Assignment

on
Models of Collaboration
Between
Education And Service

By :Divyanshi

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 INDEX
S.NO. CONTENT PAGE.NO.
1 Introduction 3
2 Meaning and 3-4
definition of
collaboration
3 Effects, need and 4
principles of
collaboration
4 Objectives and types 5-6
of collaboration
5 Types of relationship 6-7
among health
professionals
7 Model of 7-15
collaboration
8 Conclusion 15
9 Bibliography 16

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Introduction :

The nursing profession is faced with increasingly complex health care issues driven by
technological and medical advancements, an ageing population, increased number of people
with chronic disease and spiraling cost. Collaborative partnership between educational
institutions and service education has been viewed as one way to provide research which
ensures an evolving health care system with comprehensive and coordinated services that are
evidenced based, cost effective and improve health outcomes.

Collaboration is a substantive idea repeatedly discussed in health care circles. Though the
benefits are well validated, collaboration is a seldom practice. Collaboration is an intricate
concept with multiple attributes. Attributes are defined by certain nurse authors , including
sharing of planning, making decision, solving problems, setting goals, assuming responsibility,
working together cooperatively, communicating, and coordinating openly.

Considerable progress has been made up in nursing over the past several decades, especially in
the area of education. Countries have either developed new, strengthened and reoriented the
existed nursing educational programmes in order to ensure that graduates have the essential
competency to make effective contribution in improving people’s health and quality of life.

Meaning of collaboration :

The roots of the word collaboration, name co-, and elaborate, combine in LATIN to mean “ to
work together” . That means interaction between two or more individuals, which can
encompass a variety of action such as communication, information sharing, coordination,
cooperation, problem solving and negotiation.

Teamwork and collaboration are often used synonymously. 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.

Definition of collaboration :

 It is a process by which members of various discipline ( or agencies ) share their

expertise to accomplishing a common goal. Accomplishing these goals requiring these
individual to understand and appreciate what they are contributing to whole.
 “ Collaboration is the most formal inter organizational relationship involving shared
authority and responsibility for planning, implementation, and evaluation for a joint
effort(Hoard,1986.)
 According to Virginia Henderson Collaborative care ‘as a partnership relationship
between doctors, nurse and health care providers with patients and their families’.

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  Baggs And Schmitt, 1988 Collaboration is ‘ Nurse and physicians cooperatively
working together, sharing responsibility for solving problems and making decision to
formulate znd carry out plans for patient care.
 Mattessich, Murray And Monsey (2001) collaboration as a mutually beneficial and
well defined relationship entered into by two or more organizations to achieve common
goal.

Effects of collaboration (Abramson And Mizrahi 1966):

 Improved patient outcome.

 Reduced length of stay.
 Cost saving.
 Increased nursing job satisfaction and retention.
 Improved teamwork.

Need for collaboration :

 Increasing gap between nursing education and nursing services.

 Graduates nurses often lack practical skills despite their significant knowledge in nursing
process and theory.
 Clearly a partnership between nursing educators and hospital nursing personnel is
essential to meet this challenge.
 To combine theoretical knowledge with sufficient technical training.

Competencies required for a nurse as a collaborative:

 Communication skills.
 Mutual respect and trust.
 Giving and receiving feedback.
 Decision making.
 Conflict management.

Principles of collaboration :
 Assets, attitudes and values that each potential partner brings.
 Accountability to each others.
 Agreements to be mutual and documented.
 Acknowledgement of each other contribution.
 Achievements –monitored.
 Reciprocal benefits.
 Respect for each partners.

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  Responsibilities - well defined and agreed upon.
 Tact and talent

Objectives of collaboration :

 Provide client directed and client centered care using a

multidisciplinary, integrated, participative framework.
 Enhance continuity across continuum of care.
 Improve client and family satisfaction with care.
 Provide quality, cost effective, research based care.
 Promote mutual respect , communication.
 Develop interdependence.

