ADVANCED NURSING PRACTICE

A SEMINAR ON
TRANSCULTURAL
NURSING

SUBMITTED TO, SUBMITTED BY,

PROF.V.MARY ELIZABETH MS.RIYA PHILIPOSE
PRINCIPAL I YEAR M.Sc(N)
VIJAYA COLLEGE OF NURSING VIJAYA COLLEGE OF
KOTTARAKARA NURSING
KOTTARAKARA

SUBMITTED ON, 11/7/19

 VIJAYA COLLEGE OF NURSING

COURSE- I YEAR M.Sc (N)

SUBJECT- ADVANCED NURSING PRACTICE

TOPIC- TRANSCULTURAL NURSING

UNIT- X
NURSING PRACTICE

NAME OF THE STUDENT-MS.RIYA PHILIPOSE

NAME OF THE HOD-MRS. RAJI RAJU
NAME OF THE EVALUATOR-PROF. V. MARY
ELIZABETH
HOURS ALLOTTED- 1 HOUR
SUBMITTED TO- PROF.V. MARY ELIZABETH
DATE OF SUBMISSION- 9/7/19
 INDEX
SL.NO CONTENT PAGE NUMBER

I INTRODUCTION

II. DEFINITION OF TRANSCULTURAL

NURSING
III GOAL OF TRANSCULTURAL NURSING

IV HISTORICAL PERSPECTIVES

V CHANGING CONCEPT OF
TRANSCULTURAL NURSING
VI IMPORTANCE OF TRANSCULTURAL
NURSING
VII PROCESS INVOLVED IN CULTURAL
COMPETENT CARE
VIII CULTURAL ASSESSMENT

IX CULTURAL CARE THEORY BY

LEININGER
X CULTURAL PERSPECTIVE OF PAIN

XI NURSES ROLE

XII APPLICATION IN NURSING FIELD

XIII FUTURE OF TRANSCULTURAL

NURSING
XIV NURSING PROCESS OF A CULTURALLY
DIVERSE PATIENT
XV SUMMARY

XVI ABSTRACT

XVII CONCLUSION

XVIII BIBLIOGRAPHY
 COLLABORATION MODELS IN
NURSING

INTRODUCTION
Collaboration is a process in which two or more individuals work together jointly
influencing one another, for the attainment of a goal. The word collaboration
implies working together for the greater good, but it actually encompasses far more.
Several preconditions must be in place for collaboration to be successful.
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. The value system among the participants must be similar. Successful
collaborative nursing practice and collaborative healthcare practice need to
encompass all of these conditions. Collaboration 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. A multidisciplinary
plan of care should be decided by all of the team members. Individual disciplines
must be willing to work together, have the same objectives and goals, and provide a
plan of care which is individualized to the patients need. A multidisciplinary
approach to care sounds simple in theory, but collaboration of different skill levels
and expertise has its problems.

I. MEANING OF COLLABORATION
The word collaboration, namely co and labor are, 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, 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 synthesis different perspectives to
better understand complex problems. An effective collaboration is characterized by
building and sustaining “win –win-win” relationships.
 II. DEFINITION OF COLLABORATION
“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.”

(Heinemann et al)

“Collaboration is the most formal inter organizational relationship involving

shared authority and responsibility for planning, implementation, and evaluation of
a joint effort.”
(Horde, 1986)
“Collaboration as a …. A mutually beneficial and well defined relationship entered
into by two or more organization to achieve common goal”
(Mattessich, Murray and Monsey 2001)
III. OBJECTIVES OF COLLABORATION

