RAJKUMARI AMRIT KAUR COLLEGE OF NURSING, LAJPAT NAGAR, NEW

DELHI
ADVANCE NURSING PRACTICE

A PRESENTATION MATERIAL
on
COLLABORATION ISSUES in nursing
$ model of COLLABORATION in
nursing

ADVISOR : DR. (MRS) MOLLY BABU

HOD (OBG & GYNE)
R.A.K.C.O.N
SPEAKER : Mrs deepa
 m.Sc. semester-ii
R.A.K. COLLEGE OF NURSING,LAJPAT NAGAR, NEW DELHI- 24

TOPIC OF PRESENTATION : COLLABORATION ISSUES IN NURSING $ MODEL OF COLLABORATION

IN NURSING
SUBMITTED TO- Mrs. Molly Babu
SUBMITTED BY- Deepa Gupta
INTRODUCTION:
To provide effective and comprehensive care, nurses, physicians and other health care
professionals must collaborate with each other. No group can claim total authority over the
other. Each profession exhibits different areas of professional competence that, when combined
together, provide a continuum of care that the consumer has come to expect. Collaboration
uses the data, plan, implement, evaluate and gain objectivity by examining anothers
viewpoints. Collaboration must have shared objectives. A multidisciplinary plan of care should
be decided by all of the team members. The word collaboration, namely co and labor are,
combined in Latin to mean work together. That means the interaction among two or more
individuals. 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 :
Collaboration means a collegiate working relationship with another health care provider in
the provision of patient care.
COLLABORATIVE CARE is defines as a partnership relationship between doctors, nurses and
other health care providers with patients and their families.
By: 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 implies a process of shared planning, decision making, responsibility,
and accountability in the care of the patient. In collaborative practice, providers work well
together through effective communication, trust, mutual respect, and understanding of each
others skills. While some skills and services appear to overlap, most skills and services are
complementary and reinforce each other. Collaborative practice and care is cost-efficient.

NEED FOR INCREASED COLLABORATON

1. Consumer wants and needs: consumer wants expert humanistic care that integrate to
available technology and provides information and services related to health promotion and
illness prevention. Consumers are also aware of how life style affects health. They are willing
to participate in health promotion activities.
2. Self help initiatives: responsibility for the self is a major belief underlying holistic health
that recognize the inter dependence of body, mind and spirit. The most commonly used
therapies are relaxation techniques, massage, imagery, spiritual, healing, weight loss
programme and herbal medicine.
3. Changing demography and epidemiology: it is predicted that by the year 2020, there
will be more than 50 million adults over the age of 65 years living in the united state.
4. Health care access: several alternative health delivery systems have been implemented to
control costs. These include health maintenance organization. Ethical issues such as
rationing of health care access to health care, the use of health care technology and extra
ordinary interventions, and organ transplantation can be resolved only through collaboration.
5. Technological advances: technology has had a major influence on health care cost and
services with advances in medicine and technology. An individuals life span can be
 expanded in many cases. However the same technology may result in fragmentation of care
and acceleration of health care costs.
6. Increasing gap between nursing education and nursing services: Graduate nurses
often lack practical skills despite their significant knowledge of nursing process and theory.

OBJECTIVES OF COLLABORATION
1) Provide client directed and centered care using multi disciplinary, integrated, participative
framework.
2) Enhance continuity across the continuum of care, from wellness and prevention, pre
hospitalization through an acute episode of illness to transfer or discharge and recovery or
rehabilitation.
3) Improve clients and family satisfaction with care.
4) Provide quality, cost-effective, research-based care that is outcome driven.
5) Promote mutual respect, communication and understanding between client(s) and members
of health care team.
6) Create synergy among clients and providers, in which the sum of their efforts is greater than
the parts.
7) Provide opportunity to address and solve system related to issue and problem.
8) Develop interdependent relationships and understanding among providers and clients.

PRINCIPLES OF COLLABORATION (ART)

A
1. Asserts, attitude and value that each potential Health team members brings
2. Accountability to each other
3. Agreements to be mutual and documented
4. Acknowledgement of each other contribution
5. Achievements monitored
R
1. Reciprocal benefits
2. Respect for each partners
3. Responsibilities well defined and agreed upon
T
1. Time and timing
2. Talent
3. Trust

COLLABORATIVE HEALTH CARE:

Collaborative care is a partnership relationship between doctors, nurses and other health care
providers with patients and their families. It is a process by which health care professionals work
together with clients to achieve quality health care outcomes. Mutual health respect and true
sharing of both power and control are essential elements. Ideally collaboration becomes a
dynamic, interactive process in which clients (individual, groups, communities) confer with
physicians, nurses and other health care providers to meet their health objectives.

