Evolving Practice of Nursing Delivery Models - Assignment Example

Evolving Practice of Nursing and Patient Care Delivery Models al Affiliation Evolving Practice of Nursing and Patient CareDelivery Models Informal presentation on how nursing is expected to grow and change The nursing workforce still faces a myriad of challenges influenced by aspects such as increased globalization, advanced science and technology, and the dynamic nature of current society. Pertinent to this discussion is the vital growth and development of the nursing profession, in line with the ever-dynamic nature of the global healthcare system. Adding to this is the greater need for the profession’s departure from the ideal of ‘what is’, and subsequently focusing on ‘what should be’ in terms of health and mental care provision. Further influential is a thoughtful examination of the prevailing RN (registered nurse) profession, in terms of support for healthcare reform (IOM & RWJF, 2012). The dynamic nature of current society has necessitated a number of major reforms, key amongst them: the American Recovery and Reinvestment Act (2009), and the subsequent healthcare reform legislation – Obama Care – signed by President Obama (2010, Mar 23). As The NAP (2011) portrays, this is in addition to a range of initiatives which seek to further redesign the delivery, financial and organizational aspects of America’s healthcare system. In accordance with this reform outlook, a variety of programs are reliant on different conceptual interventions which fall specifically within the RNs’ scope of practice, i.e. transitional (continuum of) care and care coordination amongst other aspects. The associated programs pertinent to health care reform are inclusive of accountable care organizations (ACOs), nurse-managed health clinics, and primary care medical homes. Through expansion of the overall reach of insurance coverage, there is increased placement of greater demands on the prevailing primary care system present. Furthermore, through investment in the overall expansion of HIT – interoperable health information technology platforms – that critical implementation of system reforms can be effectively achieved (The NAP, 2011). This is not only vital in localized settings, but more so in terms of the spurred growth of community-wide exchange of information, as projected by the IOM and RWJF (2012). This has great potential of changing in profound ways, the scope, skill-mix (expertise) and distribution of nursing practice. Accordingly, the reformation within the health care delivery system foretells a number of crucial inputs by the nursing profession. These include: changes in the demand for RNs service provision, and the effective positioning of the nursing profession towards effectively responding to the reforms made. Furthermore, is the crucial role-play the profession has in regard to effecting a positive post-reform healthcare environment. The pertinent health reform legislation, augmented by other relevant policy initiatives, reveals a range of provisions and programs. These call upon the need for re-organization of not only the workforce responsible (in terms of delivery), but also the health care services provided and the general health care system. This is based on the influence that future implementation of these provisions and programs could fundamentally affect their future roles, input and requirements of RNs. Informative in this regard is the fact that ‘optimal care management’ comprises of a dynamic and broad range of pertinent strategies (IOM & RWJF, 2012). These are crucial towards effectively improving and intervening in the proper health care of citizen populations. This is especially critical in terms of healthcare provision for those individuals categorized as primarily chronically ill. These are patients whose care spans over a multiplicity of health care providers, and who require long-term, continuous management. In terms of the concept of continuum of care, the prevailing reforms necessarily require greater involvement of the nursing profession towards enhanced integration of the care system in terms of the guiding and tracking of patients over a given period (Evashwick, 1998). This is achievable through an all-inclusive range of health services , which span all pertinent levels of the intensity of care. Importantly, is the need of leadership in offering the requisite vision for future professional performance, as a guiding framework in day-to-day decision making processes. Additionally, the required development of effective disease management (DM) programs will be required and entails diagnosis-specific programs that specifically target chronic illnesses. To be noted is that disease management programs have been the foundational basis of care management in the health sector, hence the need for continued utility and effective development (Springgate & Brook, 2011). Feedback by Colleagues By sharing the aforementioned input with colleagues, they were of the view that indeed there is need for enhanced reform. Influential in regard to their opinions was the fact that the dynamic nature of current healthcare service provision necessitates a paradigm shift from previous dominant notions. Of primary importance hence, is the need for a shift in thinking, from the ideal of ‘what is’, and subsequently focusing on ‘what should be’ in terms of health and mental care provision. Influential in this regard is the paramount importance laid upon ‘patient-centered’ health care provision, which is founded on R&D, as well as evidence-based research. In agreement, the colleagues were of the notion that DM programs were critically important in the contemporary health arena. This is informed by the fact that the programs target patient populations suffering from specific chronic ailments i.e. diabetes, chronic obstructive pulmonary disease and heart failure amongst others. Accordingly, these programs are essential in offering health care service providers with the requisite tools, essential in the improvement of their overall clinical management. This is in addition to potentially enhancing their promotion of outreach and support initiatives, critical towards improving patient adherence to available treatment plans (IOM & RWJF, 2012). Furthermore, Evashwick (1998) portrays that this would be essential in providing effective feedback systems in the monitoring of patient outcomes. Based upon DM programs are initiatives such as care coordination and case management. These are vital in terms of the concept of continuum of care, which target populations with a multi-morbidity of chronic ailments as well as complex care needs. Influential is the fact that these strategies are reliant on continuous rigorous care coordination, in addition to well-supervised clinical management, drawing from inter-disciplinary input. As guided by provisions present within the Medicare Prescription Drug Improvement Modernization Act (2003), greater focus is placed upon the launched sequence of population-based care management pilot programs. The aim is towards testing not only the applicability of such strategies for pertinent Medicare beneficiaries, but more so, in the subsequent assessment of the achieved quality improvement outcomes as well as the cost savings that can be achieved. However, while the aforementioned programs were influential in yielding an array of imperative quality outcomes, the aspect of cost saving still remains elusive (Evashwick, 1998). While this is true in the overall sense, my colleagues were of the notion that indeed some cost saving achievements had been gained i.e. a greater reduction in avoidable hospital admissions, augmented by quality outcomes. Indeed as Springgate and Brook (2011) aver, those programs deemed successful shared a variety of important features i.e. optimal care management strategies managed by RNs, who played an integral role in the physician’s overall practice, and RNs who effectively coordinated communication and care between the patient population and the pertinent inter-disciplinary team-effort serving patients. This is in addition to the presence of nursing staff that directly provided necessary health care services by way of electronic/ telephonic and in-person methods. Furthermore, was their input on the necessary influence of ACOs, which serve as healthcare organizations that are characterized by pay and care delivery models. These seek to align care service provider reimbursements to both reductions in overall costs, and quality metrics of care for existing patient populations. Accordingly, in order to further enhance the critical output of not only ACOs, but also nurse-managed health clinics and patient-centered medical homes, the nursing profession is expected to interactively adapt to the initiated reform agendas (Springgate & Brook, 2011). Increased focus on patient-centered medical homes and nurse-managed health clinics is regarded as directly resulting from the prevailing health reforms. This is through the raised profile of diverse strategies that seek to end the negatively-impacting fragmentation in health care, in addition to subsequent poor quality and costly implications. The aim is towards further expansion in the embrace of the consensus view of primary care as pertaining to comprehensive, first-contact, coordinated and continuous care for all citizen populations. Essentially, key elements i.e. fully integrated HIT platforms and interdisciplinary collaboration, augmented by a novel payment structure which recognizes the broad range of services pertinent to the PCMHs and nurse-managed health clinics, are all vital if the reform agenda is to be successfully implemented. While these measures are essential in terms of wholesome implementation of reform, a core issue still impressed upon my colleagues – the high nursing turnover rates. This phenomenon is influential due to the fact that both PCMHs and nurse-managed health clinics are majorly dependent on a satisfied and goal-oriented nursing workforce (The NAP, 2011). Furthermore, both the PCHM and nurse-managed health clinic platforms are intended to critically address the serious deficiencies present within the prevailing primary care system. Thus, in order to effectively tackle such deficiencies, a vibrant, job-oriented, satisfied and visionary nursing workforce should be cultivated. This is essential towards adequately placing the patient as the ‘core focus’ of health care provision, through redesigning of care practice towards truly ‘centering’ primarily on patients and the caregivers. This is in addition to adequately meeting the ever-growing challenge of chronic illness management within primary care settings, as well as the optimal provision of requisite payment and resources for effective care management, as well as efficient coordination of care activities. It is only through such ideal-based change and advancement that the nursing profession can adequately cater to the growing number of patients seeking effective and wholesome health and mental care service provision (Evashwick, 1998). In conclusion, my colleagues’ impressions were mostly consistent with the research carried out in regard to health care reform, further proving influential in terms of added input. Of core importance was their perception of the issue of nursing turnover rates, which prove influential in the manner in which overall healthcare provision is applied. Accordingly, they were in agreement that nursing practice is expected to not only grow, but fundamentally change as influenced by contemporary social contexts. References Evashwick, C. (1998). Creating the Continuum of care. Health Matrix, 7(1): 30-39. IOM & RWJF (Institute of Medicine & the Robert Wood Johnson Foundation). (2012). The future of Nursing: Leading Change, Advancing Health (Policy Brief/ Report). American Association of Colleges of Nursing. Springgate, B.F & Brook, R.H. (2011). Accountable Care Organizations and Community Empowerment. Health Affairs: 1800-1801. The NAP (2011).The Future of Nursing: Leading Change, Advancing Health [Future Health Care System Reform and the Nursing Workforce: Matching Nursing Practice and Skills to Future Needs, Not Past Demands]. 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