Introduction:
Collaborative practice is based on an interprofessional approach, in which professionals learn from each other to promote improvements in health outcomes. Health care based on performance in an interprofessional team maximizes the strengths and skills of each professional, contributing to the reduction of duplicate actions and enhancing effective actions through shared decision making. The aim of this study is to understand the configuration of collaborative practice in the hospital context, from the nurse’s perspective. (randt B, 2014)
Effect of a supportive collaborative team
In view of the particularities of the work of the nurse and the nursing team, the interprofessional configuration of the collaborative practice is assumed as an important device for promoting and reinforcing the autonomy, self-esteem and motivation of the professionals. It is important to highlight the understanding that collaboration goes beyond joint work, requiring the development of strategies and the availability of resources and technologies that, when articulated, provide support for collaborative practice, providing work of excellence in service. It is also worth mentioning the fact that the collaborative practice is characterized by the involvement of different actors in the care processes, favoring the incorporation of light technologies and, therefore, stimulating communication between professionals and shared decisions. (Zwarenstein M, 2009)
One of the most relevant features of team is having a cohesive set of goals. The development process & revision of objectives must include promoting collaboration & ensuring that team members have the opportunity for full participation in any communication such that involvement of elements like democratic and non-hierarchical, to the processes related to the set of objectives. When Nursing Teams work together to formulate policies there is a great sense of belonging to the process. The process of developing a policy, which includes working towards a common goal, promotes collaboration and teamwork (Morgan S, 2015). Team members need to mutually recognize and respect their roles and professionalism and to integrate inputs into care plans. By clearly defining roles for team members, we can enhance collaboration while minimizing and facilitating delegation. It has also been reported that a certain overlapping of roles, achieved in a veiled way, can facilitate work coordination. Preuss found that the roles overlapped in the units nursing was associated with improved quality of information and reduced attendance of medication errors. 7Since this may seem contradictory evidence, the teams they can evaluate the value of aspects of both clarity and overlapping of roles within the context of a team’s work.
A collaborative care delivery facility improves service to the user. Collaboration during the phase goal development can prevent doubling of effort and confusion for the client, for inter-professional team members and other stakeholders. (GA, 2004)
Following are the main positive effects of working in a team;
• Cognitive: expansion of responsibilities and richer elaborations
• Motivational: sharing of decisions with increased motivation professional.
• Relational: increase in affectivity, recognition and a sense of belonging.
• Organizational: increased integration with promotion of sharing of knowledge, languages, methods and at the end of the objectives, the mission and the vision.
For the nurses to work individually will broaden the stereotypes of observation that lead to creation of prejudices, which make the analysis of reality and the subsequent one less reliable decision. Working within a multidisciplinary team creates competition from experiences and knowledge that allow, if well managed, to achieve the expected result e significantly enrich the diagnostic and therapeutic potential. (randt B, 2014)
Conflict:
With regard to the challenges for a collaborative practice, barriers such as relational conflicts, the influence of external issues on work, managerial aspects, professional devaluation, the lack of recognition and the lack of support from the coordinator, hinder collaboration. Nurse’s practice is geared towards meeting the demands of doctors, suggesting as a justification the fact that some of these professionals occupy management positions or have a higher hierarchical position in the institution, requiring the granting of privileges. (West MA, 2013)
One of the mechanisms that trigger conflicting relationships between health professionals is the monopoly of knowledge established between professions. Conflicts in the team can negatively impact the effectiveness of collaboration and the teamwork. Interpersonal conflict has a direct negative impact on intra-group conflict and job satisfaction.
