Nursing Care Model Paper
Nursing Care Model Nurses are the first line of defense in patient’s care and are essential in the healthcare system. They are not only delivering care to the patients, but they also teaching, advocating for their patients, and providing comfort and support for the patients and their families. The way the nurses deliver the care to the patients is guided by the nursing care model that is used in the facility. According to Finkelman (2016), “nursing practice models have been used to implement recourse-intensive strategies with the goal of decreasing expenses and using staff more effectively” (pg. 111). There are several nursing care models that are adapted and developed by the Health Care Organizations (HCOs) over time, such as total patient
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care nursing, functional nursing, team nursing, primary nursing, and case management and interprofessional practice model (Finkelman, 2016). Different facilities have adopted different nursing care module based on the nursing leader’s choice, limited nursing resources, and limited funds. The nursing care model used at the rehabilitation center/Skilled Nursing Facility (SNF) I work at is mainly a functional nursing care model.
Nursing Care Model at my Workplace
Every employee at my facility has their own line of duty to complete and to be responsible for. The head nurse overlooks the whole building and assigning the responsibility to the nurses. The floor nurses are assigned to a group of patients and their main function is to give medication, complete assessments, and specialized nursing functions. The wound care nurses mainly focus is on the assessment and the treatments of the wounds on the floors. Certified Nursing Assistants (CNAs), are mainly doing the primary caregiver duty and also getting weights and vital signs.
In addition to nurses and CNAs, there is a restorative nurse and five restorative aids who their mainly focus is in rendering the restorative programs and the prevention of the physical decline for the patients that are not receiving physical therapy during their stay and the long term residents. The main function of the activity aids, who are also CNAs, is to organize activities for the patients and residents and keep them engaged and interact with each other and to prevent injuries and isolation.
The nurse case managers/MDS are assigned by floors and are in charge of organizing the plan of care and the discharge planning for the patients.
Due to the high volume of patients, especially on the long term floors, nurse case managers are not completely involved with the patient’s care, which gives the nurses on the floors a greater responsibility for the patients.
The therapy department is mainly focused on the rehabilitation floor to assist the short-term patients in improving their functional status to discharge in their previous living placements. They give directions to the nurses and CNAs on the special treatments and care levels the patients need during their stay in the facility.
Due to assigned tasks and divided responsibilities for each of the nursing staff, the nursing care model that is practiced in my workplace is similar to the functional nursing care model. The issue with the functional nursing care model is that everybody focuses on their own tasks and at times the priority for the patients are overlooked.
Functional Nursing Care …show more content…
Model The functional nursing care model creates a serious of tasks completed by different nursing staff members. Finkelman (2016) states “the model of functional nursing is a task-oriented approach, focusing on jobs to be done” (pg. 112). This creates a fragmented work that does not include the patient as a whole. Also, everybody doing the separate task and not communicating together as a team can create fractions for staff and important information that is significant in patient’s care can fall through the cracks.
Another downside of the functional model is that the staff get overwhelmed and stress out doing a specific task over and over without critical thinking, which affects the quality of care. According to Tiedeman and Lookinland (2004), the functional nursing model was based on reliance on rules, regulation, and policies which are counterproductive to the nurses’ decision making and is against professional development, and as a result, less time is devoted to the psychosocial needs to the patients. Furthermore, “the task assignment mode contributed to the fragmentation of care, with patient problems being overlooked because they did not fit into a defined assignment (ie, the concept ‘it’s not my job’)” (Tiedeman & Lookinland (2004). On the other hand, this model is considered cost effective because it reduces the RN’s time and substitutes it with time from staff that is less trained, such as licensed practical nurses (LPNs) and CNAs. Different HCOs adopt different nursing care models without taking into consideration of the patient risk based on evidenced based practice. According to Dubois at al. (2013), based on the research conducted in hospital settings between the professional nursing models and functional models adopted by these hospitals, the professional models are associated with lower risks for patients in delivering nursing services for registered nurses (RNs) and “reflect stronger support for nurses’ professional practice” (pg. 110).
