Baylor St. Luke’s Medical Center located in Houston provides a wide range of treatment programs to patients including urology, orthopedics, oncology and cardiac services. These advanced treatment programs necessitate a large team of nursing caregivers who work in collaboration with physicians. As observed at the hospital, the interprofessional practice model is utilized in providing nursing care to patients. The model emphasizes on patient-centered care where the role of every health professional is vital in the formation of interdisciplinary teams that undertake their activities collaboratively resulting in integrated patient care that bears the characteristics of continuity and reliability (Finkelman, 2016). The model applied at the hospital demands continuous and consistent collaboration between the nursing professionals and physicians such that they form effective teams based on the patient needs. The efficacy of the model is reliant on the ability of the nursing caregivers to efficiently complete their tasks while at the same time coordinating activities with other caregivers and health professionals in their settings. The model is apparent in the hospital-based routines, patient-centered care, decision-making processes, collaboration and mutual relationships between caregivers and team meetings.
Hospital Routines
The complex care needs of patients at the facility require the input of different physicians depending on the specificity of the patient's conditions. Typically, there are general routines like treatment pathways and complex routines requiring the presence of a registered nurse and other physicians or specialists like a psychiatrist. A close analysis of these routines at Baylor St. Luke’s Medical Center revealed that nurses always consulted the physician or specialists on the best care to provide to the patient according to their diagnoses or sought the opinions of these professionals regarding various issues relating to the patient’s care. The physicians and other specialists also replicated by consulting the caregivers about their observations and the progress of the patients under their care. These routines are symbolic of a collaborative environment with effective communication between the professionals. Hence, the practice fulfills the three major characteristics of cooperation, collaboration, and communication inherent in interprofessional practice models (Finkelman, 2016).
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Patient-Centered Care
Finkelman (2016) noted that patient-centered care is among the main focuses of interprofessional practice models. The practice aims to provide the best care according to the needs of individual patients by incorporating the patient’s physical and mental comfort as well as their familial needs. Nursing care at the hospital applies this form of care by placing the patient's preferences on the forefront by delivering care. The nurses provide emotional support to patients and their families throughout the lengths of the patient’s hospital stay and during subsequent visits. Family involvement is a priority while providing care. Consultations with family members are a key feature of the hospitals applied nursing model. The nurses also provide information to patients on their prognosis and other crucial aspects of their conditions.
Decision Making Process
The nursing structure at the hospital consists of a registered nurse (RN) with one or few licensed practical nurses under the RN depending on the number of patients under their care. Unlicensed assistive personnel (UAP) then offer support to the nursing professional on several aspects of nursing care within their skills and capabilities. Despite the RN being the leader of the nursing team, the decision-making process does not entirely fall on him or her. The RN consults other members of the nursing unit before making decisions regarding the patient’s welfare or scheduling the care delivery process. Similarly, physicians actively consult the nursing unit on important aspects that will facilitate the decision-making process. Consequently, decisions are arrived at after consideration of the patient’s current position and best practices. The consultative process facilitates integrative care by ensuring continuity and reliability requirements of interprofessional practice nursing model.
Collaboration and Mutual Relationships
Although collaboration in nursing is not limited to the interprofessional practice model, it is still a key determinant of the success of the model. Emphasis is placed on collaborative practice at Baylor St. Luke’s Medical Center through the creation of proper working relationships between caregivers. Collaborative practice not only facilitates communication between nursing caregivers, it also offers an opportunity for improving integrative care for patients. The mutual relationships built while the nurses and UAPs work in the same setting are beneficial for the overall care of the patients in the hospital since ideas are exchanged and emerging conflicts easily resolved.
Team Meetings
Interprofessional practice nursing model draws on the skills and abilities of the nursing caregivers and other professionals within the hospital to provide the best possible care for the patient. Nursing leaders are therefore tasked with the role of ensuring vital aspects of the model such as collaboration, communication, non-ambiguity of roles and mutual respect are adhered to at all times in the hospital. Thus, the leaders purposely hold a weekly meeting with the caregivers, physicians and other professionals involved in patient care. The meetings are used to assess the quality of care that patients receive, the roles of caregivers and physicians together with their execution and patient outcomes relating to the application of the model. Emerging issues are also given priority in the meetings to facilitate improvements. The weekly meetings are plausible since they aid in meeting key requirements of interprofessional practice nursing model involving cooperation and collaboration (Finkelman, 2016).
Resource Review (Interprofessional Practice Model)
The article Interprofessional Collaboration and Education provide insights into methods of improving the interprofessional practice nursing model by focusing on interprofessional education (Sullivan, M., Kiovsky, Mason, Hill & Dukes, 2015). The authors suggest that improving relationships between professionals in nursing settings can begin as early as in college. Provision of high-quality patient-centered care can significantly improve if the learners from different health professionals begin their interactions at an early stage. The learners get a deeper understanding of the margins of their practice through interprofessional learning, thus refine their ability to share knowledge and engage in activities required for this model. The suggested shift in professional culture can possibly offer various benefits including improvements in safety, mitigation of the health workers shortage problems, and improvement in ethics for interprofessional practice (Sullivan, M., Kiovsky, Mason, Hill & Dukes, 2015). Notably, the practice is in the implementation stage in states such as Utah, Colorado, and Indiana.
