ADVANCED NURSING PRACTICE FIRST YEAR MSC NURSING

1. COLLABORATION ISSUES
AND MODELS WITHIN AND OUTSIDE
NURSING
Ms ARIFA T N
FIRST YEAR M.Sc NURSING, MIMS CON

2. INTRODUCTION
 Nursing Profession is faced with lot of complex health issues due to
Technological and medical achievements, Increased Elderly Population
,Increased Patients with chronic illness.
 The complexity of collaboration and the skills required to facilitate
the process are formidable. Much of the literature on collaboration
describes what it should look like as an outcome, but little is written
describing how to approach the developmental process of
collaboration.

3. COLLABORATION
 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

4. MEANING
 The roots of the word collaboration, namely co-, and laborare,
combine in Latin to mean “work together.” That means the
interaction among two or more individuals, which can encompass a
variety of actions such as communication, information sharing,
coordination, cooperation, problem solving, and negotiation
 Teamwork and collaboration are often used synonymously. The
description of collaboration as a dynamic process resulting from
developmental group stages as an outcome, producing a synthesis
of different perspectives

5. MEANING
 The collaborative process involves a synthesis of different
perspectives to better understand complex problems
 An effective collaboration is characterized by building and
sustaining “win-win-win” relationships.

6. 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)

7. DEFINITIONS
 Collaboration is the most formal inter organizational relationship
involving shared authority and responsibility for planning,
implementation, and evaluation of a joint effort
(Horde, 1986)
 collaboration as '... a mutually beneficial and well-defined
relationship entered into by two or more organizations to achieve
common goals.
(Mattessich, Murray and Monsey (2001)
 A concentrated effort of individuals and groups to attain a goal.

8. 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

9. NEED FOR COLLABORATION
 Increasing gap between nursing education and nursing service.
 Graduate nurses often lack practical skills despite their significant
knowledge of nursing process and theory.
 Clearly, a partnership between nursing educators and hospital
nursing personnel is essential to meet this challenge
 To combine theoretical knowledge with sufficient technical training

10. CHARACTERISTIC OF COLLABORATION
 Joint venture
 Co operative endeavor
 Willing participation
 Shared planning and decision making
 Team approach
 Contribution of expertise
 Shared responsibility
 Non hierarchal relationship
 Shared power (based on knowledge and expertise)

11. ELEMENTS OF COLLABORATION
 Communication
 Mutual respect and trust
 Decision making

12. PRINCIPLES OF COLLABORATION
 A STATE OF ART
 A stands for
 Assets, attitudes and values that each potential partner brings
 Accountability to each other
 Agreements to be mutual and documented
 Acknowledgement of each others contributions
 Achievements -monitored

13. PRINCIPLES OF COLLABORATION
 A STATE OF ART
 R stands for
 Reciprocal benefits
 Respect for each partners
 Responsibilities –well defined and agreed upon
 T stands for
 Time and timing
 Tact and talent
 Trust

14. TYPES OF
COLLABORATION
Interdisciplinary
Multidisciplinary
Transdisciplinary
Inter
professional
collaboration

15. TYPES OF COLLABORATION
 Interdisciplinary collaboration- it is the term used to indicate
the combining of two or more disciplines, professions, departments,
or the like, usually in regard to practice ,research, education and
theory.
 Multidisciplinary collaboration- refers to independent work
and decision making, such as when disciplines work side-by-side on a
problem

16. TYPES OF COLLABORATION
 Transdisciplinary collaboration- efforts involve multiple
disciplines sharing together their knowledge and skills across
traditional disciplinary boundaries in accomplishing tasks or goals.
Transdisciplinary efforts effects reflects a process by which individuals
work together to develop a shared conceptual framework that
integrates and extends discipline specific theories, concepts, and
methods to address a common Problems

