In the modern dispensation, the healthcare field worldwide faces the challenge of implementing universal health care programs. Finkelman (2016) highlighted critical assumptions made by the American Nurses Association in 2010 that would shape the face of nursing and the healthcare field. It is important to note that after collaborative efforts are realized, resources pulled are together, and joint education of stakeholders is implemented, the buck would rest with the nurses. Quality care, patient safety, and staff satisfaction are dependent on implementation of a system approach that enhances efficiency in care delivery. According to Finkelman (2016), the transition process to a working nursing care model is a change process wrought with significant challenges. Nevertheless, in the past few years, healthcare organizations have embraced the change by working towards the creation of leaner and more effective care systems. The need for comprehensive change calls for adoption of a governance model that Finkelman (2016) contends has the potential to bring all stakeholders on board. The implication is the crosscutting effect of the change that requires all staff and organizational departments to embrace it. The shared governance model allows decentralization of decision-making that factors in all the concepts of the nursing model metaparadigm namely: the person (patient), the environment, health, nursing goals, roles, and functions. The concepts potentially influence the main components of nursing models that include the goal the nurse is trying to achieve, the set of beliefs and values, and skills and knowledge the nurses need to function affectively. The factors have defined the evolution of nursing care models over the years. This paper seeks to identify nursing care models utilized in today's various health care settings and critically review their impact on the management of care and influence on delegation within care teams.
Identification of a Nursing Care Model in Practice
Observation of the hospital staff in the delivery of nursing care led to the conclusion that the model used is the optimized relationship-based care. Finkelman (2016) and Nadeau et al. (2017) pointed out that relationship-based care is a central aspect of the primary nursing care model. In the hospital setting it was noted that care was based on a hierarchical system with a lead nurse and others to whom care roles and duties were delegated. The observation is consistent with the one made by Finkelman (2016) that the primary nursing care model involves a primary nurse, who must be a registered nurse (RN). The primary nurse is responsible for the provision of care to the patient and the family, which was evidenced by their frequent attendance to admitted patients. The primary nurse was seen working collaboratively with other nurses. In their absence, an associate nurse, nurses who were either licensed practical nurses (LPNs) or nursing assistants (NAs) deputized them. Worth mentioning is the observation that the LPNs and/or NAs provided care by consulting the care plan developed by the lead nurse. Under the circumstances, Finkelman (2016) contended that the primary nurse must demonstrate exceptional understanding of the patients’ needs and high level of clinical autonomy.
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Knowledgeability about patients and clinical autonomy were evident at play in different aspects of nursing care. For instance, the primary nurse was noted to encourage the top-down leadership style. The RN was in charge of decision-making and designed care plans for individual patients depending on their existing clinical relationship, which would be sustained throughout the length of stay of the patient at the hospital. The RN also appeared to be responsible for delegation of work and patients to LPNs and NAs. The assignments were patient-based with the objective to ensure continuity of care. This was made possible by the fact that the RN, once assigned to the patient, remained in charge for the time the patient is at the unit, unless under unavoidable circumstances. Continuity of care was ensured through direct communication between the RN and team members who included the LPNs, the NAs, and physicians. The RN had the autonomy to integrate information and coordinate care. It was noted that the RN was solely responsible for administering and coordinating all aspects of patients’ nursing care. Finkelman (2016) observed that this model allows supervised care delivery that reduces labor-associated costs while ensuring quality and safe care delivery for patient satisfaction.
Summary of Resources Related to an Identified Nursing Care Model
The article “Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit” by Nadeau et al. (2017) offers useful insights into the challenges facing the primary nursing care model and suggestions for its improvement. The article categorically recognizes that being a relationship-based care, the model, when applied in specific settings, has been associated with dissatisfaction among patients and nurses alike. The article attributed the dissatisfaction to the complexity in the structure of primary care teams and inconsistencies in assignments when delegated by the RN. Therefore, Nadeau et al. (2017) sought to evaluate perceptions of patients, family, and nurses about the primary nursing care model in relation to its operationalization and satisfaction. To realize the objective of the study, the researchers operationalized an inpatient pediatric hematology, oncology, and bone marrow transplant unit using the model with patient specific teams comprising of two RNs and four secondary nurses. Perceptions of patient/family and nurses’ participants were collected through surveys. The analysis of the findings revealed that a very high proportion of patient/family respondents preferred being under the care of a primary nurse, and were satisfied with the manner in which primary care team members were assigned. In the same vein, nurses expressed satisfaction with the implementation of the primary nursing care model. This was attributed to the model’s ability to ensure continuity in care and improve patient safety. The findings of the study demonstrated acceptance of the model for its effectiveness in care delivery, but Nadeau et al. (2017) caution that the outcome is not the same in all settings. There is need for constant exploration of the perceptions of patients and nurses to determine elements that need improvement when implementing the primary nursing care model.
The article, “The Effects of the Primary Nursing Care Model: A Systematic Review” by Mattila et al. (2014), attempts to poke holes into the primary nursing care model. The approach can be viewed as an important strategy for inspiring organizational change. Organizational change is a pertinent issue because the article recognizes that despite wide implementation of the model in the healthcare sector, research on it is largely descriptive and outdated. Contradictory results have been posited in some cases. With such an understanding Mattila et al. (2014) intended to explore what scientific literature says about the effects of the model on patients, their families, nurses, and care organizations. The systemic review of pertinent literature revealed gaps in research on the effects of the model. According to Mattila et al. (2014), research is limited to perceptions of patients and nurses, and little focus is given to the effects of the primary nursing care model on families of patients and care institutions. The article suggested that preliminary evidence on the effects of the model show variation in benefits from one setting to another and from one beneficiary to the next. However, no consistency was noted in the findings, an observation that corroborates calls for improved research designs including randomized control trials across all aspects of the nursing professions. Implementation of comprehensive research designs need to cover factors such as job satisfaction, retention of nurses, and organizational costs. The article contended that continued implementation of the primary nursing care model needs to be evidence-based, a paradigm shift from the use of descriptive data on effectiveness. Mattila et al. (2014) pointed out the potential the model holds in ensuring efficiency, quality, and safety if inefficiencies in operationalization are addressed in accordance to the evolving state of the healthcare industry.
