COLLABORATION ISSUES

AND MODELS WITHIN

AND OUTSIDE NURSING

ANEESH LAL S V
MSC (N) 1ST YR
 CONTENT OUTLINE

 Definition
 Effect of collaboration
 Principles of collaboration
 Types
 Needs of collaboration
 Various models of collaboration between education and
service
 Collaboration outside the Nursing.
 INTRODUCTION

Nursing profession faced lots of complex health issues for

which Countries have developed new , strengthened and re-
oriented the existing nursing educational programmers in
order to ensure that graduates have the essential
competence to make effective contributions in improving
people’s health and quality of life through collaboration.
 MEANING

 The roots of the word collaboration namely co- and

elaborate, 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, co-ordination, co-
operation, problem solving and negotiation.
 DEFINTION

 “Collaboration is the most formal inter organizational

relationship involving shared authority and responsibility
for planning, implementation and evaluation of a joint
effort.” (Hoard, 1986)

 Collaboration ‘is a process by which members of various

disciplines share their expertise. Accomplishing this
requires these individuals understand and appreciate
what it is that they contribute to the whole.’
(Henneman et al)
 Murray and Monsey(2001),defined collaboration as a
mutually beneficial and well defined relationship entered
into by two or more organizations to achieve common goal.
 Virgenia Henderson defined collaboration as a partnership
relationship between doctor,nurses and other health care
providers with parent and their relatives.
EFFECTS OF COLLABORATION (Abramson
and Mizrahi 1996)

 Improved patient outcomes

 Reduced length of stay
 Cost saving
 Increased nursing job satisfaction and retention
 Improved teamwork
 Principle 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 other contributions
 Achievements-monitored
R stands for:
 Reciprocal benefits
 Respect for each partner
 Responsibilities : well defined and agreed upon.
T stands for:
 Time
 Tact and talent
 Trust
TYPES OF COLLABORATION
Interdisciplinary collaboration

It is the term used to indicate the combining of two

or more disciplines or departments integrated for
one plan formulation usually in regards to practice,
research or/and education.
 Multidisciplinary Collaboration

It refers to independent work and decision making, such as

when disciplines work side-by-side on a problem. The
interdisciplinary process, according to Garner (1995) and
Hoe man (1996), expands the multidisciplinary team
process through collaborative communication rather than
shared communication.
 Trans disciplinary Collaboration

Trans disciplinary connotes a research strategy that crosses

many discipline boundaries to create a holistic approach.
It refers the concepts or methods that were originally
developed by one discipline, but now used by several
others, such as ethnography, a field research method
originally developed in anthropology but now widely used
by other disciplines.
 INTER PROFESSIONAL COLLABORATION

In health context, when multiple health workers from

different professional backgrounds work together with
patient s, families, caregivers and communities to deliver
the highest quality of care.
 NEEDS OF COLLABORATION

 Decrease the gap between nursing service and

education.
 For increasing practical skills.
 To combine theoretical knowledge with sufficient
technical teaching.
 Reducing conflict between different units of health
care delivery.
 Providing cost effective services.
 Competencies required for nurse as a
collaborator

 Communication skills
 Mutual respect and trust
 Giving and receiving feedback
 Decision making
 Conflict management
MODELS OF
COLLABORATION
BETWEEN EDUCATION
AND SERVICE
 CLINICAL SCHOOL OF NURSING
MODEL(1995)

 This was the concept of visionary nurses from both

La Trobe university and the Alfred clinical school of
nursing.
 Clinical school offers benefits to both hospital and
university.
 It brings academic staff to the hospital, with
opportunities for exchange of ideas with clinical
nurses with increased opportunity for clinical nursing
research.
DEDICATED EDUCATION UNIT 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 theoretical work of providing
quality care to acutely ill adults.
 Faculty Mentor

Clinical staff
instructors

Students Students
 Key features of the DEU are:

 Uses existing resources and supports the professional

development of nurses.
 Exclusive use of the clinical unit by school of nursing.
 Use of staff nurses who want to teach as clinical
instructors.
 Preparation of clinical instructors for their teaching role
through collaborative staff and faculty development
activities.
 Faculty role to work directly with staff as coach,
collaborator, teaching-learning resource to develop
clinical reasoning skills.
 RESEARCH JOINT APPOINTMENT
(CLINICAL CHAIR) (2000)

 A joint appointment has been defined by Lantz et al.

