1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 13 The Nurse as Colleague and Collaborator

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 13.1 Explain the essential aspects of collaborative health care. 13.2 Discuss the nurse’s role in collaboration. 13.3 Describe competencies needed for collaborative practice. 13.4 Analyze factors that affect collaboration in health care. 13.5 Compare and contrast the roles and expectations of other disciplines providing care for clients. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities Resistance to change Assume a position of leadership and nursing expertise on healthcare teams Create new practice models and redefine relationships

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 13.1 Explain the essential aspects of collaborative health care.

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Health Care ANA’s operational definition of collaboration –“A collegial working relationship with another healthcare provider in the provision of (to supply) patient care” Virginia Henderson’s definition of collaboration –“A partnership relationship between doctors, nurses, and other healthcare providers with patients and their families”

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Health Care Characteristics and beliefs basic to collaborative health care –Clients have a right to self-determination –Clients and healthcare professionals interact in a reciprocal relationship –Equality among all is essential in healthcare relationships –Client is responsible for his or her own health

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Health Care Characteristics and beliefs basic to collaborative health care –Each individual’s concept of health is important and legitimate for himself or herself –Clients have the right to accept or refuse all or any aspect of treatment –Collaboration involves negotiation and consensus, rather than questioning and ordering

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice Objectives of collaborative practice models –Use a multidisciplinary, integrated, participative framework –Enhance continuity across a continuum of care –Improve client and family satisfaction –Provide quality, cost-effective, evidence-based care that is outcome driven

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice Objectives of collaborative practice models –Mutual respect, communication, and understanding –Synergy among clients and providers –Opportunities to solve system-related issues and problems –Develop interdependent relationships and understanding

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice Collaborative practice includes –Nurse-physician interaction in joint practice –Nurse-nurse collaboration –Interdisciplinary teams and committees

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice The drivers for collaboration in advanced practice roles –Healthcare reform –Group practice –Managed care –Certification and practice standards

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice Midrange level of collaboration –Coordination and consultation Upper level of collaboration –Comanagement and referral

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Collaborative Practice Characteristics of effective collaboration include –Common purpose and goals identified at the outset –Clinical competence of each provider –Interpersonal competence –Humor –Trust and respect –Valuing and respecting diverse, complementary knowledge

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 13.2 Discuss the nurse’s role in collaboration.

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Nurse as a Collaborator Nurses collaborate with –Clients –Peers –Other healthcare professionals –Employer institutions –Professional nursing and interprofessional organizations –Legislators

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Nurse as a Collaborator Nurses collaborate about –Clients –Bioethical issues –Legislation –Health-related research –Professional organizations

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Nurse as a Collaborator Collaboration improves client outcomes Coalition of collaboration –Client –Nurse –Family caregiver

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Benefits of Collaborative Care Care is client centered/directed Clients become informed consumers and active participants Quality improves –Adherence to therapeutic regimens increases –Lengths of hospital stay decrease –Overall costs decline Supportive work environment Professional satisfaction improves

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 13.4 Analyze factors that affect collaboration in health care.

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Leading to the Need for Increased Collegiality and Collaboration Healthcare consumers –Comprehensive, holistic, affordable, compassionate care Personal responsibility initiatives Changing demographics and epidemiology Healthcare access Technological advances

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 13.3 Describe competencies needed for collaborative practice.

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved ANA Standard 13. Collaboration The registered nurse –Partners with others to effect change and produce positive outcomes –Communicates with healthcare consumer, family, and healthcare providers –Promotes conflict management and engagement –Participates in building consensus or resolving conflict

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved ANA Standard 13. Collaboration The registered nurse –Applies group process and negotiation techniques with healthcare consumers and colleagues –Adheres to standards and codes of conduct that govern behavior among peers and colleagues –Cooperates in creating a documented plan focused on outcomes –Engages in teamwork and team-building process

