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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. ter
The m
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 respect,
communication
• Develop interdependent

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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 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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 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

PROFESSIONAL NURSE

ANCILLARY PERSONNEL

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 HEALTH
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

SCHOOL
NURSE 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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 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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• 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 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 APPLICATION

Functions are similar & equal Functions are different & equal
Primary care Acute care
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COLLABORATI
VE 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
• Improveproductivitybyavoiding
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 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 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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 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 I prefer to find win-win
win solutions

I like work where I know I like to work in

the situations where
hierarchy so I know what
is power is equally shared
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 lead a meeting, I
prefer prefer to
to sit in front of the group sit with the group in a
or at circle
the head of the table

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In arriving at a decision, I In arriving at a decision,
study I usually
the options, select one ask several other people
and more for
ahead with it their opinions

In the workplace, In the workplace it is

competent possible
people don’t worry about to be both competent
being and 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’

I define a ‘team player’ as as
someone who follows someone who shares
orders, ideas,
listens even when they
supports the leader disagree,
unquestioningly, and does and works
what is collaboratively
needed no matter how he
or she
Feels
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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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