Learning Module Facilitation and Collaboration any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the

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Certificate Program for Surgical Services Educators

Facilitation and Collaboration

Author:Julie Mower, MSN, RN, CNS, CNOR

Education and Credentialing Project ManagerCompetency & Credentialing Institute

Denver, Colorado

Reviewer: Diana Beck, MSN, RN, CNOR

Perioperative Education SpecialistSt. Mary’s Good Samaritan, Inc.

Centralia, IllinoisAdjunct Faculty

College of Nursing, University of Missour, St. LouisSt. Louis, Missouri

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Copyright 2010 by Competency & Credentialing Institute, Denver, Colo.

ISBN: 978-0-9842595-4-0

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmittedin any form or by any means (electronic, mechanical,photocopying, recording, or otherwise) without theprior written permission of the copyright owners.

Printed in the United States of America

3Learning Module 6 — Facilitation and collaboration

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Unit 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Objectives ANCC Accreditation Statement Definitions

Unit 2: Opportunities for Facilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Facilitation and Learning Facilitating at Meetings Facilitation as a Means of Managing Conflict

Unit 3: Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Benefits Challenges Opportunities Summary

Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Appendices: 6-A: Sample Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 6-B: Sign In Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 6-C Sample Tool for Organizing Committee Responsibilities . . . . . . . . . . . . . . . . . . . . . 25 6-D: “Backward Day” In-service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 6-E: Sample Syllabus for Joint School of Nursing and Perioperative Department . . . . . . . 28

Table of Contents

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Learning Module 6 — Facilitation and collaboration

Unit 1:

Introduction

Current literature stresses the need for the nurse educator to move away from the conventional approach of didactic teaching toward one that incorporates the facilitation of learning (Banning, 2005). However, facilitation is utilized in many other arenas besides traditional teaching, making this a very exciting role for the educator. The National League for Nursing (NLN) considers facilitation important enough to use it as a topic heading in its Core Competencies of Nurse Educators. Competency 1 incorporates facilitation into the creation of a learning environment. Competency 2 describes the need to facilitate learner development and socialization (NLN, 2005).

Facilitation’s twin — collaboration — encourages the nurse who has been in a predominantly perioperative role to share knowledge, skills, and expertise with other hospital departments, health care facilities, and the public.

This module supplies working definitions of facilitation and collaboration, and provides insight toward using these skills in a variety of settings. An in-depth knowledge of perioperative nursing is considered a prerequisite for mastering these skills.

Objectives

Upon completion of this module, the participant should be able to:

1) Appraise the relationship between facilitation and collaboration.

2) Identify key attributes of a successful facilitator.

3) Describe strategies for developing a collaborative relationship.

ANCC Accreditation Statement

This continuing nursing education activity has been approved by the Association of periOperative Regis-tered Nurses (AORN), an accredited approver by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. Activities that are approved by AORN are recognized as continuing educa-tion for registered nurses. This recognition does not imply that AORN or the ANCC Commission on Ac-creditation approves or endorses any product included in the presentation.


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Facilitation and Learning

The concept of facilitating learning is not new, but it has gained additional prominence with its emphasis on not only the dispensation of information, but the role it plays in developing critical thinking, problem solving, and decision-making skills (Banning, 2005). A different approach to teaching requires a differ-ent skills set; although the need to be competent in perioperative nursing practice remains unchanged, the interaction with staff members draws heavily on adult learning principles in which the nurse educator takes into account learning needs and any potential barriers (e.g., language, past experiences, relevant applica-tions, and individual learning styles) when designing learning activities.

Facilitation works best when staff members are self-directed. This does not mean self-learning activities that are done on an individual basis, or that staff members develop objectives, learning strategies, and outcomes on their own. Highly motivated and mature staff members may be able to develop and implement their own learning plan, but typically the educator develops objectives and determines a way to measure meeting the outcomes based on predetermined standards. Again, this may sound virtually identical to conventional teaching methods; the difference is in the roles of the educator and the learners. The educator’s role is to encourage staff members to engage in opportunities to learn, using different skills in ways that are comfort-able to them and consistent with their own learning styles (Bylund, et al, 2008). The staff’s responsibility is to provide the internal motivation to learn.

