,
or consensus may be more appropriate methods of
decision making than autocratic choice
12
Working together

• Different training and experience, each member of
  the team bring different strengths
• Team member need to work together in order to
  best unitize the expertise and insights of each
  member

13
???????????????

• ???????????????????????????????
• ??????????????????????????????????????????????????
  
• ??????????????? ??????????????????????????????????
  ????????????????

14
???????????????

• ???????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????????????????????????????

15
?????????????????????????????????????

• ???.?????????????? ???????????????
  ??????????????????????????????????
• ???????????????? ?????????????????????????????????
  ?????????????????
• ???????/??. ?????????????????????????????????

16
?????????????????????????????????????

• ??????????????????????????????????????????????????
  ??????????
• ????????????????????????????
• ??????????????????????????????????????????????????
  ????????????????????????????????
• ??????????????????????????????????????????????????
  ?? ??????????????????????????????????

17

• Multidisciplinary
• VS
• Interdisciplinary

18
Multi-disciplinary Team

• ????????????????????????????????????????????????
  ?????????????????? ???????????????????????????????
  ???????
• ????????????????????????????????????????????????
  ????????????????????
• (Walsh, 1994)

19
Interdisciplinary

• ???????
• ???????????????????????????????????
  ????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??? ????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????????????
  (Walsh, 1994)

20
Interdisciplinary
Multidisciplinary"

• ????????????????????????????????
  ??????????????????????????????????????????????????
  ?????????????????
• ??? interdisciplinary ????????????????????????????
  ???????????????????????? ??????????????????????
  ????????? ????????????????????????????????????????
  ??????????????????

• ????????????????????????? ????????????????????????
  ??????????????????????????????????????????????????
  ????????????????????? ????????????????????????????
  ????????????
• (Wiecha, 2004)
• ??????????????????????????????????????????????????
  ????????????????????????????????????
• (?????? ???????????, 2546)

John Wiecha (2004)
21
Interdisciplinary Team

• ?????????????????????????????????
  ??????????????????????
• ???????????????????????????????????????
• ?????????????????
• ???????????? contribute ??????????????????????????
  ?????????????????????
• ????????????? ??????????????????? ???????????
  ????????????????????????????????
  ?????????????????????????????????????????
• ???????????????
• ????????? ????????????????

?????? ??????????? (2546)
22
?????????????? Interdisciplinary
Team????????????????????????????
??????????????????????? ?????????????????????????
????????????????

• ?????????????????? ???????????????????????????????
  ?????????????????????
• - Priority setting
• - Co-ordinate treatment
• - Education Counselling
• - Discharge Planning

??????????????? Client-Centred
???????????????????????
23
Interdisciplinary collaboration

• ??????????????????????????????????????????????????
  
• ??????????????????????????????
• ?????????????????????????????????
• ???????????????? ??????????????????????????????

24
Interdisciplinary collaboration (cont.)

• ??????????????????????????????????????????
  ???????? ?????????????????????????????? intra-
  and interdisciplinary team
• ???????????????????????????????????????????
  (outcome of care)

25
???????????????????

• ??????????????????
• ??????
• ?????????????
• ?????
• ?????????????????
• ???????
• ???????????????

• ??????????????
• Speech therapist
• Podiatrist
• ????????
• Audiologist
• Dentist

26
Team Approach to Rehabilitation
??????
?????
????????????????????????????
Podiatrist
???????????
???????
????????????
???????
???????
???????????????
??????????????
?????????????
27
??????????????????
???????????????????
???????? ??????
Home Health Care
?????????????
?????????
??????????
OPD
Multi-disciplinary Assessment
????????? ??????????? ?????????????
??????????????????????????????
28
?????????????????????
29
?????????????

• ??????????
• ???????????
• ??????????
• ??????????????

30
??????????????

• Coordinator of team services
• ?????????????
• ??????????????????????????????????????
• ????????????????????

31
??????????????????????

• ????????? ????????????????????????-
• ADL
• Rang of motion
• Manual muscle testing
• Screening for gait problems
• ??????????????????????????????????????????????????
  ???????????????????????????????
• -?????????? polypharmacy ????????????????

32
???????????????

• ??????????
• ???????????????
• ?????????????? polypharmacy
• ???????????????????????
• Review ????????????????????
• ???????????????????? ????????????????

