Nursing care models reflect the ethical basis of patient care including the main structural culture of an organization. It provides a guideline for establishing and delivering care to patients and families (Mattila, Pitkänen, Alanen, Leino, Luojus et al., 2014). Nursing models of care are established to improve professional practice and they have been used as an instrument to plan and use the staff accordingly and more effectively with a goal of decreasing cost (Finkelman, 2016). Different organizations and different healthcare settings have their own way of providing care for patients which could be depending on the patients’ individual needs. Nursing care models have gone through changes over the years but they have a substantial influence on the newer models that are being made. As time changes nursing models must also change and improve to effectively adapt to a person or an organization’s specific needs. Nursing care model serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.
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Nursing Care Model in the Workplace
Aswe all know, there are many different care models and they are being improved overthe years. Some of them are not being used anymore but they have been aninspiration for the new ones that are being developed. The nursing care modelthat I have observed at my workplace is Functional Nursing. Functional nursingmodel is more focused on the task and each taskis assigned to a mix of nursing personnel who will focus on the specific taskto be done (Jennings, 2008).
I work in a Skilled Nursing Facility that hasa total of 52 patients who are divided into two separate sections, thelong-term care, and short-term care units. The short-term care unit has a totalof 20 patients who are recent hospital discharged patients who need extended careand who are not quite ready to be discharged to their homes. The long-term careunit has 32 patients who are basically elderly that need help with their care whoare not necessarily sick but who need assistance with ADL’s and medications. Thestaff who are assigned for the day consists of two nurses, one LVN, and fivenursing assistants. There is one Charge Nurse per unit in the facility who isresponsible for their own units for the day. The nurses are assigned andresponsible for the medications. We give meds in each of our units, responsiblefor new orders from the doctor and we are also responsible for orderingmedications from the pharmacy of course including all the paperwork. There isone LVN assigned to do treatments for the whole facility such as wound care ortopical medications. The nursing assistants are assigned to take vital signsfor the patients who need them and all the activities of daily living.
The modelof nursing care used in the facility is functional because everyone hasassigned tasks that need to be done and remains their focus for the wholeshift. Every single staff is assigned a particular task and their goal for theday is to finish the task assigned. The good thing about using the functionalmodel in this facility is that it is very efficient, everything is getting doneas it is supposed to regardless of the number of patients in the facility.Working daily on the tasks that need to be done, staff have become creative andhave learned to come up with their own plan to perform each task effectively. Itis also very little to no confusion regarding roles and duties. For thefacility, it is cheap and affordable because no additional staff is neededsince tasks are being done.
Although the functional nursingmodel is efficient, there are also disadvantages that it comes with. Clientsoften get confused who is assigned to them because of the number of differentstaff seeing them for different things. The care in a functional model is sofragmented that it leads to an impersonal relationship between the nurse andthe patient (Finkelmal, 2016). Another disadvantage is that the patients don’t gettheir specific needs met as an individual which results in an unhappy andunsatisfied client. Another problem that I have noticed is that since eachperson is assigned to certain tasks, they are less likely to do anything else. Whenstaff is told to do something else other than their assigned task, they becomeunhappy and are more likely to complain because the time from their assignedwork is being taken away. Thecurrent care model being used does not seem to be working with both patientsand the staff is unhappy.
The Team Nursing Model is the one Iwould recommend to be implemented to improvequality of nursing care, safety, and staff satisfaction. According to King,Long, & Lisy, (2014), the team nursing model care has an RN team leaderthat has effective communication and leadership skills. The team is comprisedof nurses that have the diversity of skills to deliver high-quality care. Eachmember of the team has to work collaboratively because of sharedresponsibility. I figure that this would be a good model for the facility sothat everyone can work together to accomplish a certain task that needs to bedone. According to Finkelman (2016), the current team model has been modifiedfor improved reliability and continuity of care as well as teamwork andmanagement that is more focused on the patient instead of being task-oriented.
Functional Nursing Model
Mattila, Pitkänen,Alanen, Leino, Luojus et al. (2014), conducted a study regarding thedevelopment of a functional model of nursing care in cancer. Theirobjective was to recommend and authenticate a functional model that addresses,guides, and quality nursing care in the Colombian National Cancer Institute. They conducted a study in threephases; analysis of the context, elaboration, and analysis of the narratives ofcare and development of the functional model of nursing care from thenarratives. The workshop showed that having a specific caremodel for nursing is correlated to being able to improve the quality of care, improveidentity, and focus actions on the essentials such as decreasing cost, increasedpatient satisfaction, developing interpersonal skills, continuity in procedures,and demonstrating that nursing is crucial to improving life situations and careof users (Mattila, Pitkänen, Alanen, Leino, Luojuset al., 2014). The result of the study allowed the National Cancer Institute’sModel of Nursing Care to be proposed and authenticated because it was backedand supported by the participants.