1. To seek creative, integrated solution where need and goal of both the sides
are important commitment and consensual decision.
The collaboration is a working practice whereby individuals work together
with a common purpose to achieve a common goal. The collaboration helps
in taking appropriate decisions. Sharing different ideas and the
brainstorming sessions fosters critical thinking and helps in making well-
defined solutions for a problem.
2. To identify, share and merge vastly different viewpoints.
Collaboration provides every team member with equal opportunities to
participate and communicate their ideas. It generates dynamic, innovative
ideas.
3. To develop individual skill and confidence.
Collaboration is mutually beneficial for the employees as well as the
organization because when they work together, interact and share ideas, they
see and understand how other’s work, think, negotiate and operate their
ideas.
4. 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 healthcare 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 customers. Effective
communication skills are critical to successful consultation and
collaboration.
IV. NEED FOR COLLABORATION
Considerable progress has been made in nursing and midwifery over the past
several decades, especially in the area of education. Countries have either
developed new, or strengthened and re-oriented the existing nursing educational
programmes in order to ensure that the graduates have the essential competence
to make effective contributions in improving people’s health and quality of life.
As a result nursing education has made rapid qualitative advances. However,
the expected comparable improvements in the quality of nursing service have
not taken place as rapidly.

 Reduce gap between nursing education and nursing services.

The gap between nursing practice and education has its historical roots in the
separation of nursing schools from the control of hospitals to which they
were attached. At the time when schools of nursing were operated by
hospitals, it was students who are largely staffed the wards and learned the
practice of nursing under the guidance of the nursing staff. The creation of
separate institutions for nursing education with independent administrative
structures, budget and staff was therefore considered necessary in order to
provide an effective educational environment towards enhancing students
learning experiences and laying the foundation for further educational
development.

 Graduate nurses often lack practical skills despite their significant

knowledge of nursing process and theory.
Advanced education imparts knowledge. But, it has also had adverse effects.
The nurse educators are no longer practicing nursing in the wards. As a
result they are not delivering quality nursing care services directly to the
people. Also their practical skill gets reduced. Theory with practice increases
our knowledge, critical thinking etc. The practicing nurses have little
opportunity to share their practical knowledge with students due to their
busy work. As the gap between education and practice has widened, there
are now significant differences between what is taught in the class room and
what is practiced in the service settings.

 Collaboration is a very essential component in nursing.

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 helps to improve patient outcome.
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.

V. TYPES OF COLLABORATION
INTERDISCIPLINARY

MULTIDISCIPLINARY TRANSDISCIPLINARY

INTERPROFESSIONAL

1. Interdisciplinary collaboration
Interdisciplinary is the term used to indicate the combining of two or more
disciplines, professions, departments etc. usually in regard to practice,
research, education and/ or theory.
2. Multidisciplinary collaboration
Multidisciplinary refers to independent work and decision making such as
when disciplines work side-by-side on a problem. The interdisciplinary
process, according to Garner (1995) and Hoeman (1996), expands the
multidisciplinary team process through collaborative communication rather
than shared communication.
3. Transdisciplinary collaboration
Transdisciplinary efforts involve multiple disciplines sharing together their
knowledge and skills across traditional disciplinary boundaries in
accomplishing tasks or goals (Hoeman, 1996). Transdisciplinary efforts
reflect 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 problem.
4. Interprofessional collaboration
It has been described as involving “ interactions 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” (Harbaugh,1994). Interprofessional collaboration goes beyond
 transdisciplinary to include not just traditional discipline boundaries but also
professional identities and traditional roles. Interdisciplinary collaboration
team members transcend separate disciplinary perspectives and attempt to
weave together resources such as tools, methods and procedures to address
common problems or concerns.

