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Sunday, 4 December 2016

Multidisciplinary Colaboration During Emergency Condition


Multidisciplinary Colaboration During Emergency Condition
 
At this time, the Indonesian government is trying to create a condition of Indonesian society that is healthy both physically and mentally. The government realizes the importance of a healthy community in supporting the country's development. Development will be difficult to run smoothly if people are less healthy. Therefore, the government is required to create a system of quality health services and quality so reliable in times of need without any obstacles, both economic and non-economic. This means that the government needs to build health services that can be relied upon so that all layers of society both from the bottom up to the upper classes can use it. The government's efforts have been delivered in a circular issued by the Health’s Department of Indonesia which states that one of the goals to be achieved in the development of the health sector in Indonesia is reaching the community, the nation and the state where the population has the ability to reach high quality health services in a fair and evenly (Djojo, 2001).

However, it must be recognized that efforts to provide quality health services still need attention. One indicator of the need for attention to health services can be seen from the level of utilization of hospital health facilities . the hospital utilization rate in Indonesia still not optimal . Based on the statistical data outpatient population only 7.1 % . This amount is far below the PHC and PHC helper reached 33.4 % and general practice physicians who reached 27.5 % . In addition, other categories such as BOR ( Bed Occupanci Rate ) or percentage that shows the average bed used every day that there is so far below the standard . BOR level achieved general hospitals in Indonesia today still is around 50 % ( MOH RI 2004) . Whereas the standard value / ideal number that should be achieved is 70-80 % ( Djojo , 2001)

In this conditions like a hospital as a health care unit must to improved by serving the community wellness, able to give satisfaction to the patient, the health centers or doctors practice around it.

Improved quality of service, especially in the inpatient services that must be considered is the management of patient care, which is managed by specialist doctors, nurses, pharmacists, nutritionists, dentists and midwives. In the implementation of the duty of care, health care must collaborate, cooperate with each other to provide information, coordination and have a common goal of healing the patient.

The quality of health care certainly by the quality of medical care services and nursing care. Quality medical care can be provided by professional medical personnel in the field and the quality of nursing care can be provided by the nursing staff who have been equipped with the knowledge and skills appropriate clinic and have the ability to build professional relationships with patients, in collaboration with other health team, conducting ensure quality, the ability to meet the needs of patients and show caring attitude.

If observed from medical team, then to produce good quality service requires commitment and optimal performance. Therefore,in condition limit of medical team is nedeed collaboration of nurses, so that the quality of patient care is maintained. Collaboration won’t occur if the provider doesn’t know the meaning of collaboration itself. Definistion by ANA (1980) is a true partner relationship by knowing and accepting the scope of activities and responsibilities the others or together, to protect the interests of each and their common goal in mind both sides.

In the implementation of nurse collaboration with the doctor, need knowledge about indicators of collaboration that power control nurse doctor, nurse physician practice environment, shared interests and common goals.

Communications definition from etymology, communication comes from the word communicate which means "make the same". Contemporary definition explain that the communication means "send message". According to (Effendy. 2003: 9) the term communication (communication) is derived from the Latin word communication, and comes from the word “communis” that means the same.

The concept of communication according to John R. Wenburg, William W. Wilmoth and Kenneth K Sereno and Edward M Bodaken formed into 3 types:

  1. Unidirectional
This understanding stems from the understanding of resource-oriented communication is all the activities that intentionally do to deliver stimuli to evoke response of the receiver.

  1. Interaction:
This view considers communication as a process of cause and effect, action-reaction alternating direction.

  1. Transactions
This concept is not only limiting element intentionally or unintentionally, any response is observed or not observed, but also all transactions during the communication behavior are more likely to receiver-oriented communication.

Paradigm Lasswell (1972) indicates that the communication includes five elements as an answer to the question posed, that is:
1. Communicators (communicator, source, sender)
2. Message (message)
3. Media (channel, media)
4. Communicant (communicant, Communicate, receiver, recipient)
5. Effect (effect, impact, influence)

So based on the paradigm Lasswell communication is the process of delivering a message by the communicator to communicant through media that cause certain effects.

