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Submitted to- Submitted by- Respected Mam Balkeej KaurMrs. Kamaljeet kaur Msc(N) First yearMsc (N) lecturerCON, Muktsar, AIMS.

seminar on Collaboration

issues and models within and outside

nursing

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

Cont…. 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.

Effects of Collaboration (Abramson & Mizrahi 1996).

Improved patient outcomes Reduced length of stay

Cost savings Increased nursing job satisfaction and retention

Improved teamwork

MEANING The roots of the word collaboration, namely

co-, and laborer, 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

Cont…Teamwork and collaboration are often used equally.The description of collaboration as a dynamic process.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 And, ISSUE-An issue used to be a matter for consideration or

discussion or Issue is the point in question an important subject of

debate or ligitation

DEFINITIONCollaboration is the most formal inter organizational

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

Mattessich, Murray and Monsey (2001) define collaboration as a mutually beneficial and well-defined relationship entered into by two or more organizations to achieve common

A concentrated effort of individuals and groups to attain a goal.

PRINCIPLES OF COLLABORATION-A STATE OF ARTA stands forAssets,attitudes and values that each

potential partner bringsAccountability to each otherAgreements to be mutual and documentedAcknowledgement of each others

contributionsAchievements -monitored

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

NEED FOR COLLABORATIONDecreasing gap

For increasing practical skills

To combine theoretical knowledge with sufficient technical training

COMPETENCIES REQUIRED FOR NURSE AS A COLLABORATORCommunication skills

Mutual respect and trust

Giving and receiving feedbacks

Decision making

Conflict management

TYPES OF COLLABORATIONInterdisciplinary

Multidisciplinary

Transdisciplinary

Inter professional collaboration

Cont…1. 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.

2.Multidisciplinary collaboration- refers to independent work and decision making, such as when disciplines work side-by-side on a problem.

Cont…3.Transdisciplinary collaboration- efforts

involve multiple disciplines sharing together their knowledge and skills across traditional disciplinary boundaries in accomplishing tasks or goals. transdisiciplinary 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.

Cont…4. 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” .

COLLABORATIVE ISSUES WITHIN NURSING The nurse and the superintendent

The nurse and the head nurse /Departmental Nurse

The nurse and fellow nurse

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

MODELS OF COLLABORATIONClinical 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 2005The collaborative approach to nursing

care(can- care) model(2006)

CLINICAL SCHOOL OF NURSING MODEL

EDUCATION

PRACTICE

RESEARCH

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.

DEU MODEL FACULTY MENTOR

CLINICAL STAFF

INSTRUCTOR

STUDENTSTUDENT

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 resourcesSupports the professional development of nursesAllows for the clinical education of increased

number of students.

Cont…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.

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.

Cont….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

PRACTICE RESEARCH MODEL PRACTIC

E EVIDENC

E

THEORY EVIDENC

E

RESEARCH

EVIDENCE

PRACTICE RESEARCH MODEL (2001)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.

Cont…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 developmentCollegial PartnershipCollaborative Partnership and Best Practice

KEY ELEMENT Collaborative PartnershipThe 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.

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

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.

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.

The collaborative learning unit (British Colombia) model 2005The 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.

Cont…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.

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.

Cont…

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.

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.

Cont..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.

Cont… 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.

Cont…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.

Cont…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.

SUMMARIZATION

References 1. Shebeer P. Basheer ,S. Yaseen Khan ‘ A

concise text book of “ ADVANCED Nursing Practice” published by EMMESS , first edition , page no. 698-707.

2. www.google.com3. www.currentnursing.com4. www.models.com 5. www.collaborativemodels.com

THANK YOU