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TOPIC: INDEPENDENT NURSING ISSUES,COLLABRATIVE

ISSUES AND MODELS
SUBMITTED TO: SUBMITTED BY:
MISS HEENA HASHMAT AMIN
ASSISTANT PROFESSOR MSc NURSING (IST YEAR
SUBJECT/SPECIALITY: ADVANCED NURSING PRACTICE
SUBMITTED ON: 5/12/ 2023
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Historical development of INP

 The nurse practitioner (NP) role emerged in the mid-1960s due to a physician shortage.
 Loretta C Ford and Dr. Henry K Silver established the first NP program at the University
of Colorado in 1965.
 Initially focused on pediatrics, NP programs expanded to various specialties.
 Federal legislation in the early 1970s endorsed nurse certificate programs for primary
healthcare, later shifting to master's degrees.
 The 1990s healthcare reform spurred the development of three new NP programs. By
1994, 248 NP centers existed in the US, employing 49,000 NPs.
 The American Academy of Nurse Practitioners set practice standards in 1993, still
adhered to today. Currently, over 200 universities worldwide offer NP programs, with
approximately 70,000 NPs working in the US

Development of independent nurse practitioner (Independent Nurse Midwifery Practitioner) and its
development in India.

 The Indian Nursing Council (INC) has initiated a project for Independent Nurse
Practitioners trained in midwifery to address high maternal and infant mortality rates in
rural areas.
 The aim is to ensure skilled health professionals are present during childbirth to
recognize and manage complications.
 To combat the shortage of gynecologists in community health centers, INC conducted a
pilot study in West Bengal, offering 18-month training to BSc nursing graduates with
clinical experience in ob-gyn wards.
 These trained nurses, called Independent Nurse Practitioners, can prescribe medicines
following protocols and make decisions independently in the absence of gynecologists.
 The project's success in West Bengal has led to a proposal for its extension nationwide,
and a curriculum is being developed with senior obstetrics and gynecologists.
 The President of INC emphasizes the role of these practitioners as a solution to improve
the quality, access, and cost of care in rural areas.

Basic Requirements of Independent Nurse Midwifery Practitioner

Becoming independent nurse midwifery practitioner is one of the important challenges as it
needs specialized qualification. The basic requirements are mentioned below:
 Basic nursing education
 Registered nurse
 Advance Nursing Certification (Master Degree in Obstetrics and Gynecology Nursing)
 Collaboration with any hospital/agencies for referral and reimbursement.

Various Areas of Independent Nurse Practice:

 Family nurse practitioner
 Pediatric nurse practitioner
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 Acute care nurse practitioner

 Geriatric nurse practitioner
 Psychiatric and mental health nurse practitioner
 Midwifery or women's health nurse practitioner
 School health nurse practitioner
 Adult nurse practitioner

Independent nurse midwifery practitioners work in a variety of settings,

including:

 Community clinics and health centers

 Nurse managed centers
 Private practices (either by themselves or together with a physician)
 Hospitals
 Nursing homes
 Birthing centers
 Women's health clinics
 Home healthcare agencies/Home nursing
 Schools or colleges based health clinics
 They often provide care to underserved populations in rural areas or inner-city
settings.

Work of independent nurse midwifery practitioner:

 Role: Midwifery nurse practitioners are advanced practice nurses prepared to provide
primary care to women, focusing on reproductive health, conducting gynecological
exams, family planning education, menopausal care, and specialized care during
low-risk pregnancy, childbirth, and postpartum
 Settings: They work in diverse settings such as homes, hospitals, clinics, and
community agencies, acting independently or collaboratively with other healthcare
professionals.
 Independence: Capable of solo practice, legally approved to offer a defined set of
services without supervision, while also capable of recognizing and managing
deviations from the norm.
 Scope of Practice: Conduct comprehensive health assessments for health promotion
and disease prevention, emphasizing health surveillance, wellness maintenance,
and managing complications while maintaining continuity of care.
 Referrals and Collaboration: Refer patients to general practitioners or obstetricians
when beyond their expertise, collaborate with OB/GYN doctors, and consult or refer
to other healthcare providers for high-risk pregnancies or cases involving chronic
diseases.
 Impact: Studies show nurse-midwives manage perinatal care, family planning, and
gynecological needs effectively, significantly improving primary healthcare services,
particularly in rural and inner-city areas.
 Primary Care Provision: Offer primary healthcare services to women, focusing on
reproductive health, gynecological exams, family planning, and menopausal care
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 .Diverse Practice Settings: Work in various settings like homes, hospitals, clinics,
and community agencies, adapting to different healthcare environments
 .Independent Practice: Capable of independent practice, providing a defined set of
services without the need for constant supervision
 Comprehensive Health Assessments: Conduct thorough health assessments aimed
at promoting wellness, disease prevention, and early detection
 Specialization in Pregnancy & Childbirth: Provide specialized care during low-risk
pregnancies, childbirth, and postpartum periods, aiming for natural birth
experiences.
 Recognition and Management of Deviations: Identify and manage deviations from
the norm, handling certain challenging deliveries using noninvasive techniques.
 Continuity of Care: Ensure continuity of care by managing complications while
maintaining a focus on health surveillance and wellness
 Impactful Primary Healthcare: Manage perinatal care, family planning, and
gynecological needs effectively, improving healthcare services in rural and urban
areas.
 Education and Counseling: Provide education, counseling, and support to women
throughout various stages of their reproductive health journey.

Challenges for Indian midwives:

Practice challenges
Ensuring the best healthcare through the midwifery model of care.
Recognize midwives as independent practitioners with specific rights and
responsibilities.
Ensure practice structures support the availability of midwifery care for women.
Grant midwives authority and accountability within their scope of practice.
Encourage health organizations to adopt quality and standard-based midwifery care.
Facilitate seamless case consultation, collaboration, and referrals for women's
overall benefit.
Advocate for midwives to be integral parts of the healthcare system.
Provide resources and training to enhance midwifery skills and knowledge.
Establish guidelines for the integration of midwifery into mainstream healthcare.
Foster collaboration between midwives and other healthcare professionals.
Promote policies that prioritize women's access to midwifer
1. Challenges for law regulations:

 Laws Based on Education: Regulators should create laws that align with
entry-to-practice standards from accredited midwifery education programs.
 Credentialing Mechanisms: Healthcare systems need to establish
credentialing procedures that uphold professional standards specifically
tailored to midwifery.
 Recognizing Distinctiveness: Acknowledgment of midwifery as a unique
profession separate from other healthcare roles is crucial.
 Building Competencies: Established processes should enable midwives to
enhance their skills and capabilities within their legally defined scope of
practice.
 Protection of Public Health: Regulations should prioritize public safety while
ensuring access to independent midwifery services.
 Avoiding Unnecessary Limitations: Laws should steer clear of needlessly
restricting midwives' abilities to practice within their rightful scope.
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 Continuous Development: Encouraging ongoing learning and professional

growth within the framework of midwifery practice is essential.
2. Challenges for law regulations:

