identify nursing care models utilized in today s various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation

Directions : Use this form to complete the Week 5 Nursing Care Models Assignment: Nursing Care Models Worksheet (Links to an external site.)Links to an external site.

  1. Read your text, Finkelman (2016), pp- 111-116.
  2. You are required to complete the assignment using the template.
  3. Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.
  4. Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model
  5. Review and summarize one scholarly resource (not your textbook) related to the nursing care model you observed in the practice setting.
  6. Review and summarize one scholarly resource (not including your text) related to a nursing care model that is different from the one you observed in the practice setting.
  7. Discuss a different nursing care model from step #3, and how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.
  8. Summarize this experience/assignment and what you learned about the two nursing care models.
  9. Submit your completed worksheet no later than 11:59 p.m. MT on Sunday by the end of Week 5.

*****PLEASE USE THE TEMPLATE LINK ABOVE, LET ME KNOW IF IT DOESNT WORK******

GRADING RUBRIC:

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeNursing Care Model in PracticeIdentify Nursing Care Model in practice including specifics about who, what when, where, etc.

60.0 pts

Thoroughly identifies Nursing Care Model in practice including all the specifics about who, what when, where, etc.

53.0 pts

Mostly identifies Nursing Care Model in practice including most of the specifics about who, what when, where, etc.

48.0 pts

Somewhat identifies Nursing Care Model in practice including some specifics about who, what when, where, etc.

24.0 pts

Minimally identifies Nursing Care Model in practice, but describes only one or two specifics.

0.0 pts

Fails to identify a Nursing Care Model. Does not include any specifics.

60.0 pts

This criterion is linked to a Learning OutcomeScholarly Sources Related to Observed Nursing Care Model.(In addition to Finkelman, locates one scholarly resource related to Nursing Care Models Observed. Summarizes resource in template.

20.0 pts

Thoroughly reviews and summarizes one scholarly resource (not the course textbook) related to the observed nursing care model from the practice setting.

18.0 pts

Generally reviews and summarizes one scholarly resource (not the course textbook) related to the observed nursing care model you from the practice setting.

16.0 pts

Fair review of only one resource (not the course textbook) related to the observed nursing care model from the practice setting.

8.0 pts

Minimal review only one resource (not the course textbook) related to the observed nursing care model from the practice setting.

0.0 pts

Fails to provide any resources related to the observed nursing care model.

20.0 pts

This criterion is linked to a Learning OutcomeScholarly Sources Related to Different Nursing Care Model.(In addition to Finkelman, locates one scholarly resource related to Nursing Care Models Observed. Summarizes resource in template.

20.0 pts

Thoroughly reviews and summarizes one scholarly resource (not the course textbook) related to the different nursing care model from the observed model.

18.0 pts

Generally reviews and summarizes one scholarly resource (not the course textbook) related to the different nursing care model you from the observed model.

16.0 pts

Fair review of only one resource (not the course textbook) related to the different nursing care model from the observed model.

8.0 pts

Minimal review only one resource (not the course textbook) related to the different nursing care model from the observed model.

0.0 pts

Fails to provide any resources related to the different nursing care model from the observed nursing care model.

20.0 pts

This criterion is linked to a Learning OutcomeDiscuss a different nursing care model and describes how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific

60.0 pts

Discusses a different nursing care model and thoroughly describes how it could be implemented to improve quality of nursing care, safety and staff satisfaction.

53.0 pts

Discusses a different nursing care model and mostly describes how it could be implemented to improve quality of nursing care, safety and staff satisfaction.

48.0 pts

Discusses a different nursing care model and fairly describes how it could be implemented to improve quality of nursing care, safety and staff satisfaction.

24.0 pts

Discusses a different model that could be utilized but, various elements are missing related to improving quality of nursing care, safety and staff satisfaction

0.0 pts

Does not discuss a different model that could be utilized

60.0 pts

This criterion is linked to a Learning OutcomeSummary of this assignment and what you learned about the two nursing care models discussed.

20.0 pts

Thoroughly summarizes what you learned including new knowledge about nursing care models.

18.0 pts

Mostly summarizes what you learned including new knowledge about nursing care models.

16.0 pts

Fairly summarizes what you learned OR includes new knowledge about nursing care models but not both.

8.0 pts

Minimal summation is present

0.0 pts

Does not Include a summary

20.0 pts

This criterion is linked to a Learning OutcomeClarity of writing (Content is organized, logical, and with correct grammar, punctuation, spelling, and sentence structure are correct.

10.0 pts

Content is organized, logical, and grammar, punctuation, spelling, and sentence structure are correct. Correct worksheet used.

9.0 pts

Content is mostly organized, logical, and grammar, punctuation, spelling, and sentence structure are correct. Correct worksheet used.

