The choice of a nursing care delivery model can depend on multiple factors including cost-efficacy and availability of financial resources, ongoing quality improvement endeavors in a hospital, level of hospital-wide realization of customer focus principles, a need to reduce staff turnover rates, and others. At the same time, well- implemented and appropriate care model can foster significant enhancements in terms of nursing practice and patient outcomes. Therefore, it is important to note that the effectiveness of a certain model is mainly defined by its relevance to the hospital environment and formulated organizational objectives.
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Scholars and theorists in the field of nursing distinguish the following major traditional care models: primary care nursing, functional nursing, total patient care, and team nursing. Each of them possesses distinctive features which, however, can be combined and customized to particular organizational and team needs. In the given paper an example of a care model implementation will be evaluated based on the observations conducted, and its advantages and disadvantages will be discussed in comparison with other models. Additionally, possible recommendations for the improvement will be provided.
Nursing Care in Douglas Gardens Hospital
Douglas Gardens Hospital is a relatively small clinical setting that provides a great variety of healthcare services in different medical fields including geriatrics, acute and chronic disease care, and surgeries. The hospital staff includes highly competent physicians and nurses, whose daily activities are coordinated by a team leader. Along with supervision, the nursing leader’s responsibilities include training, supervision, task allocation, and delegation. Patient safety, as well as patient focus and accountability, are core to the care delivery model employed in the setting. For this reason, all the nurses in the team aim to interact with their patients in a respectful and empathic manner to promote and ensure more positive care experiences among them.
The care model implemented within Douglas Gardens Hospital is based on nurse collaboration and an individualized patient approach. Small nursing teams render care to different patient groups staying in distinct wards, while their practice is monitored and supervised by the team leader (an experienced registered nurse). In their turn, each nurse leader mainly performs the procedures requiring particular skills and qualifications and demonstrates to other team members how to do them as well.
The leader can also assign individual patients to a nurse who then renders patient care directly throughout his or her stay in the ward and communicates the results of ongoing treatment to other nurses in the team. The data collected during the observation indicates that healthcare practitioners in Douglas Gardens Hospital adhere to the team nursing model.
The core idea embedded in team nursing is cooperation and mutual support among nurses who have different levels of experience and competence. To employ team nursing effectively, hospitals should invest time and resources in the design and communication of supportive workplace culture and values to nurses, clarify expectations and responsibilities, develop and realize suitable scheduling (Hastings, Suter, Bloom, & Sharma, 2016).
Fairbrother, Chiarella, and Braithwaite (2015) state that the given model is mainly characterized by collective decision-making and note that by collaborating and sharing responsibilities, nurses can improve their perception of the workplace environment and become more satisfied with the job. When implemented properly, team nursing can substantially increase team cohesion and improve intragroup communication, which is regarded as one of the primary factors defining a high level of patient safety and satisfaction, as well as the overall performance efficiency (Hastings et al., 2016).
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For this reason, it is valid to say that the primary strengths of team nursing include the opportunities to decrease the number of potential medical errors and risks to patients and foster a faster acquisition of new skills and knowledge by less experienced nurses.
Functional Nursing Model
Functional nursing significantly differs from team nursing. It does not require collaboration between team members with different qualifications but rather encourages the assignment of tasks by practitioners’ levels of expertise and skillfulness. Dubois et al. (2013) note that the model implies that each nurse must have a broad set of skills and competencies needed to work with different patients. Thus, the major characteristic of the given approach to care is the orientation to the task and focus on the increase of productivity and service efficacy (Nagarandeh, Bahabadi, & Mamaghani, 2014).
Due to its inherent features of functional nursing can increase labor cost-efficiency (Dubois et al., 2013). Nevertheless, as Nagarandeh et al. (2014) state, the lack of patient-centeredness is the main weakness of the task method because the quality of patient-nurse interaction may be undermined.
The integration of some primary nursing principles in current practitioners’ practices may significantly benefit Douglas Gardens Hospital. The given model implies that one nurse renders care to only one patient and maintains a close relationship with him or her. As a Relationship-Based Care model, it is based on the idea that the establishment of nurse-patient relationships is essential to continuity and effectiveness of care. Competencies required to implement this approach cover a large number of areas including treatment and intervention planning, design, and application. It is considered that when nurses are sufficiently empowered and autonomous to accomplish all these activities, they become able to perform holistic care more effectively (Dubois et al., 2013).
It is important to emphasize that only highly qualified registered nurses can meet the criteria of primary nursing. Despite this limitation, it is possible to say that the implementation of the given model promotes nursing excellence. Considering that team nursing is characterized by shared accountability and lesser nurse independence in terms of professional performance, it may lead to lower individual efficacy. The primary nursing care model can help address this issue it induces an increase in professional autonomy, which is correlated with the attainment of higher proficiency and competence.
The field observation conducted in Douglas Gardens Hospital and the review of research evidence helped reveal that the existing nursing care delivery models can be implemented in multiple ways and even combined, while the factors defining the success of any model implementation range from staff availability and overall organizational environment to corporate values and formulated objectives. For instance, if the hospital aims to reduce labor-associated financial costs, it may prefer functional nursing. It is valid to say that along with economic considerations, the hospital and its leaders should take into account the capability to align current resources and practices with the criteria of the selected model, and modify their quantity and quality if needed.
As for the situation in Douglas Gardens Hospital, the findings demonstrate that team nursing is associated with multiple advantages including increased team cohesion and collaboration. Moreover, in the given model, nurses may be assigned tasks, which they feel more comfortable and competent to fulfill. As a result, job satisfaction rises while the exposure to work-related stress decreases. Nevertheless, primary nursing may provide the hospital a chance to improve the quality of patient relationships and practitioners’ excellence needed to perform holistic care.
Dubois, C. A., D’amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2014). Associations of patient safety outcomes with models of nursing care organization at the unit level in hospitals, International Journal for Quality in Health Care, 25(2), 110-117.
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.
Hastings, S. E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC Health Services Research, 16, 245.
Nagarandeh, R., Bahabadi, A. H., & Mamaghani, J. A. (2014). Impact of regular nursing rounds on patient satisfaction with nursing care. Asian Nursing Research, 8, 282-285.