Rehabilitation Team

Transdisciplinary Approach: AnAtypical Strategy for ImprovingOutcomes in Rehabilitative andLong-Term Acute Care Settings

Carolyn Reilly, MN RN CCRN

In the rehabilitation and long-term acute care settings, anatypical strategy has emerged in the past few years wherebythe central focus is on improving patient care through a teamapproach in which responsibilities are shared and the normalboundaries of the healthcare professions blurred. This articleprovides a conceptual analysis of this unique, transdiscipli­nary approach to care delivery. Differentiation between inter­disciplinary, multidisciplinary, and transdisciplinary tech­niques is provided through case scenarios. Defining attributes,necessary antecedents, and the many possible positive out­comes from the transdisciplinary approach to practice is dis­cussed. This concept analysis defines for the rehabilitation or

In an era ofhealthcare redesign, several novel approaches todelivering high-quality care at a reduced cost have emerged. Us­ing clinical guidelines, Carelvlaps'", or pathways is one ap­proach whereby populations of patients that consume signifi­cant resources are identified, and standardized plans of care aredeveloped. Other design changes include decentralization ofservices, skill mix changes.and shared governance. In the re­habilitation and long-term acute care settings, an atypical strat­egy called transdisciplinary approach (TA) recently has beendeveloped, whereby the central focus is to improve patient carethrough a team approach, in which responsibilities are sharedand the normal boundaries of the various healthcare professionsare blurred. The case scenario that follows introduces this newconcept within a facility that combines the rigors of rehabilita­tive practices with acute and sometimes critical care in a long­term acute care setting.

Case scenario: Mr. C was transferred to a long-term acutecare facility at 2 pm on a Thursday afternoon. His admissionwas coordinated among the team members assigned to his care,so that an arena assessment could occur. In his room, his as­signed nurse, certified nursing assistant (CNA), and respirato­ry therapist made himcomfortable and oriented him to his room.Mr. C was dependent upon mechanical ventilation and had ex­perienced cardiac arrhythmias throughout his hospitalization atthe transferring facility. Consequently, the caregivers initiatedmechanical ventilation on a portable ventilator and established

216 Rehabilitation Nursing s Volume 26, Number 6· Nov/Dec 2001

Keywordstransdisciplinary approach, concept analysis

long-term acute care nurse a method that can be used to re­design care delivery, to promote improved patient outcomes,and to achieve a cohesive team environment.

Carolyn Reilly is the director of quality and risk manage­ment at Tahoe Pacific Hospital in Sparks, NV, and a doctor­al student at the University of Nebraska Medical Center.Her research interests include transdisciplinary care, out­come management, and acuity measurement with the chron­ically ill population. Address correspondence to CarolynReilly, 2385 E. Prater Way, Suite 101, Sparks, NV 89434, e­mail carolynre@lifecare-hospitals.com.

telemetry monitoring. His daughter was given a welcome pack­et and some basic information about visiting hours, cafeteria lo­cation, and facilities.

Although the team had hoped to complete an arena assess­ment, whereby all disciplines would jointly complete one com­prehensive assessment, Theresa, Mr. C's primary nurse, sug­gested that he was too fatigued from the transfer and would bebetter served by a limited assessment that would meet immedi­ate needs, followed by a more formalized assessment the nextday. The team concurred and an initial assessment was com­pleted only by Theresa and Allen, the respiratory therapist.

The next morning, Joe, Mr.C's physical therapist, helped himto the bedside commode with Theresa and Monica, Mr.C's CNA.Joe was able to assess Mr. C's balance, strength, and coordina­tion while offering suggestions in proper body mechanics dur­ing transfer to Monica, who was still in orientation. Throughoutthe morning, the other team members worked together to meetMr.C's needs and complete a thorough assessment.

In the afternoon, Sheri, the case manager, facilitated a teamconference with the patient and his daughter to develop thetreatment plan. Among the other team members attending wereMr.C's primary physician and his physiatrist. At this conference,specific barriers to discharge were identified and a plan devel­oped to meet Mr.C's needs. Sheri then reviewed all documen­tation with the team members and summarized the plan of treat­ment and discharge.

Mr. C's daughter wasencouraged to bring to his room somefamiliar items from his home to help himto feel more comfort­able.Joe askedthat she also bring sweatpants and a shirt so thatMr. C could dress every day. Allen and Lisa, the speech lan­guagepathologist,discussedwith Mr.C his need for a speakingvalvefor his tracheostomyand developeda schedulefor its use.Mary, theclinical nutritionist, discussed Mr.C's nutritional needs,and the team discussed at length tube feeding goals, initiationof a boweland bladderprotocol,and the timingof swallow eval­uations. Specific short-andlong-termgoalsfor recovery werees­tablishedwith Mr.C and the finalplan of care and interventionswere documented on the chart for weekly review and progressrecording.

