Collaborative Nursing – A Review

 

Dr. V. Indra

Academic Head, SON, Texila American University, Coimbatore, India

 

ABSTRACT:

Collaboration is a substantive idea repeatedly discussed in health care circles. The benefits are well validated. Yet collaboration is seldom practiced. The lack of a shared definition is one barrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are formidable. Much of the literature on collaboration describes what it should look like as an outcome, but little is written describing how to approach the developmental process of collaboration. In an attempt to remedy the all too familiar riddle of matching ends with means, this article offers key lessons to bridge the discourse on collaboration with the practice of collaboration. These lessons can benefit clinical nurse managers and all nurses who operate in an organizational setting that requires complex problem solving.

 

 

INTRODUCTION:

Collaborative care is a healthcare model which aims to improve patient outcomes through inter-professional cooperation. This will commonly include a primary or tertiary care team working with allied health professionals – such as dieticians, physiotherapists or mental health professionals – or medical specialists [1].

 

Effective collaboration encourages patients, families and healthcare providers to be active participants in the treatment process which in turn promotes improved quality outcomes, improvements in patient experience, patient safety, and effective use of resources [1].

 

Some of the hallmarks of collaborative care involve prioritising patients, commitments from those in leadership positions to ensure inter-professional collaboration, effective communication across the team, and contributions from practitioners who are all equally and highly experienced.

 

People and animals have always had a special relationship. In primitive societies, animals provided some degree of warmth and safety. Today, animals are not only pets that provide social support but also working companions for people with physical and mental challenges [2].

 

The Role of Nurses in Collaborative Care:

Nurses are the only clinical professionals who are specially trained to understand the roles of other healthcare providers, this training provides a strong foundation for successful collaboration. Effective communication is critical for a collaborative care plan to work; nurses are trained to have adaptability, empathy, and communication skills, which allows for them to be excellent leaders and members of a care team [3].

 

Nurses ability to understand and assess a patient’s clinical, emotional, and social needs can help them to call upon available resources and create a patient-focused care plan. As nurses are offering direct patient care around the clock, they have a unique and focused view of how that care should be provided. Nurses can be role models in their honest and open communication with team members about the quality of patient care which is being provided and the work environment [4].

 

Case Study:

The Transitional Care Unit (TCU) is an 18-bed high-acuity, bedside telemetry, step-down unit with an open admission structure. The TCU cares for a diverse surgical and medical patient population. The surgical population includes patients with multisystem trauma, complex surgical issues, and kidney transplants. The medical population includes patients needing acute and chronic mechanical ventilator management, those experiencing hemodynamic and respiratory instability, those requiring sepsis management, and patients in acute alcohol withdrawal. The patient-to-nurse ratio was generally 2:1 or 3:1 before the implementation of team nursing, and this ratio was unchanged after the implementation of team nursing [5].

 

The concept of the team nursing model was first considered for implementation in the TCU due to turnover, an influx of new nurse hires, an increase in patient acuity, fluctuating staffing needs, and a decrease in both staff morale and satisfaction. The need to implement team nursing in the TCU was determined by staff feedback and a high recruit of novice nurses [5].

 

Team Nursing:

The team nursing model of care involves pairing nurses who work as a team to deliver patient care. This model utilizes the diversity of skills, education, and qualification level of the entire staff. Team members work collaboratively and share responsibility. Nurse satisfaction is increased when team nursing is used because nurses feel supported, the environment is collaborative, and staff communication improves. Research shows that team nursing can improve quality and patient safety [6].

 

The concept of team nursing was developed in the 1950s in response to changes in nursing skill mix. According to Fernandez et al., numerous patient-care facilities that had adopted a team nursing model for patient care reported improved levels of communication and significant increases in job satisfaction and staff morale.⁶ Because our skill mix included novice nurses, the need for support and mentoring of less experienced RNs was identified. Research revealed team nursing provided an increased level of support for less experienced staff, improving their confidence in providing nursing care [6].

 

Initial Steps in Collaborative Nursing:

The results of a baseline survey to evaluate staff satisfaction and morale indicated staff members were dissatisfied because of a lack of teamwork and support from peers in patient care. Believing that poor nurse satisfaction is related to undesirable patient outcomes and decreased quality of care, the authors of this article, who were the key stakeholders, decided that a team nursing model of care would be implemented. After the start of team nursing, patients received care from two nurses per shift rather than one. This also created continuous nursing coverage [6].

 

Planning for changing the unit practices included educating staff individually, in staff meeting presentations, and via electronic communication. All staff received instruction in pairing novice and seasoned nurses to care for a four- to six-patient assignment according to guidelines, responsibilities of the charge nurse and the paired team members, and modification of the patient handoff process [7].

 

On each shift, the charge nurse's responsibility was to pair nurses appropriately based on patient acuity and create balanced assignments. Teams conducted patient handoff together and collaborated throughout the shift to accomplish tasks and provide coverage when either member was off the unit [7].

 

The chief stakeholders conducted a brief trial of team nursing over a 24-hour period before rollout. No barriers were identified that would prevent a timely implementation. Team nursing in TCU was then launched for a trial period of 90 days. Ongoing evaluation included monthly staff surveys to elicit feedback and monitor the level of morale while identifying barriers [7].

