Introduction
There is no doubt that organizational factors have a significant effect on the quality of care. The delivery of nursing care can be organized differently and result in different patient outcomes, different rates of medical errors, and different job satisfaction. In order to improve the quality of care, it is important to recognize the role nursing care models play in today’s healthcare settings. This paper seeks to address the role of different models for the delivery of nursing care. The researcher provides an overview of three nursing care models, one of which is currently in use in a particular medical facility, and recommends a superior model. The research is informed by literature review.
Identified Nursing Care Model
The practice setting is a small community hospital with a total capacity of 40 patients. Nursing care delivery model currently in use is a traditional form of nursing care delivery called team nursing. The following observations let the researcher conclude the type of model in use.
At the hospital, one registered nurse (RN) and two licensed practical nurses (LPNs) are responsible for approximately 20 patients each, making a total of 2 RNs and 4 LPNs. RNs report to nurse manager. The delivery of care is divided between nurses: RNs act as a leader and coordinate the work of LPNs. The responsibilities of RNs include assigning duties, planning of care for acute patients, and telemetry. RNs are also responsible for the training of new personnel. LPNs work with more stable patients and are responsible for medications and IVs. The communication in the hospital is enhanced through written nursing care plans and group discussions between RNs and LPNs regarding patient statuses.
This form of nursing care delivery is considered team nursing. Team nursing is a model of nursing care delivery which originated in the middle of the 20th century (Fairbrother, Jones, & Rivas, 2010, p. 203). The team nursing model is based on the concept of cooperation and shared responsibility, and as such, is an example of an integrated model. The objective of this model is to provide medical care by utilizing the input from all of the team members (Fairbrother, Jones, & Rivas, 2010, p. 203). Such model is less fragmented than functional nursing since it relies on coordinated efforts, with RN acting as a team leader. The cooperative environment is encouraged since the provision of care is divided between personnel. A line of organization establishes the exact responsibilities of individual team members.
Team Nursing Literature Review
The paper by Fairbrother, Jones, and Rivas focuses on the implementation of team nursing in acute inpatient environment during a controlled trial. The researchers compare the benefits of team nursing model to an individual patient allocation model. In comparison to individual patient allocation model, team model results in a higher job satisfaction and quality of care, although the benefits were most appreciated by graduate nurses, while experienced nurses complained about the difficulties associated with caring for 10-12 patients at a time (Fairbrother, Jones, & Rivas, 2010).
Another research paper seeks to address the effectiveness of team nursing on staff wellbeing in acute care setting. The researchers conducted a systematic review to assess the effect of this organizational model on job satisfaction and found that team nursing model had no significant effects on job satisfaction compared to total patient care (King, Long, & Lisy, 2015). The researchers also highlighted the fact that quantitative research on the effects of team nursing on job satisfaction was limited, and thus the researchers could not evaluate the effect of this model on absenteeism and burnout of the personnel.
Primary Nursing Literature Review
A different model for the delivery of nursing care is the primary nursing model, which is the focus of the research paper by Mattila et al. The researchers conduct a systematic literature review to describe “the effects of the primary nursing model for patients, their family members, nursing staff and the care organization” (Mattila et al., 2014, p. 1). Primary nursing model allocated responsibility for a patient to a single nurse, who oversees the treatment exclusively during the patient’s hospital stay (Mattila et al., 2014, p. 1). In comparison to team nursing, the focus of primary care model is on the patient, rather than on tasks. As such, this model is viewed as superior to team nursing (Mattila et al., 2014, p. 2). The researchers claim that the research on the effects of primary nursing is limited; however, primary care nursing showed positive results on patient satisfaction and can help reduce healthcare costs (Mattila et al., 2014, p. 10).
Another research paper is focused on the perceptions of primary nursing in pediatric oncology care setting. The researchers conducted focus group interviews with patients and staff to evaluate their perception of the primary nursing model. The results indicated that this model is “confused and unstructured” due to great variations in the role of the primary nurse, which were unexpected by staff (Korhonen & Kangasniemi, 2013, p. 732).
Implementation and Recommendations
The implementation of team nursing started with the creation of teams of two team members (LPNs) and a team leader (RN). RN was responsible for delegating responsibilities and LPNs shared the tasks between each other under the supervision of RN. The idea of shared responsibility was promoted on meetings with the focus of each person’s contribution as a team.
A recommended model is a hybrid model, a model which combines different components of team nursing and primary nursing model for the best results (Fernandez, Johnson, Tran, & Miranda, 2012, p. 6). Such model is considered a nurse-directed care model, and makes use of the best practices typical of team nursing and primary care, such as patient allocation and interpersonal communication, and establishes a patient-centered approach to medical care. Research suggests that a hybrid model demonstrates “significant improvement in quality of patient care, reduction in restraint use and rates of seclusion” (Fernandez, Johnson, Tran, & Miranda, 2012, p. 12).
Conclusion
The research provided new insight into the relationship between nursing care organization and the quality of care. Nursing models were created to provide the infrastructure for delivering nursing care and as such, various nursing care models provide different experience for patients and medical personnel. In the light of recent healthcare reforms, the research in the field of the delivery of nursing care has been driven by the need to evaluate the efficacy of these models and single out high-performing ones. The research made me realize why organizational factors are important in the process of healthcare improvement. As a nurse, I need to use best evidence-based practices and help share the knowledge with other nurses. I need to be a knowledgeable consumer of research and using it in evidence-based practice.
References
Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220. Web.
Fernandez, R., Johnson, M., Tran, D., & Miranda, C. (2012). Models of care in nursing: a systematic review. International Journal of Evidence-Based Healthcare, 10, 324-337.
King, A., Long., L., & Lisy, K. (2015). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care wards: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 13(11), 128-168.
Korhonen, A., & Kangasniemi, M. (2013). It’s time for updating primary nursing in pediatric oncology care: Qualitative study highlighting the perceptions of nurses, physicians and parents. European Journal of Oncology Nursing, 16(6), 732-738.
Mattila, E., Pitkanen, A., Alanen, S., Leino, K, Luojus, K., Rantanen, A., & Aaito, P. (2014). The Effects of the Primary Nursing Care Model: A Systematic Review. Journal of Nursing Care Quality, 3(6), 1-12. Web.