Introduction




 



As pediatric nurse practitioners, our task is to
provide health care to infants and children. This is a big responsibility with
difficult tasks that come with it. However, in a certain situation at work, this
has not been the big problem that confronts us. Rather, the problem lies with a
person and how she works with us. There is a registered nurse in my pediatric
ward inside the private hospital where I work. This nurse always works for her
own interest and seems to think that all she does is right and thus she puts the
blame on the other colleagues. Even though she is the In-Charge nurse, she only
likes to stay with the medicine trolley and distribute medicine to the patients
but all the ward responsibility and problems will lay on the junior RN, EN and
HCA, so she could stay in a complain free situation all the time. Most of the
staffs feel very frustrated and do not like to work with her, but since the
hospital lacks ‘experienced’ RN for IC, we, the staff needs to bear with her
working attitude




 




What Is Collaborative Practice?



 



            Collaborative practice is the
application of interventions and therapies that require the knowledge, skill,
and expertise of multiple health professionals (Potter & Perry, 2004).
Collaborative practice and its interventions require critical thinking and
decision making. When encountering collaborative interventions, the nurse does
not automatically implement the therapy but determine whether it is appropriate
for the patient. Every nurse faces an inappropriate or incorrect order at some
time. The nurse with a strong knowledge base recognizes the errors and seeks to
correct it.



            Through collaborative practice, the
nurse along with other health care professionals taps the best resources to
individualize nursing interventions. During collaboration, the nurse includes
the patient, family, and members of the health care team. In addition, the nurse
also reviews previous clinical experiences and priorities to select nursing
interventions that have the best potential for achieving the expected outcomes.
With the contributed experience of every member in collaborative practice,
health care interventions and processes become more efficient and experience
based.



In order that patients become beneficiaries of
optimum health care interventions there is therefore a need for
multi-disciplinary collaboration between clinicians and other health care
providers. The foundation of this collaboration is education. Clinicians,
patients, administrators and politicians need access to the new concepts of pain
and its management in order to start realizing this goal (Lumby & Piccone,
2000).



Shared leadership is a collaborative
team process in which team members share key leadership roles (Storey, 2004).
Shared
leadership
is empowering employees to act autonomously, be decisive at the
point-of-service, and create a
shared

vision aligned with organizational goals.
Shared

leadership
development and autonomously practicing
nurses

appear to be the equation for success in delivering quality patient outcomes in
today’s organized health care delivery systems. Employees must develop or refine
new behaviors and skills in empowerment, facilitation, negotiation, systems
thinking, and accountability on behalf of patients (George, et al, 2002).



Shared leadership is a way to
strengthen continuous learning and enhance
relationships between
leaders/managers, health care staff and patients,
which are the
foundation upon which the nurses can develop a new type of relationship with
management and with each other. This in turn could significantly improve the
work environment. There is an emphasis on ‘relationships’ since these
relationships

can be tenuous at times as both managers and staff members adopt attitudes of
contention and competition with each other.



 




What Is Happening Now?



 



            According to Mullins (2002),
customer satisfaction, workforce quality, and of course, the rickety economic
conditions are the areas that need to be improved. It is believed that Mullins’
(2002) account has a bearing on the nursing profession in direct or indirect
ways. It may resonate clinical governance, but it is related with collaborative
practice. The subsequent paragraphs are about to extract the main point of the
essay – the need for a collaborative practice within health institutions.



According to Mullins (2002), the reason behind
is the inability to handle stress and an unsupportive management. To illustrate
further, a very experienced Registered Nurse (RN) is being replaced by a health
care assistant, who had a minimal nursing training. Unfortunately, HA has not
required technical experience to replace operation room nurse. As a result,
there is fewer and fewer experienced, trained and skilled staff in a team. This
leads to many difficulties in a team working together.



When all team members are relatively
inexperienced, it is believed that they are prone to errors. In effect, Mullins’
(2002) findings can be considered accurate. Being prone to errors further
implicates that the hospital is not delivering quality health care
services. Aside from that, among the health care providers themselves, low
morale and stress emerge as a consequence of work overload especially to
existing staff. The existing staff is burdened with heightened responsibilities,
cannot communicate pleasantly, and collaborate with fellow colleagues. Adding up
all these things, it only becomes a losing situation for everyone.




 




Organizational Change



 



            Organizations are shaped
by their culture, which include assumptions, values, norms,
organization

members, and their behaviors. They are also shaped by characteristics, which
include strategies, technologies, structures, and processes. Where there are
people and technologies, there are organizations. There are four key elements
that define
organization:
(a) people and their roles within the
organization;

(b) the purpose of the
organization;

(c) the work activities; and (d) a person’s working relationship with the
organization
(Spohn, 2005). Everyday our lives are touched by some element of
an organization,
whether it is a visit to the doctor, a board meeting, or forming alliances on an
uninhabited island.