(1994), as ‘a formalized agreement between two
institutions 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.
 Outcomes for educational institutes

 Donnelly, Werfel and Wolfe (1994) identified that it come

more in touch with real world and more readily able to
identify research questions, that have the potential to
improve the quality of care.
 It increases collaborative relationship with the service
provider, which is important for long term work force
planning.
 It also facilitates improved access and support to external
research project funding.
 PRACTICE –RESEARCH MODEL
(PRM)(2001)
 It is an innovative collaborative partnership agreement
between Fremeantle hospital and Curtin University,
Australia.
 This model encouraged a close working relationship
between RN and academics.
 It facilitated strong links at the health service with the
nursing research, evaluation unit, medical staff and other
allied health professionals.
 Aims of PRM

 To encourage nurses to develop meaningful research

proposals.
 To teach research process via research experience.
 To enable nurses to have a key role in the professional
development.
 To plan and implement changes to practice based on
research evidence.
 key element of PRM

 Collaborative partnership: It is formed by nursing health

professionals, from the community health service and the
university who recognized the need to bridge the theory-
clinical practice gap.
In practical term , this involved a formal contractual
arrangement between the organization that led to the
establishment of as nurse research consultant (NRC)
position.
Core values and aims of the collaborative
partnership
Four key concepts related to this includes:
 Practice drives research
 Principle of collegial partnership
 Collaborative ownership
 Best practice

(Downie et al. 2001).

Operational framework of the PRM:

 To enhance knowledge of nurses related to research for

which journal clubs were established.
 It also includes encouraging nurses to reflect on current
nursing practice and identify clinical problems based on
their knowledge and experience in order to develop
meaningful research proposal and practice guidelines.
 NRC worked with staff to identify, plan and implement
changes to practice based on research evidence.
 The main reason for the success of the collaborative
arrangement has been provision of infrastructure to support
the dissemination of research and quality improvement
findings through clinical meetings, workshop and
conference presentations by the nursing staff involved in
the various projects.
 COLLABORATIVE CLINICAL EDUCATION
EPWORTH DEAKIN (CCEED) MODEL (2003)

 Nursing education students coached by nurse supported

by clinical facilitators who are supported by hospital
administration and university.
 The model developed to facilitate clinical learning,
promote clinical scholarship and build capable nurses
workforce.
 Students attending lectures at Deakin university, but
completing all tutorials, clinical learning at Epworth
hospital.
 KEY FINDINGS OF THE 2005 PILOT
CCEED PROGRAM WERE:

 Students’ learning objectives were met and satisfaction.

 Undergraduate clinical education was valued by instructor
as a workforce investment strategy.
 Instructors were enriched in their clinician role as a result
of their participation in the program and reflection on the
process.
 Instructors continuity promoted a trusting relationship that
enabled instructors to confidently encourage student
initiative.
 THE COLLABORATIVE LEARNING UNIT
(BRITISH COLUMBIA) MODEL,2005

 The collaborative learning unit model was based on

the ‘Dedicated education units’ concept developed,
successfully implemented in Australia.
 In CLU model, students practice and learn following
an individual set rotation and choosing their learning
assignment, according to their learning plans.
 Student were responsible for communicating their
learning plan with faculty and clinical nurse.
 Specifically, a collaborative learning unit is a nursing unit
where all members of the staff, together with student and
faculty, work together to provide quality care.
 All nursing staff members on the collaborative learning
unit are involved in this model and therefore, students
not only gain a wide variety of knowledge but also has
the ability to provide practice experiences to the
students.
 OUTCOME

 CLU model provides a positive learning environment and

quality nursing care.
 In the CLU approach the students are not attached to the
units as an ‘extra set of hands’ to augment the clinical
nurses, but present as learner with primary interest in
gaining knowledge and competency associated with
standard nursing practice.
 THE COLLABORATIVE APPROACH TO
NURSING CARE MODEL (2006)

 This model proposed by the Christine E. Lynn college of

nursing and Florida Atlantic university.
 The goal was to design an educationally dense , practice
based experience to socialize students to the role of
professional nurse.
 A secondary goal was to enhance and support the
professional and career development of clinical nurses.
 This model focuses on student’s care activities move from
the demonstration to an immersion into a professional role.
 Through this model the student comes to know the
organizational context of nursing practice, multifaceted role
of professional nurses and assumes responsibility to know
the meaning of nursing in each situation.
 There is reconceptualization of the work of the faculty
member. As faculty is education focused expert part who
supports and nurtures the nurse learner.
 The faculty has accountability for overall evaluation of the
students achievement of nursing practice course
objectives.
 In this model, the healthcare organization becomes an
active participant in creating learning environmental and
contributing to the learning activities.
 In return, the college becomes an active partner in the
professional development and retention of nurses at the
practice facility.
 THE BRIDGE TO PRACTICE MODEL
(2008)