VI. 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 viewpoints 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 clinical decision making.
Communication must be appropriate and timely.
 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.
VII. MODELS OF COLLABORATION BETWEEN EDUCATION AND
SERVICE
The nursing literature presents several collaboration models that have
emerged between educational institution and client agencies as a means to
integrate education, practice and research initiatives as well as providing a
vehicle by which the theory practice gap is bridged and best practice
outcome are achieved.
 1) Clinical School of Nursing model (1995)

It is one that encompasses the highest level of academic and clinical nursing
research and education. This was the concept of visionary nurses from both La
Trobe and ‘The Alfred Clinical School of Nursing University’. This occurred
within a concern of long history of collaboration cooperation between these two
institutions going back many years and the establishment of the Clinical School in
February, 1995. The development of the Clinical School offers benefits to both
hospital and university. It brings academic staff to the hospital, with opportunity for
exchange of ideas with clinical nurses with increased opportunities for clinical
nursing research. Many educational openings for expert clinical nurses to become
involved with the university’s academic program were evolved. The move to the
concept of the clinical school is founded on reorganization of the fundamental
importance of the close and continuing link the theory and practice of nursing at all
levels.
 2. Dedicated Education Unit Clinical Teaching Model (1999)
In this model, a partnership of nurses executives, staff nurses and faculty
transformed patient care units into environments of support for nursing students
and staff nurse while continuity of the critical work of providing quality care to
acutely ill adult. Various methods were used to obtain formative data during the
implementation of this model in which staff nurses assumed the role of nursing
instructor. Result showed high student and nurse satisfaction and marked increase
in clinical capacity the allowed for increase enrolment. Key features of the DEU
are:-
 Uses existing resources
 Supports the professional development of nurses.
 Potential recruiting and retention tool.
 Allows for the clinical education of increased number of students.
 Exclusive use of the clinical unit by school of nursing.
 Use of staff nurses who want to reach as clinical instructor.
 Preparation of clinical instructor for their teaching role through collaborative
staff and faculty development activities.
 Faculty role to work directly with staff as a coach, collaboration,
teaching/learning resources to develop clinical resourcing skill, to identify
clinical expectations of students evaluate students achievements.

3. The Collaborative Approach to Nursing Care (CAN-Care) Model

(2006)
The CAN-Care model emerged as academic and practical leaders acknowledge
the need to work together to pronounce the education, recruitment, and retention
of nurses at all stages of their career. The idea of partnership model emerged
when the Christian E. Lynn College of Nursing, Florida, Atlantic University,
was awarded a grant from Tenet health Care Foundation Accelerated Second
degree BSN Program.
Goal:
 The goal was to design an educationally dense, practice based experience to
socialize second-degree students to the role of professional nurse
 A secondary goal was to enhance and support the professional and career
development of unit based nurses.
 A commitment to a constructivist approach to learning an immersion
experience to recognize the unique needs of accelerated second degree
learner, and
 To emphasis the partnership among the academic and practice setting, were
guiding forces in the creation.
The model emerged from a dialogue among leaders from the academic and
practice setting focusing on the areas of expertise and potential contributions
of each partner. The essence of the CAN-Care model is the relationship
between the nurse learner (student) Care and nurse expert within the context
of each nursing situation. The semantics of the based nursing student as
learner and unit based nurse as expert. The learner is responsible and
accountable for engaging in the learning process and for work talking an
active role in establishing a dynamic learning partnership with the nurse
expert. Unit-based nurse are expert in the work of nursing care. The title
unit-based nurse expert was chosen to recognize the grifts they engage in a
partnership for the purpose of nurse meeting the need of the assigned patient
population as well as to reflect on and to come to know the different models
of collaboration between Nursing Education and Art and Science of Nursing
Practice. The faculty member promotes the growth of the nurse expert as a
professional and the journey of the learner in coming to know a career in
nursing. This is a major change in focus from the traditional role of faculty
change being in control of the teaching of students.
By the application of CAN-care model the focus is to:
 Care student’s activities moves from demonstration of discrete skills and
prescribed outcome to an immersion into the professional nurse role, learner
to hear and respond the patient needs.
 Through this model the students come to know the organizational context of
nursing practice, the multifaceted role of professional nurse and assume
responsibility for coming to know the meaning of nursing in each unique
situation.
 The unit-based nurse acquires new skills based in mentoring, exposure to
evidences with the college.
 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.
The primary role of the faculty member in the model is to nurture the nurse
expert/nurse learner relationship and to support the growth and development
of both expert and learner in their respective roles and responsibilities. The
on-site faculty member becomes an advisor, resource, role model and
educator for both the nurse expert and the nurse learner. Here the health care
organization becomes active participant in creating learning environment
and contributing to the learning activities.
 3. The Bridge to Practice Model (2008)
Key features of model:

