Psychiatric illnesses take place in the context of socioeconomic circumstances. A growing body of evidences support that a multidisciplinary care system that includes not only medical management but also social and psychological care significantly improves short-term and long-term outcomes of diseases. However, at the current stage, multidisciplinary teams often function without an exact manual and would rely on traditions and previous customs that vary among centers, which can make individual professionals involved in the care to feel uncertain and ambiguous in terms of his or her roles. This can pose a serious a risk of professional frustration and sense of disempowerment, which can negatively impact team dynamic and quality of patient care. This article attempts to articulate possible challenges that can be faced by multidisciplinary team, and how such challenges can be addressed and handled. To achieve this, first, elements of multidisciplinary care model will be identified, and roles of each professional member will be delineated. Then, challenges that can be faced by a multidisciplinary team will be addressed, using a historical example of National Institute of Mental Health (1946) and a personal account from a British social worker. Then, possible solutions for the current problems will be discussed, which include implementing effective communication systems and adapting a multidisciplinary care plan to address the special needs of different age groups. In closing, I will emphasize that multidisciplinary care is both a medical and ethical imperative; not only sociobehavioral interventions will improve patient adherence, prevent relapse, and maximize the effect of the care, but also the model will facilitate patient’s recovery of agency, the ability to discern right from wrong, and autonomy, the right to make the decision that is most consistent with their beliefs and value systems. / Urban Bioethics

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Individuals with chronic illnesses must manage long-term uncertainty and decision making as they cope with the ways the illness influences almost every aspect of their lives. In the context of pediatric illnesses, parents assume the burden of uncertainty management and decision making during the diagnosis and treatment of their child’s illness. It is common for children with complex chronic illnesses to see multiple specialists for the treatment of their condition. The first visit to a specialist is often more elaborate than a routine primary care visit. While previous research has explored parents’ decision making and uncertainty management during a child’s diagnosis and during end-of-life care, less is known about these experiences during the long-term management of a chronic illness through the care of multiple specialists. The aim of the current study was to explore uncertainty and decision making during parents’ first visit to a multidisciplinary clinic for the care of their child’s complex chronic illness. Data were collected through survey measures and semi-structured interviews with 30 parents after their first visit to a vascular anomaly clinic at a large Midwestern children’s hospital. The results suggest parents’ communication with the team of specialists helps them reappraise uncertainty, engage in effective uncertainty management, and feel validated in their decision making. However, the findings also indicate that parents face multiple uncertainty management dilemmas, including not wanting certain types of information, feeling overwhelmed by the amount of information they receive, and having different information preferences than their spouses. Ultimately, the results also have important implications for existing uncertainty theories and their application to parents’ uncertainty experiences.

A better understanding of task allocation for the registered nurse (RN) within the scope of the multidisciplinary care team model is required. Patients, healthcare staff, and medical facilities that utilize RNs in multidisciplinary care teams will benefit from improved role identification. A multidisciplinary care team consists of a variety of health care professionals and without role identification, confusion, miscommunication, and negative patient outcomes can occur. A literature review demonstrated that a gap in knowledge existed related to task allocation and role identification of RNs within a multidisciplinary care team. The purpose of this study was to evaluate RNs’ scope of practice within a multidisciplinary care team of an acute care medical center and identify a new theory regarding RNs’ perceptions of their role. A grounded theory approach was used to explore and reveal these perceived role identifications through the lens of the accountability theory. The research questions and the guided interview explored RNs’ self-perceived role identifications that have shaped RNs’ expectations of their scope within the multidisciplinary care team model. The results found nurses to be experts of patient care and that the nursing role has a 24/7 responsibility while being the closest, most personal role to the patient, thus, the RN feels accountable for all the needs to the patient, even if the needs or actions are outside of the nursing assigned role or tasks. From these results emerged a new theory, the perpetual accountability theory. Identified recommendations regarding RNs’ roles and their utilization within the multidisciplinary care teams allow a positive social change of greater success at delivering best practices and optimum patient outcomes.