One difference from the traditional lecture format is the educator’s association with the learners; these relationships allow for the transfer of stories on personal experiences (i.e., “reflective practice”) and are excellent opportunities for the educator to role model the desired behaviors and outcomes for the activ-ity. Sharing stories provides an opportunity for living vicariously through someone else, brings a level of “humanness” to the encounter, and is important in self-directed learning. These reflections should not monopolize the conversation, but should serve as a supplement to the information being presented.

Any notion that education is a “safe” profession should be banished. Expect to be challenged by staff. In fact, questioning on both sides is considered to be integral to the facilitation process (Moore, 2009). Be prepared to provide the rationale (preferably evidence-based) for any changes in practice or routine. It is wise not to take these confrontations personally, but to remember that challenge is the first step toward empowerment and as such, should be cultivated and encouraged. Staff members who are asking questions are developing critical thinking skills that test the accuracy and validity of assumptions and beliefs. See Key Point 6-1 for tips on how to proactively manage challenging behavior.

Unit 2:

Opportunities for Facilitation

Learning Module 6 — Facilitation and collaboration8

Unit 2: Opportunities for Facilitation

The flip side of challenging staff are those staff members who because of culture, personal experience, or language are hesitant to par-ticipate in critical thinking activities or group interactions. Developing and maintaining a safe, non-threatening environment with op-portunities to interact in a group and abun-dant modeling of desired behavior becomes even more important (Mangena and Chabeli, 2005).

Perhaps one of the most important things a nurse educator can do as a facilitator is to “set the stage” for a successful learning environ-ment. Consider incorporating:

• acircularseatingarrangement;

• collaborativeandsupportivemodesof learning, including group ac-tivities, individual staff input, and frequent feedback; and

• sittingratherthanstandingwhenothers are speaking.

Facilitating at Meetings

Due to their clinical expertise and leader-ship and communication skills, nurse educa-tors frequently find themselves as contribut-ing members of hospital committees and task forces. Based on the group and its mission, the educator may volunteer or be asked to serve as the chairperson.

A frequent complaint from those who attend meetings on a regular basis is that there tends to be much wasted time. The following guidelines will aid in preventing the organization’s definition of unproductive (e.g., non-direct patient care related) time from taking on both a literal and figurative meaning.

• Start on time . Starting late sends the message that timeliness is not valued; some people actually consider it a sign of disrespect. Do not wait for latecomers, and do not waste the time of those who have arrived promptly by “catching up” the tardy members. It is the responsibility of the member to obtain any missed information. Use breaks or after the meeting for this purpose.

Key Point 6-1Constructively Managing

Challenging BehaviorStaff members who are most familiar with traditional teaching methods may look at the apparent laissez-faire approach to learning as an opportunity to make their own rules or digress from the subject at hand. This is where the facilitator needs to set clear boundaries on expected behaviors:

1. First and most important, the educator must be competent in the subject being presented. Staff are quick to uncover in-consistencies, hesitancies, and poorly researched information. It is acceptable for the educator not to be the expert, but the person who is should be in the same room. It is much easier to appear self-confident when the homework has been done.

2. Provide the tools to do the job. Handouts, articles, comput-ers, instrumentation — anything that will be used — needs to be available and working.

3. Objectives must be clearly defined in measurable terms at the beginning of the session. Much of the behavior exhibited during in-services and equipment demonstrations is related to lack of information about expected outcomes. If learners do not know what is expected, they will make their own de-termination on how to spend that time. Be clear at the onset about what staff members are expected to know and/or do by the end of the session.

3. Provide frequent “spot checks” on progress, and give feed-back often. Encourage flexible learning strategies that honor past experiences.

4. Effective time management is perhaps the most difficult skill to learn. Be clear how much time is available for a given activ-ity, how the learners will know when they have been success-ful, and the consequences of not meeting a deadline.

Learning Module 6 — Facilitation and collaboration 9


• Come prepared . This means both the facilitator and committee members.

• Outline members’ roles clearly at the onset and repeat as necessary .