8.0 pts

Content is somewhat organized, logical and grammar, punctuation, spelling, and sentence structure are correct. Correct worksheet used.

4.0 pts

Content is somewhat organized, but may lack logic. Several errors occur in grammar, punctuation, spelling, and sentence structure. Correct worksheet used.

0.0 pts

Content is disorganized and writing has numerous grammar, spelling, or syntax errors. Correct worksheet not used.

10.0 pts

This criterion is linked to a Learning OutcomeReferences are properly cited and referenced within the worksheet.

10.0 pts

Excellent APA formatting is apparent in both references and citations, Few errors are noted.

9.0 pts

Good APA formatting is apparent in both references and citations. Some errors are noted.

8.0 pts

Fair use of APA formatting is present in both references and/or citations. Several errors are noted.

4.0 pts

Multiple APA formatting errors exist in references and citations. References are not present for all cited sources. Many errors are noted.

0.0 pts

APA formatting was not used. OR multiple references and citations are missing.

10.0 pts

Total Points: 200.0

FINKLEMAN PAGES 111-116

• Assumption 1: The role of nurse leaders in future patient care delivery systems will con- tinue to require a systems approach with all disciplines involved in the process and out- come models. • Assumption 2: Accountable Care Organizations will emerge and expand as key defining and differentiating healthcare reform provisions that will impact differing care delivery venues. • Assumption 3: Patient safety, experience improvement and quality outcomes will remain a public, payer and regulatory focus driving work flow process and care delivery system changes as demanded by the increasingly informed public. • Assumption 4: Healthcare leaders will have knowledge of funding sources and will be able to strategically and operationally deploy those funds to achieve desired outcomes of improved quality, efficiency, and transparency. • Assumption 5: The joint education of nurses, physicians, and other health professionals will become the norm in academia and practice promoting shared knowledge that enables safer patient care and enhancing the opportunity for pass-through dollars to apply to APRN residencies and/or related clinical education (2010, pp. 1–3). The five NAM core competencies are interrelated with these assumptions. Also, all of these ele- ments have been discussed in earlier chapters or will be discussed in later chapters, as they are critical aspects of leadership and management. Intertwined within these critical elements is the recognition of the importance of leadership, autonomy, responsibility, delegation, and accountability. Autonomy, which focuses on an individual’s ability to make decisions, requires accountability. Autonomy, which focuses on an individual’s ability to make decisions, requires compe- tence and skills that focus on the nurse–patient relationship. It also means that there needs to be an organized assessment method to determine patient care needs and reassigning staff. Nurses also have the right to consult with others as professionals when they provide or manage care. Autonomy, control, and decision making are related, and state Nurse Practice Acts reflect on nurse autonomy. Nurses who feel that they have autonomy know that they have the right to make decisions in their daily practice and also actively participate in developing organiza- tional policy and change. Staff autonomy, however, does not work in organizations in which leaders are authoritarian and when centralized decision making and control are key character- istics of the organization. This situation will quickly lead to conflict. In addition, the work environment must be conducive to collaboration with physicians and all relevant staff, as is discussed in Chapter 13. A nursing practice model that does not address responsibility will not be effective. Along with this is the need to clearly recognize the importance of delegation. Delegation is discussed in more detail in Chapter 15. Accountability is a term that is typically found in job descriptions and descriptions of organizational structure. “It is related to answer- ability and to responsibility—judgment and action on the part of the nurse for which the nurse is answerable to self and others for those judgments and actions” (Fowler, 2015, p. 44). “Responsibility refers to the specific accountability or liability associated with the perfor- mance of duties of a particular nursing role and may, at times, be shared in the sense that a por- tion of responsibility may be seen as belonging to another who was involved in the situation” (Fowler, 2015, p. 44). Nurses need to know that when they provide patient care, their work has relevance—it must reach outcomes. Accountability, autonomy, and responsibility need to be considered when nursing practice models are assessed. Nursing models of care are developed to support or enhance professional practice, and by considering these elements and characteristics, the models will be more effec- tive. Within an HCO, how do nurses provide nursing care? What is a model of care? Are these elements found in the model? Models might also be called nursing or patient care delivery sys- tems. These models have undergone major changes over the past several decades. Nursing prac- tice models have been used to implement resource-intensive strategies with the goal of decreasing expenses and using staff more effectively. Nursing models help to identify and describe nursing care. The NAM emphasis on the five core competencies could also be used for a model, and as newer models are discussed later, it is easy to see how these five competencies are the key ele- ments of healthcare delivery.