 Laws Based on Education: Regulators should create laws that align with entry-to-
practice standards from accredited midwifery education programs.
 Credentialing Mechanisms: Healthcare systems need to establish credentialing
procedures that uphold professional standards specifically tailored to midwifery.
 Recognizing Distinctiveness: Acknowledgment of midwifery as a unique profession
separate from other healthcare roles is crucial.
 Building Competencies: Established processes should enable midwives to enhance their
skills and capabilities within their legally defined scope of practice.
 Protection of Public Health: Regulations should prioritize public safety while ensuring
access to independent midwifery services.
 Avoid ing Unnecessary Limitations: Laws should steer clear of needlessly restricting
midwives' abilities to practice within their rightful scope.
 Continuous Development: Encouraging ongoing learning and professional growth within
the framework of midwifery practice is essential.
3. Educational challenge:

 Creating New Professional Categories: Implementing direct entry midwife programs

introduce a distinct category solely focused on maternal care, necessitating clear
delineation and standards for this specialized role
 Reflecting Population Diversity: Developing mechanisms to recruit midwives that mirror
the diverse Indian population requires proactive identification and fostering of
competencies aligned with community needs.
 Categorizing Midwives by Expertise: Recognizing and categorizing midwives based on
their specialized expertise within the field of midwifery is crucial for optimizing their roles
and contributions
 .Addressing Evolving Healthcare Demands: Educators must adapt to evolving
healthcare demands by ensuring midwives are equipped with the necessary skills and
knowledge to meet these challenges.
 Tailoring Education to Diverse Needs: Curricula and training should be designed to
accommodate the diverse healthcare needs and regional variations within the Indian
population
 Integration of Specialized Skills: Integrating specialized skills into midwifery education is
essential to support the varied requirements within maternal care and related healthcare
contexts.

4. Challenges for research activities.

 Evolving Evidence-Based Practice: Continuous growth in research is necessary to

support evidence-based midwifery practice, ensuring it aligns with the latest findings and
advancements
 Independence and Autonomy: Analyzing midwifery practice from the perspective of
women receiving care is vital for promoting independent and consumer-oriented care
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 Consumer-Centric Analysis: Research efforts need to prioritize understanding consumer

needs and experiences to enhance midwifery practices in a way that best serves
women's healthcare requirements
 Continual Improvement: Embracing a culture of ongoing analysis and improvement
based on consumer insights ensures that midwifery practices adapt and improve to meet
evolving healthcare needs.

5. Challenges for policy makers

 Expanding Scope Beyond Traditional Bodies: Convincing policy makers about the
significance of independent midwifery practice requires broadening perspectives
beyond conventional regulatory and professional entities
 .Demonstrated Positive Impact: Research consistently shows the positive
contributions of midwifery to women's and infants' health, emphasizing the need for
policy makers to acknowledge and support these findings.
 Advocating for Independent Practice: Policy makers need to be persuaded of the
vital role that independent midwifery plays in enhancing healthcare outcomes,
advocating for policies that promote and safeguard its practice.

Independent practice issues:

1. Conflict of interest: A conflict of interest occurs when an individual or entity is involved in

multiple interests or relationships, and these interests could potentially influence their decision-
making or actions in a way that could be considered biased, unethical, or detrimental to one or
more of those interests. This conflict might arise when personal, professional, financial, or other
interests clash with their obligations or responsibilities in a different role or situation. In
professional contexts like healthcare or business, managing and disclosing conflicts of interest
is crucial to maintaining integrity, transparency, and trust

Nurses' primary obligation is to provide professional care to their clients.They must avoid using
their position to influence clients for personal financial gain or non-financial benefits.Selling
products or services to clients they're treating can create a conflict of interest.This conflict might
prioritize the nurse's personal interests over the client's needs.Nurses in independent practice
should be particularly cautious about endorsing or advertising products to avoid such conflicts.

2. Endorsements: Endorsement refers to the public expression of support or approval for a

person, product, service, or idea by someone well-known or influential, often to promote or give
credibility to the endorsed entity

 Ethical Concerns: Advertising can raise ethical questions, such as ensuring accuracy,
avoiding deceptive claims, and maintaining professionalism.
 Patient Trust: Misleading or overly aggressive advertising might erode patient trust,
impacting the nurse's reputation and practice.
 Conflict of Interest: Promoting products or services in advertisements without
transparency could lead to conflicts of interest, especially if they directly benefit the
nurse financially.
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 Endorsement and Nursing: Involves a nurse leveraging their professional status to

support a commercial product or service.
 Conflict of Interest Concerns: Endorsing a product without disclosing alternatives can
raise concerns about conflicts of interest.
 Potential Misleading Information: Not providing information about other options might
mislead the public.
 Trust Compromise: Endorsements without full transparency can compromise trust in the
nurse's recommendations.
 Example Scenario: A nurse providing independent foot care services should avoid
selling foot care products to clients to maintain professional integrity and prevent
conflicts of interest.
 Regulatory Compliance: Advertisements must comply with local laws and professional
regulations to avoid legal issues or penalties.

4. Advertising: There are limitations on how a nurse can advertise his or her services.
Advertising may take various forms, such as business cards, listing in telephone directories,
announcements in newspapers and periodicals, and promotional materials. It can include
information such as a description of services and nursing credentials, practice experience,
fees, address and phone number.

 Transparency: When advertising services, nurses must provide accurate and

transparent information about their credentials, services offered, experience, fees,
and contact details. Lack of transparency could mislead potential clients and
compromise trust.
 Compliance with Regulations: There are often specific regulations and guidelines
governing how healthcare professionals, including nurses in independent practice,
can advertise their services. Violating these regulations can lead to legal issues or
professional consequences
 Maintaining Professionalism: Nurses must maintain a professional image in their
advertising. This includes avoiding misleading claims, adhering to ethical standards,
and ensuring the information provided is truthful and not exaggerated.
 Client Relationships: How nurses advertise their services can impact client
relationships. Misleading or overly aggressive advertising might lead to mistrust or
dissatisfaction with the nurse's practice.
 Patient Autonomy: Providing clear and accurate information allows patients to make
informed decisions about their healthcare options. Limitations in advertising could
potentially restrict patients' access to information necessary for informed decision-
making.

