The Total Patient Care Model of Nursing Delivery - Research Paper Example

The Total Patient Care Model of Nursing Delivery Abstract The primary objective of this research paper is to determine if the quality of nursing delivery to patients can be enhanced through the model of total patient care. Nursing services can meet effectively and efficiently, the needs of the patients if medical administrators implement and adopt care delivery models that maximize benefits of nursing care in order to meet the physical, social, and biological desires of patients. The paper describes the model of total patient care in terms of personnel are utilized in its implementation, roles and responsibilities of the personnel, coordination of work, critical relationships and the educational requirements for various personnel involved in the model. The paper will also focus on the effects of costs on the applicability of the model total patient care. Despite being one of the best models of nursing, it is critical for nurses to understand the merits and demerits of the model so that they can minimize the constraints and maximize on its advantages. Key words: nurse, nursing, model, care, patient Introduction Models of nursing care constitute the procedures and structural representations that illustrate the flow of the health care operations (Rivers & Glover, 2008). Models of nursing care support high-quality services that patients receive in the healthcare centres. Models of patient care provide nurses with theories about people, health, patients’ environment, and the role of the nurse in the treatment process. The availability of various models allows nurses to select the care model that best reflects the area of their work and the group in which the client is suited. According to Mueller & Savik (2010), the models of patient care are necessary because they help nurses to plan patient-care services; proper planning is the critical element of ensuring quality and efficiency in the care process. Models of patient care enhance the way in which nurses assess and deliver treatment services to patients. The patient-care models may involve costs and time; despite this, novice nurses do develop their own patient-care models to enhance the quality of their services. Total patient care is a method of delivering nursing care to patients, which involves a registered nurse being held totally accountable and responsible for providing all care received by the patient during their eight-hour shift (Fairbrother, Jones & Rivas, 2010). The model of total patient care was developed to enhance the cost, convenience, personnel qualities and professional competency of the of care providers. Care is the nursing attention that nurses provide to patients, including medication administration, meeting the biological needs of patients, and satisfying the psychological needs of the patients. The system of total patient care was developed as an alternative to primary care after the achievement of registering enough nurses to implement primary nursing. The model was developed through team nursing to combat fragmentation of the nursing care. Description of the Total Patient Care Model The model of total patient care is commonly used in Intensive Care Units (ICU) and Postanesthetic Care Units (PACU). Under the model of total patient care, licensed practical or registered nurses replace the nursing team who give total care to a group of patients. The nurse providing care is held accountable and responsible for the health care progress of one patient (Dubois, D'Amour, Tchouaket, Rivard, Clarke & Blais, 2012). The nurse is also responsible for planning, organizing, coordinating, and performing total care to the patients. Total patient care is one of the oldest models; the students of nursing typically performed this model in their vocational training. The registered nurse is responsible for all the care provided to a patient during a specific shift. The standard time for any shift is eight hours. The shifts are organized in such a way that there are three nurses exchanging shifts each day. A 24-hour day is divided into three shifts, and each shift assigned eight hours (Mueller & Savik, 2010). Since there are both night and day shifts, nurses have days when they are in night shifts and days when they attend to daytime shifts. Transitional leaves of two or three days are usually given to enable nurses reorganize themselves as they plan to change their shifts. The personnel utilized in the total patient-care model include registered nurses, licensed practical nurses, and the nursing aides. The hierarchical representation of these personnel is that the registered nurses are the highest in the hierarchy, followed by the licensed practical nurses and the lowest are the nursing aides. The factors that differentiate the three personnel in the hierarchy include the level of education, experience in the nursing profession and professional competence (Mueller & Savik, 2010). Registered nurses have received the most specialized educational training in the field of nursing; their period of both instructional and vocational training is sufficient in enhancing their skills and knowledge in patient care. The licensed practical nurses and nurse aides undergo comparative shorter periods of training and do not receive highly specialized education; they, therefore, work under close supervision of the registered nurses. Responsibilities of the registered nurses The registered nurse is responsible for supervising and coordinating the work of other less qualified nurses such as the licensed practical nurses and the nurse aides (Mueller & Savik, 2010). Registered nurses rarely perform direct care for the patients because their primary duties include supervision and accountability. Registered nurses give directions to licensed nurses and nurse orderlies on how to treat patients; the registered monitors closely the performance of these personnel to ensure they do not perform poor treatments such as wrong medications and delayed attentions that may expose them to legal liability. The model of total