Question

Describe the nursing care delivery models you have observed in the clinical setting. List the advantages and disadvantages of each, and note the delivery models you liked best and why.

Answer 1

The nursing care delivery system means “the process of delivering care to the client by combining various aspects of nursing service which will fit to various patient care settings to produce a common outcome of delivering quality care and meeting the needs of clients.Traditional models of patient care delivery include total patient care and functional, team, and primary nursing. These models differ in clinical decision making, work allocation, communication, and management, with differing social and economic forces driving the choice of model.

The four classic nursing care delivery models used during the past five decades in clinical settings are:

(1) total patient care,

(2) functional nursing,

(3) team nursing, and

(4) primary nursing.

Efforts to continually improve both the quality and cost-effectiveness of patient care have resulted in variations to these four classic models.

Advantages :

Nursing care delivery models, detail the way task assignments, responsibility, and authority are structured to accomplish patient care. The nursing care delivery model describes which health care worker is going to perform what tasks, who is responsible, and who has the authority to make decisions. The basic premise of nursing care delivery models is that the number and type of caregivers are closely matched to patient care needs to provide safe, quality care in the most cost-effective manner possible.

Nursing models:

1. Total patient care is a model of care designed around a registered nurse overseeing personal care to one patient during a specific period of time. RNs can assist with medical, home care and care management needs, such as oversight of health services.

Advantages and disadvantages:

The greatest benefit of total patient care is the one-on-one attention and monitoring a skilled nursing professional provides.

The drawback to total patient care is the price. A dedicated nurse providing medical assistance is more expensive than a professional caregiver who is hired for companionship services. Unlike hospice care, total care is not provided indefinitely, but rather assists a patient for a short period of time or longer if needed.

Total patient care relies on a good, patient-nurse dynamic. When it comes to senior care, a compassionate, relational caregiver is essential.Providing the highest quality of care is our goal at Commonwise Home Care. If the one-on-one caregiver we provide to your loved one is not a good fit, we will replace them with another member of our care team.

2.Functional nursing was designed around an efficacy model that seeks to get many tasks accomplished in a short period of time.

Instead of one nurse performing many functions, several nurses are given one or two assignments. For example, there is a medicine nurse whose sole responsibility is administering medications.

Functional nursing was designed around an efficacy model that seeks to get many tasks accomplished in a short period of time. Functional Nursing evolved during World War II as a result of the nursing shortage as registered nurses were needed to nurse the troops. Staff members assigned to complete specific tasks for a group of patients. Unskilled workers trained to perform routine, simple tasks. Hospitals adopted functional nursing due to lack of qualified staff and the decreased cost of using lesser skilled personnel.

Advantages and disadvantages:

Functional nursing is task-oriented in scope. Instead of one nurse performing many functions, several nurses are given one or two assignments. For example, there is a medicine nurse whose sole responsibility is administering medications. A treatment nurse is charged with giving patients diagnostic tests as well as providing accurate diagnoses according to the patient's symptoms and test results. A charge nurse works in tandem with the physician and ensures that the patient receives optimum care. The principle idea of functional nursing is for nurses to be assigned tasks, not patients.

The disadvantages are:

• Fragmentation of nursing care and therefore wholistic care is not achieved;
• Nurses accountability and responsibility are diminished;
• Patient's cannot identify who their “real nurse” is;
• Nurse-patient relationship is not fully developed;

3. Team nursing

It involves use of a team leader and team members to provide various aspects of nursing care to a group of patients.

Advantages and disadvantages:

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 experienced and specially qualified nurses to nursing orderlies.

The advantages of team nursing is usually associated with democratic leadership. It allows members to contribute their skills or their own special expertise. As team leaders, they should use their knowledge about each member’s abilities when making patient assignments. Recognizing the individual worth of all employees and giving team members autonomy result in job satisfaction.

In team nursing, the registered nurse is able to get work done through others. Each member of the team is able to participate in decision making and problem solving. Team nursing is an effective method of patient care delivery and has been used in most inpatient and outpatient health care settings. The team nursing also improved patient satisfaction and able to identify personnel who are responsible for his care. Every team member has the opportunity to learn and teach colleagues because a variety in the daily assignment given.

Disadvantages of team nursing is establishing a team concept takes time, effort and constancy of personnel. Unstable staffing pattern make team nursing difficult. This can lead to blurred lines of responsibility, errors, fragmented and depersonalized patient care. Sometimes the team leader may not have the leadership skills required to effectively direct the team and create a “team spirit”. There is less individual responsibility and independence regarding nursing functions.

Communication in these models is complex. Insufficient time for care planning and communication may lead to unclear goals. The need for excellent communication and coordination skills makes implementing team nursing difficult and requires great self-discipline on the part of the team members. There is shared responsibility and accountability, which can cause confusion and lack of accountability. These factors contribute to registered nurse dissatisfaction with these models. Continuity of care may suffer if the daily team assignments vary and the patient is confronted with many different caregivers. Frequently, insufficient time is allowed for team care planning and communication.. For team nursing to be effective, the leader must have a good communication, organizational, management, and leadership skills must be an excellent practitioner.

4. Modular Nursing

Modular Nursing is a modification of team nursing and focuses on the patient's geographic location for staff assignments; the unit is divided into groups referred to as modules - also called districts or pods.The same team of caregivers is assigned consistently to the same geographic location. Each location, or module, has an RN assigned as the team leader, and the other team members may include LVNs/LPNs and Unlicensed Assistant Personnel

5. Primary nursing :

The change to primary nursing eliminated one level of nursing supervision, the traditional team leader, and flattened the well-worn hierarchical structure.

Advantages
 High-quality, holistic patient care
 Allows for time/opportunity to establish relationship with patient and their family / support system
 RN – autonomy; ability to make nursing care decisions
Disadvantages
 Primary nurse must be able to practice with a high degree of responsibility and autonomy
 RN must accept 24-hour responsibility
 Issue – how to staff to allow for primary nurses absence (days off, illness); alternate shifts ;
 Communication – changes in patient condition
 Reluctance of other RN’s to follow nursing orders.
 More RNs needed; not cost-effective
 Patient condition change requiring movement to different level of care – different location-different nurse.

From all the nursing care models, I like functional nursing the most because it is an organizational model for assigning nursing personnel that is task- and activity-oriented, using auxiliary health workers trained in a variety of skills. Each person is assigned specific functions performed for all patients in a given unit, and all report to the head nurse.