COLLABORATION ISSUES AND MODELS WITHIN AND OUTSIDE

NURSING

Sangeetha AntoeM.Sc (N)

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INTRODUCTION

• Derived from a latin word collaborare, ‘to labor together’

• To collaborate is to ‘work jointly with others or together’

• In olden days nurses was seen as providing assistance to the physician. The term Handmaiden is used to describe this role

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DEFINITIONS

• Colaborative care ‘as partnership relationship between doctors, nurses and other health care providers with patients and their families’

-Virginia Henderson• Collaboration is ‘Nurses and

physicians cooperatively working together, sharing responsibility for solving problems and making decisions to formulate and carry out plans for patient care’

-Baggs and schmitt,1988 4SANGEETHA ANTOE

OBJECTIVES

• Provide client-directed and client-centered care using a multidisciplinary, integrated, participative framework

• Enhance continuity across continum of care

• Improve client and family satisfaction with care

• Provide quality, cost effective, research based care

• Promote mutual respect, communication

• Develop interdependent

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CONTINUUM OF COLLABORATION

HIGHEST LEVELREFERRAL

CO-MANAGEMENT

CONSULTATION

COORDINATION

INFORMATION EXCHANGE

PARALLEL FUNCTIONING

PARALLEL COMMUNICATION

LOWEST LEVEL6SANGEETHA ANTOE

PRINCIPLES OF COLLABORATION

• AAsserts, attitudes and values that each

potential partner bringsAccountability to each otherAgreements to be mutual and

documentedAcknowledgement of each other

contributionAchievements monitored

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Principles cont’d

• RReciprocal benefitsRespect for each partnersResponsibilities-well defined and

agreed upon

• TTime and timingTact and talentTrust

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Types of relationship among Health professionals

• Complementary relationship• Symmetrical relationship• Parallel relationship

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Complementary relationship

• One person is dominant and the other is submissive

• Control is not divided equally between the two participants

• Relationships are stable and predictable also inhibit creativity and independent thinking

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Complementary relationship

PHYSICIAN

NURSE

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Symmetrical relationship

• Control is more evenly distributed between the two participants

• Free to express their opinions• Power struggles occurs when

participants compete to acquire or give up control

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Symmetrical relationship

BOTH DOMINANTBOTH SUBMISSIVE

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Parallel relationship

• Control moves back and forth between the two participants

• Participants take turns holding and giving control, depending on the circumstances, rather than competing for control

• Effective and flexible communication

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Parallel relationship

NURSE / PHYSICIAN

NURSE / PHYSICIAN

PHYSICIANNURSE

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COLLABORATIVE MODELS

Traditional Practice Model

TRADITIONAL PRACTICE MODEL

PHYSICIANPHYSICIAN

PROFESSIONAL NURSEPROFESSIONAL NURSE

ANCILLARY PERSONNELANCILLARY PERSONNEL

PATIENTPATIENT

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TRADITIONAL PRACTICE MODEL

• Authority tends to flow in a downward direction with little exchange of ideas.

• Patient care is fragmented• Minimal communication between

team members and the patient• Minimal evaluation of the care• Comprehensiveness and quality

of care is questionable19SANGEETHA ANTOE

NURSING – INSTITUTION

COLLABORATION MODEL

NURSING – INSTITUTION COLLABORATIVE RELATIONSHIP

INSTITUTIONAL GOALS

NURSING ADMINISTRATION

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Nursing – Institution Collaboration model

• COLLABORATION AT CLINICAL PRACTICE LEVEL

The staff Nurse collaborate with other staff Nurses to

1. Develop the plan of care2. Provide the care in an integrated and

comprehensive manner3. Evaluate the outcome of care

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• COLLABORATION WITH NURSE EDUCATOR

The clinical nurse specialist collaborate with Nurse educator to develop a curriculum that is more appropriate to health care needs and to day-to-day clinical practice situation

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• COLLABORATION WITH NURSE RESEARCHER

Communication between nurse researcher and Nurses in clinical practice , that Nursing care problems and issues can be approached and solved systematically