Types of collaboration :

 Interdisciplinary collaboration
 Multidisciplinary collaboration
 Tran disciplinary collaboration
 Inter professional collaboration

Continuum of collaboration:
Highest level:

Referral

Co- management
Consultation
Coordination

Information exchanger
Parallel functioning

Lowest level

Interdisciplinary collaboration : It is the term used to indicate the combining of two or more
discipline, profession, departments, or the like, usually in regard to practice, research,
education and theory.

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Multidisciplinary collaboration : It refers to independent work and decision making, such as
when discipline work side by side on a problem.

Trans disciplinary collaboration : In this efforts involves multiple discipline sharing together
their knowledge and skills across traditional disciplinary boundaries in accomplishing task or
goals. Trans disciplinary efforts effects reflects a process by which individuals work together to
develop a shared perceptual framework that integrates and extends discipline specific theories.
concepts, and method to address a common problems.

Inter professional collaboration : It has been described as ‘involving interaction of two or more
discipline involving professional who works together , with intentions mutual respect and
commitment for the sake of more adequate response to a human problem.

Types of relationship among health professional

Complementary relationship :One person is dominant and other person is submissive. Control
is not divided equally between the participants. Relationships are stable and predictable also
inhibit creativity and independent thinking.

Physician

Nurse

Symmetrical relationship : Control is more evenly distributed between the two participants.
They are free to express their opinion. Power struggles occur when participants compete to
acquire or give up control.

Both dominant Both submissive

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Parallel relationship : Controls moves back and forth between the two participants.
Participants takes turn holding and giving control, depending on the circumstances, rather then
competing for control. Effective and flexible communication occur .

Nurse/physician

Nurse physician

Nurse/ physician

Models of collaboration :

(1) 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.
Physician

Professional Nurse

Ancillary Personnel

Patient

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 (2) Nursing institution collaboration model :
 Collaboration at clinical practice level :
The staff nurse collaborates with other staff nurses to develop the plan of care,
to provide care in integrated and comprehensive manner, and to evaluate the
outcome of care.
 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.
 Collaboration with nurse research : Communication between nurse researcher
and clinical practice, that nursing care problems and issues can be approached
and solved systematically.

Institutional goals

Nursing Administration
Nursing Institution Collaboration Model

(3) Public Health Nurse Model :

Hospital Based nurse

Public health nurse Consumer Physician

Public health agency

 In this model there is a communication among all members.

 Patients needs are assessed.

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  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 consumer need.
 Nurse and physician have mutual respect.

(4) Clinical school of nursing model (1995) : This model 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 clinical school offers benefits to the hospital and university. Opportunities
for exchange of ideas with clinical nurses with increased opportunities for clinical nursing
research.

(5) Dedicated Education unit (DEU) clinical teaching model (1999) : In this model a partnership
of nurse executer staff nurses and faculty transformed patient care unit into environment of
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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 resources.

 Supports the professional development of nurses.
 Allows for the clinical education of increased number of students.
 Exclusive use 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
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’s achievements.

DEU Model Faculty

Mentor

Clinical Staff Instructor

Ss
Students Students

DEU Model
(6) 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’s hold a position in
each institution and carried 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.
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  In this arrangement the researcher is a faculty members at the educational
institution with credibility in conducting research and with an interest in
developing a research program me 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 Evidence

Research Evidence Theory evidence

Research Joint Appointment Model (2000)

(7) Practice research model (2001) :

 It is an innovative collaborative partnership agreements between Fremantle Hospital

health services and Curtin University of Technology in Perth, Western Australia.
 The parternership engages academic in the clinical setting in two formalized
collaborative appointment. This partnership not only enhances communication
between educational and health services, but fosters the development of nursing
research and knowledge.
 This model encouraged a closed working relationship between registered nurses and
academics, and has also facilitated strong links at the health services with the nursing
research and evaluation Unit, medical staff and other allied health personnel.
Role of Nurse research consultant in practice research model (PRM) :
 In the PRM , the role of Nurse research consultant was articulated as that of
mentor and consultant on issues related to research, methodology, publication
and dissemination.