Care and Service Team Nursing care Models Team nursing model was adopted first after the World War II due to the shortage of nursing. Aside from nursing other personnel was taught how to give medications, change wounds, provide care, and other tasks to provide care for the wounded. A nursing team consists of an RN, LPN and unlicensed assistive personnel (UAP) where RN has the decision making authority. The previous team concept focused more on the tasks and did not have a good collaboration and communication between team members. Today, team nursing has evolved to meet the standard in organizations and leadership corresponding to the needs for better care through collaboration and coordination of patient-centered care. Also, this model focuses more on key elements “to empower staff, interprofessional collaboration, and a case management approach to patient care” Finkelman, 2016, pg. 112). Healthcare system is evolving rapidly and the need for the nurses to provide a patient-centered care and improve the satisfaction rate needs to have a team approach and collaboration between interdisciplinary team members and the patient/family. A team approach will create a better picture of the health issues of the patient, and working together will come up with a complete plan of care. According to Fairbrother, Chiarella, & Braithwaite (2015), “given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions” (pg. 489). Also, on the analysis presented by Fairbrother at al. (2015), only team nursing allows flexibility in a workplace characterized by hierarchical stratification and constant work culture change.
According to Cioffi and Ferguson, 2009, multiple HCOs shifted their nursing care models to team nursing care models due to skill mixed changing especially in acute healthcare settings. The healthcare is becoming more complex and requires a more skilled nursing approach to delivering a quality of care for patients. Delegating tasks that do not require skilled nursing care, but are supervised by RNs, will allow RNs more time to complete skilled tasks and deliver the quality of care. Nurses working as a team toward the patient-oriented goals will benefit from a team approach, team effectiveness, shared responsibility and increased the availability of support and engagement with the multidisciplinary team (Cioffi and Ferguson, 2009).
Implementation and Recommendation
Due to functional nursing care delivered to my workplace, there are many issues that are overlooked.
Changing to a team nursing care approach will improve the quality of care for the patients and residents. The nursing team provides total continuous care to a group of patients which avoid the possibility of the important information or priority of care to be missed. This method benefits both nursing team and the patients and would be a better fit for my workplace. Working together as a team, nurses and other team members not only collaborate and coordinate the care toward the same goal toward a patient-centered care but also share responsibility and accountability together. This approach alleviates nurses from assuming complete responsibility for the patient care, which makes her less pressured and less stressed out. Instead of completing tasks that are assigned to each discipline in my workplace, we should change the culture of delivering care as a team approach. Also, allowing additional staff, who can assist the nurses such as the ward clerk and the appointment scheduler that can cover the non-nursing tasks and allow nurses to spend more time with the
patients.
Conclusion
The team nursing model should replace the functional nursing model which is used today in some HCOs including my facility. The team nursing approach allows a patient-centered care and shared responsibility which benefits nurses and improves patient care. As stated by Finkelman (2016), “accountability, autonomy, and responsibility need to be considered when nursing practice models are assessed” (pg. 111). The team nursing model encourages a shared accountability, responsibility, and autonomy, between the nursing team.
care nursing, functional nursing, team nursing, primary nursing, and case management and interprofessional practice model (Finkelman, 2016). Different facilities have adopted different nursing care module based on the nursing leader’s choice, limited nursing resources, and limited funds. The nursing care model used at the rehabilitation center/Skilled Nursing Facility (SNF) I work at is mainly a functional nursing care model.
Nursing Care Model at my Workplace
Every employee at my facility has their own line of duty to complete and to be responsible for. The head nurse overlooks the whole building and assigning the responsibility to the nurses. The floor nurses are assigned to a group of patients and their main function is to give medication, complete assessments, and specialized nursing functions. The wound care nurses mainly focus is on the assessment and the treatments of the wounds on the floors. Certified Nursing Assistants (CNAs), are mainly doing the primary caregiver duty and also getting weights and vital signs.
In addition to nurses and CNAs, there is a restorative nurse and five restorative aids who their mainly focus is in rendering the restorative programs and the prevention of the physical decline for the patients that are not receiving physical therapy during their stay and the long term residents. The main function of the activity aids, who are also CNAs, is to organize activities for the patients and residents and keep them engaged and interact with each other and to prevent injuries and isolation.
The nurse case managers/MDS are assigned by floors and are in charge of organizing the plan of care and the discharge planning for the patients.
Due to the high volume of patients, especially on the long term floors, nurse case managers are not completely involved with the patient’s care, which gives the nurses on the floors a greater responsibility for the patients.
The therapy department is mainly focused on the rehabilitation floor to assist the short-term patients in improving their functional status to discharge in their previous living placements. They give directions to the nurses and CNAs on the special treatments and care levels the patients need during their stay in the facility.
Due to assigned tasks and divided responsibilities for each of the nursing staff, the nursing care model that is practiced in my workplace is similar to the functional nursing care model. The issue with the functional nursing care model is that everybody focuses on their own tasks and at times the priority for the patients are overlooked.
Functional Nursing Care …show more content…
Model The functional nursing care model creates a serious of tasks completed by different nursing staff members. Finkelman (2016) states “the model of functional nursing is a task-oriented approach, focusing on jobs to be done” (pg. 112). This creates a fragmented work that does not include the patient as a whole. Also, everybody doing the separate task and not communicating together as a team can create fractions for staff and important information that is significant in patient’s care can fall through the cracks.
Another downside of the functional model is that the staff get overwhelmed and stress out doing a specific task over and over without critical thinking, which affects the quality of care. According to Tiedeman and Lookinland (2004), the functional nursing model was based on reliance on rules, regulation, and policies which are counterproductive to the nurses’ decision making and is against professional development, and as a result, less time is devoted to the psychosocial needs to the patients. Furthermore, “the task assignment mode contributed to the fragmentation of care, with patient problems being overlooked because they did not fit into a defined assignment (ie, the concept ‘it’s not my job’)” (Tiedeman & Lookinland (2004). On the other hand, this model is considered cost effective because it reduces the RN’s time and substitutes it with time from staff that is less trained, such as licensed practical nurses (LPNs) and CNAs. Different HCOs adopt different nursing care models without taking into consideration of the patient risk based on evidenced based practice. According to Dubois at al. (2013), based on the research conducted in hospital settings between the professional nursing models and functional models adopted by these hospitals, the professional models are associated with lower risks for patients in delivering nursing services for registered nurses (RNs) and “reflect stronger support for nurses’ professional practice” (pg. 110).
Care and Service Team Nursing care Models Team nursing model was adopted first after the World War II due to the shortage of nursing. Aside from nursing other personnel was taught how to give medications, change wounds, provide care, and other tasks to provide care for the wounded. A nursing team consists of an RN, LPN and unlicensed assistive personnel (UAP) where RN has the decision making authority. The previous team concept focused more on the tasks and did not have a good collaboration and communication between team members. Today, team nursing has evolved to meet the standard in organizations and leadership corresponding to the needs for better care through collaboration and coordination of patient-centered care. Also, this model focuses more on key elements “to empower staff, interprofessional collaboration, and a case management approach to patient care” Finkelman, 2016, pg. 112). Healthcare system is evolving rapidly and the need for the nurses to provide a patient-centered care and improve the satisfaction rate needs to have a team approach and collaboration between interdisciplinary team members and the patient/family. A team approach will create a better picture of the health issues of the patient, and working together will come up with a complete plan of care. According to Fairbrother, Chiarella, & Braithwaite (2015), “given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions” (pg. 489). Also, on the analysis presented by Fairbrother at al. (2015), only team nursing allows flexibility in a workplace characterized by hierarchical stratification and constant work culture change.
According to Cioffi and Ferguson, 2009, multiple HCOs shifted their nursing care models to team nursing care models due to skill mixed changing especially in acute healthcare settings. The healthcare is becoming more complex and requires a more skilled nursing approach to delivering a quality of care for patients. Delegating tasks that do not require skilled nursing care, but are supervised by RNs, will allow RNs more time to complete skilled tasks and deliver the quality of care. Nurses working as a team toward the patient-oriented goals will benefit from a team approach, team effectiveness, shared responsibility and increased the availability of support and engagement with the multidisciplinary team (Cioffi and Ferguson, 2009).
Implementation and Recommendation
Due to functional nursing care delivered to my workplace, there are many issues that are overlooked.
Changing to a team nursing care approach will improve the quality of care for the patients and residents. The nursing team provides total continuous care to a group of patients which avoid the possibility of the important information or priority of care to be missed. This method benefits both nursing team and the patients and would be a better fit for my workplace. Working together as a team, nurses and other team members not only collaborate and coordinate the care toward the same goal toward a patient-centered care but also share responsibility and accountability together. This approach alleviates nurses from assuming complete responsibility for the patient care, which makes her less pressured and less stressed out. Instead of completing tasks that are assigned to each discipline in my workplace, we should change the culture of delivering care as a team approach. Also, allowing additional staff, who can assist the nurses such as the ward clerk and the appointment scheduler that can cover the non-nursing tasks and allow nurses to spend more time with the
patients.
Conclusion
The team nursing model should replace the functional nursing model which is used today in some HCOs including my facility. The team nursing approach allows a patient-centered care and shared responsibility which benefits nurses and improves patient care. As stated by Finkelman (2016), “accountability, autonomy, and responsibility need to be considered when nursing practice models are assessed” (pg. 111). The team nursing model encourages a shared accountability, responsibility, and autonomy, between the nursing team.