 First, students complete all of the clinical experiences in one participating

hospital.
 Second, one full-time teaching faculty serves as a liaison for each bridge
hospital.
 This faculty member is given a space, usually in the nursing education
department, and is then available to serve as a resource for not only the
clinical associates but also for the hospital nursing staff.
 In this model, therefore, there can be numerous clinical associates in one
hospital with one full-time. University faculty over-seeing the clinical
experiences.
 Third, students are actively involved in selecting their clinical placements.
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.
 Clinical placement decisions are based on academic performance and
maturational level.
 Participating students undergo 415 hours of clinical experiences focused on
medical surgical nursing.
These clinical practices progress from adults in health and illness, Basic, an
introductory nursing course to Medical Surgical nursing leadership, a senior
level course taken in the last semester of baccalaureate study.
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. Hospital that participates in the bridge model provides
senior clinical nurse preceptors whose time is paid for by the university. The
bridge to practice model emphasizes professional incentives for hospital
nurse to participate in nursing education. Planned incentives includes the
rewarding of hospital nurse with continuing education credits for
participation in the short –term training on educational methodology and
approaches. A tuition discount is offered for graduates course work at the
university for institutional students and faculty, more involvement with
clinical support services and care management, and more informed
employment choices by senior students.
Challenges Include:-
 Recruitment of interested senior clinical nurses
 Retention of clinical liaison faculty.
 Management of the tradeoff between institutional stability offered by
clinical site continuity.
 The variety of experiences offered by rotation several clinical settings.
The gap between nursing practice and education has its historical roots in the
separation of nursing school from the control of hospital to which they were
attached. At the time when school of nursing operated by hospital, it was the
students who largely staffed the ward and learned the practice of nursing
under the guidance of the nursing staff. While this separation has been
beneficial in advancing nursing education, it has also had adverse effects.
 Under the divided system, the nurse educations are no longer the practicing
nurse in the wards or directly involved in the delivery of nursing services,
not responsible for the quality of care.
 The practicing nurses have little opportunity to share their practical
knowledge with students and no longer share the responsibility for ensuring
the relevance of the training
 As the gap between education and practice has widened, there are now
significant differences between what is taught in the class room and what is
practiced in the service setting.
The need for greater collaboration nursing education and services call for
urgent attention
The majority of these models are based on a joint appointment model
where the nurse is initially employed by a health services or a university and
divides his or her time between teaching and clinical practice, Application of
these models can reduce the provided gap between education and service in
nursing thereby can help in the development of competent and efficient
nurses for the betterment of nursing profession.

4. NURSE CONSULTANT MODEL

Collaboration for in service/ Continuing education programs
The key ingredient is a partnership between educational and nursing
service institutions and personal. Partnership relationship combines the
strength of the practical application knowledge from nursing service sector
and education/theoretical knowledge from educational sector.
The benefits of collaboration in nursing education and
understanding practice:
 It provides assistance in staff development program and conducting in
service and continuing educational program.
 Aim is to further education and smooth functioning of peer profession
 Leads to flexible options for incorporating new ideas, new approaches, in
nursing practice and nursing education
 Accessible to nurses who are unable , not ready or not interested in further
formal education
 Ex-nursing updates, workshops, etc. conducted by nursing students.

