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Collaboration issues and models within and outside nursing
This document discusses various models of collaboration within nursing and between nursing and other professions. It begins by defining collaboration and exploring the historical relationship between nurses and physicians. Several models of collaboration are presented, including the traditional practice model, nursing-institution collaboration model, public health nurse model, nurse-community collaboration, and nurse-physician collaborative practice model. The document also discusses collaboration with assistive personnel, interdisciplinary collaboration, and collaboration in advanced nursing practice. It explores various skills needed for effective collaboration and ways nurses can act as collaborators. Overall, the document provides an overview of the concepts of collaboration within the nursing profession and with other health professionals from both a theoretical and historical perspective.
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An introduction to collaboration issues within and outside nursing, focusing on the significance of working together in healthcare.
Defines collaboration, highlighting a partnership among healthcare providers and objectives like client-centered care and improved satisfaction.
Illustrates the continuum of collaboration from highest to lowest levels, including referral, co-management, and information exchange.
Outlines key principles of collaboration: accountability, mutual agreements, and reciprocal respect among partners.
Describes the three types of relationships in healthcare: complementary, symmetrical, and parallel relationships.
Explains the dynamics of a complementary relationship where one participant dominates, affecting creativity and independence.
Details the symmetrical relationship where control is balanced, sharing power enhances communication.
Outlines how control shifts between participants in a parallel relationship, ensuring effective and flexible communication.
Introduction to various collaborative models in nursing and healthcare.
Details the traditional practice model where authority is hierarchical, and communication is fragmented.
Focuses on collaboration between nursing and institution to enhance patient care through integrated plans.
Describes the collaboration between clinical nurse specialists and educators for curriculum development.
Illustrates the public health nursing model emphasizing communication between various stakeholders for effective care.
Highlights the nurse's role in community collaboration for comprehensive care and maintaining quality.
Discusses the historical context of nurse-physician collaboration in healthcare, leading to improved care quality.
Presents key research findings encouraging nurses' decision-making and recognizing the importance of teamwork.
Emphasizes the significance of interdisciplinary collaboration to enhance healthcare effectiveness.
Presents research findings on the impacts of interdisciplinary collaboration on patient readmission rates.
Describes the collaborative practice model in advanced nursing, focusing on roles beyond their standard scope.
Explains a model promoting teamwork between students, faculty, and staff to enhance learning and patient care.
Discusses how a collaborative team approach improves communication and productivity across disciplines.
Describes a pilot project aimed at improving patient care quality through academic leadership and collaboration.
Details the dual role of the head of nursing in providing leadership in both academic and practical settings.
Discussion on the Rush model where nursing leadership integrates care, education, and research efforts.
Highlights essential collaborative skills necessary for effective teamwork and enhancing healthcare delivery.
Details the collaborative role of nurses with clients and peers in healthcare decisions and quality care.
Discusses nurses’ collaborations with professional organizations and legislators to influence healthcare policy.
Introduces a self-assessment tool to aid understanding of gender-based communication styles in collaboration.
Wraps up the presentation, reiterating the theme of collaboration in nursing.
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Collaboration issues and models within and outside nursing
- 1. COLLABORATION ISSUES AND MODELSWITHIN AND OUTSIDE NURSING Sangeetha Antoe M.Sc (N)
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- 3. INTRODUCTION • Derived froma 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 SANGEETHA ANTOE 3
- 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 SANGEETHA ANTOE 4
- 5. OBJECTIVES • Provide client-directedand 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 SANGEETHA ANTOE 5
- 6. CONTINUUM OF COLLABORATION HIGHESTLEVEL REFERRAL CO-MANAGEMENT CONSULTATION COORDINATION INFORMATION EXCHANGE PARALLEL FUNCTIONING PARALLEL COMMUNICATION LOWEST LEVEL SANGEETHA ANTOE 6
- 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 SANGEETHA ANTOE 7
- 8. Principles cont’d • R Reciprocalbenefits Respect for each partners Responsibilities-well defined and agreed upon • T Time and timing Tact and talent Trust SANGEETHA ANTOE 8
- 9. Types of relationshipamong Health professionals • Complementary relationship • Symmetrical relationship • Parallel relationship SANGEETHA ANTOE 9
- 10. Complementary relationship • Oneperson 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 SANGEETHA ANTOE 10
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- 12. Symmetrical relationship • Controlis more evenly distributed between the two participants • Free to express their opinions • Power struggles occurs when participants compete to acquire or give up control SANGEETHA ANTOE 12
- 13. Symmetrical relationship BOTH SUBMISSIVE BOTHDOMINANT SANGEETHA ANTOE 13
