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Total Care Model in Nursing Practice

The use of different models of care can significantly change the way nurses interact with patients. Such aspects as the quality of care, the lack of attention to detail, and nurses’ fatigue and burnout may depend on the chosen model. As models of care employ different staff allocation and workload techniques it is important to evaluate them to introduce the best one to a particular setting. In my experience I observed the total care nursing structure being implemented.

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While this model of care may be considered outdated, it is still popular among some patients and organizations as total care nurses are responsible for providing one or more clients with full care (Finkelman, 2017). A different nursing model that is still relevant to many clinical settings is team nursing – an approach that employs a group of nurses to care for patients, each worker having his/her duties and qualifications (Finkelman, 2017). In this essay, the introduced models of care will be reviewed and compared based on scholarly literature.

Observed Nursing Care Model

Total care nursing is a model, otherwise called the individual patient allocation model, which is an approach in which each nurse has to take full responsibility for one or multiple patients (Duffield, Roche, Diers, Catling-Paull, & Blay, 2010). This does not mean that one nurse needs to do everything directly related to interacting with this patient –assistants may help with some activities. However, the responsibility for the allocated patient lies on one nurse, giving staff members full authority and control over their actions. According to Duffield et al. (2010), this approach can be considered the first classic care model.

The authors also note that total care is still popular among patients due to the consistency of interactions and the comfort of communicating with one specialist during their stay at the hospital. Some nurses may also find this model suitable as they have more power and know their duties.

Another article by Fairbrother, Jones, and Rivas (2010) compares total care to team nursing, providing a case of a hospital changing between these models as an example. The authors find that the patient allocation model was significantly affected by nurses’ value of autonomy bringing this approach to the workers’ attention in the 1980s. Team nursing as a comparison was seen as a barrier to professional growth, while total care allowed nurses to gain full control over their plans and actions.

Nevertheless, the study also notes that the current trends in nursing care may be changing towards team-based care as nurses have increased workloads in comparison to earlier years (Fairbrother et al., 2010). Thus, allocated nursing becomes difficult for staff members who need to provide full care for a continuously growing number of patients, while the staffing rates are decreasing.

Different Nursing Care Model

A comparison of all nursing models of care with the focus on team nursing is presented in the study by Fairbrother, Chiarella, and Braithwaite (2015). In this article, the authors find that all nursing approached have changed over the years because they had to adapt to the new clinical settings. Team nursing changed as well, becoming relevant to the current care delivery environment. Thus, this approach may be seen as valuable to nurses as it helps staff members to utilize their strengths and focus on particular skills, creating a collaborating atmosphere.

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Moreover, the certification level of nurses is also noted as an important aspect of choosing an appropriate model as many of them, including total care, require a high level of nurses’ education for the majority of staff members. The authors conclude that an adapted team nursing model may contribute to the personnel’s teamwork, leadership characteristics, and connection to the patient and each other.

The value of team nursing for patients is discussed in the article by Reiss-Brennan et al. (2016). The authors analyze team-based care practices and their impact on patient outcomes and the hospital’s financial situation. In this study, each participating team member is described as having specific responsibilities which are then combined to provide full care for patients. Thus, nurses work as a group of trained professionals in their sphere.

The researchers note that patients in team-based care can reach out not just to a single nurse but to a team of knowledgeable and responsible specialists. The framework of team nursing used in the study helps the hospital to produce better patient outcomes and lower the payments for care. According to the results, team nursing is more effective in the examined setting because the dynamic nature of modern healthcare corresponds well with teamwork-based practices.

Observations

The use of the total care model in my experience was based on the needs of patients and the lack of new ideas coming from nursing staff and management. Nurses continue to care for multiple patients during their stay at the hospital. This gives them more autonomy over their actions as each nurse has several clients for whom he/she cares. However, as the rates of nurses and patients started changing, nurses found themselves being overloaded with responsibilities.

Thus, while total care nursing is still implemented in the practice setting, many nurses are performing worse than before. One nurse commented that sometimes she could make a mistake in treating a patient as she was overwhelmed by her extensive list of duties. Thus, patients also are not satisfied with this model, although they still prefer the interaction with a single nurse.

Recommendation

For the discussed practice setting, one can recommend team nursing as a solution. While it is an old approach, its current modification may fit well with the modern state of nursing care. The ability of workers to divide their responsibilities and focus on specific areas may be helpful not only for clients but nurses as well. The current view of team nursing is more interested in teamwork and collaboration than a strict delegation of authority (Fairbrother et al., 2015).

Therefore, this model may be suitable for a clinical setting where the interaction between nurses may contribute to the quality of care. Team nursing can replace the total care model currently used by the hospital. The former is a system of different specialists, including nurse managers, educators, assistants, and RNs, all working together to care for patients. Moreover, nurses may find that they are more satisfied working in this model as well, because their workload may be lowered, giving them more time to complete their tasks.

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Conclusion

This experience allowed me to understand that a chosen nursing care model can significantly change the way both nurses and patients view the clinical setting. For patients, communication with nurses may be especially valuable, although proper interaction with a team of nurses may produce positive results as well. Teamwork can be used to nurses’ advantage and help them relieve their workload if they are occupied. Modern healthcare may value team nursing more than total care because it relates to such useful concepts as teamwork and communication. I have learned about different nursing care models while completing this assignment and understood that models of care could change and adapt to surroundings which means that some of them can become useful again.

References

Duffield, C., Roche, M., Diers, D., Catling-Paull, C., & Blay, N. (2010). Staffing, skill mix, and the model of care. Journal of Clinical Nursing, 19(15-16), 2242-2251.

Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: Where does team nursing sit? Australian Health Review, 39(5), 489-493.

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.

Finkelman, A. (2017). Professional nursing concepts: Competencies for quality leadership (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Reiss-Brennan, B., Brunisholz, K. D., Dredge, C., Briot, P., Grazier, K., Wilcox, A.,… James, B. (2016). Association of integrated team-based care with health care quality, utilization, and cost. JAMA, 316(8), 826-834.

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