 The Bridge to practice model proposed by Catholic

university and school of nursing in America.
 It uses a cohort approach in which student’s complete
medical ,surgical, clinical and nursing education at the
same facility.
 Students must apply for clinical placement in the hospital
of their choice. Clinical placement decisions are based on
academic performance and maturational level.
 THE BRIDGE TO PRACTICE MODEL
(2008)

 First, students complete all of their clinical experiences in

one participating hospital.
 Second, one full time teaching faculty serves as a liaison
for each bridge hospital who serve as a resource not only
as clinical associate but also for the hospital nursing staff.
 Third, students are actively involved in selecting their
clinical placements.
 DUAL ROLE MODEL IN NIMHANS

 Following the amalgamation of 1974 in NIMHANS resulting,

the faculty of the nursing department took up the dual
responsibility.
 In 1975 grade II nursing superintendents were designated
tutors to maintain uniformity in the department.
 Combined workshops were conducted under the guidance
of WHO to prepare nursing superintendent cadre for
teaching role.
 DUAL ROLE MODEL IN NIMHANS

 After both groups felt comfortable to assume dual

responsibility, the area of supervision were designated.
 The HOD of nursing given the responsibility for both service
and education component of the department.
 Integration of education with service raised the quality of
patient care and also improved the quality of learning
experiences for students, under the close supervision of
teachers who were also practitioners.
 INTEGRATIVE SERVICES EDUCATION
APPROACH IN COLLEGE OF NURSING, CMC
VELLORE and AIIMS
 Here nurse educators are practicing in the wards of directly
involving in the delivery of nursing services. This enables
the practicing nurse to share her practical knowledge to the
student nurses.
 Govt. of India conducted a pilot study on bridging the gap
between education and service in selected institutions like
one ward of AIIMS.
 The project was successful, patients and medical
personnel appreciated the move but it required financial
resources to replicate this process.
 Integration of nursing education and services:
INC 2019

 A Pragmatic model for future health care in india.

 Resolution approved by General Body in its meeting held
on 02.12.2018- Integration of Nursing education and
service(Dual role)
 Overall aim: To provide high quality nursing care to
patients and clinical education and training of students by
optimal utilization of all cadres of nursing manpower in the
academic and clinical setting.
 COLLABORATION OUTSIDE NURSING

Cultural Relativism.
Cultural Sensitivity.
Transcultural Reciprocity.
 OBJECTIVES

 To achieve maximum and effective utilization of HR

resources.
 To provide quality patient care.
 To provide quality clinical education and training to
students.
 To bridge the gap between nursing education and practice.
 To provide ongoing staff development through collaborative
efforts.
 To work in collaboration with all nursing personnel.
 SUMMARY
 Definition
 Effect of collaboration and Types
 Needs of collaboration and principles
 Various models of collaboration between education and service:
 CLINICAL SCHOOL OF NURSING MODEL(1995)
 DEDICATED EDUCATION UNIT CLINICAL TEACHING MODEL (1999)
 RESEARCH JOINT APPOINTMENT (CLINICAL CHAIR) (2000)
 PRACTICE –RESEARCH MODEL (PRM)(2001)
 COLLABORATIVE CLINICAL EDUCATION EPWORTH DEAKIN (CCEED) MODEL
(2003)
 THE COLLABORATIVE LEARNING UNIT (BRITISH COLUMBIA) MODEL,2005
 THE COLLABORATIVE APPROACH TO NURSING CARE MODEL (2006)
 THE BRIDGE TO PRACTICE MODEL (2008)
 DUAL ROLE MODEL IN NIMHANS
 INTEGRATIVE SERVICES –EDUCATION APPROACH IN COLLEGE OF NURSING,
CMC VELLORE
 Integration of nursing education and services: INC 2019
 REFERENCE

1.Kaur elal[2015]”Text book of advanced Nursing

Practice”1st edition,Jaypee Brothers Medical
publishers p 984-990
2.Potter and perry[2005]”Fundamentals of
Nursing”6th edn,elsevir,Noida p324-325
3.https:\\flocuments.in/document/collaboration
issues-nursing.
 CONCLUSION

Closer collaboration between nurse educators and nurse

who provide patient services is essential to give students
an appropriate balance of preparation. All the models
peruse collaboration as a mean og developing trust,
recognising the equal value of stakeholders and bringing
mutual benefit to both partners in order promote high
quality research, continued professional education and
quality health care. Application of this model can reduce
the perceived gap between education and service in
nursing thereby can help in the development of
competent and efficient nurses for the betterment of
nursing profession.