5. Mutual Interaction Model of Collaboration

Williamson has proposed mutual interaction as a model for maximizing
patient participation in the health care process. Mutual interaction as a model
combines collaborative aims with the decision-making framework of the
nursing process. The model not only endeavors to involve patients in their
own care, it assures through their participation that patients assume a greater
proportion of the responsibility for the outcomes of care than would be the
case were they to take an entirely passive role.
 Mutual interactions as a model combines collaboration aims with the
decision making framework of the nursing Process. It provides a method for
simultaneously, building concerns and solving problems by its integrations
of negotiation and decision making through verb, and non-verbal exchanges
patient and nurse comes to agreement on the desired outcomes and stragies
to be employed for promoting and restoring the patient, health.
Assumptions
 The individual has a right to self-determination and choose to participate in
the process of decision making.
 The patient and the professional interact in a relationship and are amenable
to each other’s influences.
 The responsibility for health is a professional one, not a professional one.
 Each individual, concept of health is legitimate for that person.

Phases of The Mutual Interaction Model

Phase Activity

Exploratory The patient states reasons for seeking care expectations

for general out comes. In this phase the nurse encourages
the patient to share the story of his and her illness to state
the reasons of seeking care. The nurse states the services
he or she is able to provide. Patient and nurse decide
whether patient desires and expectations matchwith the
nurse skills,they explore the options to proceed refer or
terminate.
Information The patient and nurse define the patient problems and
sharing and identity the available resources
analysis
The patient and nurse each states his/her objectives for
Mutual post care and negotiates specific outcomes. Patient and nurse
settings define their respective roles in meeting patient care
outcomes. Skills. For goal be attainable. They must reflect
the patient value belief system, resources and skills A
patient seeking a quick solution to health problem will be
unlikely to attain outcomes that requires long-term
measures.
 Phase Activity

Strategy The patient and nurse explore strategies and discuss

devising the risks and benefit of strategies considered. Patient
and nurse reach an agreement on strategies and arrive
at a patient acre contact. In this phase, nurses and
patient jointly select strategies to reach mutually
defied outcomes. Exchange focus on benefits. Cost
and risks of alternative strategies and on the probable
consequences of any given course of action in light of
the patient particular situation.
Implementation The patient and nurse do a formative evaluation of
of alternatives care in progress, they exchange information needed in
order to make ongoing adjustments in the plan.
Corrective changes are made concurrently with the
implementation of care.
Evaluation The patient and nurse review the patient care
experience, they share information needed to make a
summative, evaluative and prepare to terminate the
contract.

