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Nursing care models reflect the ethical basis of patient care including the main structural culture of an organization. It provides a guideline for establishing and delivering care to patients and families (Mattila, Pitkänen, Alanen, Leino, Luojus et al., 2014). Nursing models of care are established to improve professional practice and they have been used as an instrument to plan and use the staff accordingly and more effectively with a goal of decreasing cost (Finkelman, 2016). Different organizations and different healthcare settings have their own way of providing care for patients which could be depending on the patients’ individual needs. Nursing care models have gone through changes over the years but they have a substantial influence on the newer models that are being made. As time changes nursing models must also change and improve to effectively adapt to a person or an organization’s specific needs. Nursing care model serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.
Nursing Care Model in the Workplace
As we all know, there are many different care models and they are being improved over the years. Some of them are not being used anymore but they have been an inspiration for the new ones that are being developed. The nursing care model that I have observed at my workplace is Functional Nursing. Functional nursing model is more focused on the task and each task is assigned to a mix of nursing personnel who will focus on the specific task to be done (Jennings, 2008).
I work in a Skilled Nursing Facility that has a total of 52 patients who are divided into two separate sections, the long-term care, and short-term care units. The short-term care unit has a total of 20 patients who are recent hospital discharged patients who need extended care and who are not quite ready to be discharged to their homes. The long-term care unit has 32 patients who are basically elderly that need help with their care who are not necessarily sick but who need assistance with ADL’s and medications. The staff who are assigned for the day consists of two nurses, one LVN, and five nursing assistants. There is one Charge Nurse per unit in the facility who is responsible for their own units for the day. The nurses are assigned and responsible for the medications. We give meds in each of our units, responsible for new orders from the doctor and we are also responsible for ordering medications from the pharmacy of course including all the paperwork. There is one LVN assigned to do treatments for the whole facility such as wound care or topical medications. The nursing assistants are assigned to take vital signs for the patients who need them and all the activities of daily living.
The model of nursing care used in the facility is functional because everyone has assigned tasks that need to be done and remains their focus for the whole shift. Every single staff is assigned a particular task and their goal for the day is to finish the task assigned. The good thing about using the functional model in this facility is that it is very efficient, everything is getting done as it is supposed to regardless of the number of patients in the facility. Working daily on the tasks that need to be done, staff have become creative and have learned to come up with their own plan to perform each task effectively. It is also very little to no confusion regarding roles and duties. For the facility, it is cheap and affordable because no additional staff is needed since tasks are being done.
Although the functional nursing model is efficient, there are also disadvantages that it comes with. Clients often get confused who is assigned to them because of the number of different staff seeing them for different things. The care in a functional model is so fragmented that it leads to an impersonal relationship between the nurse and the patient (Finkelmal, 2016). Another disadvantage is that the patients don’t get their specific needs met as an individual which results in an unhappy and unsatisfied client. Another problem that I have noticed is that since each person is assigned to certain tasks, they are less likely to do anything else. When staff is told to do something else other than their assigned task, they become unhappy and are more likely to complain because the time from their assigned work is being taken away. The current care model being used does not seem to be working with both patients and the staff is unhappy.
The Team Nursing Model is the one I would recommend to be implemented to improve quality of nursing care, safety, and staff satisfaction. According to King, Long, & Lisy, (2014), the team nursing model care has an RN team leader that has effective communication and leadership skills. The team is comprised of nurses that have the diversity of skills to deliver high-quality care. Each member of the team has to work collaboratively because of shared responsibility. I figure that this would be a good model for the facility so that everyone can work together to accomplish a certain task that needs to be done. According to Finkelman (2016), the current team model has been modified for improved reliability and continuity of care as well as teamwork and management that is more focused on the patient instead of being task-oriented.
Functional Nursing Model
Mattila, Pitkänen, Alanen, Leino, Luojus et al. (2014), conducted a study regarding the development of a functional model of nursing care in cancer. Their objective was to recommend and authenticate a functional model that addresses, guides, and quality nursing care in the Colombian National Cancer Institute. They conducted a study in three phases; analysis of the context, elaboration, and analysis of the narratives of care and development of the functional model of nursing care from the narratives. The workshop showed that having a specific care model for nursing is correlated to being able to improve the quality of care, improve identity, and focus actions on the essentials such as decreasing cost, increased patient satisfaction, developing interpersonal skills, continuity in procedures, and demonstrating that nursing is crucial to improving life situations and care of users (Mattila, Pitkänen, Alanen, Leino, Luojus et al., 2014). The result of the study allowed the National Cancer Institute’s Model of Nursing Care to be proposed and authenticated because it was backed and supported by the participants.