Transdisciplinary approachFirst proposed as a model for educating children with cere­

bral palsy, transdisciplinary approach (TA)has become a mod­el of healthcare delivery in new settings. Currently,the term isused to describe care approaches used in the management ofchronic illnesses (vanEijk & de Haan, 1998) and as a practicemodel for nurse practitioners(Hartwig & Landis, 1999).It hasbeen suggestedfor use in home care application(Sherry, 1994),in rehabilitationfacilities (Rosenet al., 1998),and in long-termacute care facilities (e.g., LifeCare Management Holdings Fa­cilities of Plano, TX).

TAholds particularpromisefor improvinghealthcaredeliv­ery and team cohesiveness within the subspecialtiesof rehabil­itativecare and long-termacute care. These two areas, more sothan any other healthcare sector, rely upon teamwork amongseveral disciplines to coordinate and provide patient care. TAoffersa uniqueapproachto facilitatingthis cooperationand hasthe promise of improved patient outcomes through the syner­gism of teamworkand role blending.

Giventhe vagueunderstandingof the term transdisciplinary(it is often confused with multidisciplinary and interdiscipli­nary), a linguistic strategy known as concept analysis is usedhere to explain the TAconcept.Foremost, the purposebehindaconcept analysis is to examineand describe the idea and its usein current language(Walker & Avant, 1995).Toaccomplishthistask, all definitions of the term(s) are considered, defining at­tributesare identified,case scenariosare generatedto help clar­ify true and contrary cases, and antecedents and consequencesare identified.Thus, the purposes of this particular analysisareto define and clarify the meaningof TA and to discuss the ben­efitsof employing TAin acutecareand rehabilitative settings. Fi­nally, a conceptualmodelof care withTAas the nuclearprocessfrom which positiveoutcomesemanate is presented.

Uses of the conceptTodevelop theTAconcept, several processes anddatasources

wereused.Definitions weretakenfromdictionaries andfromtheliterature.A searchwas made of the electronicdatabasesMED­LINE, CINARL, and HealthSTAR, using the Medical SubjectHeadings(MeSH)term transdisciplinary. References fromjour­nal articles found in this search led to additionalreviewand re­searcharticles.Finally, discussions withmultiplehealthcaredis­cipline colleagues who work within a transdisciplinary model

helped ground the concept and reaffirm the defining attributesdetailedin the literature.

The onlyformaldefinition of thetermtransdisciplinary foundin any dictionaryof the Englishlanguagewas in Merriam-Web­ster (1999), which (incorrectly) defined transdisciplinary as in­terdisciplinary (1999). Therootwordstrans- and discipline wereresearchedfor their variedmeanings that couldbe appliedto theconcept.The New 040rd Dictionary ofEnglish (OxfordUniver­sity, 1998)listed trans- as the prefixfor across,beyond,on or totheother side,from theLatin trans meaningacross. A chemistrydefinition fordenoting molecules withtransarrangements of sub­stituents was also listedbut is not applicablefor this discussion.Synonymsincludethrough, surpassing, and transcending.

The word discipline, from Middle English with origins inOld French and Latin (Frenchfrom Latin disciplina [i.e., teach­ing or learning], and discipulus [i.e., pupil]) first appeared inthe 13th century. It has several definitions, including (a) pun­ishment; (b) obsolete: instruction; (c) a field of study; and (d)training that corrects,molds, or perfects the mental faculties ormoralcharacter(Merriam-Webster, 1999). TheNew 040rd Dic­tionary ofEnglish (OxfordUniversity, 1998)furtherdefinesdis­cipline as "a branchof knowledge, typicallyone studiedin high-·er education." Therefore, an apt definition for TA, combiningthe root definitionsof trans- and discipline, would be "The de­livery of care transcendingthe normal boundaries of a specificfield of study."

In the literature, the termtransdisciplinary canbe tracedto theearly 1970sas a teammodelfor educating childrenwithcerebralpalsy(Rosenetal.,1998). In this, andin morerecentusesas a teamapproachfor healthcare delivery, several principles are describedas core to TA.Foremostis that care is deliveredbased upon pa­tient needs rather than on staff trainingor job descriptions. Fur­ther,teamrecommendations arebasedon the patient'sgoals,andnot on team members' expertise. Finally,the ultimate goal is topromoteintegrated assessment andto develop a unifiedtreatmentplan that is executed by all team members (Haig et al., 1994;Hartwig& Landis, 1999;Sherry,1994;Rosen et al., 1998).

