Evolving Practice of Nursing and Patient Care Delivery Models

Nursing care models classify and describe nursing care. They were developed to support and improve professional practice by taking into consideration which model will be the most beneficial. Patterns of nursing care delivery have advanced over the years, including total patient care/case method, functional nursing, team nursing, primary nursing, Care and service team models, complementary models, and case management models. The following paper will describe the implementation of these patterns of care nurses have delivered throughout the years and examples of newer models used in the healthcare field.

Throughout the years, the delivery structure has taken on forms with a similar pattern of Care. This delivery pattern of Care was influenced by the types of patients that were cared for, the cost, and the educational backgrounds of the employees hired (Ellis & Hartley, 2012). These nursing models were developed to support and improve professional practice by introducing these elements and characteristics of a model of Care, the elements found within the model, and the patient care delivery system (Finkelman, 2016). A variety of these patterns are used today and have gone through changes over the past few decades.

Total patient care/case management was the first system used in the United States for the delivery of nursing. The home health nurse works with only one patient providing all required home care. The healthcare teams were divided into the home care aid performing household duties (cooking, light housekeeping) and the other providers (occupational therapist, social worker). While providing this specific Care had its advantages, some disadvantages were working long hours with minimal pay and lack of consistency. Some of the structure of the total patient care/case management model can be seen in today's homes. The functional method of nursing care occurred during the Great Depression, which led to an increase in the number of patients that were being admitted to the hospital, along with the advancement in technology. A charge nurse assigns various tasks to their peers on the unit, according to their level of skills. One nurse might administer all medications, while another nurse might chart them. Although useful in its own way, the care system of delivery has its disadvantages. The Care is divided, and no one individual is responsible for the planning of a patient's Care. Confusion and communication among multiple caregivers begin to cause problems. Providing Care without being mindful of the needs of others can create Care that could be compromised (Finkelman, 2016). This model is not widely used nowadays but may still be used in facilities like long-term nursing, subacute units, or behavioral/psychiatric inpatient services.

The concept of team nursing was developed with more patient-centered Care in mind. Developed after World War II during the nursing shortage, this concept involved licensed practical/vocational nurses and nurse aids. As a registered nurse assumes the team lead role, each unit has two or more teams composed of two nurse aids, a licensed practical/vocational nurse, and a registered nurse working together to provide comprehensive Care (Ellis & Hartley, 2012). The registered nurse assumed all the responsibilities for the Care of the patients making all their decisions. Some disadvantages to this approach are the teams tend to communicate amongst themselves and not with the other interdisciplinary professionals. In addition, the continuity of Care might be compromised as the assignments change daily. A team nursing conference was formed to provide opportunities for all staff to participate in the decision-making process. Today, the team model has changed to meet the need for consistency and collaboration to become a common method of care delivery (Finkelman, 2016).

The pattern of the primary care model was made popular in the 1980s when nurses were not satisfied with team nursing. The registered nurse, who was the primary nurse, was assigned a patient from admission until discharge. An associate nurse works with the same patient on opposite shifts from the primary nurse. The primary nurse develops the plan of Care that is carried out throughout the patient's admission. This created continuity of Care for the patients while the nurse maintained a high level of self-sufficiency. Sometimes the associate nurse had difficulty following the plan the primary nurse had established due to the patient's condition changing daily (Ellis & Hartley, 2012). At times, other healthcare disciplines are consulted without the knowledge of the primary nurse. This model restricts collaboration among the team, leaving one nurse to handle the patient care, ensuring outcomes are met (Finkelman, 2016).

Complementary models began in 1988, utilizing ancillary staff in order for the nurse to have more time to provide patient Care. New substitution models are used that have specific job descriptions for each technician while the registered nurse supervises (Finkelman, 2018).

Cross-training is another approach to the complementary model. Different specialties are trained to perform different tasks within healthcare. For example, a nursing assistant could be trained to draw blood. As the need for staffing becomes challenging, this flexibility meets the patients' needs so the staff can provide safe, efficient Care (Finkelman, 2018).

Case management involves registered nurses who manage patient care to ensure healthcare services are provided, making sure costs are minimized and policies are followed. They are able to identify treatments patients follow from admission to discharge, rehab, and back home. Case managers are used in many different healthcare settings. Although they do not provide direct patient care, they manage the patient's interaction in the healthcare system. Disagreements among the physicians and the role of case management become problematic as the physicians feel this is an intrusion on their autonomy in the decision-making process. Physicians believe case managers are more focused on decreasing costs rather than what is best for the individual (Ellis & Hartley, 2012).