patient care limits the responsibilities and accountability to the registered nurses to shifts of eight hours. Responsibilities of the licensed practical nurses The licensed practical nurses are responsible for giving injections to patients, administering drugs, prescribing medicines and monitoring the response of patient towards the treatment process (Rivers & Glover, 2008). Responsibilities of the nurse aides The nurse aides assist the registered nurses in implementing personal care of patients. The nurse aides may sometimes be assigned simple tasks of nursing to do under close supervision of the registered nurses. The nature of work assigned to nurse aides varies from one hospital to another; these tasks include housekeeping, helping patients to move in and out of the care unit, patient baths, and maintaining the cleanliness of the care unit (Rivers & Glover, 2008). Coordination of Work The registered nurse regulates and coordinates the activities of the licensed nurse and nurse orderlies. The registered nurse gives directions to these personnel on the activities they should be involved in at each particular time. The registered nurses do not directly participate in the patient-care process (Rivers & Glover, 2008). The licensed practical nurses directly offer treatment to patients; they participate directly in the treatment of patients. Licensed practical nurses give medical injections and drug subscriptions to patients. As the licensed nurse performs specialized treatment processes, the nurse orderlies primarily help in general chores such as housekeeping, patient bathing, and treatment unit cleanliness. The Reporting Relationships The registered nurse occupies the highest position in the total patient-care model. The licensed nurse is closely attached to the patient and reports the progress of the patient to the registered nurse (Mueller & Savik, 2010). When the patient needs specialized attention, the licensed practical nurse seeks advice from the registered nurse. The licensed nurse fills in the occurrence records and submits the books to the registered nurse to intervene where necessary. The nurse orderlies report the patient-care unit matters to the licensed practical nurse who in turn works on the matters or reports them to the registered nurse for further actions. Educational Requirements for Personnel under the Total Patient Care Model The education for the registered nurse varies across programs, but it ranges between four and eight years. The nurse undergoes intensive training in the psychological sciences, social, biological and the technical aspects of the nursing. The licensed practical nurse receives an education program of one to two years in elementary nursing to enable them to do routine procedures and treatments under the guidance of the registered nurse (Fairbrother, Jones & Rivas, 2010). The nurse aides receive a few months training after which they continue receiving regular on-the-job training courses to enhance their skills and capabilities. The vocational training is crucial since it enables the nurse orderlies to identify new developments in the nursing profession and adapt to changes that take place over time. Educational training and experience is vital for all nurses participating in the patient-care model since it helps them to gain experience, understand the ethics of the profession and make rational advancements in patient-care systems to match with changing times and contexts. Contribution of the Model to Cost Reduction, Quality of Care and Patient Satisfaction Despite the total patient model being expensive, the cost-benefit analysis of the model reveals that it has the potential of achieving cost reductions in patient care. According to Mueller and Savik (2010), the model of total patient care appears to be cost saving, especially when the model is online-centered. The office care-centered models are associated with statistically significant better outcomes and higher costs than the models that are less patient centered (Mueller & Savik, 2010). The nurse leaders and patients should determine whether the improvement in patient satisfaction and outcomes associated with the total patient-care model is worth the investment in the costs. The total care model can be cost effective when performed online; nurses should consider to viability of implementing the online care model and maintain similar effectiveness to standard in-office care. Proper application of technological advancements such as Electronic Healthcare Records (EHR) and Artificial Intelligence (AI) in health care centres can reduce the costs of patient care associated with the total patient-care model (Mueller & Savik, 2010). These technologies increase the speed of communication between patients and nurses, ease the process of drug prescription, and enhance the interaction with the patient’s family members and friends. The process of adopting the total patient-care model requires prior consideration of the available resources. Resources include human, time and capital investments that are required in the service-delivery process. Nurse leaders make strategic plans for model adoption before further investments. The first step is to carry out the cost-benefit analysis to determine the viability of the adopting the model. The cost-benefit analysis considers the cost of resources that will be required for a particular project, and compares it with the expected benefits (Fairbrother, Jones & Rivas, 2010). The nurses then consider the financial and capital resources available and determine whether they are sufficient to cater for the needed inputs. Nurses cannot ratify the adoption of the total patient-care model if they ascertain that the healthcare agency lacks sufficient resources to implement the project. The total care delivery model has the potential for ensuring job satisfaction among the participating nurses. Job satisfaction involves the ability of a task to give a sense of contentment to the worker and create pleasurable feelings among the workers about their jobs (Dubinsky & Skinner, 2004). The model gives nurses the opportunity to work and express their knowledge in the course of attending to the patients. The delivery model of total patient care enables the nurses to freely interact with the patient, offer specialized services and work hard to ensure the patient assigned to them recovers from illness. Successful completion of the treatment process enables nurses to feel contented with their jobs and desire to work even harder to improve the outcomes. The payments that nurses receive from implementing this model enable them to satisfy their physiological and psychological needs (Dubinsky & Skinner, 2004). Physiological needs include the basic human wants; the remunerations and compensations enable the nurses to buy the basic commodities of life. Psychological needs are also satisfied through fulfillment and self-esteem. Merits and Demerits of the Care Delivery Model Merits The total patient-care model ensures a high degree of autonomy among the nurses. The model provides foundations and opportunities for nurse leaders to develop their own philosophies of care that are best suited to particular health care environments (Dubinsky & Skinner, 2004). Health care contexts differ from one place to another depending on time and circumstances. Nurses need to tailor their treatment interventions to rhyme with the available conditions. Total patient-care model gives nurses the autonomy to implement their own plans, but within the limits of acceptable codes and ethics of treatment. Total patient-care model clearly defines the lines of responsibility and accountability among the personnel participating in the care treatment process. According to this model, nurses who are assigned a particular shift are accountable for all events that occur during their shift. Clear definition of lines of responsibility and accountability is crucial in the leadership processes because it limits carelessness and negligence (Mueller & Savik, 2010). Nurses at a specific eight-hour shift will assume their responsibilities with due care since they fear the liabilities, and consequences associated with lack of excellent performance. Each personnel also knows their roles and cannot work past their limits. This ensures proper division of labor and specialization, which enhances the efficiency and quality of patient care. Another merit of the total patient-care model is that ensures that patients receive holistic and unfragmented care. The model requires selected nurses to take one patient and care for all their needs. This ensures that patient’s needs are met timely and holistically unlike in the cases where several nurses see many patients (Mueller & Savik, 2010). The one nurse who is responsible for a particular patient understands the needs and desires of the patient due to close interactions over time. The assigned nurse studies and masters the physiological and psychological needs of the patient and the exact time when they should be given attention. The close rapport between the patient and the nurse eliminates the chances of fragmented care. Demerits The main drawbacks of the total patient-care model include cost-ineffectiveness, different approaches by different registered nurses (RNs) and lack of RN availability. The implementation of the total patient care requires the three classes of personnel; that is, the registered nurse, the licensed practical nurse, and the nurse aides. These nurses require to be compensated; the compensations even increase to nurses who take work during night shifts (Fairbrother, Jones & Rivas, 2010). Nurses may sometimes conflict in the processes of patient care because every nurse wants to use different approaches to treatment. Additionally, the registered nurse is not directly involved in the treatment process; this limits the availability of the nurse in the care process. Conclusion Patient care models are crucial in the treatment processes because they give information about the people, professional roles of nurses, the environment of the patient and proper methods of giving treatments to patients. The models provide critical information to the people who do not participate in the nursing profession an idea of the roles that nurses perform. The patient-care models' guide novice nurses in designing their own delivery care frameworks that fit their areas of operation. The model of total patient care was developed to replace team nursing after enough nurses were registered to oversee the treatment processes. The main participants in this model include the licensed practical nurse, registered nurses, and nurse aides. The model of total patient-care support the provision of holistic and personalized care since it enables nurses to plan care that adapts to their own needs. The responsibility and accountability rest upon the nurses who are present at a given shift. The model of a total patient is advantageous as it ensures high degree of autonomy and ensures holistic, unfragmented care. The main cons of the model are lack of RN availability, cost-ineffectiveness, and RN having different approaches to care. Nurses need to collaborate and eliminate the demerits associated with this model and maximize on its advantages because it promises efficiency, quality, and effectiveness of patient care. References Dubinsky, A. J., & Skinner, S. J. (2004). High performers: Recruiting & retaining top employees. Mason, Ohio: Thomson South-Western. Dubois, C., D'Amour, D., Tchouaket, E., Rivard, M., Clarke, S., & Blais, R. (2012). A taxonomy of nursing care organization models in hospitals. BMC Health Services Research, 12, 286-312 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 : A Journal for the Australian Nursing Profession, 35(2), 202-20. Mueller, C., & Savik, K. (2010). Identifying and validating the components of nursing practice models for long-term care facilities. Research in Gerontological Nursing, 3(4), 270-81. Rivers, P. A., & Glover, S. H. (2008). Health care competition, strategic mission, and patient satisfaction: Research model and propositions. Journal of Health Organization and Management, 22(6), 627-641. Read More