Nurse practitioners and physicians: a collaborative practice

The rapid evolution of health care delivery within the United States has created increased opportunities for nurse practitioners (NPs) to work in a variety of challenging advanced practice roles and to impact the quality of health care. The NP role was originally developed to meet a perceived shortage of primary care physicians, especially for underserved populations. Today, NPs work in various fields, such as geriatrics and women's and family health care, as well as in various systems such as private practice and health maintenance organizations. Effective collaboration with physician colleagues will promote improved communication, health care management, and positive health outcomes. Barriers to effective collaboration are reimbursement, territorialism, and role confusion on part of the health care team and the general public.     

Interdisciplinary collaboration between primary care, social insurance and social services in the rehabilitation of people with musculoskeletal disorder: effects on self-rated health and physical performance

Previous research shows there can be good results from co-financing between welfare sectors on the perceived quality of interprofessional collaboration. However, little is known about the impact on patient outcome of such schemes. This study aimed to assess whether co-financed teams with personnel from primary care, social insurance and social services have any effect on patients' health status. A comparative study of patients attending health care centres with and without a co-financed collaboration model was carried out. Although research has shown positive results from co-financed collaboration on staff and organization, we could not find that this new interdisciplinary team structure gave a better patient health outcome than conventional care.     

Interdisciplinary collaboration between primary care,social insurance and social services in the rehabilitation of people with musculoskeletal disorder: Effects on self-rated health and physical performance

Previous research shows there can be good results from co-financing between welfare sectors on the perceived quality of interprofessional collaboration. However, little is known about the impact on patient outcome of such schemes. This study aimed to assess whether co-financed teams with personnel from primary care, social insurance and social services have any effect on patients' health status. A comparative study of patients attending health care centres with and without a co-financed collaboration model was carried out. Although research has shown positive results from co-financed collaboration on staff and organization, we could not find that this new interdisciplinary team structure gave a better patient health outcome than conventional care.     

Opportunities for nursing-dental collaboration: addressing oral health needs among the elderly

Providing quality oral health care for the growing elderly population is a major challenge, particularly for those residing in long-term care institutions. The Surgeon General's report on oral health in America (2000) noted that elders are at particularly high risk for oral health problems, and poor oral health in seniors has been linked to general systemic health risks such as cardiovascular disease, stroke, poor nutrition, and respiratory infection. This article outlines the need for greater attention to oral health care for the elderly in both nursing education and practice, and describes opportunities for effective inter-professional collaboration between nursing and oral health professionals. It also provides specific recommendations for fostering such collaboration. Working together, nurses and dental professionals can raise awareness of this issue, promote higher standards for oral care, and improve oral health and quality of life for elderly Americans.     

Interprofessional collaboration in the ICU: how to define?*

The intensive care unit (ICU) is a dynamic, complex and, at times, highly stressful work environment that involves ongoing exposure to the complexities of interprofessional team functioning. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings. Evidence suggests effective interprofessional collaboration results in improved outcomes for critically ill patients. One recent study demonstrated a link between low standardized mortality ratios and self-identified levels of collaboration. The aim of this paper is to discuss determinants and complexities of interprofessional collaboration, the evidence supporting its impact on outcomes in the ICU, and interventions designed to foster better interprofessional team functioning. Elements of effective interprofessional collaboration include shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing. In the ICU setting, teams continually alter due to large staff numbers, shift work and staff rotations through the institution. Therefore, the ideal 'unified' team working together to provide better care and improve patient outcomes may be difficult to sustain. Power sharing is one of the most complex aspects of interprofessional collaboration. Ownership of specialized knowledge, technical skills, clinical territory, or even the patient, may produce interprofessional conflict when ownership is not acknowledged. Collaboration by definition implies interdependency as opposed to autonomy. Yet, much nursing literature focuses on achievement of autonomy in clinical decision-making, cited to improve job satisfaction, retention and patient outcomes. Autonomy of health care professionals may be an inappropriate goal when striving to foster interprofessional collaboration. Tools such as checklists, guidelines and protocols are advocated, by some, as ways for nurses to gain influence and autonomy in clinical decision-making. Protocols to guide ICU practices such as sedation and weaning reduce the duration of mechanical ventilation in some studies, while others have failed to demonstrate this advantage. Existing organizational strategies that facilitate effective collaboration between health care professionals may contribute to this lack of effect.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Families' and decision makers' experiences with mental health care reform: the challenge of collaboration

Family-driven collaboration is fundamental to developing a new model of health care and eliminating fragmented services in mental health. The province of Québec (Canada) recently undertook major transformations of its mental health care system. These transformations represent an opportunity to improve collaboration between families and health care practitioners and to understand which factors facilitate this collaboration. This article describes how families and decision makers perceive collaboration in the context of a major transformation of mental health services and identifies the factors that facilitate and hinder family collaboration.     