Transforming nursing practice: Barriers and solutions acknowledge the challenges that nursing professionals face on a daily basis and how these barriers prevent the nurses from reaching their full potential (Kunic & Jackson, 2013). The author noted that the focus in healthcare is shifting towards promotion of wellness, disease prevention and better management of chronic diseases. While the shift is welcomed, nurses continue to face the same problems as before or even worse. Achieving the intended shift requires the embracing of modern era nursing models like the interprofessional practice model. This model provides safe, cost-effective patient-centered care (Kunic & Jackson, 2013). The benefits of this model are that it improves the care afforded to patients while at the same time assisting the nursing caregivers to overcome the challenges that they encounter in their practice. Thus, critical changes in nursing practice are possible using this model.
Resource Review (Team Nursing)
The article Work engagement supports nurse workforce stability and quality of care: nursing team‐level analysis in psychiatric hospitals sought to determine how aspects of the work environment and work engagement in nursing care affected job outcomes and the quality of care that patients received (Van Bogaert, Wouters, Willems, Mondelaers & Clarke, 2013). The study was conducted among nurses working in a team environment in psychiatric hospitals. While patients outcomes are known to improve when nurses have a higher rate of job satisfaction, the impact of work engagement in the form of vigor, work dedication and absorption are not well understood (Van Bogaert, Wouters, Willems, Mondelaers & Clarke, 2013). The scarcity of health care professionals necessitates the creation of a good working environment for nurses to reduce levels of job dissatisfaction and improve patient outcomes. Work engagement was found to improve job satisfaction across nursing teams and also positively impacted on patient outcomes.
Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting by Deravin, Francis, Nielsen & Anderson (2017) explore the impact of the introduction of the team nursing care model on job satisfaction and staff stress. While the introduction of this nursing model was expected to improve levels of job satisfaction and reduce stress, results indicated otherwise. There was either increased levels of stress among nursing staff of no positive impact, similar levels of job satisfaction did not improve. However, with proper organizational support, the new model positively impacted on job satisfaction and stress levels. Implying that the introduction of the new care model should take into considering other factors such as staff readiness, skill mix and the ability of the management to support the staff.
Implementation of the Interprofessional Practice Model
Baylor St. Luke’s Medical Center performed a full implementation of this model. Care delivery at the facility follows all the aspects of the interprofessional practice model. Notably, the focus on the quality of care that the patient receives in the hospital is crucial in determining the outcomes. As a result, the nursing caregivers engage the patient and their families in decision making. Patient education is also given utmost attention with the understanding that it improves outcomes. The hospital management encourages the formation of excellent working relationships between nursing staff, physician and other professions involved in patient care. These relationships enhance collaboration which is key to the success of the model. The right skill mix is vital not only among the nursing staff but also throughout the hospital personnel. The hospital thus employs specialists in all the advanced treatment programs it provides such that the nurses work with competent people while providing care. Low employee turnover among the nursing staff coupled with the hospital's excellent reputation is a testament to the success of the model.
Team Nursing
Continuous improvement in the quality of care that the nursing staff at the hospital provide is crucial in improving outcomes. The current model impacts positively on nursing care, however, improvements are possible with the incorporation of certain aspects of a different model. Implementation of a team nursing model is possible owing to the proximity in ideologies between the interprofessional practice model and the nursing model. Team nursing emphasizes the right skill mix which is vital in forming a complete nursing unit. Team nursing is associated with work engagement which reduces stress and burnout. Thus, patient safety will improve while at the same time improving on satisfaction. Certainly, team nursing can be implemented at the hospital at a very low cost.
Conclusion
Selection of an appropriate nursing model is determined by the patient needs in a hospital, the cost involved and the ability of nursing staff to provide the best care to the patients under the specific model. Modern nursing models are focusing on patient-centered care to improve outcomes. The interprofessional practice model is simple to implement and incorporates best practices not only for the nursing staff but also for other professionals in the clinical setting. Aspects of the team nursing model can also be incorporated into this model to improve patient safety and improve the levels of job satisfaction among the nursing staff.
References
Deravin, L., Francis, K., Nielsen, S., & Anderson, J. (2017). Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting. Journal of Hospital Administration , 6 (1), 60-72.
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality car e (3rd ed.). Boston, MA: Pearson.
Kunic, R. J., & Jackson, D. (2013). Transforming nursing practice: Barriers and solutions. AORN Journal , 98 (3), 235-248.
Sullivan, M., Kiovsky, R. D., Mason, D. J., Hill, C. D., & Dukes, C. (2015). Interprofessional collaboration and education. AJN the American Journal of Nursing , 115 (3), 47-54.
Van Bogaert, P., Wouters, K., Willems, R., Mondelaers, M., & Clarke, S. (2013). Work engagement supports nurse workforce stability and quality of care: nursing team‐level analysis in psychiatric hospitals. Journal of Psychiatric and Mental Health Nursing , 20 (8), 679-686.