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Competencies Basic to Collaboration Communication skills –Communication styles are especially important to successful collaboration  Norton’s theory of communication style  Three communicator styles Dominant Contentious Attentive

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Competencies Basic to Collaboration Mutual respect –When people show honor or esteem toward one another Trust –When a person is confident in the ability, strength, reliability, and honesty of another person Giving and receiving feedback –Positive and negative

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Competencies Basic to Collaboration Decision making –Shared responsibility for outcome Conflict management –Intrapersonal conflict occurs within the person –Interpersonal conflict occurs between two or more people when people are called on to carry out roles with opposing or incompatible goals or expectations –Intergroup conflict occurs with disagreements or differences between members of two or more groups

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Competencies Basic to Collaboration Conflict management –Five stages of conflict  Latent  Perceived  Felt  Overt  Conflict aftermath

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Competencies Basic to Collaboration Conflict management –Resolution strategies are important to success –Resolution strategies  Problem solving/confrontation  Negotiating/bargaining  Smoothing over  Avoidance  Forcing

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 13.5 Compare and contrast the roles and expectations of other disciplines providing care for clients.

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses partner with –Physician  Often considered leader of the healthcare team  May be the first point of contact for the patient, has primary responsibility to determine diagnosis and plan treatment  Nurses ensure treatment regimen is implemented  Training requires four-year baccalaureate, four years medical school, three to eight years of internship and residency

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses partner with –Pharmacists  Prepare and dispense medications, administer immunizations, provide information about medications  Nurses work with pharmacists to ensure safe administration of medications  Training requires at least two years of postsecondary education, doctor of pharmacy degree, residency

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Dietitians and nutritionists  Counsel patients on nutrition issues and healthy eating habits, develop and evaluate meal plans, promote better nutrition  Nurses may consult dietitians or nutritionists to assist patients with nutritional support  Training requires a baccalaureate degree in dietetics, foods and nutrition, food service systems management, clinical nutrition, or related field

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Social workers  Provide counseling and support for clients and their families, help people solve and cope with problems in their everyday lives  Nurses work with social workers to determine patient self-care abilities and potential needs  Training requires at minimum a baccalaureate degree in social work; often requires master’s degree in social work, including supervised practicum or internship

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Physical therapists  Assist patients to improve their movement and manage their pain; assess musculoskeletal function, strength, and mobility; develop treatment plan  Nurses may suggest a physician order for physical therapy and reinforce physical therapy plan  Training requires a doctoral degree in physical therapy, supervised clinical internship in various settings

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Occupational therapists  Help patients to improve their ability to perform activities of daily living, teach patients how to use assistive devices, work to modify patient’s work or home environment  Nurses may consult with occupational therapist and reinforce occupational therapy plan  Training requires a master’s or doctoral degree in occupational therapy, supervised clinical internship in various settings

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Speech-language pathologists  Assess, diagnose, treat, and help prevent communication and swallowing disorders in patients  Nurses may reinforce treatment plan and provide feedback on effectiveness of particular treatment plans  Training requires a master’s or doctoral degree in speech- language pathology; supervised clinical internship may be required

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses work with –Respiratory therapists  Implement physician-prescribed respiratory diagnostic and therapy procedures, perform complex respiratory assessment and treatment procedures  Nurses may consult with respiratory therapists to develop and modify treatment plans, work to ensure effective ventilation and prevent respiratory infection  Training requires either associate or baccalaureate degree

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Health Care Nurses may also work with –Audiologists, chiropractors, dentists, home health aides, medical assistants, medical records and health information technicians, optometrists, personal care aides, podiatrists, recreational therapists, and others

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Interprofessional Focus Interprofessional conferences afford opportunity for contribution from many professionals Interprofessional team members can reinforce each other’s instruction to patient and family and can participate in research activities to promote effective care

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Global Collaboration World Health Organization (WHO) Achieves greater coherence among the many actors contributing to global health International nursing organizations –International Council of Nurses –Sigma Theta Tau International –Governmental organizations –Nongovernmental organizations