33
?????????????????????????

• ???????????????????????????????????
• ?????????????????
• ??????
• ?????????? ????????
• ???????? ?????????????????????????????

• ??????????????????
• ????????????????????????
• ????????
• ?????????
• ?????????????????????????????????

34
????????????

• ????????????????????????????????????????
• ??????????????????????
• ?????????????
• ????????????????????????????????
• ??????????????????????????????????

35
???????? ??????? ????????????????

• ?????????????????
• ???????????????????????
• ???????????????
• ??????????????????????????????????
• ????????? ???? ????????

36
?????????????? ??????????????????

• Geriatrician/physician
• Geriatric resources nurse
• Ambulatory service nurse
• Pharmacist
• Physiotherapist
• Dietitian
• Social Worker

37
???????? ???????????????????????????

• ???????????????????????????????(Geriatrician/physi
  cian)-
• ??????????? ????????????
• ??????????????????
• ??????????????????????????????
• ??????????????????? ?????????????

38
???????? ???????????Multi-disciplinary Team

• Geriatric resources nurse GRN)
• ?????????????????????????????? ward ?????
  ????????????????????????????????????
• ????????????????
• ?????????????? ??????? ????????
• ?????????????????? (Functional Ass.)
• ADL ?????????????????????????????????
  ?????????????????????? ???? ????
  ??????????????????

39
???????? ??????????? Multi-disciplinary Team

• Ambulatory service nurse
• ??????????????????? ????? ????????????????????????
  ??
• ??????????????? GRN ?????????????????????
  discharge planing
• ????????????? ?????????? ????????????????????????
  
• ???????????????
• ?????????????
• ?????
• ???????????

40
???????? ????????????????Multi-disciplinary Team

• Pharmacist
• ?????????????????????? ???? ???? ????
• ????? ??????????? side-effect, drug interaction,
  polypharmacy
• Physiotherapist
• ?????????????????? Ac.illness
• ??????? ?????????????????????????
• ????????????????????????????????

41
???????? ????????????????Multi-disciplinary Team

• Dietitian
• ????????? ???? ???????????????????
• Social Worker
• ????????????????? ???.
• ???????????????????? (??????)

42
????????????????????????

• ???????????????????????
• ??????????????????
• ???????????????????????????????????????
• ???????????????????????????????

??????? ???????????? (2546)
43
???????? ?????????????

• ????? GRN ???????????????????? ???????????????????
  ????????? ??????????????
• ??????? review ?????????????????
• ?????????????????????????????
• ????????????????????????? 1 ??????????????????????
  ????????? ????????????????????????????
• ????????????????????????????????????????????
• ???????????????????????????????????????????

44
???????????????????????????????????????

• ??????????????????????????????????????????????????
  ???? ??????????????????????????????? ??????????
  ?????? ??????????????????????????????????????
• ?????????????????
• ????????????????????????
• ?????????????????????????? ????
  ??????????????????????????????????????
  ??????????????? ??????????????????????

45

• I acknowledge and respect your perspective
  in this matter, but for the following reasons. I
  disagree with your conclusions, and believe I
  should do something else

46
?????????????

• ?????? ??????????? (2546) Team care for
  hospitalized geriatric patients.
  ??????????????????????????????????? ??????
  ??????????????????????????????. 19-21 ?.?.46 ?
  ??????????????????.98-100.
• ??????? ??????????? (2546) ???????????????????????
  ??????????????. ??????????????????????????????????
  ? ?????? ??????????????????????????????. 19-21
  ?.?.46 ? ??????????????????. 92-97
• Eliopoulos, C. (1990) Caring for the Elderly in
  Diverse Care Setting, Philadelphia
  J.B.Lippincott Company.
• Luggen, A.S. and einer, S.E. (2001) NGNA Core
  Curriculum for Gerontological Nursing (2nd ed.) ,
  St.Louis Mosby.
• ONeill, P.A. (2002) Caring for the Older Adult
  A Health Promotion Perspective, Philadelphia
  W.B.Saunders Company.
• ETHICS IN MEDICINE University of Washington
  School of Medicine. Retrieved on 2 March 2009
  from http//depts.washington.edu/bioethx/topics/t
  eam.html