There is ample evidence pointing to the fact that different ways of organizing and providing health care vary in their impact on patient outcomes across a wide range of measures. Even though these outcomes depend on provider groups, they are, nonetheless, sensitive to nursing interventions (Finkelman, 2012). Numerous case-control studies have established empirical links between nursing inputs under different care models and safety outcomes such as falls, medication errors, pneumonia, and urinary tract infections (Dubois et al., 2013). In addition, effective models of care can markedly improve “patient safety, and patient, staff, and physician satisfaction” (Finkelman, 2012, p. 509).
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The aim of this paper is to review the implementation of two nursing models. The paper will also provide recommendations for improving the quality of nursing care, safety, and staff satisfaction with the help of a model of nursing care.
Current Nursing Model
The primary nursing care model has been observed in a maternity unit. The model was implemented in a hospital several years ago in order to improve communication between different stakeholders involved in the provision of care. In their systematic review, Mattila et al. (2014) argue that the organization of care under the model takes place between a patient and a nurse who has been assigned to them. It follows that responsibility for the planning and provision of care lies with the named nurse. It has to be borne in mind that the organization of care delivery presupposes delegation of responsibility to other members of a nursing team when the named nurse is off duty (Mattila et al., 2014).
Earlier research has established empirical links between the quality and safety of care and the model (Fernandez, Johnson, Tran, & Miranda, 2012). Under the model, patient satisfaction with respect to the information they receive substantial increases in comparison with a team nursing approach. The model also scores highly on a nursing support scale (Fernandez et al., 2012). When it comes to the nursing staff effects, the primary care model is associated with high autonomy levels. In addition, the implementation of the model is related to lower rates of absenteeism and health complaints. Furthermore, in comparison with team nursing units, primary care units assess their quality of care significantly higher (Mattila et al., 2014).
Together, the two studies indicate that the primary nursing model is associated with an increase in the quality of key job characteristics. By providing healthcare practitioners with more autonomy, the model helps to improve both patient outcomes and promote the wellbeing of nursing staff, thereby reducing turnover intentions.
The Relationship-Based Care Model
The relationship-based care (RBC) model presupposes a transformative approach to nursing care delivery and promotes the creation of a collaborative and patient-centered environment. The model is based on three types of relationship: “the provider’s relationship with patients and families, the provider’s relationship with self (self-awareness) and the provider’s relationship with collaborative colleagues.” (Cropley, 2012, p. 334). By implementing the model, a healthcare organization can improve not only patient satisfaction but also that of their families and nursing staff. Furthermore, through the operationalization of responsibility and accountability, the RBC model can diminish the cost of care provision. Other measures such as readmission and retention rates have also been found to be higher in units that adopt the relationship-based approach to care when compared with other units (Cropley, 2012).
A study on the implementation of the RBC model in a neonatal intensive care unit shows that commitment to continuity of care can be markedly stronger when relationships become a primary focus of care delivery (Faber, 2013). Equally significant is the minimization of barriers to visiting under the model. It is especially important during the process of performing delegated nursing services. The study suggests that the RBC model assists nurses with decision-making by helping them to identify the needs of their patients (Faber, 2013).
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It is clear that the implementation of the model can facilitate teaching and learning and improve work allocation in an organization. It has to do with the fact that the RBC model revolves around collaborative care, which is known for its positive impact on patient outcomes. Moreover, by transforming a culture of an organization with the model, it is possible to improve staff satisfaction.
Implementation of the Primary Nursing Care Model
The nursing model provides a comprehensive framework for organizing care delivery in the maternity care unit. The model presupposes a patient-centered approach to the provision of care during pregnancy as well as during and after delivery. The primary nursing care model provides nursing staff with a high level of autonomy; however, named nurses are responsible for key clinical outcomes of their patients (Fernandez et al., 2012). These outcomes include but are not limited to types of delivery, an average length of labor, and the incidence of perineal tearing (Fernandez et al., 2012).