Liang& Turkcan (2016), conducted a study between functional care delivery modeland primary care delivery model in acuity-basednurse assignment and patient scheduling
in oncology clinics. The goal of the study is to develop better methodsto decrease the time consumed for nurse assignment and patient scheduling inoncology clinics that use different delivery of care models. To solve the nurseassignment problems in the Functional delivery model, a multiobjectiveoptimization model was proposed to minimize patient waiting time and nurseovertime (Liang & Turcan, 2016). The authors have found that the deliverycare methods used in the oncology clinics are based on numerous factors includingthe availability of skilled nurses in the particular area, staffing costs,patient satisfaction, and patient safety. They have found that there are more advantagesthan the disadvantage of using the Functional care delivery method in oncologyclinics compared to Primary care delivery model although it is not the purposeof the study. Advantages of functional care delivery model include lessrestricted patient scheduling due to nurse availability, nurse balanceworkload, less nurse required and the care model can easily be implementedwithout changing the scheduling system.
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The Functional caredelivery model for both studies have been proven to be useful in specifichealthcare settings. The study conducted by Mattila,Pitkänen, Alanen, Leino, Luojus et al. (2014), mainly states that having aspecific model in the healthcare setting is beneficial to the patient, staffand the organization. The study by Liang& Turcan, (2016), stated that the Functional caremodel delivery can be beneficial in the oncology clinic when considered inpatient scheduling and acuity-based nursing assignments.
Team Nursing Model
A studyconducted by King, Long, & Lisy (2014), comparedthe effectiveness of team nursing to total patient care on the well being ofstaff when organizing work in acute care settings. Based on the documentedmodels of care, the organization of work for nurses canhave a big influence on the wellbeing and performance of nurses and nursingteams as it is key in defining the nurses work environment (King, Long, &Lisy, 2014). In this study, staff wellbeing was basedon staff satisfaction, turnover, absenteeism, stress levels and burnout. Bothquantitative and qualitative reviews were done on nursing models and effectsbut none narrowed the focus on the two models and their direct effect on staffwellbeing. Instead, the data will assist in establishing the effect of eachmodel on the nurses delivering them.
In the study by Fairbrother, Chiarella, & Braithwaite (2015), they suggest thatteam nursing is the best solution to the fast-changing work in healthcareservices and the projected pressures on the nursing workforce. The authorsstated that team nursing continues to holistically and professionally provide nursingactions and care in the healthcare setting. Fairbrother, Chiarella, &Braithwaite (2015) have found that only team nursing is probably the most adequatelyflexible in a workplace with rank changes and recurrent change in work culture.The authors have found based on their analysis, that using team delivery ofcare allows acute nursing to justify the skill and experience sequence, factorsrelated to the nursing workforce, and the hospital-based healthcareenvironment.
Teamnursing based on two studies reviewed have positive effects on the staff,patients, and organizations. The study conducted by King,Long, & Lisy (2014), have given them both qualitative and quantitative dataas far as effects of the care models on the staffs’ wellbeing. Although themodels do affect the wellbeing of the staff, they were not able to narrow downwhich models truly affect them. In the study by Fairbrother, Chiarella, &Braithwaite (2015), they have concluded that team nursing is the most flexibledelivery care system that can adjust to any change in the workplace whether itmay be management, staff or organizational change.
Nursing care models were developed to serve as a guideline to nurses and healthcare organizations for establishing and delivering care to patients. The use of nursing care model varies depending on the healthcare setting and the population it serves. I have learned through this assignment that no matter what kind of nursing model is being used, they all have the same goals of decreasing cost, maintaining providing safety and quality nursing care, increasing staff satisfaction. The nursing care models can change over time but it is developed to adjust and adapt to a person or organization to meet their specific needs. It is ultimately good to have a guideline that can be followed but we have to keep in mind that things can change and there are a lot of variables that can cause these changes. It is important that we remain flexible especially if it improves our work environment. Nursing care models serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.
- Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: where does team nursing sit?. Australian Health Review, 39(5), 489-493.
- Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.
- Jennings BM. Care Models. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2635/
- King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(1), 59-73. doi:10.11124/jbisrir-2014-1533
- Liang, B., & Turkcan, A. (2016). Acuity-based nurse assignment and patient scheduling in oncology clinics. Health Care Management Science, 19(3), 207-226. doi:10.1007/s10729-014-9313-z
- Mattila E, Pitkänen A, Alanen S, Leino K, Luojus K et al. (2014) The Effects of the Primary Nursing Care Model: A Systematic Review. J Nurs Care 3:205. doi:10.4172/2167-1168.1000205