• Limit discussion to the topic at hand . If resolution of an issue cannot be reached, table it for a future meeting or find alternative means for obtaining members’ opinions (e.g., e-mail or phone survey, individual discussion). Careful advance planning should help prevent this situa-tion.Ifthetopicisespeciallyfractiousand/ortimesensitive,scheduleameetingspecificallyforthat issue and communicate the agenda to members ahead of time.

“Running” a meeting takes a special set of skills that may be very different from those used daily in the edu-cator role in the perioperative department. Although the nurse educator may be asked to share expertise on a subject, the main role as a meeting facilitator is to expedite the goals of the committee. Typical tasks will include:

• Development of and distribution of an agenda . Administrative support may be available for this, but many educators will need to type up and distribute the agenda themselves. The agenda may be fixed and not deviate from month to month, or be based on an identified need or prob-lem. Some facilities have a specific template that meeting facilitators are expected to follow. A sample agenda is provided in Appendix 6-A. It is helpful to provide an estimated time that has been allotted for each agenda item, and the persons involved. Sending out the agenda a week be-fore the meeting will serve not only as a reminder, but allow assigned persons time to complete any last-minute duties.

• Provide an environment for accomplishing the task at hand . This means having any hand-outs,articles,additionalcopiesofminutes/agenda,laptop/projector,andaroomthatisfreeofinterruptions and can accommodate the number of people expected.

• Ensure that attendees sign in and provide contact information . This will help with drafting meeting minutes and communications in the future. A sample sign-in roster is found in Ap-pendix 6-B.

• Introduce the attendees . Unless everyone knows everyone else, take a few minutes at the be-ginningof themeetingfor introductionsandtobrieflydescribe thecontributions/expertisemembers are bringing. As a courtesy, if guests are there for one agenda item, put that item at the beginning of the meeting, or give an approximate time for them to arrive.

• Appoint someone to take notes . It is virtually impossible to facilitate a meeting and write at the same time. If a note taker is not practical, write up minutes as soon as possible after the meet-ing. It is amazing how quickly details are forgotten. A sample form to help track discussions and responsibilities is included in Appendix 6-C.

• Establish or reinforce (with an experienced group) the rules of engagement . Key Point 6-2 contains a summary of successful strategies for facilitating a meeting.



Perhaps the most important role of a meeting facilitator is to recognize and handle conflict, inappropriate feedback or behaviors, and criti-cism. These situations are distressing to the en-tire group and must be addressed immediately so that a constructive environment may be re-established. The facilitator should support the person “under fire” by acknowledging the in-cident. This person is then more likely to rally and use the incident as a positive learning event. A skilled facilitator will “turn awkward mo-ments prophylactically into creative opportuni-ties” (Bylund et al, 2008, p. 435) to keep the environment safe and the meeting productive. Persons who display behaviors counterproduc-tive to the committee’s mission (e.g., chroni-cally late, verbally abusive, excessive negativism) will benefit from one-on-one counseling on appropriate behaviors.

Facilitation as a Means of Managing Conflict

Facilitating a dispute differs from facilitating a meeting or guiding an educational experience; in this case, the facilitator acts as a neutral third party to help a group resolve conflict. Nurse educators may find themselves in this role as a result of their communication skills and knowl-edge of group processes. Resolving conflict involves communicating in a manner that de-creases defensiveness.

Consider using a “feedback sandwich,” in which strengths are discussed at the beginning and end of the conversation, and the suggested change is “sandwiched” between them. An important and frequently overlooked strategy is to provide time for self-assessment and reflection; what was go-ing well may have been overlooked in the heat of the moment and needs to be emphasized.

Silence can be a powerful tool, and listening closely to what is being said may provide clues to

Key Point 6-2The Meeting Facilitator’s

“To-Do” List

Begin and end on time.

Clearly state ground rules (can also print them on agenda handouts).

Ask attendees to turn off cell phones and pagers, or set them to vibrate. Persons who are consistently on the phone should be politely invited to leave.

For lengthy meetings or those held during a meal time, consider allowing food and/or drinks in the room.

Reiterate the purpose of the meeting, what is planned to be accomplished, and any other information that would assist in meeting outcomes.