5.Practice guideline independent practice fees: The college does not determine or
approve specific service fees. According to Nursing Act 1991 and the accompanying
regulations, the following activities related to fees are considered professional
misconduct
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a. Submitting an account or charge for services that the member knows is false or misleading It
means that if a nurse knowingly creates a bill or charges for services that they are aware are
incorrect or misleading, it's considered a violation of professional conduct. For instance, if a
nurse bills for a service that wasn't actually provided or exaggerates the cost of a service
beyond what was actually done, it's considered unethical behavior in the nursing profession.
This phrase refers to the act of a nurse knowingly providing inaccurate or deceptive information
regarding the services they've rendered. It involves submitting bills or charges for services that
the nurse knows are not accurate or truthful. It's considered professional misconduct because it
involves intentionally misleading others about the services provided or the costs associated with
those services.

b. Failing to fulfill the terms of an agreement for professional services.. "Failing to fulfill the terms
of an agreement for professional services" refers to a situation where a nurse or healthcare
professional doesn't meet the conditions or obligations outlined in a contract or agreement for
the services they've agreed to provide. It could involve not delivering the promised services, not
meeting quality standards, not completing the work within the agreed-upon timeframe, or any
other violation of the terms established in the professional service agreement

c. Charging a fee that is excessive in relation to the service for which it is charged and/or.

d. Offering or giving a reduction for prompt payment of an account. Before setting fees, a nurse
should research the fees of other nurses who have similar qualifications and experience, and
who provide comparable services. make me this understand.

6. informed consent Nurses in independent practice are expected to obtain informed consent
before performing any treatment For consent to be valid, it must relate directly to the treatment.
Treatment is defined as anything that is performed for a therapeutic, preventive, palliative,
diagnostic, cosmetic or other health related purposes, and includes a course or plan of
treatment.

in independent nursing practice, obtaining informed consent becomes crucial due to the direct
responsibility of the nurse. Issues may arise when patients are not fully aware of the nature,
risks, and benefits of the treatment, leading to potential misunderstandings, dissatisfaction, or
even legal implications if treatments are performed without proper consent. Nurses must ensure
patients understand the specifics of the treatment, its purpose, risks, alternatives, and give
consent voluntarily before proceeding with any procedure.

7.Business or legal council

Nurses may want to seek legal advice before starting an independent nursing practice. Explain
this as an independent practice issue
Seeking legal counsel before starting an independent nursing practice is a critical step due to
various independent practice issues:

 Regulatory Compliance: Understanding the legal frameworks, regulations, and licensing

requirements for independent practice is essential. Legal counsel helps nurses navigate
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complex healthcare laws, ensuring compliance with state-specific regulations and

professional practice standards.
 Business Structure and Contracts: Setting up an independent practice involves decisions
about business structures, contracts with clients, liability considerations, and insurance.
Legal advice assists in structuring the business appropriately and drafting contracts to
protect the nurse's interests.
 Risk Management: Lawyers specialized in healthcare law can provide insights into risk
management strategies. This includes advice on liability, malpractice insurance, and
steps to mitigate legal risks associated with independent practice.
 Intellectual Property and Licensing: Legal guidance helps nurses understand intellectual
property rights, such as protecting unique practice methods or innovations. Additionally,
it assists in navigating licensing agreements or issues related to the use of healthcare
technologies and software.
 Dispute Resolution: In case of legal disputes or conflicts, having prior legal counsel can
equip nurses with the knowledge and resources to handle such situations effectively,
potentially avoiding costly legal battles.
 For nurses venturing into independent practice, legal advice serves as a foundational
step, providing the necessary guidance and expertise to establish a compliant, legally
sound, and professionally managed practice.

8. Liability protection: often in the form of professional liability insurance (also known as
malpractice insurance), is a safeguard that individuals or businesses acquire to protect
themselves against claims of negligence or malpractice. In the context of healthcare, this
insurance specifically covers healthcare professionals, including nurses, in case they are sued
by a patient or client for alleged mistakes, errors, or negligence in their professional services.

The college recommends that nurses in independent practice purchase liability protection to
enable public redress if any problem occurs.

Liability protection is a crucial independent practice issue for nurses due to several reasons:

 Personal Liability: In independent practice, nurses are personally liable for their actions.
Liability protection, such as professional liability insurance (malpractice insurance),
safeguards nurses against potential lawsuits stemming from professional negligence or
errors in their practice.
 Financial Security: Legal issues and claims can result in significant financial burdens,
potentially jeopardizing an independent nurse's personal assets and practice. Liability
protection offers financial security by covering legal expenses, settlements, or judgments
in case of lawsuits.
 Maintaining Practice Continuity: A lawsuit or legal claim can disrupt an independent
nurse's practice. Liability protection ensures continuity by providing support during legal
proceedings, allowing the nurse to focus on their practice without undue financial or
professional distress
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 .Professional Reputation: Even unfounded claims can damage a nurse's reputation.

Liability protection helps in managing and mitigating the effects of such claims on the
nurse's professional standing and credibility.
 Peace of Mind: Having liability protection in place offers peace of mind to independent
nurses, allowing them to concentrate on delivering quality care without constant worry
about the potential legal repercussions.
 For nurses operating independently, where they lack the institutional support or legal
teams of larger healthcare facilities, liability protection is an essential safeguard against
legal risks, promoting a more secure and sustainable independent practice.

9.Networking :within entrepreneurial support groups is a crucial independent practice issue

for self-employed nurses due to several reasons:

 Peer Feedback and Support: Connecting with peers allows nurses in independent
practice to exchange experiences, seek advice, and gain insights into various
aspects of running a business. This peer feedback offers valuable perspectives and
solutions to common challenges faced in independent nursing.
 Idea and Issue Sharing: Networking groups provide a platform for sharing innovative
ideas, discussing best practices, and addressing common issues encountered in
independent practice. This exchange helps nurses navigate challenges more
effectively.
 Planning for Contingencies: Being self-employed means managing all aspects of
their practice, including planning for vacations, sickness, or unexpected absences.
Through networking, nurses can learn how others manage these situations, gather
tips for contingency planning, and ensure continuity of care for their clients.
 Professional Growth: Networking fosters continuous learning and professional
development. Nurses can attend workshops, seminars, or discussions within these
groups to enhance their skills, stay updated with industry trends, and adapt their
practice to meet evolving healthcare needs.
 Mental and Emotional Support: Independent practice can sometimes feel isolating.
Networking groups offer a supportive environment where nurses can discuss
challenges, share successes, and find emotional support from others facing similar
situations.
 Overall, networking within entrepreneurial support groups empowers self-employed
nurses by providing a supportive community, knowledge exchange, and resources
crucial for thriving in their independent practice.

The process of independent Nurse Practitioner:

1. Novice
2. Advanced Beginner.
3. Competent.
4. Proficient.
5. Expert.
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Collaboration: Collaboration (from Latin com- "with" + labor are "to labor", "to work") is the
process of two or more people, entities or organizations working together to complete a task or
achieve a goal.
Collaboration is a process in which two or more individuals work together jointly influencing one
another, for the attainment of a goal.
Collaboration is a partnership in which all parties are valued for their contribution. Collaboration
uses the data, plan,
Implement, evaluate and gain objectivity by examining another's viewpoints. Collaboration must
have shared objectives.
Collaborative health care practices facilitate better patient outcomes. The healthcare team
works as a group utilizing individual skills and talents to reach the highest of patient care
standards.