CONTINUUM OF HEALTH:

LEVELS OF COLLABORATION TYPES OF COLLABORATION

Highest level

Referral Transdisciplinary collaboration

Co-management
Consultation Interdisciplinary collaboration
Co-ordination
Information exchange Multidisciplinary collaboration
Parallel functioning
Parallel communication Unidisciplinary collaboration
Lowest level

A continuum of collaboration begins with ;

Parallel communication: where by every one communicating with the client independently and
asking the same question.
Parallel functioning: have more co-ordinate communication, but each professional has separate
intervention and a separate plan of care.
Information exchange: It involves planned communication, but decision making is unilateral,
involving little, coordination and consultation represent mid range levels of collaboration, where
provide us retain responsibility and accountability for their own aspects of patience are directed
to other providers when the problem is beyond their expertise.

TYPES OF COLLABORATION (TEAM)

A team is a group of people linked in a common purpose
1. A Unidisciplinary team is a group composed of different people from the same discipline
who work together.
2. A Multidisciplinary team is a group of people from different disciplines whose individual
members develop the treatment plans independently. Generally, each discipline will conduct
an independent assessment of the patient. One person, usually the physician, orders the
services and coordinates the care. The group may meet, but generally each discipline
implements their independent plan as an additional layer of services. There is no joint
planning or discussion of how one service affects another. Services may overlap, duplicate,
and be fragmented.
3. An Interdisciplinary team is a group of people from different disciplines who assess and
plan care in a collaborative manner. A common goal (s) is established and each discipline
works to achieve that goal. Care is interdependent, complementary, and coordinated.
Joint decision making is the norm. Members feel empowered and assume leadership on the
appropriate issue depending on the patients needs and the members expertise.
4. 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.

EFFECTS OF COLLABORATION (ABRAMSON & MIZRAHI 1996).

Improved patient outcomes
Reduced length of stay
Cost savings
Increased nursing job satisfaction and retention
Improved teamwork

CHARACTERISTICS OF EFFECTIVE COLLABORATION INCLUDE:

1. Shared goals and purpose: First collaboration in community health nursing is goal
directed. The nurse, clients and other involved in the collaborative effort or partnership
recognize specific reasons for entering into the relationship. For examples: A company with
150 employees seeks to develop a wellness program. The community health nurse, company
employee representative, a safety expert, a hygienist, a health educator, an exercise
therapist, a nutritionist and a psychologist might work together to develop specific physical
and mental health goals. The team enters into the collaborative relationship with broad
needs or purposes to be met and specific objectives to be accomplished.
2. Mutual participation: Collaboration involves mutual participation; all team members
contribute and are mutually benefited. Collaboration involves a reciprocal exchange in which
team players discuss their intended involvement and contribution. The professionals
 including the nurses involved in the collaboration will offer their own specific ideas and
expertise to design the wellness program.
3. Maximized use of resources: A third characteristic of collaboration is that it maximizes the
use of community resources. The collaborative partnership designed to draw on the
expertise of those who are most knowledgeable and in the best positions to influence a
favorable outcome.
4. Clinical competence of each provider
5. Clear responsibilities: Collaboration team members work in partnership and assume
clearly defined responsibilities. As in a football team, each member in the partnership plays a
specrtic role With related tasks. The nurse may play a case management or group leadership
role, whereas others assume roles appropriate to their areas to expertise. Effective
collaboration clearly designates what each member will do to accomplish the identified
goals.
6. Set boundaries: Collaboration in community health practice has set boundaries, with a
beginning and end that fall within the goals of the communication. An important part of
defining collaboration is determining the conditions under which it occurs and when it will be
terminated. The temporal boundaries sometimes are determined by progress towards the
goal. Sometimes by the number of team member contacts.
7. Humor: Proper use of humor can be used to achieve significant results and increase the
effectiveness of collaboration
8. Trust: Trust occurs when a person is confident in the action of another person.
9. Valuing and respecting diverse, complementary knowledge

COMPETENCIES BASIC TO COLLABORATION:

