C.
M PATEL COLLEGE OF
NURSING
GANDHINAGAR
COLLABORATION
ISSUES AND
MODELS
INTRODUCTION
• Collaboration is a process in which two or more
individuals work together jointly influencing one
another, for the attainment of a goal.
• Derived from a latin word collaborare, ‘to labor
together’
• To collaborate is to ‘work jointly with others or
together’
DEFINITIONS
• Collaborative care ‘is 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’
“ Collaboration is the most formal inter organizational
relationship involving shared authority and
responsibility for planning, implementation and
evaluation of a joint effort”
OBJECTIVES
• Improve client and family satisfaction with care
• Provide quality, cost effective, research based care
• Promote mutual respect, communication
• Seek creative, integrated solution where needs and goal
of both side are important.
• Learn to grow through co-operative problem solving
resulting in greater understanding.
• Identify, share and merge vastly different view point.
• Enhance continuity across continuum of care
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
Principles cont’d
• R
Respect for each partners
Responsibilities-well defined and agreed upon
• T
Time and timing
Tact and talent
Trust
NEED FOR COLLABORATION
• Decreasing gap between nursing education and
nursing services
• For increasing practical skills
• To combine theoretical knowledge with sufficient
technical training
• Enhance job satisfaction
• Reduce conflict between health care
professionals
COMPETENCIES REQUIRED FOR NURSE AS A
COLLABORATOR
• Communication skills
• Mutual respect and trust
• Giving and receiving feedbacks
• Decision making
• Conflict management
• Flexibility
• Confidence
TYPES OF COLLABORATION
Interdisciplinary
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.
• [Link] collaboration- refers to independent
work and decision making, such as when disciplines work
side-by-side on a problem.
The interdisciplinary process expands the
multidisciplinary team process through collaborative
communication rather than shared communication.
Cont…
• [Link] 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”
• Inter professional collaboration goes beyond trans
disciplinary to include not just traditional discipline
boundaries but also professional identities and
traditional roles.
Types of relationship among Health
professionals
• Complementary relationship
• Symmetrical relationship
• Parallel relationship
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
Complementary relationship
PHYSICIAN
NURSE
Symmetrical relationship
• Control is more evenly distributed between the two
participants
• Free to express their opinions
Symmetrical relationship
BOTH SUBMISSIVE
BOTH DOMINANT
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
Parallel relationship
NURSE / PHYSICIAN
NURSE PHYSICIAN
NURSE / PHYSICIAN
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
COLLABORATIVE MODELS
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
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.
CLINICAL SCHOOL OF NURSING
MODEL
EDUCATION
RESEARCH PRACTICE
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 environments of support
for nursing students and staff nurses while continuing the critical
work of providing quality care to acutely ill adults. Various methods
were used to obtain formative data during the implementation of
this model in which staff nurses assumed the role of nursing
instructors. Results showed high student and nurse satisfaction and
a marked increase in clinical capacity that allowed for increased
enrollment.
• Key features of DEU are:
• Uses existing resources
• Supports the professional development of nurses
• Allows 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.
• The Director of Nursing Research, provides education
regarding research and assists with the conduct of
research in the practice setting. She/he also lectures or
supervises in the educational institution. A formal
agreement exists within the two organizations
regarding specific responsibilities and the percentage of
time allocated between each. Salary and benefits are
shared between the two organizations.
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.
• The key concepts exemplified in the application of
the model include practice-driven research
development, collegial partnership, collaborative
ownership and best practice.
PRACTICE RESEARCH MODEL
PRACTICE
EVIDENCE
RESEARCH
EVIDENCE
THEORY
EVIDENCE
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.
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.
Cont…
• Unlike the traditional one-to-one preceptorship-, an
emphasis is placed on student responsibility for self-
guiding, and for communicating their learning plan with
faculty and clinical nurses (e.g., the approaches to
learning and the responsibility they are seeking to
assume).
• All nursing staff members on the Collaborative Learning
Unit are involved in this model and, therefore, not only
do the students gain a wide variety of knowledge but
the unit also has the ability to provide practice
experiences for a larger number of students.
Barriers of collaboration
- Lack of communications.
- Lack of understanding
- Lack of mutual trust
- Lack of respect for each other
- Attitude problems
- Administration and organization structure
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
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
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
Summary
Bibliography:
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brother publication ; New delhi. Page no : 273-285.
– Joan .M Stanley, “ ADVANCE NURSING PRACTICE” ; 3rd edition, 2011;
F A davis Publications, Philadelphia.p.p- 134-136
– Lucille A Joel, “ ADVANCE NURSING PRACTICE” ; 1st edition, 2009;
F A davis Publications, Philadelphia.p.p 145-160
– Navdeep kaur brar, “ ADVANCE NURSING PRACTICE”; 1st edition, 2015;
jaypee brother publications, new delhi; p.p- 984 to 990.
– Samta soni, “ TEXTBOOK OF ADVANCED NURSING PRACTICE”; 1st edition,
2013; Jaypee publications, new delhi.p.p – 352- 356.
– Shebeer P Basheer & Yasseen Khan, “ A CONCISE TEXTBOOK OF
ADVANCE NURSING PRACTICE”; 1st edition, 2012; EMMESS
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