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  Although the PRM was specifically designed to enhance the 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 agreements.
(8) Nurse community collaboration model :
 In this nurse collaborates with other agencies or institutions in the
community.
 Care is provided in a comprehensive manner.
 Quality is maintained.
 Professional derive satisfaction as their individual skills and expertise are
appropriately used.

Consumer

Nurse School
system

Nurse Community Collaboration Model

(9) Collaborative Clinical education EP worth DEAKIN (CCEED) Model (2003):
 In an effort to improve the quality of new graduates transition, Epworth
hospital and DEAKIN 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 CCEED Model developed to facilitate clinical learning, promote clinical
scholarship and build nurse workforce capability.

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 CCEED Model (2005)

Key finding of CCEED Model 2005 were :

 Students learning objectives were met and satisfaction was high.

 Undergraduates clinical education was valued by preceptors and managers as a
workforce investment strategy .
 Preceptors were enriched in their clinician roles as a result of their participation in the in
the program and reflection on the process.
 Preceptors managed multiple roles in order to meet demands of patient care and
student learning.
(10) The Collaborative Learning Unit (British Colombia) Model 2005 :
 It was based on the ‘ Dedicated education unit, 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, student practice and learn on a nursing unit, each
following an individual set rotation and choosing their learning assignment,
according to their learning plan.
 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 augments the
Nursing workforce.

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  In this Model nurses faculty, clinical nurses and students works collaboratively to
enhance learning opportunities as well as developed the professional
knowledge base of nursing.

(11) The collaborative approach to nursing system (CAN –Care) Model (2006) :

 The CAN- Care model emerged as academics and practice leader

acknowledge the need to work together to promote the education,
recruitment and retention of nurse at all stages of their career.
 The goal was to design the 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.
 The essence of CAN – Care model is the relationship between nurse learner
and nurse expert, within the context of each nursing situation.
 Through this model the students 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 important

during the 20th centaury , the nursing profession has undergone the immense changes.
 Nurses has been 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 relationship with other providers.
 This evolution has changed how nurses has been educated, clinically prepared and how
they perceive their role.
 Starting with the turn of the centaury debates concerning the appropriateness of
professional nursing practice, registered nurses began assessing not only their licensure
status but their roles related to other professional.
 In the early year of nursing profession, it was generally believed that the nurses served
and care for their patients by assisting physician. However the perception of nursing
often varied dramatically from its practice.
 During wars and times of crises, nurses worked with besides physician conducting
surgical procedures, diagnosing care, and prescribing treatments and drugs.
 The role of public health nurse, as it developed earlier in this centaury, was often
independent with nurses working with families of patient with tuberculosis or other

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 highly contagious diseases and providing a broad range of interventions, both health
and socially focused.
 Intrisinic to nursing is the collaborative process : nurses and physician working together
and independently assessing diagnosing and caring for consumers by preparing patient
histories conducting physical and psychosocial assessment, and reviewing and
discussing their cases with other health professionals to determine the hanging health
status of each client.

Conclusion :

All the model pursue collaboration as a means of developing trust, recognizing the equal values
of stakeholders and bringing mutual benefit to both partners in order to promote high quality
research, continued professional education and quality health care. Application of these 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.

Bibliography :

 Sheery P. Palmer et al.(2005). Nursing Education and service collaboration:

Making difference in the clinical learning environment. The Journal of
continuing Education. 36(6). 123-128.
 Raines A.D.(2006). An innovative model of practice based learning.
International Journal of Nursing Education Scholarship.(3)1. 20-26.
 Patterson.M. (2008). The bridge to practice model: A Collaborative
Programme designed for clinical experiences in baccalaureate Nursing. Nurse
economics.(26)5. 302-306.
 Downie. J et al. (2001). Research model for collaborative partnership. Journal
of Royal college of Nursing, Australia.(8)4. 27-32.

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