Collaboration and consultation are essential elements of safe, competent, ethical nursing
practice. Nurses are expected to collaborate with patients, with each other and with members
of the health care team for the benefit of the patient. Nurses are also expected to consult with
others when any situation is beyond their competence. Collaboration is ongoing communication
and decision-making with the goal of working toward identified patient care outcomes. Effective
communication skills are critical to successful consultation and collaboration.

MEANING OF COLLABORATION

The word collaboration, namely co and labor are, combined 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. Teamwork and collaboration are often used synonymously. The description of
collaboration is a dynamic process resulting from developmental group stages as an outcome,
producing a synthesis of different perspectives.
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

1. Collaboration is an intricate concept with multiple attributes. Attributes identified by

several nurse authors include sharing of planning, making decisions, solving problems,
setting goals, assuming responsibility, working together cooperatively communicating,
and coordinating openly.

2. "Collaboration is a process by which members of various disciplines (or agencies) share

their expertise. Accomplishing this requires these individuals understand and appreciate
what it is that they contribute to the whole." (Henneman et al) "
3. Collaboration is the most formal inter-organizational relationship involving shared
authority and responsibility for planning, implementation, and evaluation of a joint effort"
(Hord, 1986)

4. "Collaboration as a..... a mutually beneficial and well-defined relationship entered into by

two or more organizations to achieve common goal" (Mattessich, Murray and Monsey
2001)
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OBJECTIVES OF COLLABORATION

 To seek creative, integrated solution where need and goal of both the sides are
important commitment and consensual decision.
 To learn to grow through co-operative problem solving resulting in greater understanding
and empathy.
 To identify, share and merge vastly different viewpoints

KEY ELEMENTS OF COLLABORATION

 Collaboration implies that health care team members work cohesively. Elements
associated with effective collaboration include cooperation, assertiveness, responsibility,
communication, autonomy and coordination.
 Cooperation: It is respecting the opinions of others and being willing to examine
alternative points of views and changed personal beliefs and personal prospective.
 Assertiveness: It exists when individual in the team support each other and all view
points are aired fully and the consensus can be achieved within the team.
 Shared responsibility: It supports a decision that is determined by consensus and
ultimately participating in implementation of a plan.
 Communication: Each team member is responsible for sharing critical information about
patient care and issue relevant to
 Coordination: It is the efficient organization of the necessary components of care,
coordination reduces duplication of effort and guarantee that the most qualified person
will address a problem or task important to the work of the disciplinary team.
 Collaboration is based on concepts of purposes, professional contribution of
practitioners, collegiality, communication and patient focused practice.
 Collegiality: It emphasis on mutual respect and professional approach to inter-team
problems rather than blaming others or avoiding responsibility for one's own error.

NEED FOR COLLABRATION:

 Reduce gap between nursing education and nursing practice.
 nurses, as the single largest health care provider group and the group with the most
sustained contact with patients, have opportunities and responsibilities to use their
communication and teaching skills to facilitate patient collaboration in their care.
 Collaboration practice provides more effective care delivery and better use of resources
and enhances job satisfaction.
 It also reduces conflict between physicians and nurses as both become more focused on
patient outcomes than on protecting their own 'turf.

TYPES OF COLLABORATION

 Interdisciplinary

 Multidisciplinary

 Tran disciplinary

 Inter professional collaboration

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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

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..

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

COMPETENCIES REQUIRED FOR NURSE AS A COLLABORATOR

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

COMMMON BARRIERS IN COLLABRATION:

 Lack of communication
 Lack of understanding and appreciation for what the others contribute to the team
 Inability to work together
 Lack of mutual trust
 Lack of respect
 Misconceptions
 Overlap of responsibilities and expertise
 Unresolved conflicts
 Unwillingness to share autonomy and responsibility.

CHARACTERISTIC OF COLLABORATION

 Joint venture
 Co operative endeavor
 Willing participation
 Shared planning and decision making
 Team approach
 Contribution of expertise
 Shared responsibility
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 Non hierarchal relationship

 Shared power (based on knowledge and expertise)

PRINCIPLES OF COLLABORATION - ART-

A
1. Asserts, attitudes and values that each potential partner 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
Time and timing
Tact and talent
Trust

NURSE AS A COLLABORATOR OR TYPES OF NURSING COLLABRATION

1. With nurse colleagues

• Shares personal expertise with other nurses and elicits the expertise of others to ensure
quality client care.
• Develops a sense of trust and mutual respect with peers that recognize their unique
contribution.

2. With other health care professionals

 Share health care responsibilities in exploring options, setting goals, and making
decision with clients and families
 Listens to each individuals views
 Participate in collaborative interdisciplinary research to increase knowledge of clinical
problems or situation

3. With professional nursing organizations

 Seeks opportunities to collaborate with and within professional organizations.
 Serves on committee in state and national nursing organizations or specialty groups
 Supports professional organizations in political action to create solutions for professional
and health care concerns+

4. With legislation
• Collaborates with other health care providers and consumes on health care legislations to best
serve the needs of the public.
ELEMENTS OF COLLABORATION
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1. Communication
2. Mutual Respect And Trust
3. Decision Making

COLLABORATION ISSUES WITHIN NURSING

1.Collaboration and the nursing shortage

• For the practicing Nursing, staffing is an issue of both professional and personal concern.
• Inappropriate staffing levels can not only threaten patient health and safety, and lead to
greater complexity of care, but also impact on Nurses health and safety by increasing nurse
pressure, fatigue, injury rate, and ability to provide safe care.
This stress can lead to ineffective collaboration work among the nurses.
2.Mandatory overtime

• Staff nurses across the world are reporting a dramatic increase in the use of mandatory
overtime as a staffing tool.

• This dangerous staffing practice, in part due to a nursing shortage, is having a negative impact
on patient care, fostering medical errors, and driving nurses away from the bedside.

4. Safety on the Job

• Staff nurses work hard on the job, but they shouldn't have to risk their health to do so.
• Unless and until a safe environment is provided for the nurse the quality of care that they
provide also get hindered.

5. Workplace bullying

• Workplace bullying is a serious issue effecting the nursing profession.

• It is defined as any type of repetitive abuse in which the victim of the bulling behavior suffer
verbal abuse, threats, humiliating or intimidating behaviors or behavior by the perpetrator that
interfere with his or her job performance and are meant to place risk.