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PUBLIC HEALTH NURSE MODEL

PUBLIC HEALTH NURSE MODEL

PUBLIC HEALTH AGENCY

PUBLIC HEALTH AGENCY

HOSPITALBASED NURSE

PUBLICHEALTH NURSE CONSUMER PHYSICIAN

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• PUBLIC HEALTH NURSE MODELIn this model there is communication

among all members1. Patient needs are assessed2. Specific plan of care is developed3. Approach is integrated and care is provided in

an efficient and effective manner4. Periodic evaluation and redirection of care

based on consumer needs5. Nurse and Physician have mutual respect

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NURSE COMMUNITY

COLLABORATION

NURSE – COMMUNITY COLLABORATION

CONSUMERCONSUMER

NURSE NURSE SCHOOL SYSTEM

SCHOOL SYSTEM

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Nurse community collaboration

• Nurse collaborates with other agencies or institution in the community

• Care is provided in a comprehensive manner • Quality is maintained• Professionals derive satisfaction as their

individual skills and expertise are appropriately used

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NURSE PHYSICIAN COLLABORATIVE PRACTICE

MODEL

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COLLABORATIVE PRACTICE MODEL

PHYSICIAN

PATIENT

PROFESSIONAL NURSE

ANCILLARYPERSONNEL

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Cont’d• Began in 1970s• Within a decentralized organizational

structure, Nurses and Physicians functions collaboratively in making clinical decisions

• Collaboration resulted in increased quality of care, patient and care provider satisfaction and decreased length of stay

• TEAM NURSING- it is important for team leaders to regularly participate in Physician rounds

• PRIMARY NURSING- physician should communicate either with each primary Nurse who is assuming care for the client on that day 33SANGEETHA ANTOE

• HOME CARE- the staff should be able to work together on decisions regarding client care

• Physician are invited to attend practice committees when clinical problems are addressed and to present timely in-service programs on new medical procedures or research findings

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RESEARCH FINDINGS

• Done in 1970 by National Joint practice Commission (NJPC)

• Recommendations1. Encouragement of nurses individual

clinical decision making2. Primary nursing3. Integrated patient record4. Joint practice committee

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COLLABORATION WITH ASSISSTIVE PERSONNEL

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COLLABORATION WITH ASSISTIVE PERSONNEL

• Relationships between Registered Nurses and unlicensed assistive personnel affect the quality of care

• BARRIERS:LanguageCultural differenceBeliefs, valuePoor team workReduced job satisfaction

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RESEARCH FINDINGS

• By Hayes(1994) on team building sessions with Registered nurses and unlicensed personnel

• Purpose to identify and align work related relationship needs

• Findings-unlicensed personnel needs appreciation and respect from RN

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INTERDISCIPLINARY COLLABORATION

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INTERDISCIPLINARY COLLABORATION

• Efficiency in health care delivery brings all members of the Health care team together

• It involves more than one disciplines• Staff must recognize the importance

of prompt referrals and timely communication with other Health professionals

• During collaboration Nurse includes the client, family and members of health team

• Nurse reviews previous clinical experiences and priorities to select Nursing interventions

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RESEARCH FINDINGS

• Sommers,l.Marton(2000) on Physician ,Nurse and social worker collaboration in primary care for chronically ill seniors

• Cohort study of 543 patients• Readmission in the intervention group decreased

and the control group readmission rate increased• Visit to the physician increased in control group

and decreased in intervention group• Seniors in the intervention group engaged in an

increased number of social activities compared to the control group

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COLLABORATION IN ADVANCED NURSING

PRACTICE

COLLABORATION IN ADVANCED PRACTICE NURSING

• Collaboration of the Nurse practitioner with the Physician occurs for those patient needs that are not within the Nurse practitioner’s scope of practice

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COLLABORATION IN ADVANCED NURSING PRACTICE( by Griffith

1984)

APN PHYSICIAN APN PHYSICIAN

SUBSTITUTIVE APPLICATION COMPLEMENTARY APPLICATIONFunctions are similar & equal Functions are different & equal

Primary care Acute care

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COLLABORATIVE LEARNING UNIT

MODEL

COLLABORATIVE LEARNING UNIT MODEL

• Staff ,student and faculty work together to create a positive learning environment and provide high quality patient care

• Increases Nursing students opportunities and exposure to clinical situations

• Bridge the gap between academic and clinical expectations

• Provide increased professional development and socialization

• Increase instructor availability and staff on the clinical unit

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COLLABORTIVE TEAM APPROACH

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COLLABORATIVE TEAM APPROACH

• It improves communication• Enable practitioners to address

complex clinical cases from different perspectives

• Improve productivity by avoiding duplication

• Includes multiple discipline such as Physician, nurses, social workers, administratiors, ethicists, clergy

