Nursing Care Models
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This paper provides consideration of two nursing care models based on several scholarly articles. The first model was observed by the author of this paper in the practice setting, and the second model is different from the observed one. Those two models are functional nursing and primary nursing care models. In addition, this paper will study scholarly resources, and conclusions will be drawn upon them. The author will describe the use of the models, which were observed, as well as recommend a different nursing care model that could be implemented to improve the quality of nursing care, safety, and staff satisfaction. This will help to understand the existing problems and find solutions.
Keywords: nursing, care, model, functional, primary
The meaning of nursing models for the development of the nursing profession is very broad. It helps to take another close look at the function of a nurse. Previously, nurses only cared for seriously ill patients; now, the nursing staff together with other specialists sees the main problem in the maintenance of health, the prevention of diseases, maximizing human independence in accordance with his or her individual features (Jost, Bonnell, Chacko, & Parkinson, 2010).
The nursing theory for scientific, educational, and practical activities is significant. At the core of nursing theory are the basic concepts that define the essence of nursing practice (Finkelman, 2015). These include the patient as one of the objects of the activities of nursing staff, the source of the patient’s problems, the focus of nursing interventions, the purpose of care, the methods of nursing interventions, the role of the nurses, the quality of care, and outcomes assessment.
Each of these concepts is presented and described in the works of theorists of nursing, and although these concepts are present in all theories of nursing, their interpretation and ways to interact with each other differ significantly (Jost et al., 2010). This paper will describe the use of the models, which were observed in the practice setting, as well as recommend a different nursing care model that could be implemented to improve the quality of nursing care, safety, and staff satisfaction. This will help to understand the existing problems and find solutions.
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The author of this work observed a model of functional nursing care in the practice setting. This model is described by Fairbrother, Jones, and Rivas in the article “Changing Model of Nursing Care from Individual Patient Allocation to Team Nursing in the Acute Inpatient Environment” (2010) and Shirey in the article “Nursing Practice Models for Acute and Critical Care: The Overview of Care Delivery Models” (2008).
Functional nursing care is based on the maximum use of the experience, skills, and abilities of nurses to provide quality care for their patients. This method focuses on the effective division of labor and control. Registered nurse distributes tasks or scope to the nurses and monitors. For example, one nurse is responsible for the distribution of medicines, the second – for the procedure, and the third – for the dressing, while a nursing assistant deals with patient feeding and hygiene.
Quite a wide application of functional nursing care is justified in terms of nurses and support staff shortage. Fairbrother, Jones, and Rivas (2010) believe that this method of nursing care is outdated and it has a number of drawbacks. For example, the medical staff may feel unsatisfied because of the simple mechanical performance of elementary work. This model of nursing care is not conducive to the development of staff. It oppresses and it does not disclose the leadership potential of nurses.
In addition, such a model can lead to fragmented patient treatment (Fairbrother, Jones, & Rivas, 2010). In medical practice, there have been cases where the improper allocation of responsibilities led to omissions on the part of the staff, for example, the medication was not been delivered to the patient, which had dire consequences for the patient (Fairbrother, Jones, & Rivas, 2010).
On the other hand, according to Shirey (2008), the model of functional nursing care has a number of advantages. For example, for the skillful management of the personnel, this model allows the quick performance of all the necessary manipulations with the patient and enables nurses to provide timely assistance. In addition, the undoubted advantage is that every nurse knows exactly the responsibilities and rationally uses their time. As mentioned above, this model is very useful in the conditions of shortage of medical personnel (Shirey, 2008).
Another model that has aroused the interest of the author of this paper is primary nursing care, described by Jost et al. in the article “Integrated Primary Nursing: A Care Delivery Model for the 21st Century Knowledge Worker” (2010). This model implies that a nurse is responsible for a particular patient 24 hours. The purpose of this model is to satisfy all the needs of the patient. Furthermore, Jost et al. (2010) suggest that this method provides a deep dive of nurses in patient care, awareness of the methods of treatment.
The nurse is legally responsible for the patient, so while at the bedside, not only does the nurse solve the patient’s problems but also carries responsibility for assessing the situation and the results of care planning, intervention. A nurse cares for one to five patients, depending on their condition. A nurse sends information about changes in the condition of the patient to the physician or to the members of the interdisciplinary team (social worker, rehabilitation specialist) who are not medical professionals (Jost et al., 2010).
