Care Delivery Model Paper

Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision-making and so reduce conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according to Pearson et al (1999,p ).

The Quality and Safety Education for Nurses (QSEN) Institute developed six core competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Quality and Safety Education for Nurses Institute, 2017). At my facility, it is clearly evident that they have adopted these six core competencies to improve patient quality and safety. My facility created the Office of Patient Experience which supports care that is safe, of high quality and high value. Patient satisfaction is a top priority which is why our guiding principle is known as “Patients First”. Through teamwork and collaboration, we deliver care that is patient-centered by working together in multidisciplinary rounds on the inpatient units. Also, the nursing education department supports quality, safety and consistent nursing care through a database of policies and procedures developed using evidence-based research. Lastly, the nursing informatics department is working towards making our EPIC system more patient-centered. They are doing this by decreasing the redundancy in charting for the nursing staff and finding ways to improve processes which automate tasks. This in turn will reduce the time that the nursing staff spends with their computer and increase the time that the nursing staff can spend with their patients.

A common goal all healthcare providers share, is the desire to provide excellent patient care. The delivery of care is constantly changing in healthcare, however, the patient will continue to remain the focus of care. The success of nursing care thrives off the ability to fulfill patient needs and to maintain patient safety and satisfaction. When patients are admitted to the hospital, their need for an increase in their level of care and attention, due to the decline in their health status, and inability to preform normal daily activities of daily living. The loss of independence places the patient in a vulnerable state of mind, causing the individual to rely on members of the healthcare team to assist with basic self-care needs while in a stable and well-organized environment. A structured environment can be accomplished through the practice of hourly rounding on all patients.

Cardiac diseases alone have been estimated, direct and indirect costs, for the overall American population are “approximately $165.4 billion for 2009” (CDC, 2013). A survey found that heart disease accounted for 4.2 million of the hospitalizations in 2006. In 62% of these cases were short stay hospitalizations and occurred amount peoples ages 65 and older. These hospitalization rates also vary by gender, racial, and ethnic groups.

Staffing models play a significant part in the deliverance of care in a health system as it allows systems to put forth adequate staffing to provide a high level of care. The quality of care providers deliver is influenced by individual provider characteristics such as knowledge and experience, as well as human factors such as fatigue. The quality of care is also influenced by the health care organization or system, which involve not only staffing levels, but also patient need, the availability and organization of other staff and support services, and the climate and culture created by leaders in that setting. The same nurse may provide care of differing quality to patients with similar needs under variable staffing conditions and in different work environments. According to The National Center for Biotechnology Information, staffing and patient care quality and safety are directly related. Figure 1 generically illustrates staffing model framework and

The demographic of clients in the long term care delivery model has a range that starts in infants and ends with the elderly, this care also includes persons with disabilities (mental and physical). According to Hooyman (2014),”to address escalating health and long-term care costs, the locus of care for older adults and persons with disabilities is shifting from institutional to community-based settings (p.25). Community based settings would fall under the realm of assisted living, nursing homes where there would be onsite staff that included nutritionist to ensure residents had a balanced diet, physicians, certified nurse aides or medical assistants, nurses, physical therapists, pharmacy technicians, and a health care administrator, but a large portion of long term care is also carried out by family members and friends due to the financial costs associated with facility care which offsets the coverage provided by private insurance, Medicaid and Medicare. The ultimate goal is to have a positive outcome and assist the person receiving care in regaining their

Question 2: I provide almost all of the care for assigned patients throughout the shift but may not have the same patients from their admission to discharge

The three models create nurse-led health care services and expand the practice of nursing and change the delivery of patient care. Nurses have the chance to play as a leader to integrate and deliver the seamless, holistic, accessible care to the patients in non-acute care settings, such as a nurse-led clinical. In addition, PPACA also assists to establish the evidence-based protocols and comparative

quality of patient care, and can be implemented in practice, to provide solutions to nursing

In 1978 the fırst multi-site mental health epidemiologic study in the U.S. reported that more than 50% of community respondents with depressive disorders were treated exclusively within the primary care system. As a result, primary care was labeled the “de facto mental health system” for Americans with the more prevalent but less severe mental health disorders. Subsequent re- search over the next decade found that only 25% to 50% of patients with depressive disorders were accurately diagnosed by primary care physicians. Moreover, among those accurately diagnosed only 50% received minimally adequate pharmacologic treatment, and less than 10% received a minimally adequate number of psychotherapy visits.