Concept Analysis of Interdisciplinary Collaboration

PURPOSE. The study aims to explore the meaning of interdisciplinary collaboration within the context of health care. ORGANIZING FRAMEWORK. Rodgers' Evolutionary View of Concept Analysis was employed to identify attributes, antecedents, and consequences of interdisciplinary collaboration. METHODS. Utilizing an inductive approach, a systematic review of the literature was undertaken in August 2007 to clarify the current use of interdisciplinary collaboration in health care. FINDINGS. Interdisciplinary collaboration is commonly described using the terms problem‐focused process, sharing, and working together. The elements that must be in place before interdisciplinary collaboration can be successful are interprofessional education, role awareness, interpersonal relationship skills, deliberate action, and support. Consequences of interdisciplinary collaboration are beneficial for the patient, the organization, and the healthcare provider. CONCLUSIONS. A comprehensive definition of interdisciplinary collaboration within the context of health care is presented as an outcome of this analysis. It is recommended that further inquiry in this area focus on the development of valid measures to accurately evaluate interdisciplinary collaboration in health care.     

Nursing perceptions of collaboration with indigenous healers in Swaziland.

Ethnography implemented through interviews and participant observation was utilized to answer the question: "How do nurses from various health care settings (government, private, mission, industrial and non-governmental organizations) perceive collaboration between indigenous and cosmopolitan health care systems?". Fieldwork took place over a period of 12 months, and 65 nurses were formally interviewed. Religious affiliation and clinical setting may affect perceptions of collaboration. Nurses in mission and private rural practice perceive collaboration positively. Government nurses in rural settings indicate a need for national health policy to structure collaboration efforts, while government nurses in urban settings were ambivalent or expressed negative perceptions. Regardless of perceptions, all modes of collaboration expressed by nurses served to further the goals of cosmopolitan health care. Utilizing rural health motivators as culture brokers was suggested to enhance collaboration between indigenous and cosmopolitan health care systems.     

Interprofessional collaboration in palliative nursing: what is the patient-family role?

Interprofessional collaboration occurs when health professionals from different disciplines work together to identify needs, solve problems, make joint decisions on how best to proceed, and evaluate outcomes collectively. Interprofessional collaboration supports patient-centred care and takes place through teamwork. Team interactions, wider organizational issues, and environmental structures, such as safety, quality, efficiency and effectiveness issues influence this model of care. These broader contextual influences affect practice where there are tensions between the ideals of interprofessional collaboration and the realities of practice. This is evident when the patient and family position in interprofessional collaboration is considered. This article will discuss factors that affect interprofessional collaboration in relation to patients and families in palliative care. First, a definition of interprofessional collaboration is given, followed by an outline of the need for interprofessional collaboration. A brief discussion of key issues that influence collaboration follows, and a review of the implications for practice is presented.     

Models of collaboration.

For primary care clinicians to address the complex needs of their patient population, they must be able to collaborate with mental health professionals. Collaborative health care represents the creation of a new health care paradigm, and collaborative health care delivery systems mirror the complexities of human suffering. Clinicians from multiple disciplines can combine resources and strategies to share responsibility for their patients and with their patients. A brief review of the history of mind/body split and the resulting professional separatism is followed by sections on the spirit of collaboration, the spectrum of collaboration, key ingredients for effective collaboration, and some thoughts about the future of collaboration. A special practical section on getting started and following through is included.     

Service collaboration and hospital cost performance: direct and moderating effects

BACKGROUND: Growing reliance on service provision through systems and networks creates the need to better understand the nature of the relationship between service collaboration and hospital performance and the conditions that affect this relationship. OBJECTIVE: We examine 1) the effects of service provision through health systems and health networks on hospital cost performance and 2) the moderating effects of market conditions and service differentiation on the collaboration-cost relationship. RESEARCH DESIGN: We used moderated regression analysis to test the direct and moderating effects. Data on 1368 private hospitals came from the 1998 AHA Annual Survey, Medicare Cost Reports, and Solucient. MEASURES: Service collaboration was measured as the proportion of hospital services provided at the system level and at the network level. Market conditions were measured by the levels of managed care penetration and competition in the hospital's market. RESULTS: The proportion of hospital services provided at the system level had a negative relationship with hospital cost. The relationship was curvilinear for network use. Degree of managed care penetration moderated the relationship between network-based collaboration and hospital cost. CONCLUSION: The benefits of service collaboration through systems and networks, as measured by reduced cost, depend on degree of collaboration rather than mere membership. In loosely structured collaborations such as networks, costs reduce initially but increase later as the extent of collaboration increases. The effect of network-based collaboration is also tempered by managed care penetration. These effects are not seen in more tightly integrated forms such as systems.     

