3. 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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4. 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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5. 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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7. 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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8. Principles cont’d
• 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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9. Types of relationship among Health
professionals
• Complementary relationship
• Symmetrical relationship
• Parallel relationship
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10. 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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12. 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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14. 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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19. 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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22. 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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23. • 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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24. • 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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26. PUBLIC HEALTH NURSE MODEL
PUBLIC HEALTH
AGENCY
HOSPITAL
BASED NURSE
PUBLIC
HEALTH NURSE CONSUMER PHYSICIAN
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27. • 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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30. 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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33. 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
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34. • 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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35. 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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37. 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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38. 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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40. 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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41. 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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43. 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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44. 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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46. 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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48. 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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50. 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 Nurse’s time and talents
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51. 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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53. 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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55. 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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57. 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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58. 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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59. 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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60. Cont’d
• 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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61. 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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63. 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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64. 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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65. 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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