The definition of terms often is made clearer by listingantonymsor definingterms that contradict the term or describeits opposite. In this analysis, transdisciplinary can be directlyopposed to the terms multidisciplinary and interdisciplinary. Inthemultidisciplinary teamapproach, therolesof eachteammem­ber are clearly definedand communicationis relativelylimited.Differentdisciplineswork with the same client, yet functionin­dependently. Each conducts his or her own discipline-specificassessmentand formulates discipline-specific goals. The resultsare then shared at team meetings (Rosen et al., 1998).With theinterdisciplinary team approach,team membersengagein prob­lem solvingand care deliveryfrom their discipline (Lamorey&Ryan, 1998). Recommendationsare a result of group decisionmaking that may include problem solving beyond an individ­ual's particular knowledgebase (Hartwig & Landis, 1999).

Defining attributes of TATo further differentiatetransdisciplinaryfrom interdiscipli­

nary or multidisciplinary, defining attributes have been takenfrom the literature. Walkerand Avant(1995) describe defining

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Transdisciplinary Approach

attributes as characteristics of the concept that appear repeated­ly in the literature (Walker & Avant, 1995). The literature de­lineates five premises as needing to be met before TA is possi­ble. They are role extension, role enrichment, role expansion,role release, and role support.

Role extension is a process whereby one's own discipline­specific knowledge is continually increased (Woodruff & Me­Gonigel, 1988). It is essential that each team member understandshis or her individual role and responsibilities, as well as those ofother team members. "Feeling secure in one's role and knowingthat individual contributions are facilitating positive patient out­comes are essential components in creating an environment whereeach discipline is comfortable collaborating with the other"(Akhavain, Amaral, Murphy, & Nehlingerr, 1999, p. 2). Further,"having the security in one's own role leads to the resolution ofrole, turf, and status issues" (Lamorey & Ryan, 1998, p. 325).

The definition ofterms often is made clearer by listing

antonyms or defining terms that contradict theterm or describe its opposite. In this analysis,

transdisciplinary can be directly opposedto the terms multidisciplinary and

interdisciplinary.

Role enrichment is being aware and knowledgeable of the oth­er disciplines represented on the team (Woodruff & McGonigel,1988).Although healthcarepersonnel recognize and appreciate thevarious other professionals, the level of role enrichment to whichthe defining attribute refers is only achieved through team com­munication, coordination of care, and a high degree of collabora­tion. Team members are encouraged to communicate, collectivelyplan and implement assessments, discuss results, and develop inte­grated treatment goals during team meetings (Rosen et al., 1998).

It is through team meetings that the third critical attribute,role expansion, is expressed. Here, each member of a disciplineeducates the others regarding his or her own expertise (Lamorey& Ryan, 1998). Knowledge is shared as team members teacheach other to make specific judgments and decisions about in­terventions that transcend the boundaries of traditional roles(Lamorey & Ryan).

The fourth critical characteristic, role release, is reported ex­tensively in the literature. Incorporating the skills acquired fromother disciplines blurs the traditional discipline boundaries (Lyon& Lyon, 1980). Although a model case is presented later in thisarticle, a simple example would be that of a speech-languagepathologist (SLP) who helps a client to sit more comfortably fortherapy by applying proper body mechanics principles learnedfrom his or her physical therapy colleagues. In this example, theclient's comfort is the primary objective (beyond that of disci­pline-specific goals such as mastering swallowing techniques),the healthcare provider assumed responsibility for the task andhelped the client meet a goal by applying techniques learnedfrom another discipline.

218 Rehabilitation Nursing > Volume 26, Number 6· Nov/Dec 2001

Role support, the last defining attribute, would be evident ifthe physical therapist should walk by at just the moment the SLPwas helping the patient to a more comfortable position and gavethe SLP feedback on how he or she was instructing the patientabout body mechanics. Support of, and feedback to, others aboutthe implementation of a particular skill are the hallmarks of rolesupport (Woodruff & McGonigel, 1988).