• Eg: diabetes patient 48SANGEETHA ANTOE

CASE WESTERN RESERVE

UNIVERSITY MODEL

CASE WESTERN RESERVE UNIVERSITY MODEL

• Based on the concept of academic leadership for Nursing

• Pilot project in 1960• SPECIFIC OBJECTIVES:

Improve the quality of patient careEnhance the learning climate for Nursing

students and staffPromote a spirit of inquiry and the development

of research in NursingPromote interprofessional collaborationImprove the utilization of Nurse’s time and

talents

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Cont’d

• It was designed to change the organization of Nursing service to a decentralized pattern similar to the organizational structure in the School of Nursing, with a head of Nursing for each institution rather than an overall head

• JOINT APPOINTMENTS:1. Shared appointment-chairperson=director of

each clinical speciality, faculty=nurse clinician appointee

2. Faculty associate appointment-dean=administrative associate in hospital

3. Clinical appointment

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UNIVERSITY OF ROCHESTER

MODEL

UNIVERSITY OF ROCHESTER MODEL

• Initiated in 1972• The head of Nursing service serves as

both of the Dean of the school of Nursing and Director of Nursing services

• The school of Nursing has overall responsibility for the delivery and quality of Nursing care

• The head of Nursing is responsible for providing academic leadership, assuming administrative responsibilities in both the University and the Medical center and formulating top level policies for program for education, practice and research

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RUSH UNIVERSITY MODEL

RUSH UNIVERSITY MODEL

• Head of Nursing serves as both Dean of college of Nursing & Vice President for Nursing affairs at the Medical center

• Assisted by Associate Deans & chair person

• Chair person is responsible for integrating Nursing care, Nursing education & Research

• Faculty serves as classroom and clinical teacher and also consultant to Nursing staff and as role model for patient care, Research and interdisciplinary collaboration

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Collaboration skill

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COLLABORATION SKILLS

• Willingness to work together• Readiness to collaborate through education,

maturity & prior experience• Understands their own limits & their

discipline’s boundaries• Communicates effectively• Trust one another• Committed to working together

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Collaboration skill cont’d

• Flat organizational structure• Support to act autonomously• Recognition of team accomplishment• Co-operation• Valuing of knowledge & expertise rather

than titles or roles• Creativity & shared vision

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NURSE AS A COLLABORATOR

• WITH CLIENTS– Acknowledge, supports and

encourages in health care decisions– Encourages client autonomy– Helps to set mutually agreed goals– Provides client consultation

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Cont’d

• WITH PEERSShares personal expertise with other

nursesEnsure quality client careDevelops a sense of trust and mutual

respect• WITH OTHER HEALTH CARE

PROFESSINALRecognizes the contributionListens to others viewShares health care responsibilitiesParticipates in collaborative

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Cont’d

• WITH PROFESSIOANAL NURSING ORGANIZATIONS

Seeks out opportunities to collaborate with and within organizations

Serves as committees in state, national and international nursing organizations

Supports professional organizations• WITH LEGISLATORS

Offers experts opinion on legislative initiatives and related on health care

Collaborates with other health care providers

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Self assessment

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Gender culture self assessment

COLUMN ONE COLUMN TWO I prefer to compete to win

I prefer to find win-win solutions

I like work where I know the hierarchy so I know what is expected of me

I like to work in situations where power is equally shared

I can disagree or even argue with my friends and allow it to affect the relationship

I expect my friends to side with me in disagreements and tend to take it personally if they dont

when I lead a meeting, I prefer to sit in front of the group or at the head of the table

when I lead a meeting, I prefer to sit with the group in a circle

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In arriving at a decision, I study the options, select one and more ahead with it

In arriving at a decision, I usually ask several other people for their opinions

In the workplace, competent people don’t worry about being nice

In the workplace it is possible to be both competent and nice

I spend little time in getting to know my co-workers personally

It is worthwhile to spend time getting to know my co-worker as a personal level

I define a ‘team player’ as someone who follows orders, supports the leader unquestioningly, and does what is needed no matter how he or she feels

I define a ‘ team player’ as someone who shares ideas, listens even when they disagree, and works collaboratively

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scoring

• COLUMN ONE- predominantly male gender style. When you work with women, you can anticipate some difficulties because of differences in behavior & conversational patterns

• COLUMN TWO- predominantly female gender style. When you work with men, you can anticipate some difficulties because of differences in behavior & conversational patterns

• BOTH- combination of male & female gender style. You should be able to work successfully with both men and women

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