In this case, nurses are responsible for specific patient recovery. They carry out all maintenance from the date of admission to discharge. Nurses meet the patient at the hospital, conduct surveys, discuss a care plan with the patient, advise the patient or relatives, and most importantly, take care of the documentation by filling the sheet of patient nursing care.
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The advantage of this model of nursing care, according to Jost et al. (2010), is that nurses have information about everything that happens to the patient. The authors of the article also believe that in this way, there forms the relationship of trust between the nurse and the patient, which in turn contributes to a speedy recovery. Patient care is carried out more thoroughly when compared with the model of functional nursing care. Even if the doctor, for any reason, replaced, the nurse is able to provide complete information about the course of treatment, appointments, and status of the patient entrusted to her (Jost et al., 2010).
However, according to Wan, Hu, Thobaben, Hou, & Yin (2011), the model of primary nursing care is not advantageous regarding cost. Experience has shown that this model is quite expensive for the medical institution, so they have to cut spending on other needs. In the current economic situation, some hospitals cannot afford such a model of nursing care (Wan et al., 2011). Nevertheless, Jost et al. (2010) and Wan et al. (2011) are of the opinion that the model of primary nursing is by far the best presented in the medical practice.
Based on the experience gained in the course of observations, it is possible to say that the use of the model of functional nursing care in modern conditions is justified. The division of responsibilities of nurses exists in a number of medical institutions, particularly in psychiatric wards. During the observations, the author could see that the main role in the distribution of responsibilities belonged to a registered nurse. She was the one to appoint the responsibilities of each nurse (Fairbrother, Jones, & Rivas, 2010). Thus, each member of the staff knew his or her responsibilities, which they had to comply with during the shift. Due to the coordinated actions of staff, the shortage of nurses was not noticeable; the algorithm of actions was clear and well-executed. Undoubtedly, the main burden fell on a registered nurse.
However, in this way, a clear leader is revealed. It is important that the registered nurse knows all the responsibilities assigned to her and she is attentive. To the rest of the staff, nurses would not feel pressure or oppression by performing routine tasks, varying responsibilities, and a change of duties is applied. This helps the staff not to lose their skills, develop new ones, and express themselves on the other side. Patients, in turn, receive comprehensive care and decent medical care. In practice, such a model of care is very efficient and effective (Shirey, 2008).
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However, in order to get better medical care, the author of this paper would suggest the use of the primary nursing model. Despite the fact that this model has been recognized as expensive, it is the best model of nursing care available today. One should not forget that the purpose of health care is the care of the patient, satisfying all his or her needs, and as a result, saving lives and improving health. That is why one should pay attention to the model of nursing care. The person-oriented approach, individualization, and patient safety are the key aspects of modern health care. By using a model of primary nursing care, it is possible to achieve the most effective insurance of patient’s safety (Jost et al., 2010).
After all, the nurse is responsible for the patient in person, and responsibility for his or her safety lies completely on the nurse too. This approach is certainly much more effective than collective responsibility. The quality of nursing care also benefits when using this model. The nurse is fully involved in patient treatment, which greatly reduces the risk of medical errors and improves the quality of treatment monitoring (Wan et al., 2011).
A trusting relationship of the patient with a nurse also leads to positive results, as evidenced by the scientific literature (Jost et al., 2010). Especially, such a model should be applied in the cases of cancer, when important emotional connection and support are rather important. In terms of employee satisfaction, the model of primary nursing care also has advantages. Nurses have the ability to self-development, improvement of their professional skills, and leadership development, which in the future will help in the promotion of their careers. Routine activities are not excluded, but they are not as monotonous as in the case of the functional nursing care model (Wan et al., 2011).
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In the course of the research, the nursing models were investigated. Based on the scientific literature, such models as functional nursing care and the primary model of nursing care were considered. Considering the above-mentioned information, it is possible to conclude that the functional model of nursing care is deficient from the point of view of a person-centered approach to patient treatment as well as in terms of employee satisfaction. Undoubtedly, some improvements can affect the quality of care, for example, the distribution and variation of duties or the periodic change of roles of staff. In general, this model is not optimal but acceptable in the case of the shortage of medical personnel as well as in a number of cases related to the specifics of the medical institution.
With regard to the primary model of nursing care, this model is the most advanced one in modern medical practice. It allows reducing the risk of medical errors, improves patient safety, and helps nurses develop professionally and personally. Despite the relatively high cost of such a model of nursing care, it is justified in terms of basic health goals, namely, saving lives and improving the health of the patient. Therefore, it can be recommended for use in medical facilities of any type.