Nursing care models reflect the ethical basis of patient care including the main structural culture of an organization. It provides a guideline for establishing and delivering care to patients and families (Mattila, Pitkänen, Alanen, Leino, Luojus et al., 2014). Nursing models of care are established to improve professional practice and they have been used as an instrument to plan and use the staff accordingly and more effectively with a goal of decreasing cost (Finkelman, 2016). Different organizations and different healthcare settings have their own way of providing care for patients which could be depending on the patients’ individual needs. Nursing care models have gone through changes over the years but they have a substantial influence on the newer models that are being made. As time changes nursing models must also change and improve to effectively adapt to a person or an organization’s specific needs. Nursing care model serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.

Nursing Care Model in the Workplace

As
we all know, there are many different care models and they are being improved over
the years. Some of them are not being used anymore but they have been an
inspiration for the new ones that are being developed. The nursing care model
that I have observed at my workplace is Functional Nursing. Functional nursing
model is more focused on the task and each task
is assigned to a mix of nursing personnel who will focus on the specific task
to be done (Jennings, 2008).

 I work in a Skilled Nursing Facility that has
a total of 52 patients who are divided into two separate sections, the
long-term care, and short-term care units. The short-term care unit has a total
of 20 patients who are recent hospital discharged patients who need extended care
and who are not quite ready to be discharged to their homes. The long-term care
unit has 32 patients who are basically elderly that need help with their care who
are not necessarily sick but who need assistance with ADL’s and medications. The
staff who are assigned for the day consists of two nurses, one LVN, and five
nursing assistants. There is one Charge Nurse per unit in the facility who is
responsible for their own units for the day. The nurses are assigned and
responsible for the medications. We give meds in each of our units, responsible
for new orders from the doctor and we are also responsible for ordering
medications from the pharmacy of course including all the paperwork. There is
one LVN assigned to do treatments for the whole facility such as wound care or
topical medications. The nursing assistants are assigned to take vital signs
for the patients who need them and all the activities of daily living.

            The model
of nursing care used in the facility is functional because everyone has
assigned tasks that need to be done and remains their focus for the whole
shift. Every single staff is assigned a particular task and their goal for the
day is to finish the task assigned. The good thing about using the functional
model in this facility is that it is very efficient, everything is getting done
as it is supposed to regardless of the number of patients in the facility.
Working daily on the tasks that need to be done, staff have become creative and
have learned to come up with their own plan to perform each task effectively. It
is also very little to no confusion regarding roles and duties. For the
facility, it is cheap and affordable because no additional staff is needed
since tasks are being done.  

            Although the functional nursing
model is efficient, there are also disadvantages that it comes with. Clients
often get confused who is assigned to them because of the number of different
staff seeing them for different things. The care in a functional model is so
fragmented that it leads to an impersonal relationship between the nurse and
the patient (Finkelmal, 2016). Another disadvantage is that the patients don’t get
their specific needs met as an individual which results in an unhappy and
unsatisfied client. Another problem that I have noticed is that since each
person is assigned to certain tasks, they are less likely to do anything else. When
staff is told to do something else other than their assigned task, they become
unhappy and are more likely to complain because the time from their assigned
work is being taken away. The
current care model being used does not seem to be working with both patients
and the staff is unhappy.

            The Team Nursing Model is the one I
would recommend to be implemented to improve
quality of nursing care, safety, and staff satisfaction. According to King,
Long, & Lisy, (2014), the team nursing model care has an RN team leader
that has effective communication and leadership skills. The team is comprised
of nurses that have the diversity of skills to deliver high-quality care. Each
member of the team has to work collaboratively because of shared
responsibility. I figure that this would be a good model for the facility so
that everyone can work together to accomplish a certain task that needs to be
done. According to Finkelman (2016), the current team model has been modified
for improved reliability and continuity of care as well as teamwork and
management that is more focused on the patient instead of being task-oriented.

Functional Nursing Model

                Mattila, Pitkänen,
Alanen, Leino, Luojus et al. (2014), conducted a study regarding the
development of a functional model of nursing care in cancer. Their
objective was to recommend and authenticate a functional model that addresses,
guides, and quality nursing care in the Colombian National Cancer Institute.
 They conducted a study in three
phases; analysis of the context, elaboration, and analysis of the narratives of
care and development of the functional model of nursing care from the
narratives. The workshop showed that having a specific care
model for nursing is correlated to being able to improve the quality of care, improve
identity, and focus actions on the essentials such as decreasing cost, increased
patient satisfaction, developing interpersonal skills, continuity in procedures,
and demonstrating that nursing is crucial to improving life situations and care
of users (Mattila, Pitkänen, Alanen, Leino, Luojus
et al., 2014). The result of the study allowed the National Cancer Institute’s
Model of Nursing Care to be proposed and authenticated because it was backed
and supported by the participants.