LIMITATIONS OF MUTUAL INTERACTION

 Patient role expectations: Patients sick role perceptions influence the role
they expect to play in nurse-patient encounters. Previous experience gives
patients a sense of what to expect that may act as a strong influence on their
behavior.
 Patient knowledge: Patient socialized to take the dependent role, may defer
to nurse, expert knowledge. This is particularly true when patients believe
they lack the knowledge necessary for decision making. Once they are
provided with the information, many patients become willing and able to
participate.
 Patient personality characteristics: Patients differ from one another in
their personal traits and characteristics. Some patients naturally acquire or
develop a stronger internal locus of control and a stronger sense of self-
efficacy than others. Patients with these characteristics are more likely to
seek out a collaborative arrangement in the health care encounter.
 Patient definition of the situation: Patients look for cues and symbols that
indicate the social norms and sanction for specific behavior. These define
action in formal and informal situations. Interpretations of social cues vary.
Thus, it is necessary provides to understand the patient definition of the
situation and whether that definition is compatible with collaboration.
These factors influence initial patient responses to collaboration which may
range from enthusiasm to bewilderment to distress. Although patient
characteristics determine Patient, tendency to participate, nurse,
characteristics influence the degree to which a patient is invited or given
permission or to participate.
6. Research Joint Appointments (Clinical Chair) (2000)
A joint Appointment has been defined by Lantz et al. (1994), as “ a
formalised agreement between two institutions where an individual holds
a position in each institution and carries out specific and defined
responsibilities.”
The goal of this approach is to use the implementation of research
findings as a basis for improving critical thinking and clinical decision-
making of nurses. In this arrangement, the researcher is a faculty member
at the educational institution with credibility in conducting research and
with an interest in developing a research programme in the clinical
setting. The Director of Nursing Research, provides education regarding
research and assists with the conduct of research in the practice setting.
She/he also lectures or supervises in the educational institution. A formal
agreement exists within the two organizations regarding specific
responsibilities and the percentage of time allocated between each. Salary
and benefits are shared between the two organisations.
Outcomes identified by Donnelly, Warfel and Wolfe (1994) for
the educational institution are that it becomes more in touch with the real
world and more readily able to identify research questions, that have the
potential to make a difference to quality of consumer care delivery. There
is also an increasing collaborative relationship with the service provider
which is important for long term workforce planning. The clinical chair
also facilitates improved access and support to external research project
funding.
7. Practice- Research Model(PRM) (2001)
It is an innovative collaborative partnership agreement between Fremantle
Hospital and Health Service and Curtin University of Technology in
Perth, Western Australia. The partnership engages academics in the
clinical setting in two formalized collaborative appointments. This
partnership not only enhances communication between educational and
health services, but fosters the development of nursing research and
knowledge.
The process of the collaborative partnership agreement involved
the development of a Practice- Research Model (PRM) of collaboration.
This model encouraged a close working relationship between registered
 nurses and academics, and has also facilitated strong links at the health
service with the Nursing Research and Evaluation Unit, medical staff and
other allied health professionals.
Key elements underlying the process of collaboration and development of
the PRM are:-
 Collaborative partnership- The collaborative partnership was formed by
nursing health professionals, from the community health service and the
university who recognized the need to bridge the theory- clinical practice
gap and acknowledged the futility of continuing to work in isolation from
each other. In practical terms, this involved a formal contractual
arrangement between the organizations that led to the establishment of a
Nurse Research Consultant position.
 Core values and aims of the collaborative partnership- Before the actual
framework of the collaborative partnership was decided, a literature review
of the most common models of collaboration in nursing practice was used to
promote discussion between the organizations to clarify and formalize the
assumptions underlying the core values, roles and responsibilities of the
partners, as indicated by Spross (1989). During this phase, four key concepts
emerged: firstly, that ‘practice drives research’, secondly, the principle of
‘collegial partnership’, thirdly, ‘collaborative ownership’ and finally, ‘best
practice’.
8. Collaborative Clinical Education Epworth Deakin (CCEED)
model(2003)
In an effort to improve the quality of new graduate transition, Epworth
Hospital and Deakin University ran a collaborative project (2003) funded by
National Safety and Quality Council to improve the support base for new
graduates while managing the quality of patient care delivery. The CCEED
model developed to facilitate clinical learning, promote clinical scholarship
and build nurse workforce capability. The CCEED undergraduate program
sees undergraduate nursing students attending lectures at Deakin University
in the traditional manner but completing all tutorials, clinical learning
laboratories and clinical placements at Epworth Hospital throughout their
three year course. Tutorials, laboratories and clinical placements are
conducted by Epworth clinicians who are prepared and supported by Deakin
School of Nursing faculty. These clinicians also support the student-preceptor
relationship in the clinical learning component of the curriculum. The
expectation was that increased integration between hospital and university
would enhance clinical education resulting in improved student’s application
of knowledge and skills as well as increased socialization to the clinician
role.
Key findings of the 2005 pilot CCEED program were
  Students learning objectives were met and satisfaction was high.
 Undergraduate clinical education was valued by preceptors and
managers as a workforce investment strategy.
 Preceptors were enriched in their clinician role as a result of their
participation in the program and reflection on the process.
 Preceptor continuity promoted a trusting relationship that enabled
preceptors to confidently encourage student initiative.
 Preceptors managed multiple roles in order to meet demands of patient
care and student learning.