6.Lack of respect

• Nursing can be a gratifying profession; however, nurses continue to experience lack of respect
from their patients, doctors, administrators, and even from their coworkers.
• Meds cape’s online survey (2011) reported that 31.4 percent of the respondents interviewed
identified "lack of respect from other healthcare providers/non-nurses" as being one of the most
distressing job factors."
• Also, in an ANA 2011 Health and Safety Survey, physical assault and verbal abuse were
shown to have gone down but the issue still remains to be a big concern.
• RNs in the survey reported that "on-the-job assault" was one of their top-three safety
concerns.
• The survey reported that within a 12-month period, 11 percent of RNs were physically
assaulted and 52 percent were either threatened or verbally abused.
• Many cases go unreported because some feel that this problem is just part of their job.
• Many of the problems in nursing are due to the lack of legislation to address these issues.
• Because the health care industry is constantly evolving due to health reform, more problems
will continue to emerge.
 16

7. Regulatory barrier
• Societies of medical profession continue to try limit advanced practice through legislative and n
regulatory reforms.
• Legislation and regulation have been barrier to the implementation of collaborative role.
• Collaboration cannot be mandated. It is a process that develop over the time

COLLABORATION ISSUES OUTSIDE NURSING

• Nursing is the largest health care work force of the world• Nursing, as a profession, can be
very rewarding and challenging, however many problems exist and most are becoming worse
due to lack of legislation to address these issues.
1.Disciplinary differences
 Often clinicians differ in their basic philosophy of care.
 In earlier days it was practiced as physician supervise advanced nursing practice.
 But now the view advanced that supervision precludes the development of a
collaborative relationship and that physicians not fully supervise nurse but works in
collaboration with them rather than supervision there should be preferably the scope of
autonomous nursing management and identify high risk population within a particular
population or practice.
2.Meeting patients expectations:

• In one out of three patients who stayed in a hospital at least one night, reported that "nurses
weren't available when needed or didn't respond quickly to requests for help." (IN USA)
• Meeting patient expectations is hard enough as it is and some people fear it may worsen as
healthcare and the elderly population increases.
• They also worry that nurses will be stretched too thinly and may not be able to achieve the
needs and demands for their patients

COLLOBRATIVE ISSUES:

 Communication Gaps: Incomplete or unclear communication among healthcare team

members. Lack of standardized communication protocols leading to misunderstandings.

 Conflicting Care Plans: Differences in opinions on patient care strategies among team
members. Inconsistent approaches that may impact patient well-being.

 Inadequate Information Sharing: Limited sharing of crucial patient information between

healthcare professionals. Insufficient utilization of electronic health records for
comprehensive data exchange

 .Differing Professional Perspectives: Varied viewpoints and priorities among healthcare

professionals. Challenges in aligning nursing perspectives with those of other healthcare
team members.
 17

 Role Ambiguity: Unclear delineation of responsibilities and roles within the healthcare
team. Lack of clarity in understanding each team member's contributions.

 Resource Constraints: Limited availability of resources (staff, equipment, time) impacting

collaborative efforts. Struggles with managing workload and maintaining quality care.

 Interdisciplinary Collaboration Challenges: Difficulties in integrating care across different

disciplines within healthcare. Fragmentation in services due to a lack of interdisciplinary
collaboration

 Resistance to Change: Reluctance among team members to adopt new practices or

technologies. Barriers to embracing innovative approaches that enhance collaboration.

 Addressing these collaborative issues is essential to fostering a cohesive healthcare

team and providing optimal patient care.

THE COLLABRATION APPROACH TO NURSING CARE (CAN –CARE MODEL) :

The CAN-Care Model, established in 2006, underscores the importance of collaboration among
academic and practical leaders in the field of nursing

The main difference between academic and practical leaders lies in their focus and roles within
the context of a profession, such as nursing:

Academic Leaders:
Focus: Primarily concerned with educational aspects and theoretical knowledge
Roles: Involved in teaching, curriculum development, research, and academic administration.
Examples: Professors, deans, academic program coordinators.
Practical Leaders:
Focus: Primarily concerned with real-world application and hands-on experience.
Roles: Engaged in direct patient care, healthcare administration, and the practical aspects of a
profession. Examples: Experienced nurses, clinical supervisors, healthcare managers
Practical leaders play a vital role in collaborating with academic leaders to address challenges
related to nursing education, recruitment, and retention, as highlighted by the CAN-Care Model.
Their insights and real-world experience contribute to the development and implementation of
effective strategies for the betterment of the nursing profession.
In the context of nursing, for instance, academic leaders would be involved in designing and
delivering educational programs, while practical leaders would be those actively working in
clinical settings, implementing healthcare practices, and managing day-to-day patient care.
 18

The CAN-Care Model emphasizes collaboration between these two types of leaders to address
comprehensive needs within the nursing profession, promoting a holistic approach that
combines theoretical knowledge with practical application.
This collaboration aims to enhance education, recruit more nurses, and retain them throughout
their careers.
The concept of a partnership model arose when the Christian E. Lynn College of Nursing at
Florida Atlantic University received a grant from the Tenet Health Care Foundation. This grant
was specifically for launching an Accelerated Second Degree BSN Program, emphasizing the
collaborative effort to address needs in nursing education, recruitment, and retention. In
essence, the model emphasizes working together to support and advance the nursing
profession

( A Second Degree Bachelor of Science in Nursing (BSN) program is designed for individuals
who already hold a bachelor's degree in a field other than nursing and are looking to transition
into nursing as a career. Here's what it typically involves:

Prerequisite Bachelor's Degree: Applicants must have a previous bachelor's degree in a

discipline other than nursing. This program allows individuals to leverage their existing
educational background in a different field.

Accelerated Format: Second Degree BSN programs are often accelerated, meaning they are
designed to be completed in a shorter timeframe compared to traditional BSN programs. This is
to capitalize on the candidate's prior educational experience.

Nursing Education: The program focuses on providing the necessary nursing education and
clinical training for individuals to become registered nurses (RNs). It covers nursing theory,
clinical practice, and may include specialized coursework.

Clinical Experience: Like other nursing programs, there is a clinical component where students
gain hands-on experience in healthcare settings, applying their theoretical knowledge to real-
world patient care.

Preparation for Licensure: The goal of a Second Degree BSN program is to prepare students to
sit for the NCLEX-RN (National Council Licensure Examination for Registered Nurses), which is
required for licensure as a registered nurse.

These programs are beneficial for career changers or individuals seeking a more direct route
into nursing without repeating a full undergraduate education)

GOAL:

1.The goal was to design an educational dense, practice-based experience to socialize second
degree students to the role of a professional nurse.
This goal indicates the intention to create an educational program that is robust in content and
strongly rooted in practical experiences. The aim is to familiarize second-degree students, those
who already hold a bachelor's degree in a different field, with the responsibilities and
expectations associated with the role of a professional nurse. The term "socialize" in this context
suggests not only providing academic knowledge but also immersing students in practical, real-
world scenarios to help them adapt to and understand the professional aspects of nursing. The
 19

emphasis is on a comprehensive and hands-on approach to prepare these students for a

successful transition into the nursing profession.
2. A secondary goal was to enhance and support the professional and career development of
unit based nurses.

