In different medical facilities, nurses’ work, cooperation, connections to other members of the medical staff and employees, and their role in providing care may be organized and understood differently. The system that incorporates various aspects of nurses’ work and various concepts about their role is called a nursing care model. Different nursing care models exist, and they have been evolving for centuries. The evolution of models within recent decades has been particularly intensive (Finkelman, 2012). Along with the technological development, some models become obsolete, and new ones arise. It can be argued that the change in the nursing care model can improve the quality of care in a given facility. The system employed in the studied facility was identified as the care management model. Based on the review of academic literature, it is recommended to the facility to shift to the synergy model of patient care. Finally, it is described how the suggested model can be implemented.
In the observed case of delivering nursing care, describing features, and exploring the overall structure will allow classifying the facility according to the list of nursing care models. The criteria that should be considered for this classification include the organization of nurses’ work, the way they cooperate, the distribution of tasks and responsibilities, and the general understanding of the nature and function of care displayed in the operation of nurses and their interactions with other members of the medical staff as well as with patients. In the studied facility, the emphasis on nursing care is put on optimizing the process of delivering care. The key concept that the nurses’ practice is based on is integration. There is a recognized need to make services, technologies, and knowledge integrated in order to turn the nursing teams into well-organized functional bodies’ ability to deal with the flow of patients. The goal is to set up a mechanism of nursing care, where nurses act as “gears,” and have this mechanism adjusted for constant processing of patients divides into certain groups.
In order to understand how the goal is pursued, it is necessary to consider actual procedures. First of all, the organization of nursing care in the studied facility employs the project approach. It implies that the delivery of care is planned, implemented, and evaluated in stages according to certain guidelines. Nurses have instructions with thorough descriptions of what they are supposed to do in a given case. Also, the planning of care delivery considers various related factors, such as resources and costs. Health promotion and preventive healthcare activities are considered related to nursing care, too. Patient profiling is an integral part of the observed model. The planners create a system where patients are analyzed, and their profiles are organized in accordance with constantly updated epidemiological data. It is believed that such an approach will allow composing nursing care teams in such a way that they will meet the needs of certain groups of patients. Nurses approach patients based on instructions that take into consideration the profile of a patient. The leader of the nursing staff acts as a planner, and evaluator, and a decision-maker. The topics of nurse advocacy or delegation are not emphasized; instead, the nurses’ functional fitness is the focus. The interactions between nurses and physicians are partially regulated by instructions that include guidelines and recommendations for nurses, along with examples of real-life situations.
According to the described features, the nursing care model in the studied facility is identified as the care management model. This model primarily focuses on integrating processes and services (Finkelman, 2012). An important aspect of identifying the model is the population-based approach to patients as opposed to the individual approach that is used in some other models. Also, the care management model is characterized by the presence of disease management programs and benchmarking, and both were observed in the studied facility.
In order to properly analyze the current model and recommend a different one that the facility could benefit from, it is necessary to review relevant academic literature describing research efforts dedicated to describing and analyzing nursing care models. Among recent studies, there was not much attention paid to the care management model. The reason is that this model is considered by theorists to be somewhat outdated (Finkelman, 2012). Although the key elements of the model, such as project approach and integration, are still important in various spheres of today’s management, management of care is regarded by researchers and practitioners as special and requiring specific approaches in the modern world. However, some scholars have addressed issues associated with the care management system.
In her book, Huber (2013) discusses various aspects of managing care from the perspective of leadership. Although the author does not use the term “care management model,” she addresses the approach characteristic of this model when assessing different care delivery and organization systems. In the part of the book dedicated to caring, models, it is noted that, in the modern world, nursing care management becomes more challenging because the healthcare processes are becoming more complicated. The response to the increasing complexity should be innovation and technological advancement. However, there is a need to reconsider the model itself if it is based on integration. Huber (2013) argues that “[t]rying to integrate so many data points in care delivery can overwhelm the care provider who is making clinical judgments” (p. 72), which leads to increased risks of failures. It means that modern nursing care models should be more flexible and strive for optimizing the delivery of care by means of approaches different from integration.
Care management was also discussed by Lowe, Plummer, O’Brien, and Boyd (2012), who argued that certain nursing care models lack the understanding of the nurse’s role. The authors argue that role clarity is a key indicator of a successful nursing care model, as it allows developing effective strategies. The clearer the role of nurses in healthcare provision is defined, the more beneficial it is for a facility. However, Lowe at al. conclude that “the ability to clearly express their [nurses’] function does not exist” (p. 677), which, however, does not take away from the importance of constant efforts to achieve a widely agreed-upon understanding of nurses’ functions. These efforts should be supported by exploring the issues of interprofessional relations in healthcare facilities. Although the care management model does strive for clearly defining the role of nurses, it lacks proper considerations of inter-professional cooperation, which makes the model weak.