9. The collaborative Learning Unit(British Columbia) Model, 2005

This model was based on the ‘Dedicated Education Units’ concept
developed, successfully implemented and researched in Australia. The
Collaborative Learning Unit Model of practice education for nursing is a
clinical education alternative to preceptorship. In the CLU model, students
practice and learn on a nursing unit, each following an individual set rotation
and choosing their learning assignment, according to their learning plans. All
nursing staff members on the Collaborative Learning Unit are involved in
this model and therefore not only do the students gain a wide variety of
knowledge but the unit also has the ability to provide practice experiences for
a large number of students.
10. Collaboration of Nursing Education and Service in India
The gap between nursing practice and education has its historical roots in the in
the separation of nursing schools from the control of hospitals to which they
were attached. At the time when schools of nursing were operated by hospitals,
it was the students who largely staffed the wards and learned the practice of
nursing under the guidance of nursing staff. However, service needs often took
precedence over student’s learning needs.
There are two institutions which are practicing dual role, education and
practice: NIMHANS, Bangalore and CMC, vellore. The models of these
institutions will help to improve the quality of Nursing Education with overall
objective of improving the quality of nursing care to the patients and community
people.
a) Dual role model of NIMHANS
Following the amalgamation of 1974 resulting in NIMHANS, the faculty of the
nursing department took up the dual responsibility of providing clinical services
as well as conducting teaching programs. In 1975, all the Grade II nursing
superintendents working in the hospital were designated tutors to maintain
uniformity in the department. Combined workshops were conducted under the
guidance of WHO consultant Mrs. Morril to prepare the tutors who came from
Grade II Nursing Superintendent cadre for teaching purpose and to make the
Lectures and tutors associated with educational programmes (DPN course and
9-month course in psychiatric nursing) comfortable with clinical supervision.
After both groups felt comfortable to assume the dual responsibility, the areas of
supervision were designated. The Head of the Department of Nursing was given
the responsibility for both the service and the education component of the
department.
 Integration with education with service raised the quality of patient
care and also improved the quality of learning experiences for nursing students,
under the close supervision of teachers who were also practitioners.
b) Integrative Service – Education approach in CMC, Vellore.
College of Nursing under Christian Medical College, Vellore, where nursing
educators are practicing in the wards or directly involving in the delivery of
nursing services. This enables the practicing nurse to share her practical
knowledge to the student nurse who is practicing in the concerned wards.
Government of India conducted a pilot study on bridging the gap
between education and service in selected institutions like one ward of AIIMS.
The project was successful, patients and medical personnel appreciated the
move but it required financial resources to replicate this process.
SUMMARY

So far we discussed about the collaboration issues and models in nursing.

Collaboration means collegial working relationship with another health care
provider in the provision of patient care. The objectives include provide client
directed and centered care using multidisciplinary, integrated, participative
framework. The characteristics of effective collaboration include clinical
competence of each provider, humor, trust etc. benefits of collaborative care
include competencies basic to collaboration, communication skills, mutual respect
and trust. Effective steps for collaboration includes clearly identify the value link to
the organization strategies etc. The collaborative model (or conversational model)
is a theory for explaining how speaking and understanding work in conversation,
specifically how people in conversation coordinate to determine definite references.
CONCLUSION

Estimating the future need for registered nurse with various educational
backgrounds is complicated by differing perception of educators and employers
about the appropriate base of knowledge and skill new graduates need. These
differences began to be apparent when nursing education moved away from its
historical base in hospitals response to abuses and inadequacies. Collaborative care
as a partnership relationship between doctors, nurses and other health care
providers with patients and their families. It is a process by which health care
professionals work together with clients to achieve quality health care outcomes.
Mutual respect and a true sharing of both power and control are essential elements.
Ideally collaboration becomes a dynamic, interactive process in which clients offer
with physicians, nurses and other health care providers to meet their health
objectives.

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6. www.nursingmodels.com

7. www.collaborativemodels.com