L’obésité de l’enfant et de l’adolescent constitue un problème de santé publique important auquel sont confrontés depuis les années 1970 tous les pays industrialisés. Son origine multifactorielle, l’absence de médicaments présentant une balance bénéfice/risque favorable et l’absence de recommandations quant à la chirurgie bariatrique en font un problème thérapeutique complexe. Ceci a induit une grande variété de prises en charge thérapeutiques dont la comparaison reste difficile en absence de critère permettant de juger de leur efficacité. Ce travail avait pour but de déterminer l’efficacité d’une prise en charge multidisciplinaire dans le Centre « Les Oiseaux » pendant 8 mois, en hospitalisation complète. Une étude rétrospective incluant 1063 patients entre 1991 et 2007 a été réalisée. 746 sujets ont retourné le questionnaire 2 ans après leur sortie et 185 sujets, 5 ans après. Parmi eux plus de 75 % ont maintenu durablement au moins la moitié de leur perte de poids.Dans le but de retrouver des marqueurs précoces d’efficacité thérapeutique, nous avons aussi suivi une cohorte de 16 adolescentes et mis en place un programme de monitorage de 895 variables, données cliniques, psychologiques et biologiques ainsi que des données de pratique d’activité physique. Chaque variable a été testée pour son caractère discriminant et sa faisabilité. Une approche de métabolomique par empreintes a été mise en place sur des échantillons urinaires. Par analyse multivariée, nous avons pu montrer que le maintien 6 mois après la sortie, de la perte de poids était positivement corrélé avec la prise en charge psychologique, l’implication familiale et la capacité de conserver une activité physique suffisante, elle même sous-tendue par l’amélioration de l’estime de soi. / Obesity in childhood must be considered as a major issue in Public Health. Since the 1970s, all developed countries must have faced an increasing prevalence of this metabolic disorder. However since the epidemic of obesity has multifactorial causes, and without the availability of a positive benefit/risk balance for chemical drugs and clear-cut indications for bariatric surgery, it is easy to understand that obesity is a complex issue. This complexity induced different schemes of care the comparison of which is made difficult by the absence of clear criteria for judging therapeutic efficacy. This work was aimed to determine the efficacy of a 8-months residential treatment program performed by a multidisciplinary team in the Care Centre “Les Oiseaux”. In order to demonstrate whether the treatment was of benefit for the patients, 1063 of those treated between 1991 and 2007 have been included in a retrospective study. 746 patients returned the questionnaire after 2 years and 185 patients, 5 years later. Among these patients 75 % were actually able to control their weight since they maintained at least half their weight loss. To unveil early parameters of therapeutic efficacy, we have set up a monitoring record of more than 895 clinical, psychological, and biological parameters as well as an accurate recording of the physical activity of adolescents during their stay in the Care Centre. In addition a metabolic profiling of urine samples has been performed. Each parameter was tested for its discrepancy power as well as its practical aspects. Sixteen female adolescents have then been followed for the duration of their stay according to our monitoring program. By multivariate analysis, we deduced that the maintaining of their weight loss was positively correlated with the psychological care, the family involvement, as well as the ability to keep a sufficient physical activity, which was sustained by the recovery of their self-esteem.

The aim of this study is to describe and analyse an elderly care team’s prerequisite to anchor a salutogenic perspective and approach in an elderly care team in Kalmar municipality. The study identifies factors that could impede or promote the anchoring and examine how the organisation aims to work in a single direction even if the multidisciplinary team processes a diversity of knowledge, education and abilities. The study is based on qualitative semi-structured interviews from representatives of all professions in the multidisciplinary team; social workers, paramedical professions, nurses and care-givers. The theoretical frame consisted of a translating perspective, leadership and ideas of interaction and power. The anchoring will be impact by the team’s member’s background and relation to the new method and organization. Therefore is it vital that the multidisciplinary care team strive to achieve a consensus, a consensus of how the salutogenic perspective and approach in different ways will affect their work.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

The diploma thesis is focused on the issue of acquired dysarthric and swallowing disorders in amyotrophic lateral sclerosis and on multidisciplinary care provided to patients with this disease. Theoretical part of the thesis is divided into three chapters. The introductory chapter presents a summary of current knowledge about amyotrophic lateral sclerosis (ALS). The following two chapters are dedicated to dysarthria and dysphagia and their specifics in ALS. The practical part of the diploma thesis is represented by the fourth chapter which incorporates a research survey focused on multidisciplinary care provided to patients with ALS. The primary aim of the research is to evaluate the multidisciplinary care provided to two selected patients with ALS with a focus on speech and swallowing disorders. The secondary objectives of the research relate to the evaluation of the extent of acquired dysarthric and swallowing disorders of these patients, providing a comprehensive overview of the course and content of the provided care and gathering information to create information brochure for patients with ALS and caregivers. The research approach to achieve the determined objectives of the research survey is creation of case studies using qualitative methods of data collection, which is a structured interview...

Summary: The main objective of this thesis is to describe the limits of existing methods and case management in providing health and social services in the Czech Republic of multidisciplinary care for a family with a disabled children. The work is divided into two parts. First - theoretical part - summarizes the theoretical issues, the basic terminology, case management, case manager, describes the role and method of use of case management in social and health services in the Czech Republic and abroad. There is also summarized the issues of families with disabled children, concept of multidisciplinary care for families with disabled children and the legislative framework governing the health and social care for these entities. The second, empirical part, qualitative research focuses on mapping the experience of families with disabled children in the multidisciplinary care of their children in practice, indications, course, professional representation of multidisciplinary care. The research describes the role of parent as a key person and needs in the care of children with disabilities through semi-structured interviews with five respondents who have children with disabilities. To better understand the needs of families with children with disabilities, case study was give through. I used information from the...