ADVANCEDCOMMUNITY

HEALTH NURSING
COURSE CODE: NSC 502
COURSE UNIT: 3UNITS
COMMUNICATION,
COLLABORATION &
CONTRACTING
 Sub-Topics
• The communication process
• Communication barriers
• Communication skills
• Characteristics of collaboration
• Characteristics of contracting
• Process of contracting
• Levels of contracting
 Learning Objectives
At the end of this lecture, you should be able
to:
• Describe the concepts of communication,
collaboration and contracting

•Discuss the usefulness of the three concepts

in community health nursing practice
 Communication, Collaboration and Contracting
• These concepts form the basis for effective relationships that
contribute to the prevention of illness, the protection and
promotion of aggregate health.
• Unlike ordinary social relationships, collaborative relationships are
based on a team approach with shared responsibilities and mutual
participation in establishing and carrying out goals.
• Clients and health care professionals enter into a working
agreement, or contract, tailored to address specific client needs.
• The concept of contracting can further assist the collaborative
process.
 1. Communication
• Group coexistence and nursing practice cannot exist
without communication

• Communication is the act of conveying information for the

purpose of creating a shared understanding

• It includes verbal, non-verbal and electronic means of

human interaction
 Communication Process
• Communication occurs as a sequence of events or a process
consisting of 7 basic steps
1. A message: an expression of the purpose of
communication
2. A sender: a person(s) conveying the message
3. A receiver: the intended recipient of the message
4. Encoding: the sender’s translation of the message to the
receiver e.g. using symbols to demonstrate
 Communication Process
5) A channel: the medium for sending the message
including- speaking, telephones, email, blogs, TV, art, hand
gestures, facial expressions, body language and even social
contexts
6) Decoding: act of translating the message into an
understandable form by the receiver)
7. Feedback loop: receiver’s indication that the message has
been decoded in the way the sender encoded
 Barriers to Effective Communication
• Selective Perception
• Language Barriers
• Filtering Information
• Emotional Influence
• Physical Barriers
• Lack of trust
• Conflict
• Information overload etc
Barriers to Effective Communication
 Effective Communication Skills
• Sending skills- verbal and non-verbal
• Receiving Skills- Active listening, Paraphrasing, reflective
questioning
• Interpersonal Skills- respect, empathy, trust and rapport
Effective Communication Skills
 2. COLLABORATION
• It involves two or more people working together in the
pursuit of a shared, collective or bounded goals

• collaboration is a process by which two professionals

engage in a non-hierarchical relationship to develop
interventions or resolve particular health issues.
 2. COLLABORATION
• Collaboration to CHNs is a purposeful interaction
between nurses, clients, other professionals, and
community members based on shared values, mutual
participation and joint effort

• It involves building trust and confidence and it is more

often voluntary.
 Characteristics of Collaboration
• Shared goals: The team enters into a collaborative relationship
with broad needs or purposes to be met and specific objectives
to accomplish

• Mutual participation: There is mutual benefits of every member

of the team. Every member feel equally valued

• Maximize the use of resources: the design is to draw on the

expertise of those who are more knowledgeable and in the best
position to influence a favourable outcome
Characteristics of Collaboration
• Clear responsibility: Every member of the team
assume clearly defined responsibility
• Boundaries: determining the condition under which
collaboration will occur and when it will be
terminated
 3. CONTRACTING
• Contracting means negotiating a working agreement
between two or more parties in which they come to a
shared understanding and mutually consent to the
purposes and terms of transaction
• Contract may be written or unwritten
• Contracts in collaborative relationship or nurse-client
alliance are flexible, changing and are based on mutual
understanding and trust
 Characteristics of Contracting
• Partnership and mutuality:
• All parties are responsible for setting up and carrying
out the terms of agreement within a dynamic balance
• members develop goals, outline methods to meet
these goals, explore resources to help achieve them,
• define the time limits for the contract and outline
their separate responsibilities
 Characteristics of Contracting
• Commitment: There is pledge of trust and dedication