The secondary goal aims to improve and bolster the professional and career development of
nurses who are already working in specific units within a healthcare setting. Here's an
explanation
:Professional Development: This involves activities and opportunities designed to enhance the
skills, knowledge, and overall competence of unit-based nurses. It could include additional
training, workshops, or certifications relevant to their specific unit or specialization.
Career Advancement: The goal is to support nurses in advancing their careers within their
current unit or in related areas. This might involve providing guidance on career paths,
encouraging further education, or offering resources for professional growth.
Skill Enhancement: Unit-based nurses may receive additional support to refine and expand their
skill set, ensuring they are well-equipped to handle the unique challenges and demands of their
particular unit.
Recognition of Unit Expertise: The goal recognizes the importance of acknowledging and
developing expertise within specific units. This can contribute to a sense of professional
accomplishment and satisfaction among nurses.
In summary, the secondary goal is focused on creating an environment that supports and
fosters the ongoing professional growth and success of nurses working in specific units,
contributing to both individual satisfaction and the overall effectiveness of healthcare units.
3.A commitment to a constructivist approach to learning, an immersion experience to recognize
the unique needs of accelerated second degree learner.
This statement reflects a commitment to a specific educational philosophy and approach for the
accelerated second-degree learner. Let's break it down:
I. Commitment to a Constructivist Approach to Learning:
This indicates a dedication to fostering an environment where learners, in this case, accelerated
second-degree students, are actively involved in constructing their knowledge. It involves
interactive and participatory learning experiences.
II. Immersion Experience to Recognize the Unique Needs of Accelerated Second Degree
Learners:
 Immersion Experience: Implies an in-depth, hands-on involvement in a learning
environment
 Unique Needs of Accelerated Second Degree Learners: Recognizes that individuals
transitioning into nursing through an accelerated second-degree program may have
distinct needs due to their prior educational and professional backgrounds.
Putting it together, the commitment to a constructivist approach means that the educational
program for accelerated second-degree learners is designed to be interactive, engaging, and
participatory. The immersion experience further emphasizes a deep and thorough involvement
in the learning process, specifically tailored to address the unique requirements and
characteristic1qs of individuals pursuing nursing through an accelerated second-degree
program. This approach aims to provide a more effective and personalized learning experience
for these learners. Address the unique requirements and characteristics of individuals pursuing
nursing through an accelerated second-degree program. This approach aims to provide a more
effective and personalized learning experience for these learners.
4. To emphasis the partnership among the academic and practice setting, were guiding forces
in the creation and enactment of the model
 20

This statement suggests that the creation and implementation of the educational model were
strongly influenced by a commitment to fostering collaboration between academic institutions
(like the Christian E. Lynn College of Nursing) and real-world practice settings (such as
healthcare facilities).

Here's a breakdown: Partnership Emphasis:

Collaboration Priority: The statement underscores the importance of working together between
academic and practical settings.

Joint Influence: Both academic expertise and real-world practical insights contribute significantly
to the design and execution of the educational model.

In summary, the guiding forces behind creating and implementing the educational model were
centered around the intentional promotion of a strong partnership between academic and
practical environments. This collaborative approach ensures that the educational model aligns
with the real-world needs of the nursing profession, offering a more comprehensive and
effective learning experience for the participants.

The application of the CAN-Care Model

1. shifts the focus from merely demonstrating individual skills and achieving predetermined
outcomes to a more immersive experience where students actively engage in the role of a
professional nurse.
This means:Move from Discrete Skills to Immersion:
Discrete Skills: Refers to isolated, specific tasks or techniques.
Immersion: Implies a deep involvement and integration into the broader context of professional
nursing practice.
Meaning: Students are encouraged to go beyond just demonstrating individual skills. They are
immersed in a holistic experience that mirrors the complexities and responsibilities of the
professional nursing role.
Transition from Prescribed Outcomes to Responsive Learning:
Prescribed Outcomes: Refers to predetermined, specific goals or results.
Responsive Learning: Suggests an adaptive and interactive learning approach that responds to
dynamic patient needs.
Meaning: Instead of focusing solely on achieving predetermined outcomes, students are guided
to listen and respond effectively to the diverse and evolving needs of patients. It emphasizes a
more patient-centered and adaptable approach to nursing care.In essence, the application of
the CAN-Care Model encourages students to move beyond the mechanics of discrete skills,
fostering a deeper, more immersive understanding of the professional nurse role. It emphasizes
the ability to respond empathetically and effectively to the unique needs of patients, aligning
with a patient-centered and dynamic approach to nursing practice.
2.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. what this means

This statement indicates that, through the CAN-Care Model, students in nursing education are
exposed to a comprehensive understanding of the nursing profession
The CAN-Care Model aims to provide a holistic education that goes beyond the basics of
clinical skills. It ensures that students not only comprehend the organizational context of nursing
 21

practice but also appreciate the multifaceted nature of the professional nursing role. Moreover, it
encourages them to take responsibility for understanding the deeper meaning of nursing in the
specific and unique situations they encounter in their practice.

3.The unit-based nurse acquires new skills based in mentoring, exposure to evidences with the
college.
the statement suggests a learning approach for nurses that involves both practical guidance
from mentors and exposure to evidence-based practices within an educational setting,
potentially a collage
4. This approach to education in the practice setting is thought to be more consistent with the
educational needs of nurses who are preparing for the challenges of professional practice in
today's acute care setting.

This statement suggests that the approach to education within the practice setting, as facilitated
by the CAN-Care Model, is believed to align well with the educational requirements of nurses
preparing for the challenges of professional practice in contemporary acute care settings.
MODEL:

Model Origins: The CAN-Care Model resulted from discussions among leaders in academic
and practice settings. It focused on recognizing the expertise and potential contributions of each
partner.

Essence of CAN-Care Model: At its core, the model emphasizes the relationship between the
nurse learner (student) and the nurse expert in various nursing situations.

Semantics in Nursing Roles: It distinguishes between the learner (student) and the unit-based
nurse expert.The learner takes an active role, responsible for engaging in the learning process
and establishing a dynamic partnership with the nurse expert.

Expertise of Unit-Based Nurses: Unit-based nurses are acknowledged as experts in nursing

care.They engage in a partnership to meet the needs of the assigned patient population and
explore collaboration models between Nursing Education and Nursing Practice.

Role of Faculty Member: The faculty member supports the professional growth of the nurse
expert and guides the learner in their nursing career journey.This marks a shift from the
traditional faculty role of being in control to a focus on supporting and guiding students. The
Bridge to Practice Model (2008): is a way of organizing nursing education where students do
all their clinical training in one hospital. A designated teaching faculty acts as a connection
between the university and the hospital, supporting both students and hospital nursing staff.
Students get to choose where they want to do their clinical placement based on their academic
performance and maturity.

Clinical Focus: In this model, students undergo their entire clinical training in a single hospital.
This approach allows for a more immersive and comprehensive learning experience.

Faculty Support: A key feature involves assigning a dedicated teaching faculty member as a
liaison. This faculty member supports students during their clinical experiences and serves as a
 22

resource not only for students but also for the hospital nursing staff. This connection aims to
strengthen the bridge between academic learning and practical application.