- 14. Parallel relationship • Controlmoves 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 SANGEETHA ANTOE 14
- 15. Parallel relationship NURSE /PHYSICIAN NURSE PHYSICIAN NURSE / PHYSICIAN SANGEETHA ANTOE 15
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- 18. TRADITIONAL PRACTICE MODEL PHYSICIAN PROFESSIONAL NURSE ANCILLARYPERSONNEL PATIENT SANGEETHA ANTOE 18
- 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 SANGEETHA ANTOE 19
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- 21. NURSING – INSTITUTION COLLABORATIVERELATIONSHIP INSTITUTIONAL GOALS NURSING ADMINISTRATION SANGEETHA ANTOE 21
- 22. Nursing – InstitutionCollaboration model • COLLABORATION LEVEL AT CLINICAL PRACTICE 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 SANGEETHA ANTOE 22
- 23. • COLLABORATION WITHNURSE 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 SANGEETHA ANTOE 23
- 24. • COLLABORATION WITHNURSE RESEARCHER Communication between nurse researcher and Nurses in clinical practice , that Nursing care problems and issues can be approached and solved systematically SANGEETHA ANTOE 24
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- 26. PUBLIC HEALTH NURSEMODEL HOSPITAL BASED NURSE PUBLIC HEALTH NURSE CONSUMER PHYSICIAN PUBLIC HEALTH AGENCY SANGEETHA ANTOE 26
- 27. • PUBLIC HEALTH NURSEMODEL In this model there is communication among all members 1. 2. 3. 4. 5. Patient needs are assessed Specific plan of care is developed Approach is integrated and care is provided in an efficient and effective manner Periodic evaluation and redirection of care based on consumer needs Nurse and Physician have mutual respect SANGEETHA ANTOE 27
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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 SANGEETHA ANTOE 30
- 31. NURSE PHYSICIAN COLLABORATIVE PRACTICEMODEL SANGEETHA ANTOE 31
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- 33. Cont’d • Began in1970s • 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 NURSINGphysician should communicate either with each primary Nurse who is assuming care for the client on that day SANGEETHA ANTOE 33
- 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 inservice programs on new medical procedures or research findings SANGEETHA ANTOE 34
- 35. RESEARCH FINDINGS • Donein 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 SANGEETHA ANTOE 35
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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 SANGEETHA ANTOE 37
- 38. RESEARCH FINDINGS • ByHayes(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 SANGEETHA ANTOE 38
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- 40. INTERDISCIPLINARY COLLABORATION • Efficiencyin 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 SANGEETHA ANTOE 40
- 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 SANGEETHA ANTOE 41
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- 43. COLLABORATION IN ADVANCED PRACTICENURSING • Collaboration of the Nurse practitioner with the Physician occurs for those patient needs that are not within the Nurse practitioner’s scope of practice SANGEETHA ANTOE 43
- 44. COLLABORATION IN ADVANCED NURSINGPRACTICE( by Griffith 1984) APN APN PHYSICIAN SUBSTITUTIVE APPLICATION Functions are similar & equal Primary care PHYSICIAN COMPLEMENTARY APPLICATION Functions are different & equal SANGEETHA ANTOE Acute care 44
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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 SANGEETHA ANTOE 46
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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 SANGEETHA ANTOE 48
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- 50. CASE WESTERN RESERVEUNIVERSITY 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 SANGEETHA ANTOE 50
- 51. Cont’d • It wasdesigned 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. 2. 3. Shared appointment-chairperson=director of each clinical speciality, faculty=nurse clinician appointee Faculty associate appointment-dean=administrative associate in hospital Clinical appointment SANGEETHA ANTOE 51
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- 53. UNIVERSITY OF ROCHESTERMODEL • 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 SANGEETHA ANTOE 53
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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 SANGEETHA ANTOE 55
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- 57. COLLABORATION SKILLS • Willingnessto 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 SANGEETHA ANTOE 57
- 58. Collaboration skill cont’d • • • • • • Flatorganizational structure Support to act autonomously Recognition of team accomplishment Co-operation Valuing of knowledge & expertise rather than titles or roles Creativity & shared vision SANGEETHA ANTOE 58
- 59. NURSE AS ACOLLABORATOR • WITH CLIENTS – – – – Acknowledge, supports and encourages in health care decisions Encourages client autonomy Helps to set mutually agreed goals Provides client consultation SANGEETHA ANTOE 59
- 60. Cont’d • WITH PEERS Sharespersonal expertise with other nurses Ensure quality client care Develops a sense of trust and mutual respect • WITH OTHER PROFESSINAL HEALTH Recognizes the contribution Listens to others view Shares health care responsibilities Participates in collaborative research SANGEETHA ANTOE CARE interdisciplinary 60
- 61. Cont’d • WITH PROFESSIOANAL ORGANIZATIONS NURSING Seeksout 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 SANGEETHA ANTOE 61
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- 63. Gender culture selfassessment 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 SANGEETHA ANTOE 63
- 64. In arriving ata 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 SANGEETHA ANTOE 64
- 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 SANGEETHA ANTOE 65
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