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Evolving Practice of Nursing and Patient Care Delivery Models


The improvement of nursing aid and the quality of care has always been one of the priorities in the development of medicine. The use of modern approaches allows strengthening the current health system and achieving positive patient outcomes. Reforms and changes that have occurred in this area over the past few decades have made it possible to adjust care delivery models in such a way that the level of nursing help can meet modern quality standards. Nevertheless, some amendments can still be made, and relevant measures may be taken to increase the level of medical care in institutions of different profiles.

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A presentation about Changes in Nursing Practice

In order for the entire care system to meet the expectations of patients, it is important to take into account the personality factor. Patient-centered nursing assistance, which is now practiced in many clinics, can be a good way to improve the quality of care and provide sufficient individual support to those who need it. Junior medical personnel should be aware of how aid is implemented in accordance with the provisions of this approach. The individuality of each patient’s problems should be one of the key factors determining the type of care and intervention. In case employees do not take this criterion into account, treatment rates may worsen, and the number of disaffected patients will increase steadily.

The number of personnel involved in the process of assisting patients should be sufficient to ensure that workers do not experience excessive fatigue and can perform their immediate duties effectively. According to Bodenheimer and Bauer (2016), “the number of physician assistants (PAs) entering the workforce is also growing, though not as rapidly” (p. 1016). Nurses should be motivated enough to perform their duties productively and commit themselves to work. The role of management in this process is high since the leaders of structural medical units determine the level of employees’ satisfaction with their working conditions. Therefore, the involvement of staff should be accompanied by motivation and encouragement promoted by clinics’ leadership.

The Concept of Continuity of Care

A full dedication to work is the feature of experienced and highly skilled nurses. In this regard, the concept of the continuity of care should be maintained in medical institutions of different profiles. Naert, Roose, Rapp, and Vanderplasschen (2017) consider this phenomenon in relation to young patients and argue that “continuity of care has been identified as a central feature of youth care services of high quality” (p. 116). However, this concept may be applied to all the categories of the population, including elderly patients, people with disabilities, and other groups. In case nurses provide full and continuous assistance and support throughout the treatment period, it will have a positive effect on the dynamics of recovery and will certainly reduce the number of readmissions caused by inadequate care.

Accountable Care Organizations and Other Healthcare Facilities

Such a type of medical institution as accountable care organizations (ACO) has become widely known due to specific reforms in the healthcare sector. According to McWilliams, Hatfield, Chernew, Landon, and Schwartz (2016), these facilities are “financially integrated with hospitals (vertically integrated organizations), independent multispecialty physician groups, or independent primary care physician groups” (p. 2359). The work of nursing staff in these institutions, as the authors note, is determined by the provisions of the Medicare act and is one of the primary criteria of productivity (McWilliams et al., 2016). In other types of organizations, for example, medical homes and nurse-managed health clinics, the work process also depends on the degree of personnel’s interest in the quality performance of immediate duties. Adherence to professional ethics and all the rules of care will lead to positive changes in this area and will contribute to increasing the level of nursing aid.

Nurses’ Feedback

The described opportunities to improve the quality of nursing care and potential changes that can help enhance the level of the medical air have been evaluated by nurses. Based on their feedback, a comprehensive picture of the relevance and importance of these changes can be compiled by using their answers as a rationale. Their opinions are subjective, however, these are views of the nursing sphere employees, and their positions should be taken into account. The feedback is shared by three nurses, and it will be summarized to make a comprehensive picture of their attitude to possible changes that may increase the level of care.

Feedback Summary

Changes made through the latest reforms in the field of medicine are approved by three nurses. The specialists confirm that the innovations proposed by the government allow junior medical personnel to reveal they’re potential better by defining specific duties and eliminating unnecessary workload. According to their feedback, the work experience of nurses in various medical institutions proves that excessive fatigue and performance of a wide range of tasks negatively affect productivity indicators and divert attention from the primary tasks. The respondents agree that inefficient planning and unreasonable leadership hamper the development of nursing practice. In this regard, they argue that work on training the heads of structural medical units should be thorough in order to avoid any violations of rendering assistance and inappropriate resource use.

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The number of nursing staff working in medical institutions also causes concern among the respondents. According to them, even due to reforms, the shortage of labor is sometimes felt. All three nurses agree that motivation and encouragement are the main incentives for the work of junior medical personnel since positive patient outcomes are impossible without the satisfaction of specialists with leaders’ assessment of their activities. They propose to introduce a specific system of rewarding and encouraging the most motivated employees in order to achieve as high interest as possible in the performance of the tasks set. Moreover, the nurses also mention the participation of colleagues in the process of mutual exchange of experiences. Many qualified employees may help beginners, which will help to avoid a large number of errors that are unacceptable in the treatment process. This measure, according to the respondents, may be implemented in all healthcare institutions so that junior medical personnel could rely on mutual assistance and demonstrate good teamwork. As the nurse notes, control over this interaction should also be carried out by the management.

Regarding patient-centered care, the respondents confirm its effectiveness. Nevertheless, they notice that in the conditions of high tension and stress, it is not always possible to pay attention to each individual patient. It once again proves the need for competent allocation of duties and searches for compromises in the assignment of tasks. The nurses are confident that the quality of their work can be improved if they are able to spend enough time on immediate duties and not expend forces on secondary tasks, for example, filling out documentation. The more time employees will have to provide assistance, the more effective their work will be and, as a result, the outcomes of all interventions. Therefore, a common view was expressed that the minimum of secondary tasks should be assigned to nursing staff in order to promote the practice of a patient-centered approach.

Attitude to Changes in the Organizations of Different Profiles

Based on the respondents’ answers, they confirm that all potential changes that may occur in medical institutions of different profiles can be valuable. They are sure that accountable care organizations are to be developed through substantial public funding provided through the Medicare reform. Also, the nurses believe that the practice of sharing responsibilities in accordance with positions and ranks will improve patient outcomes since more time will appear needed for the provision of full-fledged care.

According to the three nurses, in medical homes where a large number of employees are involved in the provision of assistance, changes should affect not only working but also financial conditions. As they note, the concept of continuity of care cannot be realized in those institutions where there is not enough equipment. A similar situation is observed in nurse-managed health clinics. The lack of sufficient material resources may become an obstacle to the realization of certain implementations and innovations, and the process of development will be suspended. In order to avoid it, nurses recommend establishing partnerships among healthcare institutions and constantly conducting research aimed at improving the quality of nursing care and other factors affecting patient outcomes. In case these measures prove effective, government agencies can pay attention to the result of efforts and allocate funds for the development of this field. The respondents sum up that the joint efforts of all members of the nursing team may help to achieve positive changes in their practice.


Relevant measures taken to improve nursing work indicators and the development of this sector may help to achieve changes in the institutions of different profiles. The adopted reforms have already had an impact on the state of this field, and nurses’ feedback confirms the positive dynamics. Some additional innovations may be useful, for instance, motivating and encouraging employees, reorganizing working hours, efficient allocation of responsibilities, and sufficient funding.


Bodenheimer, T., & Bauer, L. (2016). Rethinking the primary care workforce – An expanded role for nurses. New England Journal of Medicine, 375(11), 1015-1017. Web.

McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine, 374(24), 2357-2366. Web.

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Naert, J., Roose, R., Rapp, R. C., & Vanderplasschen, W. (2017). Continuity of care in youth services: A systematic review. Children and Youth Services Review, 75, 116-126. Web.

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