Several other common themes are evident in the literature, in­cluding transdisciplinary play assessment, arena assessment, andprimary care providers. Although repeatedly addressed in thissubspecialty of literature, these themes would need to be refinedto be regarded as defining attributes in a healthcare delivery mod­el. In particular, the arena assessment mentioned in the initialcase scenario can be readily adapted to the healthcare environ­ment, in that one primary provider conducts the initial client as­sessment, with all other disciplines observing, adding, or ques­tioning as needed. This approach limits the number of times thepatient is required to answer the same question or demonstratethe same activity or skill, and is considered the best for detectinganomalies because of its thoroughness and differing perspectivesof several specialties (Smith, 1997).

Transdisciplinary casesListed below are several true and invented cases to demon­

strate the TA concept. The model case provides an example ofTA use, with each of its necessary defining characteristics. Theborderline case is an example of a situation where some, but notall, of the critical attributes are present. A related case modelsrelated concepts but does not have any of the critical attributes.Finally, a contrary case is presented that is a clear example ofwhat TA is not (Walker & Avant, 1995).

A model case of transdisciplinary approach: A physicaltherapist enters a patient's room where a family member is help­ing the patient try to drink juice. The therapist, immediately notic­ing the patient coughs after each sip, remembers from a recentcare teaming conference that the patient was to have thickenedliquids only, using the chin-tuck swallowing technique. The ther­apist praises the family member for giving assistance and sug­gests that the patient would tolerate the liquid better if it werethickened; the thickener is added to the juice by the therapist,who returns it to the family member and explains the principlesof the chin-tuck swallowing technique to both patient and fami­ly member. The therapist remains in the room to verify that thepatient is swallowing the juice without choking or aspirating.

Discussion. In this model case, the therapist models role re­lease by identifying a need and providing intervention, basedupon previous role enrichment and expansion. Role extensionis assumed through the therapist's calm and competent manner.Further role expansion is evident as the therapist instructs thefamily member in helping the patient. Finally, role support isevident as the therapist remains in the room to support the fam­ily member in this delivery of care.

Borderline case: The dietitian and the nurse confer aboutMr. Jones's nutritional intake in the past 48 hours. The dietit­ian notes that the intake is well below what is required andasks the nurse to encourage the taking of supplements betweenmeals.

Discussion. In this case, role enrichment is demonstratedthrough the communication and consultation between the nurseand the dietitian. Perhapsevena mutualplan can be inferred;how­ever,no role expansion,release, or support is obvious.The inter­vention to be undertaken by the nurse is within her job descrip­tion and is not an expansion of what she knows and practices.

Related case: The RN and CNA discuss the plan of care fortheir patient load that day. The nurse assigns the giving of bathsand the taking of vital signs to the CNA; she takes responsibili­ty to complete all assessments, give medications, and changedressings. They cooperate in getting all of the patients out of bedfor meals.

Discussion. Althoughthisscenariois a nicedescription of com­munication and teamwork, it is not transdisciplinary care plan­ning. Both the CNA and the nurse are actingwithin their scopeofpractice. One criticismof TA is that there may be some role con­fusion, with the potential of breaching legal scopes of practice.This author does not advocate that, nor is it supported by any lit­erature cited. All initiativesto transcend usual discipline bound­aries are undertaken within legitimate scopes of practice. In thisparticular case, circumstancesthat might be changed to better re­flectTAandremainwithin thepermissible scopeofpractice, wouldhave the CNA assist with gait training learned from a physicaltherapist, or help withreminiscenceactivities duringpersonalcare,as learned from a certifiedtherapeutic recreation specialist.

Contrary case: An internist was assessing Mr. Jones's phys-:ical condition when Mr. Jones suddenly vomited approximately300 cc of dark brownfluid.The physician immediatelycalledforthe nurse, ordered NPO (nothing by mouth) for the patient, andordered that the emesis be cultured for occult blood.

Discussion. In this classicexample, the physicianfails to meetthe patient's immediate need, which is assistance with personalhygiene and medication to prevent further emesis. The physi­cian acts within his traditional scope of practice and expects thenurse to act within her own scope of practice. There is no col­laboration, no role enrichment, expansion, release, or support.

Antecedents of transdisciplinary approach"Collaboration flourishes in an atmosphere where there is a

high level of trust among the disciplines.'(Akhavain et al., 1999,p. 2). Trust is a crucial antecedent for collaboration and TA.Pikeet al. (1993) described how team members can readily assumeaccountability and responsibility for patient care when trust andrespect for individualperspectives are part of the team's culture.Further, developing an environment of trust and mutual respectrequires that individuals abandon antiquated notions of a hier­archy that are rooted in intellectual superiority (Evans, 1994).