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The following is a description of common models, some of which have undergone many changes over the years or are not used anymore, but they have had an impact on newer models. tOtaL Patient care/case methOd In this model, which is the oldest, the registered nurse is responsible for all of the care provided to a patient for a shift. A major disadvantage of this model is the lack of consistency and coordinated care when care is provided in eight-hour seg- ments. This type of care is rarely provided today, except among student nurses who are assigned to provide all of the care for a patient during the hours that they are in clinical. Even in this case, the students frequently do not provide all of the care as they may not be qualified to do this, and a staff nurse maintains overall responsibility for the care. Home health agencies use a form of this model when nurses are assigned patients and provide all the required home care; however, even this has been adapted as teams provide more home care. An RN may coordinate the care and provide professional nursing services, but a home care aide may provide most of the direct care, and other providers such as a physical therapist, dietician, and social worker may be required for specialty care. FunctiOnaL nursing The model of functional nursing is a task-oriented approach, focusing on jobs to be done. When it was more commonly used, it was thought to be more efficient. The nurse in charge assigned the tasks (e.g., one nurse may administer medications for all or some of the patients on a unit; an aide may take vital signs for all patients). A disadvantage of this model is the risk of fragmented care. In addition, this type of model also leads to greater staff dissatis- faction with staff feeling they are just grinding out tasks. When different staff members provide care without awareness of other needs and the care provided by others, individualized care may also be compromised. This model is not used much now. It can be found in some long-term care facilities and in some behavioral/psychiatric inpatient services, although in a modified form. In the latter situation, a registered nurse may be assigned the task of medication administration for the unit, and psychiatric support staff may be assigned such tasks as vital signs and safety checks of all patients. In this situation, RNs would still be assigned to individual patients to coordinate their care. team nursing This model was developed after World War II during a severe nursing short- age and other major changes in medical technology occurred. It replaced functional nursing. A nursing team consists of a registered nurse, licensed practical/vocational nurses, and UAP. This team of two or three staff provides total care for a group of patients during an 8- or 12-hour shift. The RN team leader coordinates this care. In this model the RN has a high level of autonomy and assumes the centralized decision-making authority. Although the past approach to team nursing was thought to use decentralized decision making with decisions made closer to the patient, there actually was limited team member collaboration. In addition, these teams tended to communicate only among themselves and not as well with physicians and other healthcare providers. The team concept or model also focused on tasks rather than patient care as a whole. More current versions of the team model are different from this earlier type. Currently the team model has been changed to meet shifts in organizations and leadership corresponding to the needs for better consistency and continuity of care as well as collaboration and coordination and patient-centered care. PrimarY nursing In the late 1970s, care became more complex, and nurses were dissatisfied with team nursing. In the primary nursing model, the primary nurse, who must be an RN, pro- vides direct care for the patient and the family; an associate nurse provides care following the care plan developed by the primary nurse when the primary nurse is not working and assists when the primary nurse is working. The primary nurse needs to be knowledgeable about assigned patients and must maintain a high level of clinical autonomy. When primary nursing was first used, it was easier to substitute RNs for other healthcare providers as cost was not as much of a focus as it is today. Over time the nursing shortage changed and salaries increased. Implementing primary nursing then became more difficult, and healthcare cost moved to the top of the concerns. Primary nursing is often viewed as a model in which the primary nurse has to do everything, limiting col- laborative or team efforts, although it does not have to be implemented in this way. Second-generation primary nursing clarified some of the issues about this practice model. One of the critical problems with primary nursing was whether or not it required an all-RN staff,