Such as in case of a doctor who identifies himself as the leader of the health team and responsible for decisions that involve the team. In this regard, it is emphasized that the reach of collaborative practice does not require horizontal relationships with respect to decisions involving professionals from different categories, which makes collaborative practice in panoramas in which hegemony and monopoly in decision making predominate. In this case, the dominant posture adopted by doctors is a barrier to the effectiveness of collaborative practice, given the restriction of the autonomy of professionals from different categories, which can cause experiences of moral suffering. (randt B, 2014)
Such suffering has been investigated in different areas of activity of health professionals, as well as in the field of teaching, being characterized as the impossibility of acting according to moral judgment in situations that involve the need for deliberation (Kanj M, 2009). From this perspective, collaborative practice, which is based on shared decision-making among the actors involved in a process of communication and institutional support, is assumed as a protective factor for experiences of moral suffering.
Nursing teams needs to gain knowledge on how to agree in conflict and how to ensure that they are established processes to achieve this. Decision-making processes must be developed so that they give indications in the different one’s situations. For example, while soliciting input and building consensus of the team may be the best way to long-term planning, this is not necessarily the method best for making decisions in emergency situations when it needs to be undertaken immediate action (Kanj M, 2009). One of the causes of possible conflict is the transmission of messages during the discussion in the group
How to enhance team-based communication:
The configuration of collaborative practice in daily nursing is sustained and strengthened through the recognition expressed by professionals. The discussion of clinical cases and the updating of knowledge through access to scientific articles are translated as an expression of appreciation and professional recognition. (Solet D, 2005)
The challenges faced by nurses in their daily lives signal the adoption of strategies aimed at the development and consolidation of collaborative practice. Such strategies include support for coordination, communication, knowledge, congruence of professional objectives, meetings and innovative strategies that encourage participation and the adequacy of institutional objectives with professional values (GA, 2004). The holding of meetings and the creation of socializing spaces is one of the strategies that enhance the interaction between the team, extrapolating the clinical discussion and reaching interpersonal relationships, bringing professionals together and encouraging collaborative practice (Kanji M, 2009). Hold strategic meetings for the entire team on a regular basis. This gives each team member the opportunity for presenting & any changes are discussed, as well as to provide all team members with the opportunity to express ideas, concerns and share news about the project. In order not to waste time unnecessarily, reduce the duration of these meetings to a maximum of 50 minutes and try to organize them as best as possible by following these simple rules.
• Assign a team member to take the time.
• Compile a “lineup” with the topics of the meeting and invite it to all team members before the meeting.
• Ask members for be ready for discussing the agenda items.
• Unless they are urgent matters, avoid discussing topics that are not on the agenda, however making it clear that these will be discussed in the next meeting.
• Plan your next meeting in advance and make a list of topics to discuss in upcoming meetings.
Conclusion:
Considering the above, it is assumed that collaborative practice is configured as an important form of work organization in the hospital setting, with repercussions for the professional practice of nurses and staff and the quality of care. From the nurse’s perspective, the configuration of collaborative practice in the hospital environment is complex and requires relational processes. Such processes are recognized in an ambiguous way, sometimes as potentialities, sometimes as barriers to carrying out the work. Thus, the nurse develops strategies that help him to seek collaborative practice, such as communication, meetings, innovative methodologies and organizational identification.
References
GA, P. (2004). Metaphors: words as bridges and barriers to effective medical communication. The unconscious guidance of metaphors–our medical “common sense”-can both enhance and hinder effective communication between patients and physicians. Minnesota Medicine.
Kanj M, M. W. (2009). Promoting health and development: Closing the implementation gap, Nairobi, Kenya. 7th Global Health Conference on Health Promotion.
Morgan S, P. S. (2015). Observation of interprofessional collaborative practice in primary care teams: an integrative literature review. International Nursing Journal.
randt B, L. M. (2014). A scoping review of interprofessional collaborative practice and education using the lens of Triple Aim. J Inter prof Care.
Solet D, N. J. (2005). Lost in translation: Challenges and opportunities in physician to-physician communication during patient handoffs. Academic Medicine.
West MA, L. J. (2013). Illusions of teamwork in healthcare. Journal of Health Organiation Management.
Zwarenstein M, G. J. (2009). Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev.