Leadership and Management: Delivery Care Models - Coursework Example

Leadership and Management: Delivery Care Models Introduction The delivery of nursing care can take on various forms and models. Depending on the type of patient and on the type of nursing care needed by the patient, the nursing models are often adjusted and applied accordingly. These models help ensure that the patient receives timely and effective health care services. This paper shall discuss the different types of patient care delivery models used in my organization. Interviews with the staff shall be conducted in order to assess their experiences in the use of these nursing care delivery models. This paper is being conducted in order to determine the different nursing delivery models being used by the nurse on particular patients and how effective these models are in caring for the patient’s needs. Discussion Based on my interviews with the different nurses in my organization, I was able to establish that the different models being used in the organization are the following: total patient care; functional nursing; team nursing; and primary nursing. Variations of these models have also been used in the clinical setting and depending on the illness and the patient being cared for. In my interview of Intensive Care Unit (ICU) nurses, as well as Postanesthetic care unit (PACU) nurses, they indicate that they mostly use the total patient care model in the delivery of nursing care. Total patient care Total patient care is very much like the case method. In the total patient care method, “the nurse is responsible for the total care for the nurse’s patient assignment for the shift the nurse is working” (Kelly, 2010, p. 226). This means that for the particular shift, the nurse is responsible for all the care requirements which a patient would need. The nurse is responsible for several patients during the shift. She may also be assisted by other nursing care professionals including licensed practical nurses (LPNs), but the main bulk of the work is the responsibility of the registered nurse. The total patient care model offers various advantages for the patient and for the nurse. Nurses enjoy autonomy with this model (Marquis & Huston, 2009). They can independently implement nursing care with minimal dictation and control from doctors and other health care professionals. The lines of responsibility and accountability are clear in this model. The nurse and the other health care professionals are aware and well-oriented in this line of responsibility and they also know how the lines of accountability flow. The patients also receive holistic and unfragmented care in this model (Basavanthappa, 2000). Their care is comprehensive and continuous. From the time they are admitted in the unit, patients receive nursing care from the nurse who is in charge of the shift, and when the shift changes, the care is passed on to the next nurse, and so on and so forth. This pattern is followed until the patient is discharged, thereby helping to ensure that the patient receives comprehensive and continuous nursing care. Nurses are however quick to point out that this type of care also has its disadvantages. One nurse mentions that each registered nurse may have a different approach to the delivery of nursing care. This was also mentioned in a discourse by Basavanthappa (2009) which mentions that each RN may indeed have a different approach to care. One of the nurses mentioned that she prefers to allow the patient to be more independent in his daily activities; another nurse mentions that she prefers to assist patients in their daily activities. Both are effective approaches to delivering patient care and they help ensure that the patient receives comprehensive and effective nursing care. This type of care is also difficult to implement because there is limited availability of RNs; and it is also not cost effective (Mosby, 2002). All in all, this type of care may serve patients well depending on their application in patient care. Functional nursing model During my interviews with nursing staff, I also found out that some of them applied the functional nursing model in their care. I noticed that some nurses in the operating room employed this technique. Based on review of literature, this functional model of care was first seen during the Second World War. At this time, there was a need to increase the number of nurses and in order to fill in the numbers, this model was used to make possible the recruitment of less skilled ancillary personnel (Fairbrother, Jones, & Rivas, 2010). In this approach, the work was assigned into different tasks and was delegated to nursing and ancillary staff according to the complexity of the tasks – based on judgment and technical knowledge. The routine tasks were then assigned to the non-skilled nursing personnel. This type of nursing care is very much based on rules and rituals and; and it is based on industrial mass production ideas on work allocation which were existing at the time, “as a task specialization and assembly-line approach had proven massively successful in industry” (Dingwall, as cited by Fairbrother, Jones, & Rivas, 2010). In the operating room, the