Nurse Brink designed a care modality that follows the functional model. With the functional model, care is provided by all members of a nursing team through different tasks (Yoder & Wise, 2015). Nurse Brink uses this model as each RN, LPN, and UAP are assigned a specific job. The jobs that each member of the nursing team has, correspond to their scope of practice (Yoder & Wise, 2015). By having each member complete their job, they’re supporting how a patient’s care is provided. With this design, it allows for each member of the team to work together in union. Though there may be a small number of staff members, they still have a role and responsibility to meet the needs of all patients.

Professional practice models can help guides nursing practice in any healthcare setting. Nursing care models are commonly adopted by Magnet organizations because they promote staff autonomy, shared decision making, patient-centeredness, and quality care. Nurses most often develop PPMs which reflect not only nursing values but the organization’s values as well. This paper will explore several elements of the Brigham and Women’s Hospital’s (BWH) Professional Practice Model (PPM). First, the model’s fundamental nursing framework will be identified. Next, a brief discussion on how the model promotes patient-centeredness, evidence-based practice, and interdisciplinary collaboration will be presented. Lastly, a summary of how the model fosters quality, safety, informatics, shared governance and leadership will be reviewed.

By focusing on overall patient care and satisfaction many areas patients are surveyed on can be improved. Once a performance standard is selected staff must develop a plan for improvement. The first step would be to research as many sources as possible to find the best evidence based practices that would work for the specific facility. This can be divided into two the two categories of direct nursing care and indirect nursing care. Direct nursing care would include implementing hourly rounding, adequate nursing staff and SBAR communication. Indirect nursing care includes availability of technology such as wireless communication, real time locating, wireless monitoring, and electronic medical records. The second step would contain education of the staff on what is to be implemented and why. The why is important for nurses to overcome any barriers that might be encountered. While nursing practice has grown based on evidence Vanhook (2009) explains the greatest barriers to evidence based practice, such as difficulty interpreting findings, limited time, and misunderstanding of research itself, and how to overcome these barriers. With phase one and two completed facilities can move forward with implementation and evaluation.

Dr. Avedis Donabedian developed a model for categorizing and measuring the quality of healthcare providing a framework that conceptualized quality in broad terms and classification to measure and assess different aspects of quality in nursing care (Sollecito & Johnson, 2013). In the footsteps of Donabedian’s framework, Dr. Beatrice Kalisch developed a model conceptualizing missed nursing care otherwise known as “unfinished nursing care” or “care left undone”. Missed nursing care as defined in the Missed Nursing Care Model is any aspect of required patient care that is omitted, either in part or whole, or delayed (Kalisch, Landstrom, & Hinshaw, 2009). The structural aspects Kalisch’s model include labor resources, nursing staff, competency level of staff, education and experience, material resources, teamwork and communication. Kalisch model indicates that nurses with recent restricted resources in the nursing process determining clinical priorities is costly making decisions either to delay or omit certain care and is heavily influenced by team perception, nurse judgment, ("Missed Nursing Care AHRQ," 2015).

It is a less efficient model because of time spent in coordinating, delegating, and supervising leads to a loss of productive work time.” In contrast, the functional nursing care model is more cost-effective. The model defines that fewer RNs with unprofessional workers can deliver care to a large group of patients. In spite of the financial benefits, the functional nursing model has been criticized due to crucial problems such as poor quality of care, low patient satisfaction, increased omissions and errors. Not surprisingly, nurses are enabled to provide a high quality of care to patients in team nursing. Tiedeman and Lookinland (2004) reviewed that “quality of care is higher with the model because the nurses have responsibility and accountability for fewer patients. The nurses know the patients better and can make assignments that best match each patient's needs with staff abilities and skills, and provide more direction, coordination, and supervision.”(p. 294) Each member is able to approach and coordinate patient needs as well as improve continuity of care in team