            Liang
& Turkcan (2016), conducted a study between functional care delivery model
and primary care delivery model in acuity-based
nurse assignment and patient scheduling

in oncology clinics. The goal of the study is to develop better methods
to decrease the time consumed for nurse assignment and patient scheduling in
oncology clinics that use different delivery of care models. To solve the nurse
assignment problems in the Functional delivery model, a multiobjective
optimization model was proposed to minimize patient waiting time and nurse
overtime (Liang & Turcan, 2016). The authors have found that the delivery
care methods used in the oncology clinics are based on numerous factors including
the availability of skilled nurses in the particular area, staffing costs,
patient satisfaction, and patient safety. They have found that there are more advantages
than the disadvantage of using the Functional care delivery method in oncology
clinics compared to Primary care delivery model although it is not the purpose
of the study. Advantages of functional care delivery model include less
restricted patient scheduling due to nurse availability, nurse balance
workload, less nurse required and the care model can easily be implemented
without changing the scheduling system.

            The Functional care
delivery model for both studies have been proven to be useful in specific
healthcare settings. The study conducted by Mattila,
Pitkänen, Alanen, Leino, Luojus et al. (2014), mainly states that having a
specific model in the healthcare setting is beneficial to the patient, staff
and the organization. The study by Liang
& Turcan, (2016), stated that the Functional care
model delivery can be beneficial in the oncology clinic when considered in
patient scheduling and acuity-based nursing assignments.

Team Nursing Model

            A study
conducted by King, Long, & Lisy (2014), compared
the effectiveness of team nursing to total patient care on the well being of
staff when organizing work in acute care settings. Based on the documented
models of care, the organization of work for nurses can
have a big influence on the wellbeing and performance of nurses and nursing
teams as it is key in defining the nurses work environment (King, Long, &
Lisy, 2014). In this study, staff wellbeing was based
on staff satisfaction, turnover, absenteeism, stress levels and burnout. Both
quantitative and qualitative reviews were done on nursing models and effects
but none narrowed the focus on the two models and their direct effect on staff
wellbeing. Instead, the data will assist in establishing the effect of each
model on the nurses delivering them.

            In the study by Fairbrother, Chiarella, & Braithwaite (2015), they suggest that
team nursing is the best solution to the fast-changing work in healthcare
services and the projected pressures on the nursing workforce. The authors
stated that team nursing continues to holistically and professionally provide nursing
actions and care in the healthcare setting. Fairbrother, Chiarella, &
Braithwaite (2015) have found that only team nursing is probably the most adequately
flexible in a workplace with rank changes and recurrent change in work culture.
The authors have found based on their analysis, that using team delivery of
care allows acute nursing to justify the skill and experience sequence, factors
related to the nursing workforce, and the hospital-based healthcare
environment.

            Team
nursing based on two studies reviewed have positive effects on the staff,
patients, and organizations. The study conducted by King,
Long, & Lisy (2014), have given them both qualitative and quantitative data
as far as effects of the care models on the staffs’ wellbeing. Although the
models do affect the wellbeing of the staff, they were not able to narrow down
which models truly affect them. In the study by Fairbrother, Chiarella, &
Braithwaite (2015), they have concluded that team nursing is the most flexible
delivery care system that can adjust to any change in the workplace whether it
may be management, staff or organizational change.

Conclusion

            Nursing care models were developed to serve as a guideline to nurses and healthcare organizations for establishing and delivering care to patients. The use of nursing care model varies depending on the healthcare setting and the population it serves. I have learned through this assignment that no matter what kind of nursing model is being used, they all have the same goals of decreasing cost, maintaining providing safety and quality nursing care, increasing staff satisfaction. The nursing care models can change over time but it is developed to adjust and adapt to a person or organization to meet their specific needs. It is ultimately good to have a guideline that can be followed but we have to keep in mind that things can change and there are a lot of variables that can cause these changes. It is important that we remain flexible especially if it improves our work environment. Nursing care models serves as a guide to nurses and organizations with goals to decrease cost, provide patient safety and to provide quality nursing care.

References

• Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: where does team nursing sit?. Australian Health Review, 39(5), 489-493.
• Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.
• Jennings BM. Care Models. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2635/
• King, A., Long, L., & Lisy, K. (2014). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care ward settings: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(1), 59-73. doi:10.11124/jbisrir-2014-1533
• Liang, B., & Turkcan, A. (2016). Acuity-based nurse assignment and patient scheduling in oncology clinics. Health Care Management Science, 19(3), 207-226. doi:10.1007/s10729-014-9313-z
• Mattila E, Pitkänen A, Alanen S, Leino K, Luojus K et al. (2014) The Effects of the Primary Nursing Care Model: A Systematic Review. J Nurs Care 3:205. doi:10.4172/2167-1168.1000205