Placement Choice: Unlike traditional models, students actively participate in selecting their
clinical placement. This decision is based on both academic performance and maturity, giving
students a sense of autonomy and ensuring they align their learning experiences with their
preferences and readiness.

Cohort Approach: The bridge to practice model proposed by Catholic University of America,
School of Nursing (2008), uses a cohort approach in which student completes medical-surgical
clinical nursing education at the same faculty Students must apply for clinical placement in the
hospital of their choice via a clinical application form
Participating students undergo 415 hours of clinical experiences focused on medical-surgical
nursing. The model adopts a cohort approach, meaning students progress through their
medical-surgical nursing experiences as a group. This group-based learning fosters
collaboration, shared experiences, and a supportive environment among peers.

Consistency: Students stay in the same hospital for all their clinical rotations, ensuring
continuity in their medical-surgical education
Thus, the Bridge to Practice Model provides undergraduates nursing students with continuity in
medical surgical education through placement in the same hospital for all medical-surgical
clinical rotation.
One distinctive feature is the continuity provided by keeping students in the same hospital for all
clinical rotations. This consistency is designed to enhance the depth of learning by allowing
students to build familiarity with the hospital environment and nursing practices.
Incentives for Nurses: The model recognizes and encourages the active involvement of hospital
nurses in nursing education. Incentives such as continuing education credits and tuition
discounts for graduates create a mutually beneficial relationship, where nurses contribute to
education, and in return, they receive professional development opportunities. Incentives for
Nurses.The model recognizes and encourages the active involvement of hospital nurses in
nursing education.

Challenges associated with the Bridge to Practice Model (2008):

1.Recruitment of Interested Senior Clinical Nurses: Attracting experienced and dedicated senior
clinical nurses to participate in the program may pose a challenge. Ensuring their interest and
commitment is crucial for providing quality mentorship to students.

2.Retention of Clinical Liaison Faculty: Retaining the designated clinical liaison faculty could be
challenging due to various factors such as workload, competing responsibilities, or changes in
personal circumstances. The continuity of faculty support is essential for the success of the
model.

3. Management of Trade-Offs with Institutional Stability: While the model emphasizes clinical
site continuity for a stable learning environment, managing potential trade-offs with institutional
stability can be challenging. Balancing the benefits of continuity with the need for diverse clinical
experiences across different settings is essential.
 23

4. Variety of Experiences Across Clinical Settings: Offering a variety of experiences is a key

challenge when students are placed in a single hospital for all rotations. Ensuring that students
receive a well-rounded education despite limited exposure to different clinical settings requires
thoughtful planning and curriculum design.

Addressing these challenges involve strategic planning, effective communication, and ongoing
collaboration between educational institutions and participating hospitals to create a balanced
and enriching learning environment for nursing students

NURSE CONSULTANT MODEL

The main focus of the Nurse Consultant Model is to establish a collaborative partnership
between educational institutions and nursing service organizations. This partnership is designed
to:

1.Combine Practical and Theoretical Knowledge: Integrate the practical application and
knowledge from the nursing service sector with the theoretical and educational expertise from
the academic sector. This fusion aims to create a comprehensive learning experience for
nursing professionals.(Teamwork Between Schools and Workplaces: It’s about schools and
workplaces working together to make sure nurses learn both the hands-on skills they need for
the job and the theory they study in books.)

2. Enhance Educational Programs: Strengthen in-service and continuing educational programs

by leveraging the strengths of both sectors. The model emphasizes continuous learning and
development for nursing personnel, ensuring they are well-equipped with up-to-date knowledge
and skills.(Continual Learning: It highlights the importance of nurses always learning and
improving their skills. There's a special emphasis on programs that help nurses keep learning
even after they finish their initial training.)

3. Promote Mutual Benefit: Foster a mutually beneficial relationship where both educational and
nursing service sectors gain from each other. This collaboration enhances the overall quality
and effectiveness of educational initiatives and contributes to the professional growth of nursing
professionals.(Helping Each Other: The model is like a give-and-take relationship. Schools and
workplaces both benefit, making sure that nurses get the best of both worlds – practical know-
how and theoretical knowledge.)

4. Ground Learning in Real-World Experiences: Emphasize the practical application strength of

nursing service professionals, ensuring that educational programs are rooted in real-world
experiences. This approach enhances the relevance and applicability of the knowledge acquired
during the educational process.(Making Learning Practical: The model focuses on making sure
what nurses learn is not just from books but also comes from the real experiences they have on
the job. This way, the education is more practical and useful.)

T he Nurse Consultant Model is like a teamwork approach between schools that teach nursing
and places where nurses work. The main idea is to bring together the practical knowledge that
nurses use on the job with the bookish or theoretical knowledge from schools.
 24

BENEFITS:

 Staff Development Support: Collaboration aids in staff development programs and

facilitates in-service and continuing education initiatives.
 Promoting Education and Professional Functioning: The aim is to advance education
and enhance the smooth functioning of peer professionals in nursing.
 Encouraging Innovation: Collaboration allows flexible options for integrating new ideas
and approaches into both nursing practice and education.
 Accessible Professional Development: It provides accessible opportunities for nurses
who may be unable, not ready, or not interested in formal education to engage in
updates, workshops, and other learning activities.

THE NURSE CLINICAL MODEL:

The Nurse Clinician Model involves shared staffing arrangements, where both teaching and
service staff have responsibilities. In shared appointments, an individual has specific duties in
both education and service, with a shared commitment of cost and time. Full-time teachers
participate in direct patient care, while full-time nursing service staff engage in teaching roles,
such as clinical preceptors, instructors, or lecturers. This model emphasizes collaboration
between education and service components in healthcare.

 Shared Staffing Arrangements: Involves both teaching and service staff responsibilities.
 Shared Appointments: One individual has specific duties in both education and service.
Shared commitment of cost and time.
 Teacher Involvement: Full-time teachers participate in direct patient care.
 Service Staff Involvement: Full-time nursing service staff engage in teaching activities
(e.g., clinical preceptors, instructors, lecturers).Collaborative Model: Emphasizes
collaboration between education and service components in healthcare.
AIMS:

 Provides opportunities for teachers to maintain and improve clinical skills

 Provide opportunities for nursing service staff to expand their knowledge base and their
clinical skills which, in turn, improves teaching and clinical effectiveness
 Role modeling for the students
REQUIREMENTS:

 Clearly define roles and responsibilities.