Identifying nursing care models in practice focuses on the nature of healthcare in order to understand how nurses function. The Robert Wood Johnson Foundation created the "culture of health," examining the extent to which nursing models make contributions to the culture of healthcare and the surrounding communities. Nursing care models focus on issues associated with the nature of health and make them useful to other providers. In the future, by exploring factors such as healthcare payment structures, workforce training, and practice policies, the barriers and facilitators can be understood, developed, and implemented into newer nursing models (Martsolf et al. et al., 2016).

Developing a model of Care for healthcare practices allows for continuous improvement in the healthcare field. The Nursing Care with a Human Approach model focuses on the nursing practice and the ability to communicate through significant advances. This was in response to the trends in the development of the professional discipline of nursing. It measures nursing practice by creating conditions of empowerment for nursing that accomplishes a practice that cares for the experience of people (Hermida et al. et al., 2018).

Various models for the delivery of nursing care implemented over the years have been performed successfully in the healthcare industry. A significant change due to the shortage of nurses has forced some rearranging. In the article, models of Care in a systematic review, the effectiveness of these varying models in a particular nursing team. Communication is the key aspect of patient care, and nursing care delivery should be fundamental to any implementation of nursing care models. (Fernandez, R., et al, 2012).

Newer nursing care models have been developed for the future of patient care delivery. The Interprofessional practice model talks about quality improvement and emphasizes the importance of interdisciplinary meetings. Interprofessional teams work together to ensure continuous quality of Care. This model addresses the needs and the use of knowledge to achieve patient outcomes (Finkelman, 2016).

The American Association of Critical-Care Nurses developed the synergy model for patient care. Characteristics such as resiliency, vulnerability, stability, complexity, resource availability, participation in Care, participation in decision-making, and predictability tie into a nurse's competency. Competencies such as clinical judgment, advocacy/moral agency, caring practices, collaboration, system thinking, response to diversity, facilitation of learning, and clinical inquiry can be applied to the clinical unit (Finkelman, 2016).

The Patient Navigation model focuses on cancer patients who have a poor prognosis, although other patient populations can benefit from this model. This model addresses barriers to quality healthcare to ensure patients get the care they need and want (Finkelman, 2016).

Several new models of Care focus on primary care through Accountable Care Organizations, Medical/Health Homes, and Nurse-Managed Health clinics. The goal of these models is to rebuild the healthcare system through these models to reach a positive outcome.

To improve the quality of nursing care, safety, and staff satisfaction, a partnership model can be recommended. Patient care is provided by registered nurses, licensed practice nurses, and the nursing assistant. A major disadvantage to this model is the development of the Magnet hospital concept. This development was geared toward nurses having high job satisfaction and a low rate of nurse turnover. Currently, my hospital only employs bachelor's degree registered nurses while encouraging the remaining associate-degree registered nurses to continue with their education. Licensed practical nurses are no longer in the acute setting but work in the surrounding clinics and doctor offices.

Conclusion

Patterns of nursing care delivery look to qualify the nursing practice. Advances in the healthcare field indicate many of these models are appropriate responses to the development of leadership required by the nursing profession as the structure of healthcare takes many forms.

References

1. Ellis, R. J, & Hartley, C. L. (2012). Nursing in Today's World: Trends, Issues, and Management
2. Fernandez, R., Johnson, M., Tran, D. T., & Miranda, C. (2012). Models of Care in Nursing: A systematic review. International Journal of Evidence-Based Healthcare, 10(4), 324-337. doi:10.1111/j.1744-1609.2012.00287.x (3)
3. Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.
4. Hermida, E. Y., & Sánchez-Herrera, B. (2018). "Nursing Care with a Human Approach": A Model for Practice with Service Excellence. Aquichan, 18(2), 149-159. doi:10.5294/aqui.2018.18.2.3 (2)
5. Martsolf, G. R., Gordon, T., May, L. W., Mason, D., Sullivan, C., & Villarruel, A. (2016). Innovative nursing care models and culture of health: Early evidence. Nursing Outlook, 64(4), 367–376. doi:10.1016/j.outlook.2016.02.009 (1) 

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