Nursing Evolving Practice and Patient Care Delivery Models


The entire nursing profession is expected to experience developmental, critical, and drastic changes in the future. These changes will emerge because the government intends to restructure the healthcare system (Neill, 2013). In this regard, the government seeks to reorganize and improve the system in a manner that will involve the nurses actively. The active involvement implies that the nurses will be well-positioned in terms of management and service delivery. Before the onset of this undertaking, it is important to inform the nurses about the expected changes. As a result, this paper will present a discussion that will touch on the probable changes. It will also make recommendations on how the nurses can prepare to adapt those changes and improve services.

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Expected Changes in Nursing Practice

In accordance to the above sentiment, there are various transformations that are expected to take place in the healthcare system, especially when it comes to the nursing practice. These changes are mainly related to critical areas of this system, including continuity of care, Accountable Care Organizations (ACO), medical homes, and Nurse-Managed Clinics.

This aspect is concerned with the maintenance of healthcare quality over a considerably long period. In the near past, continuity of care was viewed as the existence of a long-lasting relationship between a healthcare professional and a patient. This relationship enables the patient to receive care from the same person over a long time. Consequently, the professional can assess and follow the progress of the patient. Otherwise, the discrete form of care presents a situation in which the healthcare professionals consider reports that have been provided by the previous personnel.

According to this understanding, continuity is defined from the experience of the patients. In addition, it is implemented by maintaining an interpersonal relationship between the patient and the healthcare provider. However, the government intends to introduce critical changes in the continuity of care. The changes are necessary because a single profession cannot meet the needs of patients entirely. In the modern world, there are many emergent complications that require a multidisciplinary approach. This implies that healthcare professionals with different specializations and skills should participate jointly to ensure the welfare of the patients’ health. As such, the continuity of care must incorporate the other components of healthcare, including integration, coordination and sharing of information among others. Clearly, it is evident that there is a need to improve this concept in order to allow the satisfaction of patients’ needs and create an appropriate nature of the care. Accordingly, the nurses must learn to work with other professionals, such as doctors and clinical officers, in order to facilitate multidimensional care.

Changes in Accountable Care Organization (ACO)

This is a model of healthcare provision where professionals come together to work coordinately. The coordination facilitates the flow of information from one professional to another. In fact, this concept is correlated to the proposition that the previous paragraph presented. The future healthcare system must let the care provider to work together. This setup will ensure efficiency, proficiency, and effectiveness when it comes to treating patients (Holmes, 2011). Subsequently, some changes will be introduced in the nursing practice so that the trainers instill the skills of information sharing, consultation, and coexistence. These skills will be instrumental when it comes to implementing coordination and integration among the healthcare providers. Importantly, it will enable the nurses to relate and work with other specialists in harmony as well as ease (Greenwood, 2011).

Medical Homes

As a probable anticipation, the future healthcare system will promote the use of medical homes. This is a healthcare delivery system in which a group of specialists offers services from a centralized location. As such, the professionals have are capable of meeting physically and discussing issues personally. Since these locations are central and immobile, the patients are forced to move from their residents to those medical homes. In the future, there is a possibility that these homes will become mobile in order to decentralize them. As a result, the mobility will require the nurses to embrace the use of information technology since the physical communication might compromise service delivery.

Nurse-Managed Health Clinics

With the introduction of NMHC, the idea of including nurses in the leadership of healthcare facilities will be accepted gradually. This will facilitate the promotion of nurses to critical leadership positions in the future. As a result, nurses must seek to acquire managerial and leadership skills (Likupe, 2013). This undertaking will ensure that the hospitals and other crucial healthcare institutions are not incapacitated by the inclusion of nurses in leadership and management.

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Opinions of the Reviewers

Having identified some possible changes in the healthcare system, the anticipations were given to some colleague nurses for review. After their review, a number of suggestions and opinions were noted. First, it was suggested that the idea of incorporating coordination and integration to the continuity of care is very visionary. In this regard, the reviewer supported the definition of the underlying concept from the perspective of patients and healthcare providers. Further, they reinforced that patients’ experience should not be the only basis of defining continuity of care. Instead, the healthcare provision and its nature should be a crucial component of this definition. As a result, the system will ensure a multidimensional approach which can help to improve the effectiveness of the services. Although there were many positive remarks about the proposed and anticipated changes, it was suggested this coordination should emphasize interpersonal relationship more than multidimensionality. In this case, it was noted that the core ideology of the continuity of care is personal relationship.

The reviewers indicated that the primary concern is the patients, but not the healthcare provider. As a result, the patients should choose a confidential healthcare provider from the team. This personal healthcare provider will be mandated to communicate and resonate with the patients at the individual level. The proposition was necessitated by the fact that patients undergo psychological complications when they experience physical and physiological illnesses. Accordingly, they need counsel and ideological support during the period of care. As a result, the information obtained from these dialogues will be crucial to the process of treatment.

In addition, the reviewers indicated that there is a high possibility of having nurses in the management and leadership positions. They applauded the idea of including the managerial ideologies in the nursing practice. However, it was suggested that training nurses about the management skills was not enough. Indeed, the nurses should be exposed to situations where they apply those skills. One of the reviewers noted that the skills might not be effective if the nurses do not participate in management and leadership practically. As a result, nurses should start forming associations in which they should be coordinating reasonable, positive, and constructive activities to improve healthcare.

When managing these organizations, the nurses will occupy the leadership organization and become effective. Although the practitioner made this recommendation, she indicated that those organizations should not be used to propagate collective thinking and activism. She stated that, if the organizations indulge in activism, they might lead to crisis and disharmony in the healthcare profession. For the sake of that rationale, the practitioner suggested strongly that the organizations could be used to nurture the skills of coexistence, sharing information, and collaboration among other virtues of coordination. When it came to the issue of mobile medical homes, the reviewer did conceptualize how the strategy would work to improve health care. In fact, they suggested that the mobility of medical homes would lead to loss of objectivity and inherent effectiveness.


During this research, various findings concerning the future of nursing were made. First, it was noted that nurses must prepare to coordinate with other professionals in order to satisfy patients’ needs when offering continuity of care. This coordination required the nurses to acquire the skills of sharing information and communication. Further, it was established that nurses will be required to occupy leadership and managerial positions in the healthcare system. Consequently, they should seek to acquire the relevant skills to ensure that their leadership is effective and developmental. In essence, it is anticipated that inclusion of nurses in the leadership of healthcare facilities will lead to provision of effective management. The effectiveness will be caused by the diversity of ideas and strategies.


Greenwood, K. (2011). Nursing Profession Reengineered For Leadership In Landmark Report. CIN: Computers, Informatics, Nursing, 29(1), 66-67.

Holmes, A. (2011). The CNO and the ACO. Nursing Management (Springhouse), 42(8), 46-48.

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Likupe, G. (2013). Experiences of African nurses and the perception of their managers in the NHS. Journal of Nursing Management, 3, 234-246.

Neill, J. (2013). Advancing the Nursing Profession Begins With Leadership. JONA: The Journal of Nursing Administration, 43(4), 179-181.

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