In health care settings, collaboration between nurses and other professionals is critical for effective practice [1] . Care is a team effort that its continuity is not possible by a person alone. Coordination, communication and working together are essential and inevitable for effective care and to achieve common goals between different disciplines including nursing [2] . Nurses should have collaboration with other professions to solve care complex problems [3] . Professionals which interact with each other to achieve the objectives create better supportive and educational environment to obtain skills of caring and medical [4] . The absence of a favorable environment for cooperation between clinical members of the group will be followed by irreparable damage for individuals, groups, and organizations and possibly leads to struggle and conflict and the loss of social and organizational capital [5] . The difficulties in collaboration force the nurses and physicians to make decisions and carry out treatments without access to the full range of relevant information that is available about their patients and cannot obtain effective practice.

Most of The repots based on the lack of collaboration between the professions of health care and its negative effects on the health and medical system and patients is increasing [6] . Evidence shows that there is challenge in professional communication and collaboration between physicians and nurses in most cases [7] . One study found that only 13.4% of nurses had good interaction with doctors [8] . Because nursing is a profession that deals with generality of the patient and human values with regard to that collaboration in care is based on human interaction and is a social process, qualitative study is the appropriate approach for studying this phenomenon [9] .

Qualitative researches are noteworthy in some cases such as depth exploring in the processes and complexity, poorly understood phenomena, and discovering the problem [10] . In clinical field many studies were conducted with quantitative approach but there are limited studies especially in our country with qualitative method. There- fore, evaluation of the qualitative studies about care and clinical collaboration leads to that the care team will achieve to more correct understanding of different dimensions of this phenomenon and will inform them about processes, backgrounds, and affecting condition and the outcomes in order to use the results in clinical practice and decision-making.

This article provides a review of the published literature to evaluation how clinical nurses collaboration with other disciplines which had examined by qualitative approach.

In this study, we evaluated all studies with qualitative approaches which had published in the clinical interdisciplinary collaboration between nurses and other disciplinary. We removed duplicate papers with screened titles and abstracts independently and read all retained papers. The Decision to exclude or include papers was agreed by consensus with discussion and consultation for decreasing bias. This study was analyzed by narrative approach because these studies were done with qualitative methodology.

All studies were conducted in clinical field and were patient-oriented. Participants were nurses and other disciplines including doctors, social workers, physiotherapists, psychiatrists, psychologists that performed care and treatment of patients as a clinical discipline. In all studies, nurses were presented as one of the participants [11] -[17] .

In some studies, in addition to nurses, different disciplines such as psychologists, social workers were as other participants [18] [19] . These studies were evaluated the other concepts that nearly to collaboration for example were emphasized to communication. The other concept was coordination.

The researches were performed with different qualitative approach and methodology and were different from sampling method, sample size, tools used in these studies.

7 studies (46.6%) used grounded theory methodology, 3 studies (20%) used focus group, and 3 studies (20%) used an integrated approach. Also, 2 studies (13%) had used a phenomenological approach. Ethnography and action research also had assigned one case each one (6.6%). Canada with 6 studies (40%) had devoted the highest number of publications. America with 4 studies (26.6%) was the next rank. 3 studies (20%) were obtained from England, and Iran and Germany each had published one study (6.6%).

In this review, 7 published studies (46.6%) had selected health care centers as study environment [20] -[26] . Also, some studies were done in the hospitals [27] -[29] . In most studies, the main structure was three components of collaboration process, context of collaboration and consequences that they were emphasized.

Nurses participated as the main members of health care team in all these models and frameworks. Nurses as the main elements were considered and discussed as a meta-paradigm in the models and frameworks.

In the study of Herrman and Zabramski (2005) the size of hemisphere assigned among doctors and nurses in clinical practice was equivalent. This shows major and extensive participation of nurses in the field of training before and after surgery, training of patients’ discharge program, and attending in rounds other elements of structures in these studies were different, this is justified according to the different backgrounds and approaches. In these studies, the structures were organized based on the social and symbolic interactions and most of them discussed the phenomenon of collaboration from social dimensions. In the structures, three components of backgrounds, process and consequences were discussed from various angles.

Working together towards a common purpose was the base of the process of nurse and physician collaboration as a social process. The steps of this process are organized in the form of a set of categories such as becoming one, finding honesty in a people, attention to needs, the exchange of information and ideas, knowing that with whom negotiations are done, planning, being in the same situation, making the situation, and monitoring the process [9] .

