NR447 WEEK FIVE ASSIGNMENT
Nursing Care Models Worksheet
Student Name:
Identify the model of nursing care that you observed. Be specific about what
... [Show More] you observed, who was doing what, when, how and what led you to identify the particular model.
A patient arrives at the emergency room at 0900 on a Friday morning with complaints of abdominal pain and registers with the admitting clerk. The emergency medical technician (EMT) leads the patient to the examination room and assists the nurse during triage by taking the patient’s vital signs. The EMT makes the patient comfortable by adjusting the head of the bed and offering a warm blanket. The nurse interviews the patient by asking their complaint and medical, social, and surgical history. The nurse looks at the patient’s throat and listens to the heart, lung, and bowel sounds, then ask about pain location, intensity, and duration. The information is then relayed to the physician. The physician enters the room immediately and performs a physical assessment and an interview with the patient. Within minutes, new orders are given to the nurse, radiology technician (RT), and the EMT for desired diagnostic testing. The team communicates regarding patient allergies, history, and needed information for testing. The nurse identifies that the patient could be pregnant and reminds his coworkers that a urine pregnancy test is necessary for the radiology test, while the nurse is entering the patient’s information in the computer.
The EMT checks the patient identifiers and explains that he will start an IV and draw blood for labs. The nurse enters the room and checks the patient’s identifiers and gives the patient a GI cocktail. The RT communicates the need for the BUN and creatinine results for the cat scan with IV contrast. The EMT relays the desired results within ten minutes to the RT, and the patient is taken to radiology for a ct scan of the abdomen and brought back to her room. The nurse places the patient back on the monitor for continuous vital signs while awaiting diagnostic test results. The physician reviews the ct images once uploaded and looked for abnormalities while waiting on the radiologist at the main facility to review and dictate the results. Laboratory tests usually result within thirty minutes and are entered in the computer. The physician is also given printed hard copies for the chart. The ct results are available within thirty minutes of the exam, and the physician reviews the report and explains to the patient that her the ct test result displays gastritis, and all lab tests were within normal limits. The physician explains that he will give her a prescription and provide discharge instructions to the nurse for discharge. The nurse reviews the patient’s pain level and documents all vital signs while discharge instructions are pending. The nurse provides education on the prescription and has the patient sign discharge papers and allows the patient to ask any questions. The EMT enters the room to remove the IV and apply a pressure dressing with instructions to remove after five minutes. The patient is then escorted to the clerk for the signing of consents.
This interprofessional collaboration and the empowerment of the staff with identifying problems, performing roles, and taking the initiative to take action has led me to identify this model of care as the Service and Care Team Model (Finkelman, (2016). Every member of the staff knows their scope of practice and performs their duties. Information is passed between the patient and staff for continuity of care. Our freestanding emergency room is linked to our larger facility across town, but we do not have the privilege of having the services and additional departments such as social services here, but we perform independently within our facility.
Review and summarize one scholarly resource (not including your text) related to the nursing care model you observed in the practice setting.
According to Baik (2017):
Team-based care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care (p.315)
The article on team-based care states the model was not well-known but was developed due to the demands of patients, the advancement of disease processes, and the higher acuity levels. It has demonstrated the best patient outcomes with competent healthcare. The team-based model is characterized by interprofessional collaboration, a patient-centered attitude, and a holistic patient care approach (Baik, 2017). The team’s roles are understood and respected; so they can perform as a collaborative unit. The shared governance proves successful with effective communication and allows the team to work efficiently to accomplish the goal of exceptional patient care. The article helps bring understanding to the multidimensional aspect of a team-based model and clearly defines it in a structured setting that has proven cost-effective and advantageous for staff and patient satisfaction.
Review and summarize one scholarly resource (not including your text) related to a different nursing care model that you observed in the practice setting.
The article that I reviewed reflects on the different strategies that patients are cared for in a clinical setting. One nurse to one patient ratio used to be the thought, but through studies and nursing shortages, healthcare had to evolve to care for a multitude of patients. Functional nursing was a strategy where specific tasks were assigned to staff members. According to Kalisch & Schoville (2012), this model of nursing was known as the “assembly line” where the top nurse assigns tasks, takes and gives a report, organizes patient care, and assists the physician during rounding of patients (p.50-51). Functional nursing resulted in poor patient and staff relations with a lack of accountability, which left staff discouraged and failure of the nursing model. The teamwork model developed afterward and displayed positive and negative attributes toward the delivery of patient care. Which resulted in the studies and development of other care models to produce the desired outcomes to quality healthcare.
Discuss the different nursing care model from step #6 of the directions and how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.
The functional nursing model is almost like a charge nurse that delegates patients to staff, but instead, it is task-oriented such as wound care rounds, medication administration, and nursing assessments. For this model to be successful, the head nurse would have to possess excellent communication and leadership skills when delegating tasks with staff while organizing patient care. The charge nurse receives the report and delivers the information as needed to staff and delegates tasks such as medicine administration, wound care, assessment nurse, vital signs, and hygiene rounds. The head nurse does patient rounds with the physician, which can result in medication errors if changes are not communicated swiftly. This structured care setting could decrease falls and promote patient safety with continuous interaction due to daily needs and tasks from various staff throughout the day. Communication and safety huddles can eliminate medication errors, falls, and encourage satisfaction staff. Accountability for the assigned tasks should revert to that designated staff member. I feel that this model does not empower the team since they have minimal control over the patient-centered care and does not allow a relationship to develop between the nurse and the patient. The patient may be confused about who to report problems or concerns regarding care because of the many staff that is involved with their care. The charge nurse could focus on patients and reevaluate delegated tasks, identify any needs of the patient, and safety issues such as raised beds or floor hazards to ensure patient safety and satisfaction.
Summarize this assignment and what you learned about the two nursing care models discussed.
The nursing care models are different in that the professional roles are clearly defined in the team-based model versus the functional model where the tasks are delegated to staff where they work independently of the rest of the staff. The functional model requires more staff and less patient interaction with one person, whereas the team nursing model allows multitasking and the development of a rapport with the patient and family. The models share the same common goal of safe and efficient patient care, but studies have shown problem areas with both nursing models. The team-based nursing model would seem more productive with patient-centered care, and the functional nursing model can lead to disjointed care by staff and more errors due to inadequate staff communication. The staff feel more accomplished in the team model and engaged with the patient when providing the majority of their care. Patient satisfaction would increase due to the staff having more time to identify the patient’s need and one person initiating those tasks instead of one person performing vital signs and another person performing hygiene tasks, or medication administration. The functional model does not allow for staff collaboration or a trusting and intimate relationship with staff, which could impede healing and reduce patient safety and satisfaction.
References:
Baik, D. (2017). Team-based care: A concept analysis. Nursing Forum, 52(4), 313-322. doi:10.1111/nuf.12194
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.
Kalisch, B., & Schoville, R. (2012). It Takes a Team. AJN, American Journal Of Nursing, 112(10), 50-54. doi: 10.1097/01.naj.0000421024.08037.0d [Show Less]