Liang & Turkcan (2016), conducted a study between functional care delivery model and primary care delivery model in acuity-based nurse assignment and patient scheduling
in oncology clinics. The goal of the study is to develop better methods to decrease the time consumed for nurse assignment and patient scheduling in oncology clinics that use different delivery of care models. To solve the nurse assignment problems in the Functional delivery model, a multiobjective optimization model was proposed to minimize patient waiting time and nurse overtime (Liang & Turcan, 2016). The authors have found that the delivery care methods used in the oncology clinics are based on numerous factors including the availability of skilled nurses in the particular area, staffing costs, patient satisfaction, and patient safety. They have found that there are more advantages than the disadvantage of using the Functional care delivery method in oncology clinics compared to Primary care delivery model although it is not the purpose of the study. Advantages of functional care delivery model include less restricted patient scheduling due to nurse availability, nurse balance workload, less nurse required and the care model can easily be implemented without changing the scheduling system.
The Functional care delivery model for both studies have been proven to be useful in specific healthcare settings. The study conducted by Mattila, Pitkänen, Alanen, Leino, Luojus et al. (2014), mainly states that having a specific model in the healthcare setting is beneficial to the patient, staff and the organization. The study by Liang & Turcan, (2016), stated that the Functional care model delivery can be beneficial in the oncology clinic when considered in patient scheduling and acuity-based nursing assignments.
Team Nursing Model
A study conducted by King, Long, & Lisy (2014), compared the effectiveness of team nursing to total patient care on the well being of staff when organizing work in acute care settings. Based on the documented models of care, the organization of work for nurses can have a big influence on the wellbeing and performance of nurses and nursing teams as it is key in defining the nurses work environment (King, Long, & Lisy, 2014). In this study, staff wellbeing was based on staff satisfaction, turnover, absenteeism, stress levels and burnout. Both quantitative and qualitative reviews were done on nursing models and effects but none narrowed the focus on the two models and their direct effect on staff wellbeing. Instead, the data will assist in establishing the effect of each model on the nurses delivering them.
In the study by Fairbrother, Chiarella, & Braithwaite (2015), they suggest that team nursing is the best solution to the fast-changing work in healthcare services and the projected pressures on the nursing workforce. The authors stated that team nursing continues to holistically and professionally provide nursing actions and care in the healthcare setting. Fairbrother, Chiarella, & Braithwaite (2015) have found that only team nursing is probably the most adequately flexible in a workplace with rank changes and recurrent change in work culture. The authors have found based on their analysis, that using team delivery of care allows acute nursing to justify the skill and experience sequence, factors related to the nursing workforce, and the hospital-based healthcare environment.
Team nursing based on two studies reviewed have positive effects on the staff, patients, and organizations. The study conducted by King, Long, & Lisy (2014), have given them both qualitative and quantitative data as far as effects of the care models on the staffs’ wellbeing. Although the models do affect the wellbeing of the staff, they were not able to narrow down which models truly affect them. In the study by Fairbrother, Chiarella, & Braithwaite (2015), they have concluded that team nursing is the most flexible delivery care system that can adjust to any change in the workplace whether it may be management, staff or organizational change.
Nursing care models were developed to serve as a guideline to nurses and healthcare organizations for establishing and delivering care to patients. The use of nursing care model varies depending on the healthcare setting and the population it serves. I have learned through this assignment that no matter what kind of nursing model is being used, they all have the same goals of decreasing cost, maintaining providing safety and quality nursing care, increasing staff satisfaction. The nursing care models can change over time but it is developed to adjust and adapt to a person or organization to meet their specific needs. It is ultimately good to have a guideline that can be followed but we have to keep in mind that things can change and there are a lot of variables that can cause these changes. It is important that we remain flexible especially if it improves our work environment. Nursing care models serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.
- 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.
- Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.
- Jennings BM. Care Models. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2635/
- King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(1), 59-73. doi:10.11124/jbisrir-2014-1533
- Liang, B., & Turkcan, A. (2016). Acuity-based nurse assignment and patient scheduling in oncology clinics. Health Care Management Science, 19(3), 207-226. doi:10.1007/s10729-014-9313-z
- Mattila E, Pitkänen A, Alanen S, Leino K, Luojus K et al. (2014) The Effects of the Primary Nursing Care Model: A Systematic Review. J Nurs Care 3:205. doi:10.4172/2167-1168.1000205
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