1. Effective communication skills
2. Mutual respect and trust
3. Giving and receiving feedback
4. Decision making
5. Conflict management
1. Communication skills:
Three communicating style have been used in a nursing study of collaboration styles as they
relate to degree of collaboration and improved quality of care. Using attentive style and
avoiding contentious and dominant styles made a significant difference in nurse, physician
collaboration, positive patient outcomes and nurse satisfaction. The researchers assert that
attentive style can be taught by modeling the behavior of obvious listening such as making eye
contact communicating while and refraining from participating in other activities that interrupt
communicating while someone is trying it communicate. Verbal feedback and repeating back
offers the opportunity to reflect on what was said and correct misunderstanding. Developing a
non-contentious style means developing judgement in recognizing when it is necessary to stop a
conversation an insist on clarification because it is an important point and when it is better to
ignore a comment that is disagreed with because it is not essential to goal. Developing a non-
dominant style involves controlling ones behavior of monopolizing the conversation or speaking
so forcefully that feel pushed back and unwilling to respond.
2. Mutual respect and trust:
It occurs when two or more people show or feel honor or estem towards one another. Trust
occurs when a person is confident in the action of another person. Both these imply a mutual
process and outcome. They must be expressed both verbally and non-verbally. Sometimes
professionals may verbalize respect or trust of others but demonstrate by their actions a lack of
trust and respect.
3. Giving and receiving feedback:
When professional work closely together, it may be appropriate to address attitude or actions
that affect the collaborative relationship. Feedback may be affected by each persons
perception. Personal space, roles, relationships, self esteem, confidence, believes, emotions,
environment and time, giving and receiving feedback helps individuals acquire self awareness
while assisting the collaborative team to develop and understanding and effective working
relationship.
 4. Decision making:
This is at the team level involves shared responsibilities for outcome. The team must follow each
step of decision making process, beginning with clear definition of problem. Team decision
making must be directed at the objectives of the specific effort factors that enhance the process
include mutual respect and constructive and timely feedback.
Important aspect of decision making is interdisciplinary team focusing on the clients priority
needs and organizing interventions accordingly.
5. Conflict management:
Role conflict occur in any situation where individuals work together. It arises when people are
called on to carry out roles that have opposing or incompatible expectations. In an interpersonal
conflict , different people have different expectations about a particular role.

NURSE AS A COLLABORATER:
WITH CLIENTS:
- Acknowledge, supports and encourages in health care decisions
- Encourages client autonomy
- Helps to set mutually agreed goals
- Provides client consultation
WITH PEERS
- Shares personal expertise with other nurses
- Ensure quality client care
- Develops a sense of trust and mutual respect
WITH OTHER HEALTH CARE PROFESSIONALS
- Recognizes the contribution
- Listens to other view
- Shares health care responsibilities
- Participates in collaborative interdisciplinary research
WITH PROFESSIONAL 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
- Collaborators with other health care providers

NURSE AS A COLLABORATER WITH CLIENTS:

Nurse and patient share responsibility for implementing the plan. The goal is to enhance
patients self-care competencies so they can achieve and maintain optimal health. Active
participation in a mutual exchange of information promotes learning. Patients assume a
learner role when acquiring new self care competencies and a teacher role when communicating
their personal perspective of health. Nurses assume a learner role as they strive to understand
patient beliefs, motivation and desires and a teacher role when sharing professional knowledge
and skills Healthcare professionals considered themselves qualified to decide what knowledge
and skills patients needed to improve their health however, patients are the experts about their
personal perceptions, beliefs about health and desires for learning. A collaborative approach to
health teaching effectively meets patient needs for information and for participation. Through
shared responsibility, patient and nurse can see learning goals and objectives.