Organizations as structures of
action have approaches which focus on the circumstances determining the actions
of individuals in organizations. A great deal of
organization

theory
has been criticized for its normative (in this case pro-managerial) bias; for
its individualistic analysis of the members of organizations (that is, for being
more informed by psychological, than by sociological perspectives); and for
embodying an inadequate analysis of how wider relations of power and control in
society affect and are affected by organizations (in other words for
concentrating mainly on the internal exercise of managerial authority and
attempts to subvert it) (Marshall, 1998).



The world that
organization

theory seeks to analyze and describe has changed in some important
ways. Four of the more significant changes are (a) the increasing
externalization of the employment relation and the development of the “new
employment contract,” (b) a change in the size
distribution of organizations, with a comparative growth in the proportion of
smaller organizations, (c) the increasing influence of external capital markets
on organizational governance and decision making, and (d) increasing salary
inequality within organizations in the United States, compared both to the past
and to other industrialized nations (Pfeffer, 1997).



When a health care organization is not
practicing collaboration, an organizational change is needed. Collaborative
practice needs to be the norm within the health care institution. It is
suggested that health care institutions have to be one of a task culture
and role culture too. The former contemplates on completing the job
instead of looking at the ways to do it, which refers to the latter. Task
cultures require “speed of reaction”, flexibility, creativity and teamwork,
while role culture places a premium on the rules, hierarchy, authority, etc. of
the organization (Handy 1986, cited in Adeyoyin 2006).




 




Barriers to Collaboration: Conflict within Team




 



            We cannot expect people
to leave their evolved behavior at the door when they enter any environment;
gossip, dominance, harassment, and status seeking behaviors permeate
organizations and create conflict, intimidation, and jealousy. These behaviors
cannot be eliminated, but they can be understood and considered when creating
organizational policy. When considering one’s position in an
organization,

it is advantageous to be socially intelligent, which can be thought of as being
skilled at social networking, knowing whom to trust, and being able to form
powerful relationships. Such can be an element in a health care organization or
team.



Consider the differences in the power structure
of a health care organization, even in health care teams. In any given health
care system, there is a pecking order wherein everyone has a clear place. Each
person has a position that may give him or her authority over others, but they
must be accountable to those higher in the power structure. In a group therapy
environment, all participants are equal. They all have thoughts and experiences
to relate, and the intent is to have a situation wherein everyone benefits
mutually from the sharing of thoughts and experiences offered by each member
(Fisher, 2004). From such a hierarchy alone, it is inevitable that there might
be a clash of views that might cause conflicts within a team.



Rahim (2001) recognizes a duality of outcome
behind conflict wherein, it is either functional or dysfunctional. In essence,
that of which brings positive feedbacks such as innovations within the
organization in various aspects or improvement of decision-making, and
individual or group performances fall under the functional outcome of conflict.
On the other end, job stress and dissatisfaction, decreased exchange of
verbal/non-verbal interaction, poor job performances, a pronounced opposition to
change, organizational members in distrust, and low commitment to the
organization are the manifestations of conflict’s dysfunctional outcome (p. 7). 
This only leads us to the significant idea that conflict is not a concept to be
feared, for it is not negative at all times.  It actually contributes to the
good of the organization too. 



If conflicts occur within teams, it is important
that the group resolve it. Managing teams begins with creating a positive team
environment in which team members envision and understand what proper conduct
includes. Establishing clear, realistic expectations of acceptable behavior
provides purpose and direction for instilling and maintaining discipline. If the
members of the health care team are involved in making these decisions, they
will be even more likely to conform to team standards (Copeland & Wida, 1996).



Effective communication is the foundation for
managing most team problems and conflicts. Negative attitudes related to
jealousy, resentment, or distrust may be avoided or minimized through the
establishing an effective communication system, which shall be discussed in the
next part.



 




Barriers to Collaboration: Ineffective
Communication





            Communication is a
lifelong learning process for the nurse (Potter & Perry, 2004. p. 424). Nurses
make the intimate journey with patients and their families from the miracle of
birth to the mystery of death. It is necessary to build therapeutic
communications for this journey.



Nurses communicate with other people even under
stress: patients, families, and colleagues. Nurses function as patient advocates
and as members of interdisciplinary teams in a collaborative practice. They may
have different ideas about priorities for care, but they would still collaborate
to make the best intervention for a patient.



In addition, within a collaborative practice,
nurses must be assertive to ask the right questions and make their voices heard.
Being assertive to communicate one’s own needs endures balance in a nurse’s
life. Without such balance and communication, the high-stress environment may
contribute to burnout and diminish the nurse’s effectiveness.



Despite the complexity of technology and the
multiple demands on nurses’ time, it is the intimate moment of connection that
is happening in communication that makes all the difference in the quality of
care and meaning for the patient and the nurse. Here we see that communication
is essential not only between nurses and other health care professionals but
also between nurses and their patients.