Consider appointing someone to serve as timekeeper if it is believed that discussions may get off track. Time is a valuable resource, and committee members have many other responsibilities.

Ask key questions.•Silencedoesnotmeanconsent.

Keep the discussion focused and moving.• “Wehave15minutesleft.I’dlikeustorevisitwhatour

next steps are for solving this problem.”

Encourage participation by all group members.•Donotallowonepersontodominatethediscussion.

This may mean identifying the vocal person, and calling on the quiet person (e.g., “John has provided his opinion onthecausefordelayedcases.Diane,asarepresenta-tive from AM Admits, what are your thoughts?”).

Summarize key issues discussed and decisions made.•Clearlyidentifymemberassignmentsandduedates.•Discussionsareconfidential;resultsarecommunicated

to those who need to know.•Provideopportunitiesforthegrouptoaccomplish

the task or resolve the problem. If work must be done outside of the meeting time, state this clearly at the beginning of the assignment.

•Suggeststrategiesformovingforward,especiallyifthegroup becomes fixated on one issue, or cannot reach consensus on the solution to a problem..



an underlying issue that has nothing to do with the present situation. All parties are accorded the respect of voicing their opinions; a finite time limit is placed on this part of the discussion to allow time for resolution. Summarize the event to allow all parties to view the whole in a perspective other than their own. Provide opportunities for the members to resolve the problem on their own, with the focus on recommendations and constructive alternatives rather than criticism. Perhaps the most important outcome to be achieved with this type of facilitation is the maintenance of a working relationship between the parties (Philipsen, 2008).


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American Association of Critical-Care Nurses. (AACN). (2005). AACN Standards for Establishing and SustainingHealthyWork Environments. Retrieved Dec. 1, 2009 from http://www.aacn.org/WD/HWE/Docs/ExecSum.pdf.

Association of periOperative Registered Nurses. (AORN). (2009). Position statement on a healthy periop-erativeworkenvironment.RetrievedNov.30,2009fromhttp://www.aorn.org/PracticeResources/AORNPositionStatements/Position_StatementOnaHealthyPerioperativeWorkEnvir/

Banning, M. (2005). Approaches to teaching: Current opinions and related research. Nurse Education Today, 25, 502-508.

Bylund, C.L., Brown, R.F., Lubrano di Ciccone, B., Levin, T.T., Guegue, J.A., Hill, C., & Kissane, D.W. (2008). Training faculty to facilitate communication skills training: Development and evaluation of a work-shop. Patient Education and Counseling, 70, 430-436.

Gardner, D.B. (2005). Ten lessons in collaboration. Online Journal of Issues in Nursing, 10(1). Retrieved Nov. 25, 2009fromhttp://www.medscape.com/viewarticle/499266

Fewster-Thuente, L. & Velsor-Friedrich, B. (2008). Interdisciplinary collaboration for healthcare profes-sionals. Nursing Administration Quarterly, 32(1), 40-48.

Johanson, L.S. (2008). Interprofessional collaboration: Nurses on the team. MEDSURG Nursing, 17(2), 129-130. Mangena, A., & Chabeli, M.M. (2005). Strategies to overcome obstacles in the facilitation of critical think-ing in nursing education. Nurse Education Today, 25,291-298.

Moore, J. (2009). An exploration of lecturer as facilitator within the context of problem-based learning. Nurse Education Today, 29, 150-156.

Murphy, M. J. (2006). Collaboration: It’s worth our time and effort. Journal of PeriAnesthesia Nursing, 21(6), 371-376.

National League for Nursing (2005). Core competencies for nurse educators with task statements. Re-trievedDec.1,2009fromhttp://www.nln.org/profdev/corecompetencies.pdf.

References


References

NationalNursingStaffDevelopmentOrganization(NNSDO).(2007).Theroleofstaffdevelopment/staffdevelopment specialist in achieving and maintaining Magnet™ designation. Journal for Nurses in Staff Develop-ment, 23(3), 152-153.

Philipsen, N.C. (2008). Resolving conflict: A primer for nurse practitioners on alternatives to litigation. The Journal for Nurse Practitioners, 4(10), 766-772.