Consequences of transdisciplinary approachSeveral positive consequences ofTA are described in the lit­

erature. These include (a) increased professional knowledge andskills through collaborationamong team members, (b) increasedmutual respect and professional growth among team members,(c) shared responsibilitiesfor problem solving and decisionmak­ing' (d) more equal distribution of responsibilities,among teammembers, and (e) a more integrated holistic view of the clientshared by team members (Ryan-Vincek,Tuesday-Heathfield,&

Lamorey, 1995). Negative consequences of TA that are identi­fied in the literature include ambiguous role definitions, liabili­ty questions concerning indirect integrated therapy, and in­equitable delineation of work responsibilities (Geiger, Bradley,Rocks, & Croce, 1986).Both negativeand positiveconsequencescan result from team TA, depending upon the managerial sup­port and spirit of the organization in which it is attempted.

Empirical!clinical referentsThe finalstep in the conceptanalysisis to determinethe empir­

ical referents. WalkerandAvant(1995,p. 46) advisethatempiricalreferents "areclassesorcategories of actualphenomenathatbytheirexistenceor presencedemonstratethe occurrenceof theconceptit­self."Further,in manycasesthe empiricalreferentsare identicaltothe criticalattributes. This is so withTA.

To verify that the fiverolechanges (extension,enrichment,ex­pansion' release,and support)were the operationalrepresentationofTA, the author interviewedstaffmembers from each disciplinein a long-termacute care facilitythatpromotes a transdisciplinaryteam environment.The staffinterviewedrepresentedmany disci­plines including nursing (RN, LVN, CNA), respiratory therapy,physicaltherapy, occupational therapy, recreational therapy, speechpathology,and medicine. Three questions were asked:

1. What is transdisciplinary team approach?2. Did you have any training into this approach prior to

working in this position?3. How is transdisciplinary different from interdisciplinary

or multidisciplinary care?Responses wereconsistent across disciplines andincluded "com­

munication," "it's everybody's job;' ''we workoutsideof our exper­tise;' ''workingtogethertowards onepatientgoal,notdiscipline-spe­cific goal;'"everyoneworks forthegoodofthepatient, blendingroles;,and ''bestinterests of thepatientcomefirst" Noneof the respondentshad formaltraining inTAoutside oftheirpresentjobs,although afewsaid theyhad read about it in theirrespective professionaljournals.Only the physician couldnot clearlyiteratethe differences betweentrans-, inter-, andmultidisciplinary team approaches. (Thephysician,whoisnotin theemployof thefacility, couldnotdefinetransdiscipli­naryandstatedit wasnotan important concept.)

The literature has no reports of empirical research related topatient perceptions or outcomes from TA, although studies haveevaluated the staff's responsiveness and acceptance of TA.Figure 1 shows a working conceptual framework for measur­ing outcomes of patients who are chronically critically ill. Theseare typically older persons who have recovered from life-threat­ening crises but remain critically ill, with exacerbations of un­derlying chronic disease or complications of their primary ill­nesses (Daly, Phelps, & Rudy, 1991).The model presents TA ascentral to positive outcomes in this patient population within along-term acute care environment.

Several patient outcomes are listed that could be analyzed,such as cost, length of stay,hope, satisfaction, functional status,

Rehabilitation Nursing s Volume26, Number6 • NovlDec2001 219

Transdisciplinary Approach

Figure 1. Conceptual Framework for Patient Outcomes Measurement

Patient outcomes• Ventilator time • Patient satisfaction• LOS • Hope• Disposition • Quality of life• Mortality • Motivation• FIM improvement • Costs• Recidivism • Depression

Patient Care Services

Care pro!der outcomes• Employee satisfaction• Physician satisfaction• Employee proficiency• Job stress

Care system outcomes• Hospital profitability• Employee retention• Employee productivity

depression, recidivism, and mortality. The overriding hypothe­sis of the framework is that specific patient, care provider, andsystem outcomes are enhanced by a patient care delivery modelin which the transdisciplinary process has a core, pivotal posi­tion. Research is currently under way investigating the model andspecifically the role TA shares in improving outcomes of this vul­nerable population.