17. TYPES OF COLLABORATION
 Interprofessional collaboration- has been described as
involving “ interaction of two or more disciplines involving
professionals who work together , with intention, mutual respect and
commitments for the sake of a more adequate response to a human
problem

18. COMPETENCIES
REQUIRED FOR
NURSE AS A
COLLABORATOR
Communication
skills
Mutual
respect and
trust
Giving and
receiving
feedbacks
Decision
making
Conflict
management

19. CONTINUUM OF COLLABORATION

20. CONTINUUM OF COLLABORATION

21. TYPES OF RELATIONSHIP AMONG HEALTH
PROFESSIONALS
 Complementary relationship
 Symmetrical relationship
 Parallel relationship

22. 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

23. 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

24. 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

25. COLLABORATIVE ISSUES WITHIN
NURSING
The nurse and the
superintendent
The nurse and the head
nurse /Departmental Nurse
The nurse and fellow nurse

26. COLLABORATIVE ISSUES WITHIN
NURSING
 Collaboration and the nursing shortage
 Mandatory over time
 Safety on job
 Work place bullying
 Lack of respect
 Regulatory barrier

27. COLLABORATIVE ISSUES OUTSIDE
NURSING
Nurse and the
physician
Nurse and the
client
Nurse and the
health care
professionals
Nurse and
pharmacist
Nurse and
nutritionist
Nurse and the
professional
nursing
organizations

28. COLLABORATIVE ISSUES OUTSIDE
NURSING
 Disciplinary difference
 Meeting patient expectations
 Lack of respect
 Problems with nursing informatics
 Organizational barrier

29. MODELS OF COLLABORATION

30. MODELS OF COLLABORATION
 Clinical school of nursing model (1995)
 Dedicated education unit clinical teaching models(1999)
 Research joint appointment model ( 2000)
 Practice research model (2001)
 Collaboration clinical education Epworth Dakin (CCEED) MODEL
(2003).
 The collaborative learning unit (British Colombia) model 2005
 The collaborative approach to nursing care (can care) model(2006)

31. Clinical school of nursing model (1995)

32. Clinical school of nursing model (1995)
 Encompasses the highest level of academic and clinical nursing
research and education.
 This was the concept of visionary nurses from both La Trobe and The
Alfred Clinical School of Nursing University.
 The development of the Clinical School offers benefits to both
hospital and university.
 Opportunities for exchange of ideas with clinical nurses with
increased opportunities for clinical nursing research.

33. Dedicated education unit (DEU) clinical
teaching models (1999)

34. Dedicated education unit (DEU) clinical
teaching model (1999)
 In this model a partnership of nurse executives, staff nurses and
faculty transformed patient care units into environment of support for
nursing students and staff nurses while continuing the critical work of
providing quality care to acutely ill adults.
 Key features of DEU are:
 Uses existing resources
 Supports the professional development of nurses
 Allows for the clinical education of increased number of students.

35. Dedicated education unit (DEU) clinical
teaching model (1999)
 Exclusive uses of the clinical unit by school of nursing.
 Use of staff nurses who want to teach as clinical instructor.
 Preparation of clinical instructor for their teaching role through
collaborative staff and faculty development activities.
 Faculty role to work directly with staff as a coach, teaching/ learning
resources to develop clinical reasoning skills, to identify clinical
expectations of students , and evaluate student achievement

36. Research joint appointment model
(2000)
 A Joint appointment has been defined by Lantz et al. (1994),as “ a
formalized agreement between two institutions where an individual
holds a position in each institution and carries out specific and
defined responsibilities
 The goal of this approach is to use the implementation of research
findings as a basis for improving critical thinking and clinical decision
making of nurses.