In this study, authors used an appropriate approach to assess the process of collaboration between nurses and physicians, but all the necessary tools such as observation and writing remembering were not mentioned. In the interview form, there were some questions assessing the ideas and attitudes of the participants. For example, it was asked that what is your opinion about collaboration? Or whether you believe that collaboration should be done face to face.

In the study of Bagss & Schmitt (1999), the tools of observation, field notes and memos were not used and only semi-structured interview was used for data gathering. In other study, the collaboration process was assessed in 3 dimensions of knowledge exchange, managing participation among members of the team, conflicts related to inter-professional collaboration that it seems that except the first concept, the physician acceptance and the other ones are often in the form of textual variables. In this study, three major concepts were as core of the collaboration process. The first was working together as a team. The second extracted concept was partnership. The last concept which names as the heart of working together was patient-oriented. Authors had selected grounded approach to study the process of collaboration. Feeling better in the job, better learning, controlling costs, improving patient care were as the outcome [21] .

In one study, in addition to the process of collaboration, the degree of collaboration and factors affecting this process were also discussed. In this study, the researcher used the tools of questionnaire for assessment of the process and the tools of interview and observation of field notes were not used, while the questions were less about the process [30] . Since the studies of Douglas et al. (2008) and Manley (1997) were action research, the tool of observation in these researches were of particular importance, while these researchers had only used the interview as data gathering and the processes were tested. In the study of Douglas, the central concept of this process was the project momentum. In this process, it was not clear what strategies people use to manage the condition and achieve outcomes, and the authors had less maneuvering on the outcomes of the process.

In this review, the backgrounds were different. Some studies had properly considered the backgrounds and conditions and Prerequisites in order to form concepts of paradigm and development of the model [9] [28] [30] . A study had pointed out the organizational structure as a background. Of course, the researchers only considered a small dimension of organizational dimensions including roles and hierarchy [24] . While D’Amour and et al. (2008) reported that internal and inter-organizational areas were in a wider scope.

The other one study had been considered the environment as a total context including social norms, cultural values, organizational structure, and organizational regulates [20] . These concepts were in accordance with the concepts related to the study of Douglas et al. (2004) and Manley (1997) as well as Gaboury et al. (2010) that assessed the collaboration in the form of system input.

What Fewster (2011) had suggested as a consequence of collaboration between doctors and nurses was very close to the outcome of the study of Baggs & Schmitt (1999) These concepts were similar to the findings of the studies of Gagliardi (2011) and Patterson (2003) that were done with different approaches. Thus, although these studies had different backgrounds and conditions, but had very similarity in terms of the outcomes.

Since nursing is an international profession and the structure and professional relationships have functional patterns very close together, it can be assumed acceptable. Because health care providers with any conditions and structures are seeking for a common goal and to achieve this important, they will use all the tools and capacity. In Fallahikheshknab et al. (2002) results teamwork, client and family-oriented, client self-sufficient, powerful relationship of members, coordination with the roles of the nurse were the characteristics and the outcomes of multidimensional rehabilitation nursing model. Regarding the purpose of the study, these concepts are considered unique outcomes of this study.

Limitations of our study are: 1) the studies were related to the clinical fields; 2) in this study, the gray literature was not considered; 3) we didn’t have access to all thesis especially in Persian language; 4) studies were limited in English and Persian languages.

In this review backgrounds were different. Some studies had properly considered the backgrounds and conditions and antecedents in order to form concepts of paradigm and development of the model. While the others had pointed out the organizational structure as a background reported that internal and inter-organizational areas were in a wider domain. Organizational structure was important concepts that many studies had discussed as the background of collaboration and the affecting conditions. Some studies had assessed social and cultural factors as contextual variables. In other studies the environment was considered as a total context including social norms, cultural values, organizational structure, and organizational routines. Although these studies had different backgrounds and conditions, but were very similar in terms of the outcomes.

Focus of all studies was on the process of clinical interdisciplinary collaboration. In all studies nurses were considered as the essential elements and they were discussed in the studies as a meta-paradigm. Since nurses have most clinical collaboration and interaction with physicians, most studies had selected the physician as one of the other participants. However, context and processes were different but most studies reported the outcomes similarity of interdisciplinary collaboration. Thus to achieve common goals between different disciplines working together is essential for effective care in clinical settings.

The researchers would like to thank from the Research Deputy of Mashhad University of Medical Sciences for financial support.

In this study there was no conflict of interest.

MousaMahdizadeh,AbbasHeydari,Hossien KarimiMoonaghi, (2015) A Review of the Clinical Interdisciplinary Collaboration among Nurses and Physicians. Open Journal of Nursing,05,654-663. doi: 10.4236/ojn.2015.57069