Nurses interact with many individuals in the
course of their profession. Competency in communication helps the nurse maintain
effective relationships within the entire sphere of professional practice and
helps meet legal, ethical, and clinical standards of care. Failure to
effectively communicate causes serious difficulty, increases liability, and
threatens professional credibility (Potter & Perry, 2004).



In collaborative health care teams, the
dimensions of communication most often discussed relate to issues involving
personality clashes, role overlap and conflict, and the effective use and
sharing of clinically important information. Absent is an examination of
underlying problems with communication based on the professional differences
among health care providers, including how they acquired particular values over
the course of their education and subsequent clinical work experience. These
values are related to their orientations both to the patient and toward each
other (Clark & Drinka, 2000).



To summarize, effective teamwork requires good
communication. Frustrated team members often express concerns about its quality
and extent. As in any relationship between people, the ability to “keep the
lines of communication open” in a collaborative health care team is an important
indicator of effective teamwork skills.



 




Team building




 



            Collaboration requires the efforts
of a health care team. A health care team usually consists of a nurse,
physician, nurse practitioner, and social worker. Such teams usually operate in
a primary care clinic in the inner core of a large city. Like most primary care
clinics, its patients are a mix of relatively healthy individuals and the
walking wounded (Clark & Drinka, 2000).



Features of effective teams are cooperative
management and mentoring of all members of the care team. Multi-disciplinary
health care organizations provide a rich environment for collaborative research,
teaching and clinical practice (Lumby & Piccone, 2000).



Similarly, continuing education opportunities
can be provided in support of currently practicing professionals wanting more
training in teamwork and collaborative skills. This could take the form of
general workshops on the knowledge and skills necessary for effective
team-building, as well as more individualized team development and process
consultation. In most cases, currently practicing professionals have little
background or training in teamwork, yet they are often thrust into situations
where they are expected to work as part of a collaborative health care team
(Clark & Drinka, 2000).



            The table below outlines how
problems can be solved through collaborative practice:



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Yes                                                                 No



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                                                            Yes                
No



ê                                                        
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Conclusion


 



A collaborative practice among health care
providers or professionals should be the institution’s guiding framework. Health
care providers, e.g. physicians, therapists, etc. and health care assistants
alike should deliver health care service to their clients hand in hand among
each other. They have to work together as a united team. Conflicts are
inevitable, but these can be fixed through recognition of each other’s
status/identities, and of course, effective communication. Apart from effective
communication, there has to be mutuality among them, and eventually trust. When
health care providers trust and consult each other’s views in making decisions
to a certain problem, then they are said to be in a collaborative practice. 



 




References



Clark, P.G. & Drinka, T.J.K. 2000.
Health Care Teamwork: Interdisciplinary



Practice and Teaching.
Auburn House.



Copeland, B.W. & Wida, K. 1996.
Resolving Team Conflict. The Journal of



Physical Education, Recreation &
Dance.



Fisher, E.A. 2004. The Art Of
Managing Everyday Conflict: Understanding



Emotions and Power Struggles.
Praeger Publishers.



George, V., Burke, L.J., Rodgers, B.
& Duthie, N. 2002. Developing Staff Nurse



Shared Leadership Behavior in
Professional Nursing Practice. Nursing Administration Quarterly.




Hospital Authority. 2003. ‘Annual Report of Hospital Authority (2002-2003)’,




            Hong Kong


Hospital Authority. 2004. ‘Annual Report of Hospital Authority (2003-2004)’,




            Hong Kong



Kozier, B, Erb, G, Berman, A, & Snyder, S. 2004.
Fundamentals of Nursing:



            Concepts, Processes, & Practice,
7th ed., Pearson, Singapore. 



Lumby, J. & Piccone, D. 2000. Clinical
Challenges: Focus on Nursing. Allen &



Unwin.



Marshall, G. 1998. Organization
Theory, A Dictionary of Sociology, Oxford



University Press.



Mullins, L.J. 1991. Management and
Organization Behaviour, 2nd ed. Pitman



            Publishing, London



Mullins, L.J. 2002. Management and
Organizational Behaviour, 6th ed.,



Financial Times Pitman Publishing, Harlow.



Mullins, L.J. 2005. Management and
Organizational Behaviour, 7th ed., Financial



Times Pitman Publishing, Harlow.



Potter, P. and Perry, A. 2004. Fundamentals
of Nursing. Mosby, Singapore.



Rahim, MA 2001. Managing Conflict in
Organizations, Quorum Books,



Westport, CT.



Spohn, M. 2005. Organization and
Leadership Theory: An Evolutionary



Psychology Perspective. Journal
of Evolutionary Psychology.



Storey, J. 2004. Leadership in
Organizations: Current Issues and Key Trends.



Routledge.


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