The recommended model—the synergy model of patient care—has been widely explored in academic literature. Kohr, Hickey, and Curley (2012) defined it as a model that “describes nurses’ work on the basis of the individual needs of patients and their families” (p. 420). They conducted an experiment among nurses and used the synergy model as a conceptual framework. A major conclusion was that a patient-centered approach provides a better understanding of the functions and actual activities of nurses. The participants of the experiment managed to link unique care indicators to the dimensions of patient care listed in the synergy model. It also shows that the model provides a more comprehensive view of the process of care delivery than the care management model.
Among other qualitative studies exploring the benefits of the synergy model, there is the research by Cypress (2013), who interviewed patients, their family members, and emergency department nurses to find out what they thought was crucial in the nurses’ work. The obtained data were analyzed through the perspective of the synergy model. The results showed that patients and their family members should be regarded as participants in medical and nursing care. The synergy model incorporates this notion, while the care management model rather regards patients as recipients of care and often ignores family members. It is concluded in the article that healthcare facilities should support and facilitate patient- and family-centered care.
Implementation and Recommendations
Introducing the synergy model of patient care will help the studied facility address two main problematic issues it is facing now: the growing complexity of integration and the lack of patient-centered care. As demonstrated in studies that explored the synergy model (see Literature Review), this model can help resolve both issues.
The essence of the synergy model of patient care is identifying the needs of patients and matching them with certain competencies of nurses (Finkelman, 2012). The matching is achieved by linking eight patient characteristics to eight nurse competencies. The characteristics are resilience, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability. Although referred to as “characteristics,” they rather should be thought of as criteria for evaluating every patient individually and placing him or her in a certain position in a number of ranges describing his or her state, background, attitude, behavior, and prospects. Nurses’ competencies included in the model are clinical judgment, advocacy, and moral agency, caring practices, collaboration, systems thinking, response to diversity, facilitation of learning, and clinical inquiry (innovator or evaluator). These competencies describe nurses’ abilities, knowledge, practices, and processes. The very purpose of the synergy model is to ensure that patients, identified correctly within the ranges of the eight characteristics, are provided with nursing care from those who possess the competencies appropriate for a patient in a given individual case.
What the studied facility should do in order to shift from the care management model to the synergy model is to change its vision of nurses’ work and its nursing practices. As pointed out above, two crucial issues to address are service integration and the role of patients. First of all, the facility should give up its strategy to integrate all the data and services because this process becomes increasingly complex and creates risks of failures. Instead, patients’ needs and nurses’ competencies should be defined to create a system where certain patients can receive appropriate care from nurses with the best-fitting competencies. This system is more flexible, effective, and efficient than the attempts to integrate everything. Second, the facility should shift from strictly dividing patients into groups and regarding them as a flow (population-based approach) to regarding them as individuals with a certain set of needs (patient-centered approach). Also, patients and their family members should be considered participants of care delivery, not merely receivers of care. Implementing these recommendations will ensure the creation of a better nursing care model and the provision of better nursing care overall.
The observed system of nurses’ work was identified as the care management model of nursing care. It implied the integration of services and employing the population-based approach to patients. A model that was suggested instead is the synergy model of patient care. It implies a more flexible system where, instead of integration, patients’ needs are matched to competencies of nurses. The patient-centered approach is an important part of this model. Based on the review of academic studies, it is suggested that shifting from the care management system to the synergy system will raise the quality of care in the given facility.
Cypress, B. S. (2013). Using the synergy model of patient care in understanding the lived emergency department experiences of patients, family members, and their nurses during critical illness: A phenomenological study. Dimensions of critical care nursing, 32(6), 310-321.
Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care. Boston, MA: Pearson.
Huber, D. (2013). Leadership and nursing care management. Atlanta, GA: Elsevier Health Sciences.
Kohr, L. M., Hickey, P. A., & Curley, M. A. (2012). Building a nursing productivity measure based on the synergy model: First steps. American Journal of Critical Care, 21(6), 420-431.
Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify: The value of advanced practice nursing roles in health care. Journal of Advanced Nursing, 68(3), 677-685.