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which was thought to increase staff costs. The second-generation view of primary nursing noted that the mix of staff was more important than having an all-RN staff. Another concern with pri- mary nursing was a need to develop a clear definition of 24-hour accountability, which was inter- preted by some as 24-hour availability. This, of course, is not a reasonable approach, and it really does not apply to primary nursing. When the primary nurse is not working, the associate nurse provides the care. Primary nursing is a responsibility relationship between the nurse and the patient. The primary nurse is not the only caregiver but does have responsibility for planning nursing care and ensuring that care outcomes are met. Only registered nurses can be primary nurses. This role and the model require RNs who are competent and possess leadership skills. Primary nursing is not used as much today. care and service team mOdeLs In the 1980s care and service team models began to replace primary nursing. These models are implemented differently in different hospitals, as is true of most of the models. Key elements of these models are empowered staff, interprofessional collaboration, skilled workers, and a case management approach to patient care—all elements related to the more current views of leadership and management (IOM, 2011). Care and service teams introduced the different categories of assistive personnel (e.g., multiskilled workers, nurse extenders, and UAP). There has been some disagreement as to whether these new staff member roles were complementary or involve the substitution of professional nursing care. cOmPLementarY mOdeLs Complementary models began in 1988 by using nurse extenders, such as a unit assistant, who would be responsible for environmental functions. The nurse would then have more time for direct patient care. Does this reduce costs? When nurse positions are changed to nurse extender positions, there is some cost reduction, but this change can impact all nursing staff. Complementary models are not used as much today and have been replaced by substitution models in HCOs. Substitution models tend to use multiskilled technicians to per- form select nursing activities, and the RNs supervise these activities. Another approach is cross-training. This involves training staff to work in different spe- cialty areas or to perform different tasks. For example, a respiratory therapist may be trained not only to perform typical respiratory therapist tasks but also phlebotomy and basic nursing care. This offers much more flexibility in that staff can fulfill many different needs. They can then be used, as staffing adjustments are needed for changes in patient census or acuity. It is critical that this cross-training meet patient needs so staff will be able to deliver quality, safe care and not feel undue stress while delivering the care. It is also important that state practice act requirements are met, and this is not always easy to accomplish. It requires HCO education staff to provide sup- port, ongoing educational training, and documentation of competencies, as well as management staff that understand which staff members are qualified to move from area to area. Hospitals and other HCOs have tried to find the best methods for using substitution without compromising quality and safety and yet control costs. As demands change, different models will be required, and nursing leadership to develop these models will be critical. case management mOdeL As with earlier team models, the RN must spend time coordi- nating care and the work. The focus of the team is on patient-centered care as opposed to the nurse–patient relationship. The case management model is based on the assumption that patients with complex health problems, catastrophic health situations, and high-cost medical conditions need assistance in using the healthcare system effectively, and a case manager can help patients with these needs (Finkelman, 2011). Case managers may also work with the teams to achieve outcomes, which increases shared accountability. Case management can be viewed as a nursing model when the case manager is a nurse; however, in some HCOs nurses are not used as case managers but rather other healthcare professionals such as social workers serve as case managers. Several healthcare professional organizations and experts have defined case management; how- ever, there clearly is no universally accepted definition for case management. Case management is used in many different types of settings, and the setting also affects the definition. Examples of Newer Nursing Models interPrOFessiOnaL Practice mOdeL The interprofessional practice model is emphasized in the IOM reports on quality improvement by identifying the importance of all health profes- sions meeting the interdisciplinary or interprofessional competency and emphasizing the need to


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work in interprofessional teams “to cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable” (2003, p. 4). These teams include providers from different healthcare professions and occupations designed to meet the required patient needs. With increasing complex patient care needs, this model is better able to address needs and to effectively use a mix of expertise and knowledge to reach patient outcomes. Patient-centered care is the focus. sYnergY mOdeL FOr Patient careTM This model of care was developed by the American Association of Critical-Care Nurses, but it has been applied in all types of nursing units. The model recognizes the need to match the nurse’s competence with the patient’s characteristics, needs, and the clinical unit (American Association of Critical-Care Nurses, 2014). Patient characteristics incorporated into this model are as follows (American Association of Critical-Care Nurses, 2014): • Resiliency: the capacity to return to a restorative level of functioning using compensatory/ coping mechanisms; the ability to bounce back quickly after an insult • Vulnerability: susceptibility to actual or potential stressors that may adversely affect patient outcomes • Stability: the ability to maintain a steady-state equilibrium • Complexity: the intricate entanglement of two or more systems (e.g., body, family, therapies) • Resource availability: extent of resources (e.g., technical, fiscal, personal, psychological, and social) the patient/family/community brings to the situation • Participation in care: extent to which patient/family engages in aspects of care • Participation in decision making: extent to which patient/family engages in decision making • Predictability: a characteristic that allows one to expect a certain course of events or course of illness The Synergy model ties the above patient characteristics with the following nurse competen- cies (American Association of Critical-Care Nurses, 2014): • Clinical judgment: clinical reasoning, which includes clinical decision making, critical think- ing, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence-based guidelines. • Advocacy and moral agency: working on another’s behalf and representing the concerns of the patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting. • Caring practices: nursing activities that create a compassionate, supportive, and therapepeu- tic environment for patients and staff, with the aim of promoting comfort and healing and preventing unnecessary suffering. Includes, but is not limited to, vigilance, engagement, and responsiveness of caregivers, including family and healthcare personnel. • Collaboration: working with others (e.g., patients, families, healthcare providers) in a way that promotes/encourages each person’s contributions toward achieving optimal/realistic patient/ family goals. Involves intra- and interprofessional work with colleagues and community. • Systems thinking: body of knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient/family and staff, within or across healthcare and nonhealthcare systems. • Response to diversity: the sensitivity to recognize, appreciate, and incorporate differences into the provision of care. Differences may include, but are not limited to, cultural differences, spiritual beliefs, gender, race, ethnicity, lifestyle, socioeconomic status, age, and values. • Facilitation of learning: the ability to facilitate learning for patients/families, nursing staff, other members of the healthcare te