The Relay Race of holistic care

Integrated holistic care of people incorporating a 

‘Bio-Psycho-Social-Spiritual’ 

approach is akin to a relay race,

 not a competitive sprint event!

By Drew Mellor 

 

Half a life-time ago, when I worked as an ED Nurse (Emergency Dept Nurse) I was participating in a multi-discipline  debrief of a tragic incident within our department. Present were medical, nursing, radiology, social work, ED Orderly and chaplaincy personnel, all of whom had key involvement during the “signal 1” response and associated attempt at resuscitation of the young patient. Although the official term was not applied in the 1980’s, the Bio-Psycho-Social-Spiritual approach to integrated holistic care was acknowledged and was certainly the “lived experience” of personnel engaged in the critical care context. 

 

In my role as ‘Resus Nurse’, I facilitated the team debrief, and commenced with an ‘open reflection time’ (focused mainly on what worked well). I introduced the analogy of us as a team, running a relay race, not an individual competitive sprint race, highlighting the unique contribution we each made and the strategic importance of handing the baton to the appropriate ‘leg’ of the relay; and I reminded them that the critical time of team interaction was the “baton change” and the potential for dropping the baton if this critical interaction was not done efficiently and with care. On this occasion, the baton change transitions were effective.  The image was immediately engaged and used to better appreciate the integrated approach that we had witnessed and experienced.  

 

More recently, during deployment as an emergency services Chaplain in the 2019/20 Bushfires, I had opportunity to join an ADF medical team as their ‘Padre’, as they undertook a patrol in a ‘Bushmaster’ to check in on families cut off by fires in a remote part of Victoria. As I got to know various multi-disciplinary team members in the vehicle, I shared with the ADF nurse that I had a background as an ED nurse and that such training significantly equipped me for my role and responsibilities as a Chaplain. During a particular encounter, the commanding officer, after discussions with a family member at the gate of a property, turned and pointed at the ADF Nurse and me, (the chaplain) and said, “you two are up, I’d like you to assess the situation and report back”. Meanwhile the engineers cleared the driveway of felled trees so the Bushmaster had access. 

 

As the nurse and I walked to the house, I commented how much I appreciated the genuine integrated holistic approach that the ADF took toward the care of an individual person and I noted that there is much that we, as Emergency Services Chaplains, can learn from our ADF colleagues, especially in their genuine integrated approach to both planning for holistic engagement and in the way we plan for follow up of critical incidents. There may well be a legitimate place for the image of “stay in your lane”, but multi-disciplinary healthcare of an individual is not one such context.  

 

Meaningful holistic care of a person requires an integrated approach that is genuinely holistic; the latter requires members of such a team to value key ingredients of this approach; 

o A shared view and appreciation of the desired outcome

o Recognition of the skill set and expertise that at times is unique to a particular discipline/practitioner. 

o An understanding of what other disciplines do and bring, coupled with timely referral to appropriate clinicians.

o An interest in the overlay/interplay between disciplines, recognising both points of intersection and importantly ‘when to let go of the baton”.

o A shared primary agenda, focused on the needs of the patient/person/member.

o Sufficient trust within the team to risk what might come from the various ‘baton changes’ that are necessary to help transition the patient/person/member, to the next phase of health. 

o An openness to learn from the shared experience and a commitment to improve capacity and resilience during the various transition phases of the ‘team’s relay race’so that the baton is not dropped. 

o An agreement that the objective is to get the baton to the end of the relay event,without unnecessarily dropping the baton. 

 

 

 

OFFICIAL: Sensitive