Siebert, D.C. (2008). Secrets to creating effective and interesting educational experiences: Tips and sug-gestions for clinical educators. Journal of Genetic Counseling, 17, 152-160.

Yeager, S. (2005). Interdisciplinary collaboration: The heart and soul of health care. Critical Care Nursing Clin-ics of North America, 17(2), 143-148.

Recommended Readings and Additional Resources

Facilitation and Learning

Fowler, J. (2008). Experiential learning and facilitation. Nurse Education Today, 28, 427-433.

Timmons, F. (2008). Take time to facilitate self-directed learning. Nurse Education in Practice, 8, 302-305.

Using Facilitation to Resolve Conflicts

Information on facilitation as a form of Alternative Dispute Resolution (ADR). Case studies are provided to helpillustratetheprocess:http://nursingworld.org/mods/archive/mod190/ceadrful.htm.

Collaboration

Broome, M.E. (2007). Collaboration: The devil’s in the details. Nursing Outlook, 55,1-2.

Espin, S.L., & Lingard, L.A. (2001). Time as a catalyst for tension in nurse-surgeon communication. AORN Journal, 74(5), 672-682.

Hill, K.S. (2006). Diminishing competition, maximizing benefit through dissemination and collabora-tion. Nurse Leader, 4(5), 24-37.

The Joint Commission Guide to Improving Staff Communication(2nded.).RetrievedNov.30,2009fromhttp://www.jcrinc.com/common/Documents/SamplePages/GISC09_Sample_Pages.pdf.

Kerfoot. K.M., Lavandero, R., Cox, M., Triola, N., Pacini, C., & Hanson, M.D. (2006). Conceptual models and the nursing organization: Implementing the AACN Synergy Model for patient care. Nurse Leader, 4(4), 20-26.


References

Kinnaman, M.L., & Bleich, M.R. (2004). Collaboration: Aligning resources to create and sustain partner-ships. Journal of Professional Nursing, 20(5), 310-322.

McKay, C., & Crippen, L. (2008). Collaboration through clinical integration. Nursing Adminstration Quarterly, 32(2), 109-116.

Sportsman, S., & Hamilton, P. (2007). Conflict management styles in the health professions. Journal of Professional Nursing, 23(3), 157-166. Stone, D., Patton, B., Heen, S., & Fisher, R. (2000). Difficult conversations: How to discuss what matters most. New York, NY: Penguin Putnam, Inc.

Weaver, T.E. (2008). Enhancing multiple disciplinary teamwork. Nurse Outlook, 56, 108-114.

Weston, M. J. (2008). Transformational leadership at a national perspective. Nurse Leader, 6(4), 44-45.

Collaboration with Schools of Nursing

Barnsteiner, J.H., Disch, J.M, Hall, L., Mayer, D., & Moore, S. M. (2007). Promoting interprofessional education. Nursing Outlook, 55(3), 144-150.

Begley, C.M. (2009). Developing inter-professional learning: Tactics, teamwork, and talk. Nurse Education Today, 29,276-283.

Brown, D.G. (2009). An interdisciplinary collaboration in nursing education. Teaching and Learning in Nursing, 4, 52-55.

Forbes, H. and Strother, R. (2004). Guest editorial: Collaboration: Integrating education and clinical practice:ThecaseofLaTrobeUniversity/TheAlfredClinicalSchoolofNursing.Contemporary Nurse, 17, 1-2. RetrievedNov.25,2009fromhttp://www.contemporarynurse.com/archives/vol/17/issue/1-2/.

Holmes, S.P. (2004). Implementing a perioperative nursing elective in a Baccalaureate curriculum. AORN Journal, 80(5), 902-910.

Horns, P.N., Czaplijski, T.J., Engelke, M. K., Marshburn, D., McAuliffe, M. & Baker, S. (2007). Lead-ingthroughcollaboration:Aregionalacademic/servicepartnershipthatworks.Nursing Outlook, 55(2), 74-78.

McNamara, S.(2006). President’s message: Perioperative nursing in nursing school curricula. AORN Journal, 83(2), 301-304.