nurses were using this approach by assigning other routine tasks to nursing aids and licensed practical nurses in the unit in order to relieve them of the non-surgical related tasks in the operating room. They claim that they were able to concentrate on assisting surgeons during surgeries, on preoperative care, on postanesthesia care, and on recovery room care by adopting this approach to nursing care. Moreover, this type of care enabled the economical and efficient delivery of care to the patients (Cherry & Jacob, 2005). As a result of this model, fewer RNs needed to be assigned to the OR; tasks were also accomplished completely and quickly because of this model (Cherry & Jacob, 2005). The RNs only needed to be involved in the primary RN responsibilities; and all the tasks in the OR were accomplished well because of the delegation of responsibilities. This model was effective in the OR set-up in our organization and helped the nurses become more efficient in delivering care. Limited nursing staff in the hospital during the last decade prompted the application of the functional nursing care model. This model is ideal for instances of limited available nursing staff because the task is assigned based on function. The organization of work, “combined with frequent understaffing, forced nurses to be task-oriented rather than client-oriented” (Huber, 2006, p. 321). It is a type of care which was less focused on individual care, but more focused on the accomplishment of tasks. There are however disadvantages to this nursing model. The care for the patient may be fragmented (Wolf & Greenhouse, 2007). This means that, with different care personnel performing various tasks for the patient, the care may be haphazard and uncoordinated. The nurses in the OR expressed that they had this problem sometimes; however, after conducting a meeting among the members of the health care team, reasonable adjustments were made in the coordination process. Another disadvantage of this care was that it sometimes left the patients confused with many providers delivering care (Hegner, Acello, & Caldwell, 2004). However, in the OR setting, after proper coordination, this situation was resolved by the nursing personnel. Team nursing care model In this model, the RN coordinates care for several groups of patients. This type of nursing care was mostly used in the inpatient and outpatient units. The nurses in this area express that they used this approach in order to provide less fragmented care. They used it in order to coordinate with the other members of the nursing team in the fulfillment of coordinated and cooperative care. This care was first seen in the aftermath of the Second World War – as a response to the functional nursing care model. “The model used a group of nurses with diversity in education, skills and professional registration status” (Fairbrother, Jones, & Rivas, 2010). The main purpose of this type of care is on working collaboratively and cooperatively with other nurses – sharing responsibility and accountability in the course of delivering nursing care to the patients. In this model, the time span of patient-team designation differed from a shift to permanent team allocation during the patient’s hospital stay (Fairbrother, Jones, & Rivas, 2010). This type of nursing delivery model was popular during the 1960s and 70s and the application of humanistic values was emphasized at this time. A focus on the patient—in contrast to the functional model which was focused on the task was returned and a multi-level skill application was also emphasized (Fairbrother, Jones, & Rivas, 2010). As expressed by the nurses, they applied this model in the outpatient and the inpatient areas. In these areas, the patient needed devoted and focused care because they entered the unit with all possible ailments. Through the delivery of team nursing, they were assessed, diagnosed and later, appropriate interventions were implemented to them thereafter. In this model, the nurse manager was the primary coordinator and she coordinated with different nursing team leaders. The nursing team leader then coordinated with various nursing personnel including other RNs, LPNs, LVNs, and nursing assistants (Mosby, 2002). Each nursing team was assigned to a patient group which then delivered and administered nursing care to the patient. This type of care was of the utmost quality and was comprehensive enough through the inclusion of support staff. The members of the team participated in the decision-making process and also contributed their own expertise in the care of the patients (Timby, 2009). This type of care is not without its disadvantages however. In this approach, the continuity of patient care is sometimes compromised when the daily team assignments vary (Cherry & Jacob, 2005). The team leader must also have good leadership skills in order to ensure that this type of care works well for the patient (Cherry & Jacob, 2005). Primary nursing model Another type of nursing model seen in my organization is the primary nursing model. In this type of care the RN who is also the primary nurse has 24-hour responsibility for the planning, directing, and evaluation of nursing care (Sellick, Russell, & Beckmann, 2004). This was mostly seen in the palliative care unit, among nurses caring for cancer, AIDS, and other long-term care patients. This model was said to replace the team nursing approach. “Primary nursing was accomplished by a thrust toward professional staffing as an ideal resolution to the task distribution problem” (Barnum & Kerfoot, 1995, p. 84). In this type of care, if it is effective and appropriate to assign only one nurse to a patient – and if such nurse is skilled and trained enough to deliver effective nursing care, then there is no need to coordinate his care with other nurses and nursing personnel. Other nursing care experts also emphasize that primary nursing is an approach where a nurse has “responsibility and accountability for the continuous guidance of specific clients from hospital admission through discharge” (Huber, 2006, p. 322). In this case, the primary nurse provides total nursing care to the patient while the patient is hospitalized. In this model, the nurse delivers, plans, and monitors care of the patient on a 24 hour basis. On a 24-hour basis, the nurse is accountable for the patient’s care and when the nurse delegates her task to an associate she is still involved in the care process by planning the care to be given to the patient (Huber, 2006). In this type of care, there is a greater focus on the client’s needs, on nurse autonomy, and on continuity of care. In comparing the type of care offered by primary nursing in relation to the team nursing care model, primary nursing was able to deliver better quality of care, higher levels of patient satisfaction, and greater continuity of care (Huber, 2006). Patient and nurse satisfaction was also better for primary nursing as compared to team nursing. Practitioners are however quick to point out that as primary nurses, they must exhibit a high degree of autonomy. This can prove difficult sometimes as far as coordination of care is concerned. Other nurses and health professionals may not be as cooperative in the process of coordination and would prefer to practice other models of nursing. In this type of care, more nurses would also be needed. And in the current health scenario where there is shortage of nurses, this type of care is sometimes not the best model to use. The hospital is actually starting to reduce usage of this model because of ineffectiveness. This situation was also seen when the use of this model was minimized when its flaws manifested during actual application (Barnum & Kerfoot1995). Conclusion These models of nursing delivery were seen in my organization. They include: total patient care, functional nursing, team nursing, and primary nursing. The total patient care model was usually practiced in the ICU and was practiced as a means of delivering comprehensive patient care on a 24-hour shift. The functional nursing model approach, seen among OR nurses, is an approach which is largely based on the functions or the task which are to be applied in the actual patient care. Team nursing approach, seen mostly in outpatient and inpatient units, requires the cooperation of the nurse, the RNs and the different nurse personnel involved in patient care. They cooperate with each other and coordinate care in order to deliver quality patient care. Finally, the primary nursing care model, seen in palliative care nursing, is focused on delivering total and comprehensive patient care on a 24 hour basis. This includes nursing responsibility and accountability for patient care. Works Cited Barnum, B. & Kerfoot, K. (1995) The nurse as executive. Maryland: Aspen Publishers Basavanthappa, B. (2000) Nursing Administration. India: Jaypee Brothers Medical Publishing, Inc. Cherry, B. & Jacob, S. (2005) Contemporary nursing: issues, trends, & management. Missouri: Elsevier Health Sciences Fairbrother, G., Jones, A., Rivas, K. (2010) Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse. Retrieved 12 June 2010 from http://www.contemporarynurse.com/archives/vol/35/issue/2/article/3689/changing-model-of-nursing-care-from-individual Hegner, B., Acello, B., & Caldwell, E. (2004) Nursing Assistant: A Nursing Process Approach New York: Delmar Learning Huber, D. (2006) Leadership and nursing care management. California: Elsevier Health Sciences Kelly, P. (2010) Essentials of Nursing Leadership & Management. New Jersey: Cengage Learning Marquis, B. & Huston, C. (2009) Leadership Roles and Management Functions in Nursing: Theory and Application. Pennsylvania: Lippincott Williams & Wilkins Mosby, Inc. (2002) Staffing and Nursing Care Delivery Models. Bahrain Nursing Site. Retrieved 12 June 2010 from http://www.nursing-bh.com/src/std/ext/NR/Teaching%20Tools/14%20NR%20%20Deliery%20of%20patient%20care.pdf Sellick, K., Russell, S., & Beckmann, J. (2004) Primary Nursing: an evaluation of its effects on patient perception of care and staff satisfaction. International Journal of Nursing Studies, 20(4), pp. 265-273 Timby, B. (2009) Fundamental Nursing Skills and Concepts. Pennsylvania: Lippincott Williams & Wilkins Wolf, G. & Greenhouse, P. (2007) Blueprint for Design: Creating Models That Direct Change. The Journal of Nursing Administration, 37(9), pp. 381-387 Read More