collaborative issues and models collaboration.pptx

Introduction definition objective purpose collaboration process

1. Sangeetha Antoe
MESe (|)

3. 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. The term
Handmaiden is used to describe this role

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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

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5. 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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6. CONTINUUM OF COLLABORATION

HIGHEST LEVEL

—— REFERRAL

7 CO-MANAGEMENT

— CONSULTATION
H+— COORDINATION

—— INFORMATION EXCHANGE

7 PARALLEL FUNCTIONING

_ PARALLEL COMMUNICATION

LOWEST LEVEL

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7. PRINCIPLES OF COLLABORATION

Y Asserts, attitudes and values that each potential
partner brings

Y Accountability to each other
Y Agreements to be mutual and documented
Y Acknowledgement of each other contribution

Y Achievements monitored

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8. Princip! >

Y Reciprocal benefits
Y Respect for each partners
y Responsibilities-well defined and agreed upon

Y Time and timing
Y Tact and talent
“Trust

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9. ° Complementary relationship
* Symmetrical relationship
+ Parallel relationship

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10. 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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11. Complementary relationship

PHYSICIAN

Il

NURSE

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12. S Per:

* 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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13. BOTH DOMINANT

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N

BOTH SUBMISSIVE

14. 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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15. AAA

NURSE / PHYSICIAN

NURSE PHYSICIAN

NURSE / PHYSICIAN

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16. COLLABORATIVE
MODELS

17. Traditional Practice
Model

18. PHYSICIAN
T

PROFESSIONAL NURSE

ANCILLARY PERSONNEL

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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

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20. NURSING —
INSTITUTION
COLLABORATION
MODEL

22. 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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23. 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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24. 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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25. PUBLIC HEALTH
NURSE MODEL

26. HOSPITAL
BASED NURSE

PUBLIC
HEALTH NURSE CONSUMER

PUBLIC HEALTH
AGENCY

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PHYSICIAN

27. PUBLIC HEALTH NURSE MODEL

In this model there is communication among all
members

l. Patient needs are assessed

2. 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

E

consumer needs

Nurse and Physician have mutual respect

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28. NURSE COMMUNITY
COLLABORATION

29. NURSE - COMMUNITY
COLLABORATION

N

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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

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31. NURSE PHYSICIAN COLLABORATIVE
PRACTICE MODEL

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32. PHYSICIAN

PATIENT

PROFESSIONAL
NURSE

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ANCILLARY
PERSONNEL

33. Contd
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

it is important for team leaders
to regularly participate in Physician rounds

physician should

communicate either with each primary Nurse who is
assuming care for the client on that day

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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 in-

service programs on new medical procedures or research
findings

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35. pus

No

ty

RESEARCH FINDINGS

Done in 1970 by National Joint practice
Commission (NJPC)

Recommendations

. Encouragement of nurses individual clinical

decision making

. Primary nursing
. Integrated patient record

. Joint practice committee

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36. COLLABORATION WITH
ASSISSTIVE PERSONNEL

37. COLLABORATION WITH ASSISTIVE
PERSONNEL

+ Relationships between Registered Nurses and unlicensed
assistive personnel affect the quality of care
» BARRIERS:
ÜLanguage
OCultural difference
OBeliefs, value
Poor team work

DReduced job satisfaction

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38. 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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39. INTERDISCIPLINARY
COLLABORATION

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40. 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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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

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42. COLLABORATION IN
ADVANCED NURSING
PRACTICE

43. 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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44. SUBSTITUTIVE APPLICATION COMPLEMENTARY APPLICATION

Functions are similar & equal Functions are different & equal
Primary care Acute care

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45. COLLABORATIVE
LEARNING UNIT
MODEL

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

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47. COLLABORTIVE TEAM
APPROACH

48. 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

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49. CASE WESTERN
RESERVE UNIVERSITY
MODEL

50. CASE WESTERN RESERVE UNIVERSITY
MODEL

* Based on the concept of academic leadership for Nursing
+ Pilot project in 1960
+ SPECIFIC OBJECTIVES:
Ulmprove the quality of patient care
DEnbhance the learning climate for Nursing students and staff
OPromote a spirit of inquiry and the development of research in
Nursing
O Promote interprofessional collaboration
DImprove the utilization of Nurse’s time and talents

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51. 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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52. UNIVERSITY OF
ROCHESTER MODEL

53. 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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54. RUSH UNIVERSITY
MODEL

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

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57. 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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58. 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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59. 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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60. 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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61. Contd

° 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

él

62. Self assessment

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63. COLUMN ONE

I prefer to compete to win

I like work where I know the
hierarchy so I know what is

expected of me

I can disagree or even argue with
my friends and allow it to affect

the relationship

COLUMN TWO

I prefer to find win-win solutions

I like to work in situations where
power is equally shared

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

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64. In arriving at a decision, I study
the options, select one and more

ahead with it

In the workplace, competent
people don’t worry about being

nice

In arriving at a decision, I usually
ask several other people for

their opinions

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

65. scoring

2 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

2 BOTH- combination of male & female gender
style. You should be able to work successfully with
both men and women

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