NURSE AS A COLLABORATER WITH OTHER HEALTH CARE PROFESSIONALS

When several healthcare professionals are involved in teaching, it is important that each
professional communicates with the others about content, progress and approaches being used.
When providers collaborate, they reinforce each other teaching. This not only facilitates patients
learning and retention but also promotes trust in the providers.
1. Multidisciplinary Healthcare Team
The goal of optimal health for patient, can be accomplished only when patients are control
members of the healthcare team. Patients bring a particular expertise and life experience to the
interaction with health care professionals. The ANA social Policy statement identifies the
importance of patient's participation in health care.
2. Registered nurse:
Professional nurses being unique perspective to the interdisciplinary team. Nursing also
facilitates the practice of other care professional, e.g. nurses assist physicians and other
healthcare professionals carry out diagnostic and therapeutic procedures.
3. Advanced practice nurses:
The roles of advanced practice nurses include direct care, managing system of care and serving
as consultants among others. Coordination and mentoring are particularly important to effective
team functioning.
4. Nurse extenders:
Nurse extenders are cross-trained staff, whose title and job descriptions vary. They are expected
to be multi skilled and assume some tasks formally performed by RNs as well as functions
previously assigned to support personnel such as clerks and housekeepers.
5. Physicians:
Physicians use treatment modalities such as medication and surgery. They frequently consult
with others on the team as well as make referrals for therapies provided by other professionals.
6. Occupational therapists:
Assist the patient to attain optimum musculoskeletal functioning after injury, illness or surgery
by prescribing specific exercise and therapies to strengthen muscles and prevent further loss of
function.
7. Social workers:
Social workers focus primarily on discharge planning, referral to community agencies and
patient and family counseling. Social worker are knowledgeable about sources of many
supportive services in communities and collaborative with other members of the healthcare
team such as community health nurses to share such information and make recommendations
for referrals.
8. Registered dietitians:
In hospitals, long-term care facilitates and ambulatory care centers, dietitians assess patients
nutritional states and make recommendations for dietitians therapy.
9. Case manager:
Case managers monitor progress of their patients from admission to the system through
discharge and coordinate access to home or community care needed. Although case
management is geared to maintain continuity of care and optimum outcomes.
10.Utilization managers:
UMs monitor patient admission and length of stay. To criteria set by Medicare and other third
party payers. They are responsible for acting to prevent loss from exceeding established
guidelines. UMs communicate with providers to arrange for care in alternative setting when
patients are not for discharge within the limitations of guidelines.
12. Pharmacists:
Dispense medication prescribed by qualified professional. They also collaborate with members
of the healthcare team about indication for specific drugs, drug interaction with other drugs or
foods, drug side effects and over-the-counter medication.

COLLABORATIVE CARE PLAN: Critical Pathways

Critical pathways of care are intended to be used by the entire interdisciplinary team, which may include
nurse case manager, clinical nurse specialist, social worker, psychiatrist, psychologist, dietitian,
occupational therapist, recreational therapist, chaplain, and others. The team decides what categories of
care are to be performed, by what date, and by whom. Each member of the team is then expected to
carry out his or her functions according to the time line designated on the CPC. The nurse, as case
manager, is ultimately responsible for ensuring that each of the assignments is carried out. If variations
occur at any time in any of the categories of care, rationales must be documented in the progress notes.

GENERIC COLLABORATIVE CARE PLAN : CRITICAL PATHWAY

(Timeline) (Date) Day -1 Day -2
Day -3

Client D E N D E N D E N
Problem
Activity
(Includes
mobility
prescriptions
or limitation)
Diet
(Prescribed
diet,
supplementar
y or
restricted)
Medication
(Regular or
IV)
Teaching
(for
client/family)
Discharge
(Referrals or
follow up
services)

INITIAL/SIGNATURE
Comments

COLLABORATION IN A COMMUNITY-BASED NURSING

A nurse in community-based practice must have a variety of skills and talents to be
successful in assisting clients with their health care needs and in developing relationship within
the community.
1. As case manager: The nurse coordinates the activities of other members of the
healthcare team such as nutritional and physical therapists. when managing care for a
group of clients the nurse implements solid clinical decision-making skills.
2. Collaborator: A Nurse who practices community based nursing must be competent in
working not only with individuals and their families but also on the other hand related
with health care disciplines .
3. Educator: Community-based nurses also demonstrates competency in client education.
A nurse who is competent in stabilizing relationships with community service organization
can offer educational support to a wide range of clients groups.
4. Counselor: A counselor assists in identifying and clarifying health problems and in
choosing appropriate course of action to solve those problems.
5. Client advocate: Client advocacy perhaps is even more important today in community-
based practice .

MODELS OF COLLABORATION
The nursing literature presents several collaboration models that have emerged between
educational institutions and clinical agencies as a means to integrate education, practice and
research initiatives as well as providing a vehicle by which the theory clinical practice gap is
bridged and best practice outcome are achieved.

1. CLINICAL SCHOOL OF NURSING MODEL (1995)

The development of the 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 opportunities for clinical nursing research.

2.DEU MODEL FACULTY MENTOR (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. In this
the staff nurses assume the role of nursing instructor.

