Your lesson this week discussed patterns of nursing care delivery. In your opinion what is the most effective nursing care delivery model and why? What are the advantages and disadvantages of your chosen nursing care delivery model? Give specific clinical examples.
Lesson
Continuous Quality Improvement for Improved Patient Outcomes
Introduction
By this point in the course you have considered a challenge to quality patient care and identified a central or relevant issue presented by the problem. So far you have learned about theoretical frameworks or models that guide nurses to provide nursing care that is supported by evidence-based practice (EBP). PICO-formatted questions and potential interventions and activities have also been discussed. One must consider the economic ethical and social principles relevant to the current developments in healthcare and the current status of nursing.
All of the above elements may be a part of the rationale for a chosen solution to an identified problem. By now you should have conducted a literature review in order to find the best and most relevant evidence which provides a tentative solution to the identified problem. Within your own work setting how do those problems get fixed or corrected?
The Implementation Process
When planning the implementation process permission should be obtained to allow the project to commence and go forward. Securing permission involves communication with all the stakeholders for the change to be successful. Organizational culture group dynamics and informal and formal power structure are all elements that are examined during the implementation of a change.
How change is perceived depends on individual perspective. In other words the whats in it for me (WIIFM) mentality plays a role in the success of the innovation. In some situations a pilot study may be necessary to determine feasibility for the proposed change. Before a pilot study is initiated all aspects must be carefully planned. One must consider how to conduct the pilot study and where it will be conducted. We will discussion about pilot studies in the lesson next week.
Organization and Patterns of Nursing Care Delivery
Nursing care has been delivered in many ways over the years. Total patient care functional nursing team nursing primary nursing and patient-focused care are a few terms that come to mind when discussing patterns of nursing care. Each pattern of nursing care could be discussed as a single entity; in reality the patterns combine. Nurses should be prepared to work with any of the patterns of care. As healthcare challenges change so do the patterns of care.
Total patient care started as private duty nursing care in the patients home. In the 1920s and 30s and again in the 1980s the nurse assumed responsibility for the complete care of the patient. This focused the nurses attention and activities on one individual thus increasing the quality of care and patient satisfaction.
Functional nursing came about with the start of World War II when nurses took over the work in the hospitals. Due to a combination of the war effort and using nurses as employees of the hospital one of the first nursing shortages ensued. Functional nursing allowed nursing care to be broken into a series of tasks that could be performed by many people. In this model one nurse would administer medications for all the patients on a unit while another would sign off on orders and another would do admissions and discharges. This approach resulted in fragmented and impersonal care. It also caused certain patient problems to be overlooked such as psychosocial or spiritual needs. The incidence of errors and omissions increased with this type of nursing as did the lack of accountability for the total patient.
Team nursing evolved in the 1950s as an answer to the problems that were created by functional nursing. A group of patients was assigned to a team leader who was usually an RN. The care was coordinated for the patients with other team members. Assignments were made according to the skill level and ability of the team members. Good communication ensured the success of the team in providing the patient care.
Primary nursing evolved in the 1960s and 70s. This approach to patient care was designed to reduce or eliminate the fragmentation of care that resulted from the change in caregivers over the shifts. One nurse was responsible for the planning of care for the patient over a 24-hour period. Caregivers would follow the plan for interventions and provide feedback on the patients response. In this approach nursing care may be provided by different levels of staff or all RNs. Because team nursing took the RN away from the bedside primary or modified primary nursing was designed to get the nurse back to the bedside.
Patient-focused care evolved over the last 15 years. With this type of care the nurse supervises the delivery of care to the patient by unlicensed ancillary personnel (UAP). The UAP are cross-trained to perform more than one function which increases their level of productivity. This model of nursing moves the nurse to a higher level of functioning and autonomy as more tasks are delegated to UAP under the supervision of an RN. The IOM (2003e) identified the provision of patient-centered care as one of the core competencies for integrating safety and quality. The idea that health professionals come to the patient helps prevent fragmented care. Nurses can use knowledge skills critical thinking and judgment to provide quality safe patient care by coordinating the care with interdisciplinary teams.
Summary
Problem solving relies on decision-making critical thinking and/or clinical judgment. How you develop a solution for a problem is based on your own values parameters knowledge experience and situational factors. In order for healthcare professionals to provide higher quality safe patient care that care must be grounded in evidence-based practice (EBP). When examining the literature one must weigh and critically review the findings and synthesize the results. Now that we have synthesized our best analysis of the problem how can we come up with the best solution? How do we know recognize or implement the best solution? How do we evaluate the solution to the problem? In Week 5 we will explore these questionsone more step along the road to a quality healthcare environment for the future.
References
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