Nursing care delivery models comprise of different theories to allocate tasks, authority, responsibility, and organization to perform patient care. There are various models of care delivery in place that differ in their decision making, communication, work allocation, and management. The model of choice is also driven by varying economic and social forces. This paper is an observation of the nursing care model I observed in the General Hospital Emergency Department.
In an Emergency Department, efficient use of processes and resources is required to ensure the safety, timeliness, and quality of care. In my time, I observed that the nurses were initially gathered and assigned a task or a set of well-defined tasks earlier in the shift. They did not attend to a single patient alone instead would cycle between patient to patient. The nurses had to provide episodic care to patients, and a majority of times patients needed additional and immediate interventions that required acute care. From the tasks, I recognized that the in this hospital the nurses opted for the functional model to provide care.
To study the application and efficacy of the Functional nursing care delivery model, a literature review was carried out. One of the first studies researched leadership behaviors of nurse leaders in Jordanian hospitals (Majd Mrayyan, 2008). For the study, data was collected from four governmental hospitals and compared to three private hospitals that utilized the functional nursing care delivery model. Leadership behavior was found to be higher in private hospitals who used supportive models of leadership. Another study was reviewed that evaluated how cognitive functioning of patients was observed by geriatric nurses who followed the functional nursing delivery care model in their hospitals (Anke Persoon, 2008). Half of the nurses were using the primary nursing care model. It was observed that geriatric nurses made timely observations to assess cognitive functioning for diagnosis support that also helped guide nursing interventions.
Another well-known nursing care delivery model is the team nursing care model. For that two case studies were reviewed that applied the model (Greg Fairbrother, 2010). The first study undertook research in which the team nursing model was compared to the ‘individual patient allocation’ model, among two units of six members each. Social action research principles were implemented in change wards. The findings suggested that staff retention and satisfaction increased as they moved from IPA model to team nursing model. The second study reviews also researched experiences of nurses in working using team-based models of nursing care delivery (Jane Cioffi, 2009). The findings suggested that the team nursing delivery model increased team effectiveness and team approach. It increased the availability of engagement, support, and sense of responsibility within the team comprising of nurses from multiple disciplines, that also indicated that nurse involvement indecision making phases provided a sense of empowerment to the nurses.
The functional model that was applied in the emergency department observed involved the charge nurse or nurse manager make decisions over a single shift. The assignments are task-based where instead of being assigned to patients, the nurses are assigned to staff. A hierarchical communication takes place where completion is reported to the charge nurse, who collects entire patient information together and communicates to the other team members based upon it. The managers oversee the operations ensuring that all tasks are appropriately performed.
The total patient nurse care delivery model can perform better in situations such as this. The decision-making process is the same in a single shift. A nurse is assigned to one patient to look after. Assignments are divided according to the individual patients, as the RN provides guides to necessary care activities. The communication is direct, but the charge nurse communicates with other members of healthcare team while the RN may communicate with physicians. The nurse has a more significant say in care decisions, and managers are resource providers.
In conclusion, during my observation and review of different nursing models, I learned how different environments could have different health care needs, and therefore an appropriate care delivery model should be selected based on its scope of practice and facility’s management systems. A proper model ensures safety, continuity of care, quality compliance as well as nurse satisfaction.
Anke Persoon, L. J.-W. (2008). Daily observation of cognitive functioning in hospitalized patients on acute geriatric wards. Journal of Clinical Nursing, 18, 1930-1936. doi: 10.1111/j.1365-2702.2009.02811.x
Greg Fairbrother, A. J. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220. Retrieved from https://www.researchgate.net/profile/Greg_Fairbrother/publication/47447532_Changing_model_of_nursing_care_from_individual_patient_allocation_to_team_nursing_in_the_acute_inpatient_environment/links/55187f6e0cf2f7d80a3df99a.pdf
Jane Cioffi, L. F. (2009). Team nursing in acute care settings: Nurses’ experiences. Contemporary Nurse, 33(1), 2-12. Retrieved from https://www.researchgate.net/profile/Jane_Cioffi/publication/26775315_Team_nursing_in_acute_care_settings_Nurses%27_experiences/links/0fcfd503733ba521f5000000/Team-nursing-in-acute-care-settings-Nurses-experiences.pdf
Majd Mrayyan, I. K. (2008). Investigating and profiling the leadership behaviors of Jordanian nursing leaders. British Journal of Nursing, 242-247. Retrieved from https://www.researchgate.net/profile/Majd_Mrayyan/publication/5293700_Investigating_and_profiling_the_leadership_behaviors_of_Jordanian_nursing_leaders/links/0046352fb135706dbe000000/Investigating-and-profiling-the-leadership-behaviors-of-Jordanian-nursing