The implementation of the model is associated with another critical outcome—patient satisfaction. Nurses in the unit have more time to respond to the individualized needs of their patients, thereby taking a more holistic approach to care. For example, after the adoption of the model, the number of postpartum and neonatal complications in the unit has dramatically decreased. However, there is evidence that the model increases the level of nursing stress (Mattila et al., 2014). It is a significant drawback of the approach, because in the maternity unit with a large number of patients, healthcare professionals can feel overwhelmed, which might evoke turnover intentions. Another consequence of the implementation of the model is emphasized by Mattila et al. (2014) who argue that this method of organizing and providing healthcare leads to the increase of nursing costs per patient.
It should be stressed that under the primary nursing care model, it is difficult to promote continuity of care. Furthermore, many patients in the unit complain about fragmented care, which negatively influences their satisfaction. It follows that the organization should implement a new model of care in order to provide its patients with more personal nursing services and its staff with higher levels of autonomy.
In order to improve the quality of nursing care, safety, and staff satisfaction in the hospital it is recommended to consider a transition to a different healthcare model. Due to the fact that the chaotic work environment of the maternity unit puts a substantial strain on nursing staff, it is recommended to opt for a model of healthcare delivery that is associated with the more effective division of workload.
Numerous studies suggest that the implementation of the RBC model can help to develop a culture of transparency that makes caregivers feel valued (Cropley, 2012; Faber, 2013). A nursing leader should be approached with a suggestion to improve the current state of care delivery in the unit by initiating a transition to the model. It is necessary to collaborate with the leader to identify opportunities for improvement in the unit. To this end, the leader should be informed that the philosophic basis of the model is closely aligned with the organization’s vision and mission. Unlike, the model of primary nursing care, the RBC model looks beyond the delegation of duties, which is essential for enacting modern socioeconomic and cultural healthcare values (Hedges, Nichols, & Filoteo, 2012).
The adoption of the model will allow nurses to consistently attend different sets of rounds. The removal of attending barriers will improve coordination of care and increase collaboration with other teams. It means that the care delivery model will enable the active participation of nurses in the creation of care plans (Hedges et al., 2012). The implementation of the model will require a shared vision of the future among key stakeholders of the unit; therefore, it is important for the unit leadership team to develop a comprehensive communication plan (Hedges et al., 2012). The unit has many patients whose diagnoses range from pregnancy-induce hypertension to postpartum hemorrhage. It follows, that by adopting the RBC model, it is possible to have better control of high-risk patients whose emotional needs have a bearing on clinical outcomes.
The paper has reviewed the implementation of the primary nursing care model and the RBC model. It has been argued that by adopting the RBC model in the maternity unit, it is possible to effectively respond to mounting pressure to improve the quality of care. The paper has helped to understand that caring-focused care delivery helps to manage multiple key relationships, thereby optimizing patient safety and improving staff outcomes.
Cropley, S. (2012). The relationship-based care model: Evaluation of the impact on patient satisfaction, length of stay, and readmission rates. The Journal of Nursing Administration, 42(6), 333-339.
Dubois, C., D’amour, D., Tchouaket, E., Clarke, S., Rivald, S., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal of Quality in Health Care, 25(2), 110-117.
Faber, K. (2013). Relationship-based care in the neonatal intensive care unit. Creative Nursing, 19(4), 214-218.
Fernandez, R., Johnson, M., Tran, D., & Miranda, C. (2012). Models of care in nursing: A systematic review. International Journal of Evidence-Based Healthcare, 10(1), 324-337.
Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care (2nd ed.). Boston, MA: Pearson.
Hedges, C., Nichols, A., & Filoteo, L. (2012). Relationship-based nursing practice. Journal of Perinatal and Neonatal Care, 26(1), 27-36.
Mattila, E., Pitkanen, A., Alanen, S., Leino, K., Luojus, K., Rantanene, A., & Aalto, P. (2014). The effects of the primary nursing care model: A systematic review. Journal of Nursing Care, 3(6), 205-216.
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