Meaning of the care process and team approach
The team approach means that people with different skills work together for one person using one plan. Another name is interprofessional or multidisciplinary care.
Why is it needed? One person cannot know everything. A care worker knows daily life best because he or she is with the person for hours. A nurse knows health care. A doctor knows illness and medicine. A physiotherapist knows movement. Together they see the whole person.
The care process (gather, assess, goal, plan, do, evaluate) is the shared road. Every member adds facts in the first step, agrees on goals in the middle and checks results at the end.
Who is in the team and what do they do?
- The person and the family: the centre. They know the wishes, habits and life story, and they decide.
- Care worker: daily life help (eating, bathing, moving), observes small changes, records.
- Nurse: health checks, medicine help, wound care, teaches care workers what to watch.
- Doctor: diagnoses, treats, gives medical orders.
- Physiotherapist and occupational therapist: exercises and tools for movement and daily tasks.
- Dietitian: food plan for health and swallowing.
- Social worker / care manager: connects services, money matters, community help.
A care worker stays inside their own role. Do not give medical orders; report to the nurse or doctor.
The team approach in practice: sharing information
Information is shared in four ways:
- Care record: short written notes anyone in the team can read.
- Hand-over: a quick talk when shifts change, covering what happened, what to watch, what is next.
- Urgent report: a fall, chest pain, refusal of medicine is told to the nurse at once, not left for later.
- Team meeting (care conference): a planned meeting where everyone, including the person and family, review the plan.
Good habits: write facts not opinions, use plain words, give the time, sign your note, and keep private information inside the team. Use "Report, Record, Respect".
Running a good team meeting
Steps for a short team meeting: 1) the leader names the person and the goal, 2) each member tells what they saw in one minute, 3) the team looks at whether the goal is coming closer, 4) change the plan and write who does what by when, 5) ask the person and family if they agree.
When opinions differ, go back to the person's goal and the facts. Listen fully, disagree kindly, and never blame a member in front of the person.
Try it: build a team
Imagine your grandmother has a fall. List four helpers she would need, say what each one does in one line, and write what each should write in a shared notebook. Role-play a 5-minute hand-over with a friend.
Key formulas and definitions
- Team = Person at the centre + Many roles + One goal + One plan
- Sharing = Record + Hand-over + Urgent report + Meeting
- Stay in your role; report what is outside it
- Report, Record, Respect
Worked examples
1. A care worker sees swollen ankles on a resident. What should she do?
Report to the nurse, record the date, time and what she saw. She should not decide on medicine herself.
2. Name two members who help with movement and with food.
Movement: physiotherapist (or occupational therapist). Food: dietitian.
3. Two members give different advice about walking. What does the team do?
Go back to the person's goal and facts, discuss at the team meeting, agree on one plan and write it.
4. Write a good hand-over line.
"Mrs. Fatima: ate half lunch, knees sore at 3 pm, walked with frame, please check sugar at 6."
Common mistakes
- Working alone and not telling others.
- Giving medical advice outside your role.
- Writing opinions in the record instead of facts.
- Leaving the person and family out of the meeting.