3.PRACTICE RESEARCH MODEL (2001)

It is an innovative collaborative partnership agreement between Hospital and Health Service
.The partnership engages academics in the clinical setting and fosters the development
of nursing research and knowledge.

4.PRIMARY NURSING MODEL

A national project conducted by the National Joint Practice Commission (NIPC. 1981) required
hospitals to demonstrate 100% registered nurse staffing within a primary nursing model of
practice, individual clinical decision making by the nurse, a joint practice committee with equal
representation of powers, an integrated patient record, and joint evaluation of patient care.

5.DIFFERENTIATED PRACTICE MODEL

As the cost-effectiveness challenged the primary nurse model with a nursing shortage.
Primary nurse concept converted into that of a patient care coordinator (PCC) who assumes
24hour accountability for specific patients. The PCC, however, does not deliver the care
personally. Instead, a team of other nurses and ancillary help assume major responsibility for
care delivery, each with specific roles and levels of accountability.

6.COLLABORATIVE PRACTICE MODEL IN A CLINIC

The researchers first identified four key elements essential for the model-
Collaborative defining of the problems;
Joint goal setting and planning;
Providing a continuum of self management and support services;
Patient education in illness management and provided consistent assess to single
member.

7.COLLABORATION IN LONG TERM CARE(LTC Model)

This model is developed by two nurse practitioner in 1980s. which focused on elderly nursing
home residence. Roles of Evercare NPs includes collaborator, clinician, case manager, educator,
communicator and leader.

8.NURSE CLINICIAN MODEL

Share teaching and service staff responsibility.
Join appointment to describe shared staffing arrangements. Shared appointments in
which one individual has a specific responsibility in both education and service
organization and involves a sharing of cost and time commitment
Full time teachers are involved in direct patient care.
 Full time nursing service staffs are involved in teaching activities. i.e. clinical preceptors,
instructors or lecturers.

9.SHARED GOVERENCE
In nursing it is First introduced by Christman in1976 . Asserted the idea that nurses should have decision
making power within their scope of practice equal to that of physicians within theirs. A component of
magnet hospital recognition in 1988
It is a partnership between staff and management working together to promote shared
decision making and accountability to provide an improved work environment for the good of
the patient.
In shared governance, a nursing organization's management assume the responsibility for
organizational structure and resources.
In turn, staff nurses accept the responsibility and accountability for their professional
practice
It is working with other disciplines for the good of the patient. It is collaborating to
improve nursing practice.
Aims of shared governance(Jones, & Lucas,1993; Ludemann, & Brown,1989).
Empowerment of individuals within the decision making system, this empowerment is
directed at increasing nurse's authority & control over their nursing practice.
Shared governance improves staff nurses' perception of their job & practice environment.
Benefit from shared governance
Possibility to make changes
Decisions made by bedside clinicians
Promotes healthy work environment
Improves employee satisfaction, patient outcomes and employee turnover
Barriers to implementation of Shared Governance
1- The resistance of nurse managers to change their roles from autocratic decision
makers to consultants, teachers, collaborators, & facilitators of shared decision making.
2-This new role is foreign to many managers & difficult to accept, In addition, consensus
decision making takes time more than autocratic decision making , not all nurses want to
share decisions and accountability.
3- Shared governance requires a considerable & long term commitment on the part of
the workers and the organization.

10.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.
Goal:
The goal was to design an educational dense, practice-based experience to socialize
second degree students to the role of a professional nurse.
A secondary goal was to enhance and support the professional and career development
of unit based nurses.
A commitment to a constructivist approach to learning, an immersion experience to
recognize the unique needs of accelerated second degree learner, and
To emphasis the partnership among the academic and practice setting, were guiding
forces in the creation and enactment of the model.
The essence of the CAN Care model is the relationship between the nurse learner (student) Care
and nurse expert within the context of each nursing situation. The semantics of the based
nursing student as learner and unit based nurse as expert. The learner is responsible and
accountable for engaging in the learning process and for taking an active role in establishing a
dynamic learning partnership with the nurse expert. Unit-based nurses are expert in the work of
nursing care. The title unit-based nurse expert was chosen to recognize the grifts they engage in
a partnership for the purpose of nurse meeting the need of the assigned patient population as
well as to reflect on and to come to know the different models of collaboration between Nursing
Education and Art and Science of Nursing Practice. The faculty member promotes the growth of
the nurse expert as a professional and the journey of the learner in coming to know a career in
nursing.
By the application of CAN-care model the focus is to:
Care students activities moves from demonstration of discrete skills and prescribed
outcome to an immersion into the professional nurse role, learner to hear and respond to
patient needs .
Through this model the students come to know the organizational context of nursing
practice, the multifaceted role of professional nurses and assume responsibility for
coming to know the meaning of nursing in each unique situation .
The unit-based nurse acquires new skills based in mentoring, exposure to evidences with
the college
This approach to education in the practice setting is thought to be more consistent w1th
the educational needs of nurses who are preparing for the challenges of professional
practice in todays acute care setting.
The primary role of the faculty member in the model is to nurture the nurse expert/nurse
learner relationship and to support the growth and development of both expert and learner in
their respective roles and responsibilities. The on-site faculty member becomes an advisor,
resource, role model and educator for both the nurse expert and the nurse learner. Here the
health care organization becomes an active participant in creating learning environment and
contributing to the learning activities.