• Format: spelling out the terms of contract. It provides the

framework for collaboration

• Negotiation: The nurse and other team members propose

to accept certain responsibilities and determine whether
the client agree. Negotiation could also be among other
team members
 Process of Contracting
• It follows a specific sequence of steps and depends on:
• -what clients want
• -Agreeing on goals and identifying methods to achieve
these goals
• -Knowing the resources that collaborative members bring
to the relationship
Process of Contracting
•- Using appropriate outside resources
• - Setting limits
• - Deciding on responsibilities
• - Providing for periodic review
• These phases can be described in phases following the
nursing process
 Assessment: Explore needs to Identifying Issues
• Assessment naturally flows into contracting.
• There is a natural flow in the process that moves into the contract
phase.
• Remember…the assessment and contract phase never really
cease until termination.
• Both are ongoing.
 Assessment: Identifying Issues
• Listening for dominant issues/themes
• Summarization & try to verify the theme which allows the client
to assume ownership
• Identify dominant theme + check out the accuracy
• E.g.. We seem to be talking about current situation of community
from different angles:
Seems like all of these things are pointing in the direction of
improving the health status of women in the community.
Is that correct?
 Identifying An Issue
• You might feel compelled to identify an issue which the client has
not identified as a focus of concern.
• Example:
• From the discussion I have been wondering about____________.
• What do you think about_________? Is this an issue we should
consider.
 Identifying an issue...
• Remember…identifying an issue is the instance where
you have detected an issue for work that the client has
not directly indicated.
Reflecting on the Issue
• Demonstration of your understanding of the
client/community view of an identified topic of
concern.
• The identified topic may not remain the focus
of work but it is a place to start. Example: As I
understand it, the issue that you would like to
address in our work _____________.”
Clarifying Issues for Work
• Extract these issues from those the client has identified, those you
have contributed, or some negotiated combination of the two.
• I think we agree about the main issues we need to work together on.
Let’s review them as I write them down.
• First, there is the issue of __________.
• Second, there is ________________.
• The last thing we identified was ____.
• What do you think? Is this an accurate list of the issues that we'll
address together?"
• NOTE: Always include the client's opinions on a course of action
 Nursing Diagnosis/Goal setting
• Can be anything the client wants to work on, either short or
long term.
• They might include something the client wishes to attain in
the future, but does not wish to or cannot work on right
now.
• Write down what you think are some of the most ‘typical
client goals’ encountered in nursing practice
 Establishing Objective Goals
• Use the SMART format for objectives:
• Specific
• Measurable
• Achievable
• Realistic
• Timely
 Goal: Start a support Group for Pregnant Women
• S = Specific “We would like to start a support group for pregnant women”
• M = Measurable
“We would like them to meet once a week to access information on safe
motherhood practices”
• A = Attainable
“The women are eager to go to anywhere to access information on safe
motherhood practices”
• R = Realistic
“We will spend 30 minutes every Thursday and hope to start in two weeks time”
• T = Has a Time Frame
• “We will start to create awareness about the support group this week and
develop the annual schedule for the support group (including resource persons
& other logistics) within two weeks.
Making Goals Specific: Client Worksheet
Facilitating Goal Setting
• Empower the client to see what
he/she wants to do to change.
• E.g. It sounds like…you are
worried…because women are dying
every day in the community as a
result of issues related to
pregnancy… because you have a
pregnant woman and you want to
be able to do something to improve
women’s assess to quality care . .
…… Is that what you are trying to
say?
Plan/Intervention: Developing an Action Plan
• The action plan is developed
from the goals.

• You will also need to define

your role, or roles, that you
will play in the process.
 Identifying Action Steps
• Often the goals are too
large to accomplish in a
single action.
• In that case you identify
with the client small steps
or task which progress
toward the goal.
Evaluation: Planning for Evaluation
• As professional, you are
responsible for
evaluating your practice.

• Regardless of the setting

it is possible to formulate
some evaluation method
that will measure
effectiveness of practice.
Summarizing the Contract
Contract Section of the Description, Assessment, and
Contract (DAC) Model
• III Contract
A. Issues.
1. Client-identified issues
2. Health Worker-identified issues
3. Issues for Work. These are issues that both parties agree
to address.
B. Goals. Related to the issues for work these are the final
outcomes that you will be striving for.
 The DAC Model continued...
C. Plans
1. Action Plan. In this section summarize that actions that you and
the client have planned. Note who, what, when, where, and how.
2. Client Task or Action Steps
3. Worker Task or Action Steps
4. In-Session Tasks or Action Steps
5. Maintenance Task or Action Steps. Outline tasks or activities that
will occur on a regular ongoing basis.
6. Evaluative Plan. Outline the means and process by which
progress will be evaluated.
https://www.academia.edu/41616207/Description_Assessment_and_Contracting
 Levels of contracting
• Formal contracting: All parties negotiating a written
contract by mutual agreement and sometimes having it
witnessed or notarized
• Informal contracting: involves some form of verbal
agreement about relatively clear-cut purposes and tasks
 Summary
• During contracting, the nurse on the basis of the
assessment and in conjunction with the client or other
professionals, attempt to define clearly the issues and
goals for work and to develop plans likely to resolve the
identified issues and achieve the final goals.
 References
• Hitchcock, J.E., Schubert, P.E. and Thomas, S.A. (1999). Community Health
Nursing, Caring in Action . First Edition. USA. Delma Publishers.

• Harkness, G.A., and DeMarco, R.F. (2012). Community and Public Health
Nursing: Evidence for Practice. LWW.WY

• Spradley, B.W. and Allender J.A. (1996). Community health Nursing;

Concepts, Process and practice (4th Edition). Philadelphia. New York:
Lippincott.
Thank you