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Name Nim

: Tesa Dwi Ramdhayani Putri : I31110030

Implementation of Nurse-Physician Collaboration


Nurse-doctor relationship is a form of interaction that has long been recognized as providing relief to the patient. Different perspectives of looking at the patient, in practice led to the emergence of technical barriers in the process of collaboration. Individual scientific and psychological constraints, social factors, as well as the cultural placing both the profession raises the need for collaborative efforts that can make them more solid with the spirit of the interests of patients. Various studies have shown that many positive aspects that can arise if the relationship between physician-nurse collaboration went well. American Nurses Credentialing Center (ANCC) did his research at the 14 hospitals reported that the doctor-nurse relationship is not only possible, but also have a direct impact on the outcomes experienced by patients (Kramer and Schamalenberg, 2003). There is a positive correlation between the quality of doctor-nurse relationship with the patient's quality of results obtained. Barriers to collaboration of doctors and nurses often found in professional and institutional levels. Differences in status and power remains a major source of discrepancy that limit the establishment of professional collaboration in the application. Doctors tend to be male, of a higher economic level and are usually physically larger than the nurses, so that the climatic and social conditions still call for support for the dominance of physicians. Real core of nurses and doctors conflict lies in the difference of their professional attitude towards patients and how to communicate between them. From the observation of several studies in the

hospital seems to nurse in providing nursing care have not been able to carry out functions in particular collaboration with physicians. Nurses work providing care to patients based solely on medical instructions are also well documented, while the documentation of nursing care which includes the nursing process does not exist. Besides, some research results of interviews with some of the nurses of government and private hospitals, they stated that many of the obstacles encountered in implementing the collaboration, including views of a doctor who always think that is manpower vocational nurses, nurse as his assistant, and hospital policies that are less supportive. These issues if not addressed properly and proportionately feared could hamper efforts to protect the interests of patients and the public who need health care services, as well as hamper the efforts of the development of nursing as a profession.


1) Understanding of collaboration Understanding of the principles of collaboration may be less if only by the light of the results only. Discussion of how the collaborative process that happens it becomes an important point that must be addressed. How each profession perceive the meaning of collaboration should be understood by both parties so as to obtain the same perception. A doctor in the face of the patient is generally thought, "what this patient diagnosis and treatment of what he needed" this kind of thinking pattern has been formed since the beginning of the process of education. Difficult to explain precisely how the formation of such a pattern of thinking continues to grow especially medical curriculum. They also introduced a supervised clinical environment in ethical issues, recording medical history, physical examination and doctor and patient relationship. pre-clinical medical students are directly involved in the psychosocial aspects of patient care through activities such as joint guidance - patients. During this period there is almost no formal contact with the nurse, social worker or other

health professional. As a practitioner's work environment they share with the nurses but they are not trained to respond as a partner / associate / colleague. (Siegler and Whitney, 2000) On the other hand a nurse would think; what this patient's problem? How patients handle it?, What help is needed? And what can be given to patients?. Nurses are educated to be able to assess the health status of patients, planning interventions, implementing the plan, evaluate results and reassess as needed. Educators call it the nursing process. This is the basis for the argument that the nursing profession is based on the disciplines that help sick or healthy individuals in carrying out activities that promote health or recovery so that patients can be independent. Since the beginning of nurses are educated to know their role and interact with patients. Combine theory and practice of nursing in the practice of home care research and practice sakat public health services. The students worked together diunit patient care nursing staff to learn to care, and to internalize the role of running the procedure. Collaboration is a complex process that requires sharing of knowledge that is planned and deliberate intent, and a shared responsibility to care for patients. Sometimes it happens in the long relationship between health professionals. (Lindeke and Sieckert, 2005). Collaboration is a process by which nursing or nurse practitioner clinic to work with physicians to provide health services within the scope of professional nursing practice, with monitoring and supervision as giving directions or the development of cooperation mechanisms prescribed by the regulations of a country where the services rendered. Nurses and physicians to plan and practice together as colleagues, work interdependence within the limits of the scope of practice with shared values and knowledge and respect for other people that contribute to the care of individuals, families and communities.

