Posts Tagged ‘nursing care’

Models of Nursing Care Delivery

Nursing care can be carried out through a variety of organizational methods. The model of nursing care used varies greatly from one facility to another and from one set of patient circumstances to another. A review of past and current models provides a background for understanding the nursing models and methods needed for today’s changing health care delivery system.
TEAM NURSING
Team nursing, which had its origins in the 1950s and 1960s, involved use of a team leader and team members to provide various aspects of nursing care to a group of patients. In team nursing, medications might be given by one nurse while baths and physical care are given by a nursing assistant under the supervision of a nurse team leader. Skill mixes include registered nurses (RNs), often as team leaders; licensed practical nurses; and nursing assistants or unlicensed assistive personnel (UAP). With the current emphasis on cost containment in health care agencies, variations of team nursing are being used, and UAPs are increasingly being included as team members. There has been little substantiation, however, that team nursing is cost-effective. The quality of patient care with this system is questionable, and fragmentation of care is of concern.
PRIMARY NURSING
Primary nursing (not to be confused with primary health care, which pertains to first-contact general health care) refers to comprehensive, individualized care provided by the same nurse throughout the period of care. This type of nursing care allows the nurse to give direct patient care rather than manage and supervise the functions of others who provide direct care for the patient. This care method is rejected by many institutions as too costly; the patient–nurse ratio is small, and a larger professional staff is needed, because the primary nurse is usually an RN. However, primary nursing may provide a foundation for transition to case management in some institutions. The primary nurse accepts total 24-hour responsibility for a patient’s nursing care. Nursing care is directed toward meeting all of the individualized patient needs. The primary nurse is responsible and accountable for involving the patient and family directly in all facets of care and has autonomy in making decisions in this regard. The primary nurse communicates with other members of the health care team regarding the patient’s health care.This process promotes continuity of care and collaborative efforts directed toward quality patient care.
During times when the primary nurse is not scheduled to work, an associate nurse or co-nurse assists in overseeing the delivery of care. The associate nurse implements the nursing plan of
care and provides feedback to the primary nurse for evaluating the plan of care. The primary nurse assumes responsibility for making appropriate referrals and for ensuring that all relevant information is provided to those who will be involved in the patient’s continuing care, including the family. The long-term survival of primary nursing as it is currently designed is uncertain. As cost-containment measures continue and patient acuity increases, staffing ratios of patients to nurses are increasing. Many nursing service departments and agencies are meeting the increased workload demands by making modifications in their approach to primary nursing or by reverting to team or functional systems for delivering care. Others are changing their staffing mix and redesigning their models of practice to accommodate nurse-extender roles. Still others are changing to more innovative systems such as case management.