37. Research joint appointment model
(2000)
 In this arrangement the researcher is a faculty member at the
educational institution with credibility in conducting research and
with an interest in developing a research programme in the clinical
setting.
 Outcomes identified by Donnelly ,Werfel, Wolfe (1994) for the
educational institutions are that it becomes more in touch with the
real world and more readily able to identify research questions that
have the potential

38. Practice research model

39. Practice research model
 It is an innovative collaborative partnership agreement between
Fremantle Hospital and Health Service and Curtin University of
Technology in Perth, Western Australia
 The partnership engages academics in the clinical setting in two
formalized collaborative appointments. This partnership not only
enhances Communication between educational and health services,
but fosters the development of nursing research and knowledge

40. Practice research model
 This model encouraged a close working relationship between
registered nurses and academics, and has also facilitated strong links
at the health service with the Nursing Research and Evaluation Unit,
medical staff and other allied health professionals
 Key Concepts:
 Practice – driven research development
 Collegial Partnership
 Collaborative Partnership and Best Practice

41. Practice research model
KEY ELEMENT
 Collaborative Partnership
The collaborative partnership was formed by nursing health
professionals, from the community health service and the university
who recognized the need to bridge the theory- clinical practice gap
and acknowledged the futility of continuing to work in isolation from
each other.
In practical terms, this involved a formal contractual arrangement
between the organizations that led to the establishment of a Nurse
Research Consultant (NRC) position

42. Role of Nurse Research Consultant
( NRC) in PRM
Role of Nurse Research Consultant ( NRC) in PRM
 In the PRM, the role of the Nurse Research Consultant (NRC) was
articulated as that of mentor and consultant on issues related to
research, methodology publications and dissemination
 Although the PRM was specifically designed to enhance nursing
research activity and the implementation of evidence-based
community health nursing practice, the Model also encouraged the
involvement of the multi- disciplinary team to work to achieve the
aims of the partnership agreement

43. COLLABORATIVE CLINICAL EDUCATION
EPWORTH DEAKIN (CCEED) MODEL
(2003)
 In an effort to improve the quality of new graduate transition,
Epworth Hospital and Dakin University ran a collaborative project
(2003) funded by the National Safety and Quality Council to improve
the support base for new graduates while managing the quality of
patient care delivery
 The Collaborative Clinical Education Epworth Dakin (CCEED) model
developed to facilitate clinical learning, promote clinical scholarship
and build nurse workforce capability.

44. COLLABORATIVE CLINICAL EDUCATION
EPWORTH DEAKIN (CCEED) MODEL
(2003)

45. COLLABORATIVE CLINICAL EDUCATION
EPWORTH DEAKIN (CCEED) MODEL
(2003)
Key findings of the 2005 CCEED program were
 Students learning objectives were met and satisfaction was high.
 Undergraduate clinical education was valued by preceptors and
managers as a workforce investment strategy.
 Preceptors were enriched in their clinician role as a result of their
participation in the program and reflection on the process.
 Preceptors managed multiple roles in order to meet demands of
patient care and student learning.

46. The collaborative learning unit
(British Colombia) model 2005
 The collaborative learning unit model was based on the ‘dedicated
education units’ concept develop, Successfully implemented and
researched in Australia.
 The collaborative learning unit model of practice education for
nursing is a clinical education alternative to preceptor ship.
 In the CLU model, students practice and learn on a nursing unit, each
following an individual set rotation and choosing their learning
assignment , according to their learning plans.

47. The collaborative learning unit
(British Colombia) model 2005
 Clinical nurses preparing to adopt the CLU model have described a
positive learning environment as one where questions are expected .
In CLU approach the students are not attached to the units as an
‘extra set of hands’ to augment the nursing workforce
 In this model , nursing faculty , clinical nurses and students work
collaboratively to enhance learning opportunities as well as develop
the professional knowledge base of nursing

48. The collaborative approach to nursing
care(CAN- care) model(2006)
 The CAN-care model emerged as academic and practice leaders
acknowledge the need to work together to promote the education ,
recruitment and retention of nurses at all stages of their career
 The goal was to design an educationally dense , practice based
experience to socialize second degree students to the role of
professional nurse
 A secondary goal was to enhance and support the professional and
career development of unit based nurses

