The complexity of healthcare settings demands that care organizations have a definitive manner in which care is delivered. There are many forms of care delivery methods in nursing, but Finkelman (2012) outlines various distinct methods: total patient care/case method, team nursing, primary nursing, progressive patient care, functional nursing, care and service team models, among others. Some of the models are no longer in use in nursing practice, but they have made a significant contribution to the current models. Also, some of the models have maintained their main characteristics, but have been adapted to fit the modern demands of healthcare.
The use of nursing models is largely associated with improved quality of care, better efficiency, cost management, and improved documentation methods in nursing practice. This paper will analyze nursing care models with the aim of enhancing my knowledge on the role of the models in management of care and delegation. The exercise will also add to my knowledge regarding application of leadership skills and concepts in initiation and development of effective plans to the various levels of the systems, and how practice improvements can improve the quality of care delivery.
Observation of Staff in Delivery of Nursing
Nursing care models provide the medical and non-medical staff with a schematic framework that depicts the manner in which care is delivered delivery to patients. A nursing care model is an organizational method that provides the infrastructure for care delivery to patients and their families (Mattila et al., 2014). The history of care models in nursing practice can be traced back to the 20th century, although the models have evolved into what is being used today in practice (Finkelman, 2012). The evolution is necessitated by the increasing demands for healthcare, the changing roles of the nurses, and the need for best quality care services.
I visited an intensive care unit in one of the urban hospitals with the aim of exploring the type of nursing care model that the unit uses in care delivery. The intensive care unit is a 12-bed section, which is divided into four sections with three beds each. Each of the subsections is connected by a connecting door, which is rarely used. The caregivers use the main entrance doors o these sections instead of the connecting doors. The reason for avoiding the connecting doors according to the nurse of duty is to reduce the risk of cross-infection among the patients. I also observed that two nurses were on shift and responsible for each of the three-bed sections.
The care team is composed of both medical and non-medical staff in this unit. There are support staff members, for example the porters, as well as cleaners. In addition, medical staff ranging from physicians and LPNs to nutritionists visits the unit to deliver care to the patients accordingly. The care team has a definitive communication method that facilitates collaborative care. The medical staff ensures continuity of care by attending to a patient even after he/she is out of the intensive care unit. I also observed that effective communication between the different professionals and expertise attending to a patient is critical in achieving better health outcomes. The most notable feature of care delivery in this setting is that the head nurse doesn’t necessarily supervise the delivery of care.
The team of caregivers, however, reports to the head nurse at the end of a shift. The head nurse also makes occasional rounds through the unit to make sure that all is running well. Occasionally, the head nurse assists the nurses by answering questions and ensuring every resource is available. Each staff member is personally accountable for the actions taken. I also observed that the caregivers, both medical and non-medical, are very driven and barely requires prompts from a head nurse to act. The collaboration in care delivery was also impressive, as the colleagues helped each other through clarifications in times of doubt, encouragements, and support. This type of nursing care model is referred to as interdisciplinary practice model (Finkelman, 2012).
Finkelman (2012) posits that this is a relatively new model in the nursing practice, which came into being as a result of pressure from the IOM reports on improvement of quality and maximization of the expertise available in healthcare setting. The model is characterized by a mixture of nursing staff members who communicate and collaborate with the primary aim of delivering the best care services to the patients. The model is more patient-centered, rather than task-oriented. The patients’ needs are well addressed, as the mixture of expertise ensures that patients receive relevant and quality care. In addition, the model creates space for innovation and creativity due to the pooling of skills, knowledge and expertise from the different care experts.
Review of Summary of Interdisciplinary Practice Model
Cope et al. (2015) carried out a study to determine the effect that interdisciplinary practice model has on the co-morbidities of patients living with HIV. The study focused on the collaboration between pharmacists and other caregivers in the delivery of care to patients with HIV. The results of the study showed that the patients exhibited better health outcomes with the interdisciplinary model. Finkelman (2012) posits that the interdisciplinary model reduces fragmentation in a complex care system. The intensive care unit is complex, in that the needs of the patients may need attention of more than one specialist. This demand calls for more than one expert, who must collaborate with other experts in order to achieve patient goals.
Empowerment, support, innovativeness and creativity, and the shared responsibility also enhance patient outcomes. Another study by Chen and Kistler (2015) sought to determine the impact of interdisciplinary practice model on oral health of older adults with serious illnesses. According to the authors of this study, older adults are predisposed to oral diseases, and collaborative care can be implemented to improve the health of this population. The study also reveals that most patients do not receive oral health care during end-of-life stage. The results indicate that integrating interdisciplinary practice model with oral care experts improves the oral health or terminally ill patients, hence improving their quality of life.
Review of Summary of Primary Nursing Model
Primary nursing model purposes to provide comprehensive and patient-centered care throughout the period of care (Current Nursing, 2012). A nurse delivers care to a group of patients within a certain unit in a hospital. The nurse establishes a professional relationship with the patients and their families, and this relationship promotes collaboration to a certain level. The most distinguishing feature of primary care nursing is the demand for 24-hour care that is delivered by the registered nurse (Current Nursing, 2012). The RN develops an individualized plan of care with goals and objects only specific to the patient. The care delivered is directed towards achieving these goals.
Finkelman (2012) posts that primary nursing model came into being in the 1970s as a result of the increasing complexities in healthcare. The primary nurse, registered nurse, is responsible for delivering direct care, with the help of associate nurse. This demands that the RN is highly knowledgeable about the conditions of the patients to which he/she is assigned. However, primary nursing care model has been criticized as too expensive, which can be attributed to the shortage of nurses that has consequently caused an increase in salaries. Mattila et al. (2014) sought to establish the effect that primary care nursing has on patients, nursing staff, families, and healthcare organizations. The results of this study indicate that primary nursing care model enhances satisfaction with care and enhances the quality of care. However, Mattila et al. (2014) criticizes this model as too expensive compared to other nursing care models.
Havig, Skogstad, Veenstra and Romoren (2013) posits that primary care nursing, compared to team nursing, doesn’t promote collaboration between the care teams. The increasing complexity of healthcare needs sometimes requires that a patient is attended by more than one specialist. This limits the functionality of primary care nursing model. However, Havig et al. (2013) observe that the model is costly, which is a concern of the contemporary healthcare industry.
Conclusion
Nursing care models have been in existence for a long time, and have been used to improve delivery of care to patients. Efficiency, cost management, and timely care are some of the factors that determine the type of nursing model that a care organization adopts. This paper analyzed nursing care models, focusing on an observed practice model and, interdisciplinary practice model, and primary care nursing model. The interdisciplinary practice model is a preferred model as it is not only cost saving, but also enhances the quality of care, as it requires pooling together of health experts to provide competent care to a patient. This exercise enhanced my knowledge on how nursing care models can improve the quality of care, in addition to the contribution of collaboration in achieving the same.
References
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