Page 359 - Encyclopedia of Nursing Research

326 n NuRSe AND PHySICIAN INTeRDISCIPLINARy COLLABORATION

(Piamjariyakul, 2008; Piamjariyakul, patient care (Kohn, Corrigan, & Donaldson,
Schiefelbein, & Smith, 2006; Smith et al., 2000). Real and perceived differences in
N 2005). Thus, these evidence-based nurse-led power and role misunderstanding contribute
interventions are expected to improve self- to the barriers which impede the formation of
management and adherence and reduce effective nurse–physician relationships. The
rehospitalizations (Smith et al., 2003). increasing complexity and changes in health
The nurse-led group clinic visits health care delivery in recent decades have contrib-
care delivery model is well accepted by uted to the challenge of establishing positive
patients and professionals (Bartle & Haney, nurse–physician collaborative relationships.
2010) and third-party payers (American economic, societal, and business drivers have
Academy of Family Physicians, 2010). Given served to influence the health care delivery
the escalating prevalence, devastating symp- environment in which nurses and physicians
toms and morbidity, and high costs of chronic provide patient care. Technological growth
illness care, it is imperative that interventions and an increased emphasis on specialization
with the potential for improving self-man- have also impacted the development of colle-
agement and clinical outcomes efficiency be gial nurse–physician relationships (Chaboyer
tested across illness populations. Further & Peterson, 2001).
study related to the costs of group clinics led A number of historical factors have
by APNs could provide evidence for manag- influenced each profession’s roles and
ing multiple chronic diseases in outpatient responsibilities, including education and
settings. socialization which have at times created
conflict and disagreement. The barriers to
Ubolrat Piamjariyakul effective collaboration between nurses and
Carol Smith physicians are associated with differences
in communication style, gender stereotypes,
role ambiguity, and incongruent expecta-
tions (LeTourneau, 2004). To practice suc-
Nurse aNd physiciaN cessfully and in the interest of safe patient
iNterdiscipliNary care, positive collaborative relationships
between nurses and physicians must occur.
collaboratioN According to the Institute of Medicine,
“Health care is a decade or more behind
other high risk industries in it’s attention to
Nursing and medicine are irrevocably con- teamwork and collaboration to ensure basic
nected together for the care and cure of safety” (Kohn, Corrigan, & Donaldson, 2004,
patients. The traditional roles and values p. 5). Relationships between nurses and phy-
of each profession have frequently limited sicians have frequently been characterized
interprofessional relationships and made as strained and contentious (Rosenstein &
successful collaboration difficult to achieve. O’Daniel, 2005). Ineffective nurse–physician
The historical divide between the disciplines collaborative relationships have been linked
and the dominance of the medical model has to adverse patient events, medication errors,
resulted in the creation of hierarchies that have and patient mortality (Page, 2004).
not fostered the development of collaborative Nurses and physicians define collabo-
partnerships (Baldwin, 1996; Williamson, ration differently and also rank its presence
2003). Historically, nurses and physicians in the same interactions differently. Factors
have frequently practiced independently, pre- underlying changes in the nurse–physician
venting the formation of partnerships and relationship include the increase in the num-
the collaboration necessary for providing safe ber of female physicians and male nurses,