2) Members of the interdisciplinary team Interdisciplinary health care team is a group of professionals who have clearly defined rules, the general purpose and different expertise. The team will

work well if there is a contribution of team members in providing the best health care. Health team members include: patients, nurses, doctors, physiotherapists, social workers, nutritionists, managers, and pharmacists. Therefore, the collaboration team should have effective communication, responsibility and mutual respect among fellow team members. Patients were integral members of the team is important. Patient participation in decision-making will increase the likelihood of a plan becomes effective. Achievement of optimal patient health can only be achieved if the patient as a central member of the team. Nurse as a member brought a unique perspective in interdisciplinary teams. Nurses facilitate and assist patients to obtain health care from the practice of other health professions. Nurses act as an important liaison between patients and health providers. Physicians have a major role in diagnosing, treating and preventing disease. In these situations clinicians use treatment modalities such as administration of drugs and surgery. They often consult with other team members as to the provision of treatment referrals. Collaboration claimed that members of the healthcare team should work with the compact to achieve goals. Essential elements for achieving effective collaboration include collaboration, asertifitas, responsibility,

communication, autonomy and coordination. Cooperation is the value the opinions of others and willing to examine some alternative opinions and beliefs change. Asertifitas important when individuals in a team to support their opinions with confidence. Assertive action to ensure that the opinion actually be heard and consensus to be reached. Responsibility, to support a determination that is obtained from the consensus and should be involved in its implementation. Communication means that each member is responsible for sharing important information about patient care and issues relevant to clinical decision making. Autonomy includes the independence of members of the team within the limits of its competence. Coordination is necessary organization's efficiency in patient care, reduce duplication and ensure a qualified person in resolving problems. Collaboration is based on the concept of public purpose, the contribution of professional practitioners, collegiality, communication and practices that focus on

the patient. Emphasis on mutual respect, collegiality, and professional approach to the problems in the team rather than blame someone or or avoiding responsibility. Hansen suggested the concept with the same meaning: mutuality in which he interpreted as a relationship that facilitates a dynamic process between people characterized by a desire to achieve progress and satisfaction of each member. Trust is a concept common to all elements of collaboration. Without a sense believes in, there will be no cooperation, assertiveness becomes a threat, avoid responsibility, disruption of communications. Autonomy will be suppressed and coordination will not occur. The key element of collaboration within a multidisciplinary team working together can be used to achieve team collaboration : 1. Providing quality health care by combining the unique expertise of a professional 2. Maximum productivity and effectiveness and efficiency of resource 3. Peningkatnya professionalism and job satisfaction, and loyalty 4. The increased cohesiveness among professional 5. Clarity over the role of the interaction between professionals, 6. Fostering communication, collegiality, and respect and understand others. Related to the issue of collaboration and partnership about to cooperate with doctors, nurses need to anticipate the consequences of a change of vocational professional. Juridical status as an arm of the nurse change of physician to physician partners are very complex. Responsibility will also be a separate law for each error or omission. Namely, medical malpractice and nursing malpractice. There needs to be clarity from the government and the concerned parties about the legal responsibilities of nurses, doctors and hospitals. Nursing professional organizations also have to clean up and expand the organizational structure in order to anticipate changes. (Www. kompas.com. Accessed on March 20, 2007) Meeting of the doctor-nurse professionals in the real situation is more common in hospital environments. The management of the hospital can be a facilitator for such collaborative relationships covered by implementing systems or policies that govern the interaction among the various health professions. Integrated

recording of patient health data, with the round, and the development of nurse education level can also be used as a strategy to achieve that goal. Round joint in question is a joint activity between the physician-visite nurses and student nurses and medical students, with the aim of evaluating the health service that has been done to the patient. Doctors and nurses exchange information to overcome the problems of patients effectively. This activity is also as an attempt to instill early on the importance of collaboration for the progress of the healing process of patients. Round joint activities can be followed up with periodic meetings to discuss specific cases that occur between the knowledge transfer was a member of the team/

CLOSING Communication is needed to achieve effective collaboration, it is to be supported by means of communication that can bring together the patient's health data komfrenhensif so a source of information for all team members in decision making. It is therefore necessary to develop the patient's health status records of communication that allows doctors and nurses occur effectively. Nurse education needs to be improved to minimize the gap with a physician professionals through continuing education. Increased knowledge and skills can be done through formal education or at least until kejenjang specialists through training to improve skills nurses.