 

Evaluating Results:

The original goal of increasing staff satisfaction and continuity of care by 10% was surpassed. Results of the monthly staff surveys indicated an 88% compliance rate in participation in the team nursing approach. Pre-implementation survey results indicated 61% of staff felt supported during their shift. In contrast, post-implementation survey results showed that 72% of staff felt supported, an 11% increase [8].

 

Pre-implementation survey results also indicated 38% of staff felt they were held accountable by their peers; post-implementation survey results illustrated that 58% of staff felt they were held accountable. In addition, the staff's perception of continuity of care increased by over 45% throughout the course of the project [8].

 

After initiating team nursing, an incidental finding of zero falls over a 3-month period was noted. In contrast, five falls occurred in fiscal year 2015. TCU also achieved a Tier 1 rating on the Press Ganey employee engagement survey during the same period, the highest rating a nursing unit can achieve, reflecting an engaged, patient-centered culture [8].

 

 

Advantages accrue:

Benefits of team nursing observed in the TCU included increased staff satisfaction rates, improved morale, and increased patient safety. With the initiation of team nursing, many encouraging examples of the positive effects team nursing can provide were observed [9].

 

For example, a novice nurse was paired with a highly regarded, experienced nurse. The team was assigned to a high-acuity, complex patient. The experienced nurse assisted the novice nurse when her expertise was sought and also when she observed the need for her assistance. After the shift was complete, the novice nurse was thankful to have been teamed with such a knowledgeable and experienced nurse. She stated she felt supported during her shift and took away prioritization and organization skills while enhancing her assessment and critical thinking skills [9].

 

The only complaints reported were prolonged patient handoff time and incidental overtime; both were resolved. The patient handoff routine reverted to being done individually rather than as a team, which eliminated incidental overtime. Consistent nursing coverage provided a heightened level of safety and support [9].

 

Team Nursing a win:

The TCU has experienced a culture change secondary to the implementation of team nursing. The charge nurse is now more readily available to assist on the unit rather than assigning meal times, covering patient assignments, or at times, transferring patients off the unit [9].

 

One lesson learned was that the model can easily be adapted to meet the needs of the nursing staff and patients, and unit demands. Based on feedback received from staff, team nursing was adapted to meet the needs of our unit and has become the standard of care. Team nursing is a universal model of care that can be easily assimilated into any nursing unit's routines [9].

 

The Benefits of Collaborative Nursing:

The ‘Ways of Working In Nursing, Resource Package’ outlines the following ways in which collaborative nursing can be beneficial for nurses [9],

·       Allows nurses from various backgrounds and levels of expertise to perform their duties effectively

·       Ensures that temporary staff and ‘transitioning to practice’ nurses have improved supervision by senior nursing staff

·       Takes advantage of knowledge and experience of each team members, which also leads to professional development and increased knowledge for junior staff

·       Reduction in staff isolation and a more supportive working environment

·       Patient outcomes and satisfaction is improved

·       Individual team members can familiarize themselves with each other’s skills and capacities

·       Significantly reduced risk of missed care (any patient care which is omitted or delayed)

·       The workload is shared which can reduce nurse stress levels and potential manual handling injuries

·       Increased job satisfaction and morale

·       Nursing duties are made easier if team members are working together in a close environment and can assist and support one another

 

Collaborative care has proven to be highly beneficial for nurses, patients and overall performance of healthcare teams by increasing patient safety and also providing nurses with valuable healthcare experience and insight. Such outcomes can only suggest that the use of collaborative healthcare teams will increase in numbers across hospitals around the country to provide optimal services to patients in the future [9].

 

CONCLUSION:

This section concludes the article on a review of collaborative nursing.

 

REFERENCES:

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2.      Lofmark, A., Smide, B., & Wikblad, K. (2006). Competence of newly-graduated nurses-A comparison of the perceptions of qualified nurses and students. Journal of Advanced Nursing. 53(6): 721-728.

3.      Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New graduate nurse residency program: A cost-benefit analysis based on turnover and contract labor usage. Nursing Economic$. 30(4): 207-214.

4.      Trossman, S. (2015). Collaboration is key: Nurse Experts discuss challenges, pose solutions. The American Nurse. 47(5): 8-9.

5.      Steen, J., Gould, E. W., Rain Gruber, B., & Hill, J. (2011). Effect of student nurse intern position on ease of transition from student nurse to registered nurse. Journal for Nurses in Staff Development. 27(4): 181-186.

6.      Sullivan, M., Kiovsky, R. D., Mason, D. J., Hill, C. D., & Dukes, C. (2015). Inter-professional collaboration and education: working together to ensure excellence in health care. American Journal of Nursing. 115(3): 47-54.

7.      Culley, T., Babbie, A., Clancey, J., Clouse, K., Hines, R., Kraynec, M., Wittmann, S. (2012). Nursing U: A new concept for nursing education. Nursing Management. 43(3):45-47.

8.      Dreyfus, S.E. (1982). Formal models vs. human situational understanding: Inherent limitations on the modelling of business expertise. Office Technology and People. 1(2/3): 133-165.

9.      Folan, P., DeCain Tarraza, M., Delaney, M., Fardellone, C., Leners, C., Ross, E., & Fitzpatrick, J. J. (2012). Leadership initiatives to disseminate the Institute of Medicine’s Future of Nursing report. Policy, Politics, & Nursing Practice. 13(1): 38-44.

 

 

 

 

 

Received on 25.02.2019          Modified on 16.04.2019

Accepted on 31.05.2019     © A&V Publications all right reserved