Collaboration can not be defined or explained easily. Most definitions using the principles of planning and decision-making together, share advice, togetherness, accountability, expertise, and goals as well as a shared responsibility. American Nurses Association (ANA): Baggs & Schmitt, 1988; Evans & Carlson, 1992; Shortridge, McLain, and Gillis1986, (cit. Siegler & Whitney, 1994). et al., (cit. Siegler & Whitney, 1994) mentions collaboration as a reciprocal relationship in which patient care within the framework of their respective fields. Collaborative practice emphasizes shared responsibility in the management of patient care, with a bilateral decision-making process based on the respective education and the ability of the practitioner.

Although this definition includes the best, but not yet able to convey so wide variation and complexity of collaboration in health care National Joint Practice Commission (NJPC), (cit. Siegler & Whitney, 1994). The following images are three models / patterns collaborative practice:



  
The first design is a hierarchical model (picture1), emphasizing the one-way communication, limited contact between the patient and the doctor, and the doctor is the dominant figure. The second pattern is a collaborative practice model (picture 2) emphasizes two-way communication, but still puts doctors in primary position and limiting the relationship between doctor and patient. The third model in picture 3 is little change the design. This design is more focus in patient, and all service providers must work together, also with the patient. This model remains circular, stressing continuity, the condition of reciprocity with each other and no one dominates the service provider continuously

The nature of the interaction between nurses - doctor determines the quality of collaboration practices. ANA (1980) describes the collaboration as "a true partner relationship, where each side to appreciate the power of others, by knowing and accepting the scope of activities and responsibilities of each of which separately or together, to protect the interests of each and their common goal known to both sides collaboration can be analyzed through four indicators:

  1. Control – power
Share power or together control the power can exist if both doctors and nurses are equal opportunity to discuss a particular patient. Several researchers have developed a research instrument for measuring the control-power on nurse-doctor interaction. Feiger and Schmitt, (1979) developed a model to measure the communication nurse – doctor  to determine the level of power control through the 12 categories of the following processes:
  1. asking for information,
  2. Provide Information,
  3. Asking for opinions,
  4. give opinions,
  5. put forward proposals,
  6. provide guidance / instruction,
  7. making dicision
  8. provide education
  9. give support / approval
  10. ask not agree / disagree,
  11. orientation,
  12. joke

  1. Environmental Practice
Environmental practice show the activities and responsibilities of each side. Although nurses and doctors have a separate practice areas in accordance with the regulatory practices of nurses and doctors, but there are any assignment fostered together. Weis and Davis (1993) has developed an instrument called Health Role Expectation Index, measuring the perception of the relationship of collaboration between nurses, doctors, patients. Means that consists of 16 principal is form by Likert scale:
  1. responsibility of doctors
  2. responsibilities of nurses,
  3. responsibility of the user,
  4. Egalitarianism (by topic: equal access, equal power and / or the same award).
The higher the total score of the greater possibility of implementing a shared responsibility among members of the health care. Weiss and David suggested that the instruments used for, assess a person's tendency to collaborate, determine the fit between the expectations of the health care providers and the patients served and evaluate changes of habit.

  1. Interest Joint
Researchers who analyzed the common interest as an indicator of collaboration between nurses and doctors often respond from the standpoint of organizational behavior. This theorists describe importance operationally use the term firmness levels respectively (attempt to satisfy itself) and cooperation factor (work for satisfy the interests of the other side) .Thomas and Kilmann (1974) has designed of management models to measure patterns of conflict resolution: (1) compete, (2) collaborate, 3) compromise, (4) avoidance, (5) to accommodate.

  1. Purpose Joint
Management goal of healing is more oriented to the patient and can help determine areas of responsibility are related to patient prognosis. There is a goal that is entirely the responsibility of nurses, there were regarded as the sole responsibility of the doctor, there is also a goal that is shared responsibility between doctors and nurses.
 
Literature:
Effendy, Onong Uchjana. (2003). Communication Studies; Theory and Practice. New York: Rosda.
Lasswell, Harold D. (1972). The structure and function of communication in society in Wilbur Schramm, ed. Mass communication. Urbana - Chicago: University of Illinois Press




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