Summary of Resources on a Different Nursing Care Model
A different nursing care model that was initially developed by the American Association of Critical-Care Nurses, but has been applied extensively across different settings, is the Synergy Model for Patient Care. The model operates on the prerequisite that the nurse has basic understanding of the patient’s needs and environment of the clinical unit. Based on this understanding, Swickard et al. (2014) explored the possibility of adapting the model to the critical care transport setting. Their article, “Adaptation of the AACN Synergy Model for Patient Care to Critical Care Transport”, recognizes the dynamic and complex nature of the modern hospital setting, particularly in dealing with inter-hospital transfers. Swickard et al. (2014) contended that there is a wide gap in decision-making during inter-hospital transfers because discretion is left to the referring physician who may not be knowledgeable about the available means of transport or level of care needed during the transfer process. Therefore, Swickard et al. (2014) posed that the synergy model for patient care has the capacity to match the characteristics of the patient to competencies of the nurse. Thus, the model allows nurses qualified to handle the patient to be assigned to provide care during inter-hospital transfer. Exploration of the model leads to the conclusion that it has a promise to be used in the development of a framework for transfer of patients between hospitals.
The article, “Using the Synergy Model of Patient Care in Understanding the Lived Emergency Department Experiences of Patients, Family Members and Their Nurses During Critical Illness: A Phenomenological Study” by Cypress (2013), explored an important paradigm that should form the yardstick for the measurement of efficiency of nursing care models. Cypress (2013) noted that literature in the field of emergency care has failed to capture perceptions of the triad of patients, family, and nurses about one another. Therefore, the study recruited a sample consisting of patients, family members, and nurses. The participants were subjected to interviews about their experiences with the nursing care model during critical illness in emergency units. Analysis of the responses revealed that the patient psychological deficit and inclusion of family as co-participants in the care were the most important factors. Cypress (2013) recognized that the synergy model of patient care has the potential to address these critical needs by matching them to the nurse competent in the area.
Observations on the Implementation of the Current Nursing Care Model
Implementation of the primary nursing care model at the hospital has challenges that need addressing. The autonomy of the RN in decision-making is likely to have detrimental effects on the moral of supporting nurses who may perceive the aggressiveness of the lead nurse to be demeaning. In modern dynamic healthcare settings, every practitioner is competent in one way or another. The primary nursing care model restricts application of such expertise in the design of patient care plans because the role is a preserve of the RN. Therefore, such an environment, where other members of team have little input in decision-making, is likely to create laxity on the part of the supporting nurses. This is a dangerous precedent for job dissatisfaction because members of the care team are made to feel incompetent through passive participation in patient care. In addition, it is compulsory that the primary nurse must be the RN. This approach increases cost where the facility has a high bed capacity because each patient needs to be assigned a personal RN given the model’s 24-hour availability and accountability policy.
Suggested Future Model for Improving Care Quality, Safety, and Staff Satisfaction
The model that can be used to improve quality and safety in care delivery while at the same time enhancing staff satisfaction is the Inter-professional Practice Model. Finkelman (2016) posited that this model emphasizes on quality improvement because it employs the concepts of inter-professional or interdisciplinary competency and corporation. The Inter-professional Practice Model allows members of the care team to work together to ensure continuity and reliability. Contrary to the primary nursing care model, this new model provides room for a decentralized decision-making system that Finkelman (2016) argued to be the most essential when transitioning to the shared governance models of care management. With each member of the care team contributing, they would feel appreciated and recognized, which will boost morale and job satisfaction. The spillover effects can be efficiency in quality and safe care delivery.
Conclusion
Nursing care models are essential frameworks that define the delivery of care. With increased calls for quality and safety in the delivery of care, nursing models act as standards for nurses to observe, thus, ensuring responsibility and accountability. However, nursing models have different outcomes when applied to different or even similar settings. Therefore, the hospital management is responsible for deciding the care model that suits its facility best based on availability of personnel and resources. The quality of care, safety of patient, and concerns of the family members and nursing staff must be considered when deciding on the appropriate model. Emerging evidence shows new models that are effective in the modern dynamic and evolving healthcare industry. The decision to transition from one model to another must be evidence-based to ensure efficiency and effectiveness in the delivery of care.
References
Cypress, B. S. (2013). Using the Synergy Model of Patient Care in Understanding the Lived Emergency Department Experiences of Patients, Family Members and their Nurses During Critical Illness: A Phenomenological Study. Dimensions of Critical Care Nursing , 32 (6), 310-321.
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.
Mattila, E., Pitkänen, A., Alanen, S., Leino, K., Luojus, K., Rantanen, A., & Aalto, P. (2014). The Effects of the Primary Nursing Care Model: A Systematic Review. Journal of Nursing Care , 2 (3). doi:10.4172/2167-1168.1000205.
Nadeau, K., Pinner, K., Murphy, K., & Belderson, K. M. (2017). Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit. Journal of Pediatric Oncology Nursing , 34 (1), 28-34.
Swickard, S., Swickard, W., Reimer, A., Lindell, D., & Winkelman, C. (2014). Adaptation of the AACN Synergy Model for Patient Care to Critical Care Transport. Critical Care Nurse , 34 (1), 16-28.