ConclusionLamorey and Ryan (1998, p. 310) propose that "successful

professionals team together to pursue holistic solutions to thechallenges that threaten to overwhelm families, schools, clinics,and community agencies." Transdisciplinary is one team ap­proach that should be scrutinized as a possible effective meansof care delivery in the ever-changingand complex world of healthcare. Specifically, in the specialties of long-term acute care andrehabilitative care, TA can foster a more cohesive team amongthe many professional disciplines caring for patients with com­plex problems. By providing TA focused upon meeting the

220 Rehabilitation Nursing> Volume 26, Number 6· Nov/Dec 2001

patient's immediate needs regardless of the health profession­al's specialty or job description, improved outcomes for patient,care provider and the health facility can be achieved.

ReferencesAkhavain, P., Amaral, D., Murphy, M., & Nehlingerr, K.C. (1999). Collab­

orative practice: A nursing perspective of the psychiatric interdiscipli­nary treatment team. Holistic Nursing Practice, 13(2), I-II.

Daly, BJ., Phelps, C., & Rudy, E.B. (1991). A nurse-managed special careunit. Journal ofNursing Administration, 21(7/8), 31-38.

Evans, J. (1994). The role of the nurse manager in creating an environmentfor collaborative practice. Holistic Nursing Practice, 8(3), 22-31.

Geiger, W.L., Bradley, R.H., Rocks, S.L., & Croce, R. (1986). Commen­tary. Physical and Occupational Therapy in Pediatrics, 6,16-21.

Haig, AJ., Nagy, A., LeBreck, D.B., Ashenbach, D., Collins, S., Hansen,G., & Putnam, J. (1994). Patient-oriented rehabilitative planning in asingle visit: First year review of the quick program. Archives of Physi­cal Medicine and Rehabilitation, 75, 172-176.

Hartwig, M.S., & Landis, BJ. (1999). The Arkansas AHEC model of com­munity-oriented primary care. Holistic Nursing Practice, 13(4),28-37.

continued on page 244

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244 Rehabilitation Nursing' Volume 26, Number 6' NovlDec 2001

Transdisciplinary Approachcontinuedfrom page 220

Lamorey, S., & Ryan, S. (1998). From contention to implementation: Acomparison of team practices and recommended practices across servicedelivery models. Infant- Toddler Intervention, 8(4), 309-331.

Lyon, S., & Lyon, G. (1980). Team functioning and staff development: Arole release approach to providing integrated educational services for se­verely handicapped students. Journal ofthe Association for the SeverelyHandicapped, 5(3), 250-263.

Merriam-Webster. (1999). Merriam-Webster Collegiate Dictionary (10thed.). Springfield, MA: Author.

Oxford University. (1998). The New Oxford Dictionary ofEnglish. Oxford,England: Oxford University Press.

Reilly, C.M. (2000). Doctoral Research Studies. University of NebraskaMedical Center, College of Nursing.

Rosen, c., Miller, A.C., Cate, LM.P., Bicchieris, S., Gordon, R.M., &Daniele, R. (1998). Team approaches to treating children with disabili­ties: A comparison. Archives ofPhysical Medicine & Rehabilitation, 79,430-434.

Ryan-Vincek, S., Tuesday-Heathfield, L., & Lamorey, S. (1995). From the­.ory to practice: A pilot study of team members' perspectives on trans­disciplinary service delivery. Infant-Toddler Intervention, 5,153-176.

Sherry, D. (1994). Reinventing homecare. Homecare Nursing, 12(5),8.Smith, D.L. (1997). Tele-assessment: A model for developmental assess­

ment of high-risk infants using a televideo network. Infant Young Chil­dren, 9(4),58-61.

van Eijk, 1., & de Haan, M. (1998). Care ofthe chronically ill: The future ofhealthcare professionals and their patients. Patient Education and Coun­seling, 35, 233-240.

Walker, L.O., & Avant, K.C. (1995). Strategies for theory construction innursing (3rd ed.). Norwalk, CT: Appleton & Lange.

Woodruff, G., & McGonigel, M. (1988). The transdisciplinary model. In 1.Jordan, J. Gallagher, P. Huttinger, & M. Karnes (Eds.), Early childhoodspecial education: Birth to three. Reston, VA: Council for ExceptionalChildren.

Continuing education (CE) articles dis­cuss current trends and issues affectingrehabilitation nursing. This CE offering(code number RNC-185) will provide 1contact hour to those who read this articleand complete the application form on page251. This independent study offering is ap-propriate for all rehabilitation nurses. By reading this arti­cle, the learner will achieve the following objectives:1. Differentiate between the interdisciplinary, multidisci­

plinary, and transdisciplinary approaches.2. Identify the five defining attributes of transdisciplinary

care.3. Identify positive consequences of, or benefits from, ap­

plying the transdisciplinary approach to the healthcareenvironment.