Communication styles that promote perceptions of collaboration, quality, and nurse satisfaction

Interdisciplinary collaboration has been identified as an essential element of quality health care. Often, however, the degree of interdisciplinary collaboration in health care settings is limited. This failure to collaborate is usually not due to ill intent, but rather to a lack of collaboration skills. This article notes the need for very tangible, behaviorally specific ways to describe collaboration. Norton's Theory of Communicator Styles was used as a framework to identify the effect of three specific communication behaviors (styles)--namely, dominant, contentious, and attentive styles--on nurses' perceptions of collaboration, quality of care, or satisfaction with the interaction. Suggestions for teaching these three styles to health care professionals are provided.     

A study of collaboration inpatient treatment between the community psychiatric health services and a psychiatric hospital in Norway

The aim of this study was to examine factors that may have an influence on the collaboration between the health-care professionals in a psychiatric hospital and two communities' psychiatric health service departments. Interviews were conducted with three psychiatric nurses, one medical practitioner, one health and social manager and one cultural worker; thus a total of nine informants. The transcribed interview texts were analysed by means of qualitative content analysis. The main results showed that the community psychiatric nurses felt a need for more systematic interdisciplinary collaboration. The existing collaboration was characterized by ad hoc meetings. In addition, the need for information about their colleagues' professional competence was reported. The respondents called for a more regular forum for professional guidance and coordination in relation to particular client cases in order to improve the quality of psychiatric care. There was also a need for collaboration within community health care and a link to psychiatric hospital care in order to better evaluate the outcomes of care provided. In conclusion, the lack of continuity in the collaboration between health-care professionals may affect the quality of community health services because continuity is a vital component of care.     

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

Traditional medicine is used in both isolated rural areas as well as where allopathic medicine is easily available. Medical pluralism, the use of more than one health care resource, appears a universal phenomenon. ‘Traditional medicine’ can not be thought of as a unified entity but is used to describe a whole range of healing practices, however, substantial evidence exists testifying to the efficacy of much of such different practices, albeit iatrogenesis is a concern relevant to traditional as well as allopathic health care. It is proposed that collaboration between allopathic and traditional medicine (which is encouraged as part of the primary health care approach) is important not only because of the efficacy and wide use of traditional medicine, but also for its potential of improving both allopathic and traditional practice toward the ultimate purpose of improving health by developing a more holistic approach to health care. Some obstacles to the possibilities for collaboration as well as for the implementation of primary health care are mentioned.     

Nursing assistants matters—An ethnographic study of knowledge sharing in interprofessional practice

Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants’ knowledge can be shared in a team on a spinal cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural–discursive, material–economic, and social–political arrangements enabled possibilities through which nursing assistants’ knowledge informed other practices, and others’ knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team.     

Meta-analysis of the Cochrane Collaboration. Promoting collaboration between nurses and physicians

The aim of this systematic review of the Cochrane Collaboration was to assess the impact of interventions designed to change nurse-doctor collaboration on collaboration itself, on patient satisfaction, and on the effectiveness and efficiency of the health care provided. There are no good trials on interventions to improve collaboration between doctors and nurses. There are numerous strategies suggested to improve inter-disciplinary collaboration between doctors and nurses, such as joint workshops, meetings, development of team systems and strategies, and training in collaboration. However, no studies of these interventions that met the reviewers' criteria could be found. More research is needed to determine any impact of these strategies on interprofessional collaboration, and on the outcomes for patients.     

Cardiovascular Health Promotion and Consumers with Mental Illness in Australia

People with serious mental illness (SMI) have increased risk of cardiovascular disease and premature death, yet research on nurse-provided health promotion in mental health services remains under-developed. This paper informs efforts to improve the nursing role in physical health of consumers with SMI by establishing what nurse perceptions and background influence their care. Members of the Australian College of Mental Health Nursing were invited to participate in an online survey on their views on physical health care in mental health services. Survey questions included: (a) nurse–consumer collaboration in preventative care and (b) sub-sections of the Robson and Haddad Physical Health Attitude Scale to measure nurse perceived barriers to encouraging lifestyle change of consumers with SMI and frequency of nurse physical healthcare practices. Structural equation modelling was applied to investigate antecedents to physical health care, as well as relationships between antecedents. A national sample of 643 nurses reported regular engagement in health promotion (e.g. advice on diet). There was statistical support for a model depicting perceived consumer–nurse collaboration as a dual-determinant of nurse perceived barriers and self-reported health promotion to consumers with SMI. Perceived barriers to consumer lifestyle change did not predict health promotion. The effects of nurse–consumer collaboration were significant, but small. Perceived consumer–nurse collaboration in preventative care may positively influence the amount of health promotion by nurses in mental health. Perceived barriers to consumer adherence with a healthy lifestyle did not have an impact on nurse-delivered health promotion.     

Community care policy and end-of-life care: one patient's story

This article examines the effect of community care policy on the care of a young woman with a terminal illness from a minority ethnic group. Current NHS policy advocates collaboration between health and social care agencies to provide a seamless service for patients. The article considers aspects of interagency and interprofessional collaboration, teamwork and patient empowerment and analyses how beneficial these factors were in a patient's care. It also examines the concept of health promotion within the sphere of palliative care.