Nursing Care Delivery Models
The nursing care delivery model refers to a method or an approach used to offer care to patients (Yoder-Wise, 2014). Different nursing care delivery models fit in different settings. In this study, the researcher will look at a number of nursing care delivery models, their advantages and disadvantages in different nursing contexts.
Total Patient Care (Case Method)
The total patient care or case method model is a situation where one nurse offers total care to one patient. The model emphasizes the need for close patient-nurse interaction. When using the model, a nurse cannot handle more than two patients in a day. The main advantage of this model is that the patient gets maximum care from the nurse because of the attention the patient is given. The nurse is able to deliver quality work because the number of patients is reduced to one or two per day. However, the main weakness of this model is that it requires more nurses. This makes it one of the most expensive models to use in any healthcare facility.
In this model, a healthcare facility may consider using LPN/LVN, UAPs, and other unlicensed personnel to assist registered nurses (RN) in offering care to the patients. This unlicensed personnel is assigned tasks such as taking the records, transferring files among other unspecialized tasks to allow the RNs to perform specialized tasks of offering patient care. The main advantage of this model is that it can be very helpful when addressing emergencies arising from disasters such as accidents or natural calamities. It eases the pressure on nurses. It is also cost-effective. However, Revell and McCurry (2011) say that the major challenge when using this model is that quality care services offered to the patients may be jeopardized.
In team nursing, patients are assigned to small groups based on the nature of their disease and the criticality of their situation. In each group, a team leader will be responsible for managing patients’ needs assisted by licensed and unlicensed nurses. The most important factor that must be considered when using this model is that the team leader must be a highly skilled and highly experienced nurse who can coordinate with other nurses to deliver quality care to patients. The main advantage of this model is that it is cheaper compared to other models, and services are closely coordinated within the small groups. However, the use of unlicensed nurses has raised criticism about the quality of services delivered.
Primary nursing was a modification of total patient care, but in this case, nurses are more independent in their work. In return, the institutions expect accountability from them. This model was meant to replace the team nursing model that had been criticized for its infectivity. The model emphasizes the need to reduce the number of unlicensed nurses in active care delivery. According to Revell and McCurry (2011), the advantage of this model is that it makes the nurses more responsible and highly satisfied with their work. However, this model may force a healthcare institution to hire more patients.
Nursing Case Management
Nursing case management is another popular model of nursing that is actively in use today. According to Yoder-Wise (2014, p. 261), “Case management is the process of coordinating health care by planning, facilitating, and evaluating interventions across levels of care.” The main aim of this coordination is to lower the cost and increase the quality of care. The effective leadership used in this model makes it easy to identify risks, address them in a timely manner, and coordinate human resources within a healthcare system. However, this method requires a highly skilled team of nurses that may be costly to maintain.
Understanding of Care Delivery Model
According to Sojourner, Grabowski, Chen and Town (2012), different care delivery models fit in different contexts. At this stage, the researcher will focus on the appropriate care delivery model for the cardiac intensive care unit.
Cardiac Intensive Care Unit
Cardiac intensive care unit, also known as coronary care unit, refers to a hospital ward that offers specialized care for patients with various cardiac conditions such as heart attacks or unstable angina among other heart problems (Revell & McCurry, 2011). Based on personal experience, the researcher noticed that this is one of the highly specialized intensive care units within the hospital because of the delicate nature of the patients. The availability of telemetry using electrocardiography is one of the main features of this unit. This makes it possible to make an early intervention through medication or defibrillation to help improve prognosis.
Recommending case methods of nursing care delivery model
The time spent in this intensive care unit clearly shows that the case method or total patient care delivery model is the most appropriate in this department. In this unit, patients need personal attention from the nurses. The nurse in charge of a given patient who is in a critical condition should know the condition of the patient, the specific medication that is needed, and any other relevant details about the patient. A case method allows a patient to have a close and constant interaction with the patient, making it easy to monitor the progress and make the appropriate report to the relevant doctors. Case method of nursing model would fit in this context, especially when handling patients with unique heart problems. As Yoder-Wise (2014) notes, such critical heart conditions require consistency. To achieve this, it will be necessary to have a specific RN who will be responsible for all the care services for the patient. The constant interaction between the patient and the nurse also creates an attachment that makes it easy to administer medication and monitor the patient’s progress within the ward.
Staffing mix and staffing pattern
It is important to define the appropriate staffing mix and staffing pattern that is required at the cardiac intensive care unit. In defining the staffing mix, Milliken et al. (2011) says that in a cardiac intensive care unit, the staff needed include cardiologists, physicians specialized in heart failures, pulmonary intensivists, cardiology nurses, case managers, occupational therapists, palliative care specialists, clinical pharmacists, and respiratory therapists. In this paper, the researcher will only focus on the cardiology care nurses’ staffing pattern. Case method nursing model requires that a single nurse should be responsible for not more than two patients. In other private hospitals, a patient would have a staffing pattern of one cardiologist, one occupational therapist, one palliative care specialist, and one cardiology care nurse. All the other staff except the nurse can attend to several other patients in a day. However, the nurse will be restated to either one or two patients in a day when using the case method nursing model.
Milliken, O., Devlin, R., Barham, V., Hogg, W., Dahrouge, S. & Russell, G. (2011). Comparative Efficiency Assessment of Primary Care Service Delivery Models Using Data Envelopment Analysis. Canadian Public Policy 37(1), 85-109.
Revell, S. & McCurry, M. (2011). Postflood Disaster Management and the Home Health Nurse: Using Theory to Guide Practice. Journal of Community Health Nursing 27(3), 126-136.
Sojourner, A., Grabowski, D., Chen, M., Town, R. (2012). Trends in Unionization of Nursing Homes. Journal of Nursing Care 47(4), 331-342.
Yoder-Wise, P. S. (2014). Leading and managing in nursing. St. Louis: Elsevier Mosby.