SIX EFFECTIVE STEPS FOR SUCCESSFUL COLLABORATION

1. Clearly identify the value: Team members must understand the value they are
expected to deliver, whether its increasing revenue or moving the business into a new
market.
2. Link to the organizations strategies: Collaborations that are closely enmeshed with
corporate strategy will deliver the needed value
3. Select team players who are engaging, creative, and expert: Each member must
be creative, personally excited and optimistic about the project and brings the unique
expertise.
4. Build trust among co-workers: More important than employees trusting their
managers is co-workers trusting each other. For collaborators on the other hand lack of
trust is a deal breaker.
5. Define or modify processes: Collaborators require flexibility and may follow processes
that are unique to their role in the collaboration. Each team member should have a
specific responsibility and the opportunity to clarify objectives, and the team needs a
clear timeline.
6. Employ technology that is flexible and secure: Collaborators need tools to
communicate securely and flexibly. Virtual interactions such as tele presence can be just
as effective as face-to-face meetings when they replicate the in-person experiences.

BARRIERS OF EFFECTIVE COLLABORATION

Educational isolation
Professional Elitism
Organizational Hierarchy
Unrecognized Diversity
Role and Language confusion
Professional dissonance
Inadequate and inappropriate communication
Lack of understanding and appreciation
Lack of mutual trust and lack of respect
Dominance of one discipline over the other
Administrative and organizational structure and procedure
 .
COLLABORATION AS A SOLUTION TO MAJOR ISSUES IN NURSING IN INDIA
Poor quality of nursing and midwifery care due to:
Inadequate standards and guidelines for nursing practice.
Poor quality of nursing education to produce qualified graduates for service.
Shortage of qualified nurse educators.
Inadequate infrastructure for nursing education conferences.
Limited production of academic work and research.

HOW TO IMPROVE EXISTING WORKING RELATIONSHIP BETWEEN NURSING EDUCATION

AND SERVICES
Develop a formal system of dialogue such as joint committees for nursing education and
services at all levels.
Allow interchange between nursing services and nursing education wherever possible.
Give recognition to both nursing services and nursing education personnel for work in each
others spheres.
Conduct interpersonal workshop for nursing service and nursing education personnel
together.
Organize ward conferences, round etc. for both nursing education and service personnel.
Have staff conferences at the end of joint evaluation and assessment.
Encourage nursing tutors to involve ward staff in clinical institution.
Sensitize students to the positions and responsibilities.
Involve senior staff from hospital as guest lecturers.
Provide opportunities for academic training for service staff.

CONCLUSION:

Collaboration involves some shared functions and common functions and common focus on
the same mission. Recently however the health care system has moved towards more
collaborative efforts and initiatives in which providers and clients become partner in the care.

REFERENCES:
1. Basanthapa BT, Nursing administration, jaypee brothers, page no 128-130
2. Joel Lucille A , advance nursing practice, jaypee brothers, page no 156-176
3. Navdeep kaur brar, Textbook of Advanced Nursing Practice, jaypee brothers, page no-985-
995
4. Shebeer.P.Basheer, a concise textbook of advanced nursing practice, page no-698-705
5. www.models.com
6. www.collaborativemodels.com
7. www.google.co.in/webhp?
hl=en#q=collaboration+issues+inside+and+outside+nursing&hl=en&start=10
8. Carol taylor, FUNDAMENTALS OF NURSING, Lippincott, page no-183-184, 322-336
9. Vati Jogindra, Nursing management and administration, jaypee brothers, page no 88-90
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