Introduction
Organization of care delivery is a complex process that is dependent on a variety of factors such as policy and economics. However, it is also influenced by the evidence presented by nursing care models which improve the quality of care and patient safety, critical factors in medical decision-making. Care models examine aspects pertaining to organizations and inpatient settings to minute details in staff communication and patient interaction.
Models exist for various segments of the population such as the elderly or patients with chronic diseases. This report examines the use of nursing care models in practice and provides research on additional frameworks that improve the quality of care.
Observed Model
For this activity, an emergency room nursing unit was observed in a large metropolitan hospital. They were noted utilizing Henderson’s need theory in practice. Patients are admitted rapidly, requiring quick and accurate diagnosis, but also competent assessment and care. In collecting patient history and establishing a diagnosis, patients would utilize the 14 components of Henderson’s theory to determine the next plan of treatment.
In planning and interventions, nurses sought to address the physiological needs of the patient and provide adequate nursing care. The patient was then guided to identify strengths and concerns. An effective coping and treatment strategy was discussed, outlining possible options. Interventions were meant to address all aspects of health, ranging from physical to spiritual and emotional. This was especially relevant for patients who may have attempted self-harm and needed help beyond standard medical care. Nurses sought to connect with patients and address all their needs.
Model Summary
The Need Theory was developed by Virginia Henderson, who emphasized that nursing is a concept of care for the patient with the purpose of increasing independence after hospitalization. A nurse’s role is substitutive, supplementary, and complementary when working with patients. The theory is broken down into fourteen components based on fundamental human needs. The first nine components are physiological, addressing aspects such as breathing, eating, sleep, homeostasis, and cleanliness.
The tenth and fourteenth components are psychological, focusing on communication, emotion, and development through learning. The eleventh component is spiritual, having the opportunity to worship according to one’s faith. Finally, the twelfth and thirteenth components are sociological, contextual of professional and recreational activities (Ahtisham & Jacoline, 2015).
Ideally, Henderson’s theory is applicable to any practice setting and can be defined within the major concepts of nursing. Nurses focus on helping patients to achieve a state of health, comfort, and independence. According to Henderson, each nurse has a role of a “scientific problem solver” (Davis, Kenny, Doyle, McCarroll, & von Gruenigen, 2013). Patient needs are met through an individualized plan of care and treatment that takes into account unique circumstances. While practice settings may change, nurses serve the primary function of taking on various roles to understand and provide for the basic human needs of a patient.
The Need Theory focuses on holistic care that approaches treatment from a comprehensive perspective, balancing physiological, emotional, psychological, and spiritual aspects (Davis et al., 2013). Nurses use the model by engaging in practices ranging from feeding or cleaning patients to engaging in health promotion and disease prevention.
Additional Model
The Neuman systems model was created by Betty Neuman in the 1970s. The core of the theory seeks to identify an individual’s coping mechanisms and reactions to stressors. This model can be used to work with both patients and staff and is designed to guide an individual on how to manage stressors that impact health. Universally, this theory is recognized as a valid mechanism for the improvement of positive patient outcomes. It states that each individual has resources such as body temperature, response patterns, physical and mental health, and genetic makeup. Stability and health are ensured as long as stressors do not exceed the resources.
It is inevitable that a person will cycle through exhaustion and rejuvenation, but a nurse practitioner has the responsibility to help patients maintain a level of stability. Treatment occurs with the consideration that an individual has several layers, ranging from physiological to cultural and spiritual beliefs that are developed over a lifetime. Neuman argued that nursing should be concerned with people as a whole, providing a holistic level of care (Ahmadi & Sadeghi, 2017). Using considerations of this model, nurses can help to heal and function based on the individual characteristics that a patient displays.
The model is especially helpful in promoting interdisciplinary care and nurse resilience to stressors. A nurse serves as a client in an open system in interaction with the environment. Resilience is a protective factor with the Neuman Systems Model which helps a nurse adapt to stressors using intrinsic and extrinsic protective resources. When a nurse encounters a stressor and attempts to maintain stability, the model comes into play to address this issue and provide tools to deal with adversity (Turner & Kaylor, 2015). Overall the model has been widely implemented in a variety of healthcare systems. It is easily adaptable as a structural framework for administrative and interdisciplinary health that can be inserted at nurse, patient, and community levels of care.
Improving Quality
The Plan-Do-Study-Act (PDSA) cycle is a model developed specifically for healthcare quality improvement. It is a simplistic, yet efficient tool for accelerating meaningful systemic change that leads to a better quality of care. The planning stage consists of testing, observation, and collecting data on vital aspects of any given process. The “do” stage implies a limited beta on a small scale to test an intervention. “Study” suggests that data should be analyzed, and results evaluated.
Finally, “act” is the process of refining change based on learning and implementing it on a mass scale (Taylor et al., 2013). PDSA cycles are often at the core and combined with other multifaceted quality improvement interventions. Its pragmatic principles encourage the use of the PDSA model for small-scale, iterative interventions which emphasizes learning and flexibility with minimum risk to patients and organizations. Furthermore, the model relies on a scientific method-based approach of prediction of an outcome with a test and subsequent measurement to evaluate a specific concept or context (Taylor et al., 2013).
Conclusion
Through this activity, it has become evident that nursing models are an essential core to most healthcare practices, ranging from nursing to administrative. Models such as Henderson’s Need Theory and Neuman Systems Model view an individual as a complex and multilayered entity that should be cared for from a variety of perspectives beyond the basic physiological medical treatment.
Furthermore, these models can apply to nurse staff as well to managing stressors and building resilience. Meanwhile, quality improvement is best achieved through a pragmatic model such as the PDSA cycle that emphasizes observation and testing on a small scale to determine the optimal solution before the wider implementation of a specific initiative. Overall, nursing models demonstrate a significant benefit to improving and optimizing the care process.
References
Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical, 3(3), 1-8. Web.
Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice; Virginia’s Henderson need theory. International Journal of Caring Sciences, 8(2), 443-450. Web.
Davis, J., Kenny, T. H., Doyle, J. L., Mccarroll, M., & Gruenigen, V. E. (2013). Nursing peer review of late deceleration recognition and intervention to improve patient safety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(2), 215-224. Web.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2013). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. Web.
Turner, S. B., & Kaylor, S. D. (2015). Neuman systems model as a conceptual framework for nurse resilience. Nursing Science Quarterly, 28(3), 213-217. Web.