Nursing Care Models Within The Past And Today Essay

Care delivery models are an integral component for delivering patient care. With the collaboration of other members of the healthcare team, the Registered nurse is able to fully optimize his/her skill sets to provide to best quality care. As discussed consistency and coordinated care are the key. Studies must be conducted and evidence base practice must be implemented in order to find the model that is suitable for a particular unit. How models are implemented in an organization can be highly variable. Completion of this assignment has enlightened me on the profound impact that care models have in the flow of a unit. Newer models

The healthcare industry is an ever changing system in which there is constant pressure for it to provide quality care while maintaining rising cost. The pressure exerted on a healthcare system is exemplified by managed healthcare. This type of care involves integrating and comprehensive systems of health care providers, insurance, companies and government programs. University Hospital is a very large teaching hospital which scores well on accreditation tests and is known for its high quality level of care. Like all hospitals, they need to work on improving their financial situation. In order to alleviate financial stress, the hospital has taken on a “differentiated nursing practice” which has registered nurses as care

Nursing care is focused on the assessment, nursing diagnoses, planning, implementation, and evaluation of patients. This nursing process can also be implemented in aspects outside of nursing and on the nursing field as a collective group. The nursing role is evolving, following the process the outcomes have to be evaluated and put into perspective. Research is being completed the conclusions are all the same, the higher education of nursing care the better the patient outcomes.

Currently at the hospital I work in does not require bedside reporting in high acuity areas such as the emergency department. The current practice is to first identify the nurse for the assignment you are relieving, which often times can be multiple nurses. This often leads to very brief exchange of patient information so that each nurse can get to the next person and start care or leave for the day. Due to the nature of an emergency department, patient population is extremely diverse yielding reports regarding patients of different ages, diagnoses, and acuity. Couple the diverse nature of clients with the brief interactions between nurses to communicate what is presumed important regarding patient care while attempting to maintain privacy all with the distractions of a busy nursing station and it is likely some piece of information may be missed or overlooked.

The magnet hospital model is an international design to provide optimal framework for nursing care and future research. The model is composed of transformational leadership, empirical outcomes, exemplary professional practice, structural empowerment, and new knowledge combined with innovations and improvements. Hospitals that participate in the model and were awarded the title are constantly looking to improve and expand. They strive to provide expert care globally. Scheduling and staffing are done in a way to keep nurses from burning out. The lower the burnout rate the higher the rate of satisfaction and overall health of patients. When nurses are not burnt out they work optimally and want to work with their patients and that creates

With over three million nurses in the United States nurses play an important role in healthcare today. As the future of health care changes the nurses’ role will change as well. In 2008, The Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) combined partnership and put together a committee to assess nursing practices and make recommendations for the future transformations in the health care system. This report was released in 2010 and included four key components in which three will be discussed in this paper.

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.

The Robert Wood Johnson Foundation, in the beginning of 2007, funded Health Workforce Solutions LLC (HWS) in their project to create new innovative care models that can establish proficient and successful ways to deliver health care (Joynt & Kimball, 2008, January). In total, HWS selected 24 models of the original 60 care delivery models to conduct in-depth research. Throughout the years, many institutions have incorporated these different models, either independently or in combination. Although all models met the criteria of HWS, and are beneficial in their own way, the Unit-Based Care Manager model will be the subject of this paper. The Unit-Based Care Manager model, "is a new role created for Clinical Nurse Leaders (CNL 's), where a hospital unit 's care team and delivery is redesigned to leverage the CNL 's knowledge, experience, and functionality" (Joynt & Kimball, 2008, January). In fact, one example of the benefits of implying this model is hand hygiene compliance. Results show from CNL Role Immersions Practicum Experiences, that improvement went from 30% to over 70% with just this implementation ( Reid & Dennison, 2011, September 30).

According to Dobrina, Tenze and Palese (2014) nursing models guide quality nursing practice in developing and improving the nurse–patient relationship in caring for patients and families. Pridmore, Murphy and Williams (2010) state models of nursing are important as they offer a range of belief and values to guide nurses through the stages of the problem solving

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

Nursing Practice continues to evolve in order to adapt to perpetual revamping and reshaping of the healthcare system. The Patient Protection and Affordable Care Act (PPACA) calls for a dramatic and rapid metamorphosis of patient care delivery models in order to provide cost effective, safe, efficient, and high quality care to every American (Cherry & Jacob, 2016).

Both models have different approaches towards the concept of nursing. Leininger presented nursing as “activities directed toward assisting, enabling, and supporting with the cultural beliefs and values of the recipient of care” (Masters, 2014, p. 69). Nursing is a general profession which includes culturally congruent care; nurses provide care for members of diverse cultures. According to Jarošová (2014), nursing is presented by three types of activities which are culturally congruent with the needs and values of clients (p. 49). However, Roy defines nursing as “using the four adaptive modes, promote adaptation for individuals and groups, thus contributing to health, quality of life, and dying with dignity” (McEwen & Wills, 2014, p. 179). Jarošová, (2014) explained that nursing focuses on adaptive abilities of individual, families, and communities. By manipulating focal and contextual stimuli and decreasing the influence of residual stimuli, nursing strives to reduce ineffective responses and promote adaptation of individual in health and illness (p. 54).

According to the Canadian Nurses Association, limited research and clinical evidence exist on the effectiveness of nursing care delivery models across the continuum of care (2010). A literature review consisting of empirical and theoretical research was conducted to gain insight into three specific models of nursing care: primary nursing, total patient care nursing, and team nursing. The literature pertaining to each model will be explored first, followed by a comparison of the models themselves.

An advanced practice nurse with years of experience, Dr.Joanne Duffy, DNSc, RN,CCRN, created a quality-nursing care model which has been adopted by many institutions and incorporated into the practices of all of their registered nurses. The quality-nurse care model is a map of processes for making more strategic client based choices in healthcare systems. It encompasses principles on caring values, attitudes, and behaviors, and establishes the relationship between the nurse and the patient as

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember he is face to face with his enemy all the time, internal wrestling with him” (Nightingale, 1992, p. 22). Fortunately, in the nineteenth century, Florence Nightingale recognized uncertainty could cause harm to her patients (Nightingale, 1992). Equally important to the nursing professional are the nursing theorists, their work, and the evolution of the theories that followed Florence Nightingale, the founder of modern nursing (Alligood, 2014). This paper will apply Florence Nightingale’s grand theory, Merle Mishel’s uncertainty in illness theory, and Madeleine Leininger’s culture care theory to multiple sclerosis (MS) research and practice (Alligood, 2014).