 Integrate seamlessly into existing work structure.
 Establish transparent criteria for selection.
 Implement a regular work schedule.
 Provide comprehensive orientation and ongoing staff development.
 Emphasize commitment as a fundamental requirement.
 Foster good rapport and interpersonal relationships (IPR).
 Ensure it is perceived as a core part of their responsibilities, not an extra assignment.
 Encourage leadership qualities within the role

BENEFITS OF SHARED TEACHING AND SERVICE STAFF RESPOSIBILITY

 25

 Skill Enhancement: Allows teachers to maintain and improve clinical skills, while
enabling nursing service staff to expand their knowledge base and skills
 .Collaborative Strength: Combines the strengths and resources of both teaching and
service staff, fostering a collaborative and synergistic environment.
 Practical Application: Integrates practical applications from the service sector, enhancing
the real-world relevance of training
 Ownership and Participation: Promotes a sense of ownership among staff and
encourages active participation in the teaching and service responsibilities.
 Relevance of Training: Ensures that training remains relevant by bridging the gap
between theoretical knowledge and practical application in the service sector.

ISSUES:
 High level of work

THE MUTUAL INTERACTION MODEL:

The Mutual Interaction Model of Collaboration, proposed by Williamson, seeks to

maximize patient participation in healthcare by combining collaborative goals with the
nursing process's decision-making framework. Through mutual interaction, patients
actively engage in their care, taking on more responsibility for outcomes compared to a
passive role. This model integrates negotiation and decision-making through verbal and
non-verbal exchanges, allowing patients and nurses to reach agreements on desired
outcomes and strategies for promoting and restoring health.
key points of the Mutual Interaction Model of Collaboration:
 Conceptual Framework:Proposed by Williamson, the model emphasizes mutual
interaction for enhanced patient participation in healthcare.
 Combination of Collaboration and Decision-Making: Integrates collaborative aims
with the decision-making framework of the nursing process.
 Active Patient Involvement: Aims to involve patients actively in their care rather
than adopting a passive role.
 Increased Patient Responsibility: Through participation, patients take on a
greater proportion of responsibility for the outcomes of their care.
 Integration of Verbal and Non-Verbal Exchanges: Utilizes both verbal and non-verbal
communication for negotiation and decision-making.
 Agreement on Desired Outcomes: Patients and nurses engage in mutual interactions to
reach agreements on desired health outcomes.
 Strategies for Health Promotion and Restoration: Involves the collaborative development
of strategies for promoting and restoring the patient's health.
 Simultaneous Problem Solving: Provides a method for simultaneously addressing
concerns and solving problems in the healthcare process.
 Active Patient Engagement in Decision-Making: Empowers patients to actively
participate in decision-making related to their care.
 Holistic Approach: Considers both verbal and non-verbal exchanges, ensuring a
comprehensive approach to patient engagement and care.
 26

 These assumptions collectively form the foundation of the Mutual Interaction Model,
shaping the collaborative and patient-centered approach to healthcare decision-making
and participation.

ASSUMPTIONS:

 Right to Self-Determination: The assumption that individuals have the right to self-
determination and can choose to participate in the decision-making process regarding
their healthcare.
 Interactive Relationship: Assumes that the patient and the healthcare professional
engage in a relationship where they are receptive to each other's influences.
 Shared Responsibility: Recognizes that the responsibility for health is not solely a
professional one but involves shared responsibility between the patient and the
healthcare professional.
 Legitimacy of Individual Health Concepts: Acknowledges that each individual's concept
of health is legitimate for that person, emphasizing the subjective nature of health
perceptions
Phase of the Mutual Interaction Model:

1. Exploratory Phase: Patient states reasons for seeking care and expectations. Nurse
encourages the patient to share their illness story. Exploration of options to proceed,
refer, or terminate.
2. Information Sharing and Analysis Phase: Patient and nurse define problems and identify
resources. Shared analysis informs subsequent stages of care.
3. Mutual Goal Setting Phase: Patient and nurse state objectives and negotiate
outcomes.Roles are defined to meet patient care outcomes.
4. Strategy Devising Phase: Patient and nurse explore strategies, discuss risks and
benefits. Agreement on strategies and establishment of a care contract.
5. Implementation of Alternatives Phase: Formative evaluation of care in progress.
Ongoing adjustments and corrective changes during implementation.
6. Evaluation Phase: Review of patient care experience. Summative evaluation and
preparation for contract termination

LIMITATIONS:

The Mutual Interaction Model has limitations influenced by various factors:

 Patient Role Expectations: Patients' perceptions of the sick role strongly

influence their expected role in nurse-patient interactions. Previous experiences
shape patient expectations, impacting their behavior during healthcare
encounters.
 Patient Knowledge: Patients socialized to take a dependent role may defer to the
nurse's expert knowledge. Providing information can empower patients, making
them willing and able to participate in decision-making.
 Patient Personality Characteristics: Individual differences in patient traits and
characteristics, such as internal locus of control and self-efficacy, impact their
inclination toward collaborative arrangements.
 27

 Patient Definition of the Situation: Patients seek cues and symbols for social norms and
behaviors, influencing their interpretation of collaboration. Varying interpretations of
social cues affect initial patient responses to collaboration, ranging from enthusiasm to
distress.
 Influence of Nurse Characteristics: Patient participation is not solely determined by
patient characteristics; the nurse's traits also influence the extent to which a patient is
invited or given permission to participate in the collaborative process

SUMMARY

 Historical development of INP

 Development of independent nurse practitioner (Independent Nurse Midwifery Practitioner)
and its development in India.
 Basic Requirements of Independent Nurse Midwifery Practitioner
 Various Areas of Independent Nurse Practice
 Work of independent nurse midwifery practitioner
 Challenges for Indian midwives:
 Independent practice issues:
 The process of independent Nurse Practitioner
 Collaboration
 Meanining of collaboration
 Definition of collaboration
 Objectives of collaboration
 Key elements of collaboration
 Need for collaboration
 Types of collaboration
 Competencies required for nurse as a collaborator
 Common barriers in collaboration
 Characteristics of collaboration
 Principles of collaboration
 Nurse as a collaborator
 Collaboration issues within nursing
 Collaboration issues outside nursing
 Common collaboration issues
 The collaboration approach to nursing care (can –care model) :
 Bridge to Practice Model (2008):
 Nurse consultant mode
 The nurse clinical model:
 The mutual interaction model

CONCLUSION:

In conclusion, embracing independent nursing practice is vital for autonomous

decision-making and enhanced patient care. Collaborative practices, whether
interprofessional or intraprofessional, contribute to comprehensive healthcare
 28

delivery. Various collaborative models, such as the team-based approach and

collaborative care models, promote synergy among healthcare professionals,
fostering optimal patient outcomes. The integration of independent and collaborative
practices creates a dynamic healthcare environment, ensuring holistic and patient-
centered care.

BIBLIOGRAPHY:

1. Shebeer.P. Basheer, S.Yaseen Khan. Advanced Nursing Practice.2nd

edition.Banglore.Emmess;2017:654-657
2. Navdeep Kaur Brar,Hc Rawat.Textbook of Advanced Nursing Practice. First
edition.Haryana.Jaypee Brothers;2015: 976-977
3. Reddamma GG .Advaned Concepts of Nursing Practice.first edition.India.Jaypee
brothers;2021:562-563