COLLABORATION

ISSUES AND MODELS

WITHIN AND OUTSIDE
Sangeetha Antoe
NURSING
M.Sc (N)
SANGEETHA ANTOE 2
 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
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 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
SANGEETHA ANTOE 5 respect,
 CONTINUUM OF
COLLABORATION
HIGHEST LEVEL
REFERRAL

CO-MANAGEMENT

CONSULTATION

COORDINATION

INFORMATION EXCHANGE

PARALLEL FUNCTIONING

PARALLEL COMMUNICATION

LOWEST LEVEL
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PRINCIPLES OF COLLABORATION

A
Asserts, attitudes and values that each
potential partner brings
Accountability to each other
Agreements to be mutual and
documented
Acknowledgement of each other
contribution
Achievements monitored

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 Principles contd

R
Reciprocal benefits
Respect for each partners
Responsibilities-well defined and
agreed upon
T
Time and timing
Tact and talent
Trust

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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 SUBMISSIVE
BOTH DOMINANT

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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

NURSE / PHYSICIAN

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COLLABORATIVE
MODELS
Traditional
Practice Model
TRADITIONAL PRACTICE
MODEL
PHYSICIAN
PHYSICIAN

PROFESSIONAL
PROFESSIONALNURSE
NURSE

ANCILLARY
ANCILLARYPERSONNEL
PERSONNEL

PATIENT
PATIENT

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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 questionable
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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 care
2. Provide the care in an integrated and
comprehensive manner
3. 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

HOSPITAL
BASED NURSE

PUBLIC
HEALTH NURSE CONSUMER PHYSICIAN

PUBLIC
PUBLICHEALTH
HEALTH
AGENCY
AGENCY

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 PUBLIC HEALTH NURSE MODEL
In this model there is communication
among all members
1. Patient needs are assessed
2. Specific plan of care is developed
3. Approach is integrated and care is provided in
an efficient and effective manner
4. Periodic evaluation and redirection of care
based on consumer needs
5. Nurse and Physician have mutual respect

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NURSE
COMMUNITY
COLLABORATION
NURSE COMMUNITY
COLLABORATION

CONSUMER
CONSUMER

SCHOOL
SCHOOL
NURSE
NURSE SYSTEM
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 ANCILLARY
NURSE PERSONNEL

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 Contd
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 SANGEETHA
is assuming
ANTOE
care
33
for the
client on that day
 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)
Recommendations
1. Encouragement of nurses individual
clinical decision making
2. Primary nursing
3. Integrated patient record
4. 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:
Language
Cultural difference
Beliefs, value
Poor team work
Reduced 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 40 clinical
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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 practitioners
scope of practice

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 COLLABORATION IN ADVANCED
NURSING PRACTICE( by Griffith
1984)
APN PHYSICIAN APN PHYSICIAN

SUBSTITUTIVE APPLICATION COMPLEMENTARY APPLICATION

Functions 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
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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 care
Enhance the learning climate for Nursing
students and staff
Promote a spirit of inquiry and the development
of research in Nursing
Promote interprofessional collaboration
Improve the utilization of Nurses time and
talents

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 Contd
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
formulatingSANGEETHA
topANTOElevel policies
53 for
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
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to
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
disciplines boundaries
Communicates effectively
Trust one another
Committed to working together

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Collaboration skill contd
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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 Contd

WITH PEERS
Shares personal expertise with other
nurses
Ensure quality client care
Develops a sense of trust and mutual
respect
WITH OTHER HEALTH CARE
PROFESSINAL
Recognizes the contribution
Listens to others view
Shares health care responsibilities
Participates in collaborative
interdisciplinary research
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 Contd

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 I like to work in situations

the where
hierarchy so I know what power is equally shared
is
expected of me

I can disagree or even I expect my friends to side

argue with with me
my friends and allow it to in disagreements and tend
affect to
the relationship take it personally if they
dont
when I lead a meeting, I when I lead63a meeting, I
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 In arriving at a decision, I In arriving at a decision, I
study usually
the options, select one and ask several other people
more for
ahead with it their opinions

In the workplace, In the workplace it is

competent possible
people dont worry about to be both competent and
being nice
nice
I spend little time in It is worthwhile to spend
getting to time
know my co-workers getting to know my co-
personally worker as
a personal level
I define a team player as I define a team player as
someone who follows someone who shares
orders, ideas,
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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
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and
SANGEETHA ANTOE 66