Nursing care models are distinct frameworks used in care settings to deliver care services. The type of framework adopted in an organization is determined by various factors, including economic factors, leadership, recruitment and retention of staff members, and type of decision-making models used in the organization (Fairbrother, Jones & Rivas, 2010). The type of care model used determines the quality and effectiveness with which care services are delivered. There are four main types of nursing care models, which can be broadly categorized into task-oriented or patient-centered.
Team-nursing and functional care models are task-oriented, while primary-care nursing and total patient care models are patient-centered models (Kimball, Joynt, cherner & O’neil, 2007). Task-oriented models rely on a mixture of healthcare personnel to deliver services, while patient-centered nursing models are reliant on registered nurses – RNs – for the delivery of care services. The purpose of this paper is to identify the nursing care model in practice and how care is delivered using this model. The paper will also make a recommendation of a current care model of nursing that can be used to improve quality of care.
Identification of Nursing Care Model
The nursing care model used in practice is team nursing. It involves assignment of different aspects of care of a group of patients to a team of care professionals, which is led by a registered nurse as the leader of the team. Each member of the team is assigned a specific job, while the team leader is responsible for supervising the delivery of care. The assignment of the tasks as observed in practice was based on the specialty of the team members. For example, medications were administered by one nurse, while physical care was delivered by orderlies and nursing assistants under the supervision of the team leader. This implies that one patient is attended by several nurses during his/her stay at the hospital.
Fairbrother, Jones and Rivas (2010) posit that fragmentation, a characteristic of team nursing, has negative impacts on the quality of care. Despite the mix of skills afforded by team nursing in caring for the patients, the highly fragmented care accords little or no opportunity for the patient to develop a patient-nurse relationship that is very important in care delivery. As a result, patients may develop feelings of dissatisfaction, especially if their emotional needs are not effectively met. Care is delivered using predetermined schedules that define the time for each caregiver. Patients are grouped based on their characteristics, for example, age, or severity of their health conditions. The caregivers deliver care services in the units hosting the patients.
Finkelman (2012) highlights the importance of leadership in designing and implementing the appropriate models of care delivery. Leadership and management are crucial aspects of organization in healthcare. Models of care also demonstrate the organization of a care facility. For example, Catrambone, Johnson, Mion & Minnick (2009) argue that organization in a care facility is more than the design of the facility. The organization, according to Catrambone et al. (2009) has the potential to affect the quality of care, patient satisfaction, as well as job satisfaction among staff members.
Review of Scholarly Sources
Team nursing is a commonly used care model that is characterized by assignment of a group of caregivers with different skills to a group of patients. Cioffi and Ferguson (2012) describes team nursing as an old model of care that evolved in the 1950s. The article posits that the evolution of team nursing care model was as a result of criticisms about allocation of tasks, which were thought to depersonalize the patient. Team nursing, according to Cioffi and Ferguson (2012) requires exquisite leadership skills among the registered nurses who act as team leaders, as this determines the quality and efficiency of care delivery.
The tenets of team nursing approach have in the course of time been changed to suit different care settings. According to this article, there is insignificant difference between team nursing and primary care nursing model and total patient care models in terms of patient satisfaction, quality of care, and job satisfaction scores among the nurses. This model of care, through traditional, is effective in care facilities that do not experience a surge of patients with varying characteristics.
Mitchel et al. (2012) sought to outline the basic principles and values that define effective team-based approach in healthcare. This article argues that the increasing complexity of health care needs fueled the transition into team-based models of nursing. This is because team nursing care models allows a group of care professionals to deliver care services to a patient. The team can pool together knowledge and skills, hence improving the quality of care rendered to patients.
Although team nursing consolidates expertise and experience into one team to deliver high quality care, its characteristic of shared responsibility is criticized for heightening risk to avoidable adverse events (Mitchel et al., 2012). This is mostly common where communication is poor among the care givers. To overcome this weakness, it is imperative that units that utilize this model of care delivery establish a clear communication strategy. The article also argues that the tenets of team-nursing cannot fit all care situations, which is why adjustments are important.
Primary care model of nursing is another model of care delivery, which is characterized by delivery of comprehensive and patient-centered care services by a dedicated nurse throughout the period of hospital stay of the patient (Jost, Bonnell, Chacko & Parkinson, 2010). Unlike team nursing model where a group of caregivers provide care to a group of patients under the supervision of a team leader, primary care model involves one caregiver rendering care services to a small group of patients. This model is praised because of its encouragement for continuity of care, as one caregiver renders services to the patient for a certain period of time. As a result, the patient doesn’t have to deal with remembering many new faces as in team nursing model.
Primary care model is also commended for its ability to ensure quality of care services. Patient-centeredness characteristic of the model ensures that patients receive individualized care, which enhances patient satisfaction, an indicator of quality. A systematic review by Matilla et al. (2014) sought to establish the impact of the primary care model on the different aspects of care and care delivery. According to the article, there is insubstantial evidence regarding the impact of the model on caregivers, as most evidence focuses on its impact on patients. Matilla et al. (2014) also argues that this model is mostly unacceptable because it is costly. With most healthcare organizations trying to control the cost of care, primary care model of nursing is least considered in care practice.
Implementation and Recommendations
The current model of care nursing – team nursing model – is implemented by dividing nurses into small groups, ensuring that each group has a combination of skills and expertise. A registered nurse is then assigned group leader for each of the team. Patients are also divided into small groups of four-five patients, and each group of patients assigned to a team of nurses. The members of the team assigned to a group of patients are responsible of performing all services required by a patient. The team leader assigns each team member a duty and also supervises the members.
The team is responsible for ensuring that the needs of the patients are met for the period of time that the patient is under their care. In this setting, the nurses ensure 24 hour care to the patient. Scheduling is done to determine the members who will take care of the patients. Standard communication methods are established for use among the team members, especially during handoff. The standardization of communication reduces the risk of errors and adverse events. Conflicts between team members are a threat to the quality of services and the effectiveness of delivery. The team leaders have to develop measures to prevent and facilitate resolution of these conflicts. I would recommend primary care model of nursing to improve quality of care, safety, and job satisfaction.
The primary model is criticized for being expensive, but it is commended for quality of care services and improved staff and patient satisfaction. The primary care model is also versatile, as it allows accommodation of insurgent of patients or an increase in patient needs. Unlike the team nursing model, primary is patient-centered, rather than task-oriented, and this contributes to improvement of quality services. Also, there are less chances for disputes and conflicts, which contributes to better working environment, hence staff satisfaction.
Conclusion
Models of care delivery determine the quality of care services, and the efficiency with which these services are delivered to the patients. Models of care delivery can either be task-oriented or patient-centered. This paper identified the model of care delivery in my practice settings, and analyzed a different model of care delivery that would enhance staff satisfaction, improve care, and patient safety. This exercise encouraged acquisition of more knowledge on models of nursing care, how they are implemented, and their impact on the different aspects of care.
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