49. The collaborative approach to nursing
care(CAN- care) model(2006)
 The essence of the CAN-care model is the relationship between the
nurse learner (student) and nurse expert (unit based nurse ) , within
the context of each nursing situation
 Through this model the student comes to know the organizational
context of nursing practice, the multifaceted role of professional
nurses, and assumes responsibility for coming to know the meaning
nursing in each unique situation

50. NURSE AS A COLLABORATOR
With nurse colleagues
 Shares personal expertise with other nurses and elicits the expertise
of others to ensure quality client care.
 Develops a sense of trust and mutual respect with peers that
recognize their

51. NURSE AS A COLLABORATOR
With other health care professionals
 Share health care responsibilities in exploring options, setting goals,
and making decision with clients and families
 Listens to each individuals views
 Participate in collaborative interdisciplinary research to increase
knowledge of clinical problems or situation

52. NURSE AS A COLLABORATOR
With professional nursing organizations
 Seeks opportunities to collaborate with and within professional
organizations.
 Serves on committee in state and national nursing organizations or
speciality groups
 Supports professional organizations in political action to create
solutions for professional and health care concerns

53. NURSE AS A COLLABORATOR
With legislation
 Collaborates with other health care providers and consumes on health
care legislations to best serve the needs of the public

54. Nurse physician collaboration
 Nurse patient collaboration is the ideal form of implementing the
role. Nurse and physician working together create a synergism that
can result in a product that is greater than can be produced by the
professional alone

56. Collaboration within nursing
education

57. Collaboration with assistive personnels
 Relationship between the registered nurse and unlicensed assistive
personnel known as nurses aids and nursing assistants, affect the
quality of care given to hospitalized patients
 Difference in beliefs values perception and priorities create conflict,
poor team work and reduced job satisfaction and ultimately a
negative impact on patient care

58. Collaboration with assistive personnels
 Team building sessions were developed with registered nurse and
unlicenced personnel.
 The purpose was to identify and align work related relationship needs
of both groups with needs of the nursing units. This is used to
encourage collaboration between two groups.

59. Collaboration out side nursing

60. Collaboration and independent
practice: ongoing issues for nursing
 Inter – professional collaboration and independent practice: why these
issues are important during the twentieth century, the nursing
profession has undergone immense change
 Nursing has progressed from an occupation to a fully licensed
profession, with members that provide a broad range of services
independently and in a variety of professional relationships with other
providers
 This evolution has changed how nurses are educated, clinically
prepared, and how they perceive their role.

61. Collaboration and independent
practice: ongoing issues for nursing
 Starting With turn – of –the –century debates concerning the
appropriateness of professional nursing practice, registered nurses
began assessing not only their licensure status but their roles related
to other professionals.
 In the early years of nursing profession, it was generally believed that
the nurses served and cared for their patients by assisting physicians.
However the perception of nursing often varied dramatically from its
practice

62. Collaboration and independent
practice: ongoing issues for nursing
 During wars and times of crises, nurses worked with beside physicians
conducting surgical procedures, diagnosing care, and prescribing
treatments and drugs
 The role of the public health nurse, as it developed earlier in this
century, was often independent with nurses working with families of
patients with tuberculosis or other highly contagious diseases and
providing a broad range of interventions, both health and socially
focused.

63. Collaboration and independent
practice: ongoing issues for nursing
 Intrinsic to nursing is the collaborative process: nurses and physicians
working together and independently assessing, diagnosing, and caring
for consumers by preparing patients histories, conducting physical and
psychosocial assessments, and reviewing and discussing their cases
with other health professionals to determine the hanging health status
of each client
 Nurses and physicians have understood the importance of this overlap
in scopes, practice, and patient care , yet there is little literature and
virtually no legislation that clearly provides a balanced accounting of
the benefits of this working relationship.

64. Conclusion

65. Summary

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