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NURSING MODELS.
Term Paper ID:29615
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Evaluation of current models in use.... More...
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Paper Abstract:
Evaluation of current models in use. The ways nurses care for patients geared to needs of institutions in which they work. Teamwork basis of most models. Components of teamwork. Theories of nursing based on caring. Johns Hopkins model combining academic programs with practice. Milton S. Hershey Medical Center & Lehigh Valley Hospital models.
Paper Introduction:
Introduction
Nursing models define the way nurses care for patients, and as such, need to be tailored to the needs and limitations of the institution in which they are practiced. Most models are based on some form of team work, whether it be just physician-nurse team work or a team consisting of several different members of the staff, such as physicians, case managers, pharmacists, RNs, LVNs, unlicensed support staff, and clerical staff. They may involve a cooperation between different institutions, as in the Johns Hopkins model discussed below, or be confined to a particular area of a hospital, as in the perioperative model. At the core of any nursing model is quality patient care and how best to achieve it. This paper will look at some nursing models currently in practice and evaluate their parameters and
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The nursing practice model develops from the team members' input,which sets the norms, shared beliefs, embraces practice values, andestablishes communications pathways within the team (Anthony, Casey, Chauand Brennan, 2 ). A group of nursing care workers are only ateam insofar as they have congruent views about their NPM. Partners in care: A model of collaboration. K., Casey, D., Chau, T., & Brennan, P. There was mixed agreement about leadership: presence andadministrative competence were agreed on, but UAPs and not RNs believed theunit manager had greater clinical expertise. RNs and UAPs agreed onreasons to work on a particular unit (openings, preferred shift,relationship with physician, patient population), but UAPs generallybelieved that unit manager's and unit's reputations were main reasons. Collaboration between team members is crucial to theeffective working of a team. Theintegration of structural exposure and meanings defines a common workingapproach among the team's members, which makes the team more effective inachieving its goals. It also offers nurses a newcareer avenue to pursue, and promotes cooperation between physicians andnurses. A team must be cohesive, and individual goalssacrificed for the common goal. Incongruity among members maydetract from the team's ability to work to its highest potential.Differences in attitudes and behavior among team members are disruptive andcounterproductive. It began withdistribution of the hospital's Statement of Values to all employees withinthe division: patient's first; quality and excellence; commitment toteaching; importance of every member of the team; information for qualitycare; change; cost-effective; and responsibility to the State.To clarify the issue of role confusion, the tasks that could be performedonly by an RN by virtue of her professional licensure were defined. C., Tringali, R. When professional practice environments canbe established, nurses can evolve to their full potential and become a highperforming team. Each team is assigned a patient caseload basedon service specialty. Enhancing a professional environment in the organized delivery system: Lessons in building trust for the nurse administrator. The successful team members had a clear understanding of their jobdescriptions, they communicated and negotiated better with colleagues, andthey felt better about the organizations they worked in. (2 1). The nurses who worked in these teams which functioned at a highlevel were also less likely to leave their jobs than those in poorlyfunctioning teams. Different nursing models are appropriate in different circumstances,and before deciding which one is the best for a particular situation, thoseinvolved should look at other models now in practice to see which bestsuits their particular situation. J. ReferencesAnonymous. In 1993, Dr.M. The more complex and diverse the work of the teambecomes, the harder it may be to retain this congruence. Holistic Nursing, 18, 114-125. The efficiency of a team depends on the congruence of theteam members providing nursing care. This provides low-cost care to the patient, providers, and payers, and improves the functionand quality of life for older patients with CHF. This paper will lookat some nursing models currently in practice and evaluate their parametersand functions, and how they are implemented in particular settings.Nursing Models in a Professional Environment Nurses are the predominant group of caregivers, and their standard ofcare affects the outcome for their patients (Newhouse and Mills, 2 2).The Transformational Model for Professional Practice (TMPP)in Health CareOrganizations states that "organizational providers of care must achieve ahigher level of practice to meet tomorrow's challenges for providingquality care." This means nurse administrators need to create a process inthe work arena where nurses can practice at a highly professional level.Findings of a study by Newhouse and Mills (2 2) suggest that there is asignificant relationship between collaboration, professionalism, andleadership in the TMPP. The focus of the new institute was on innovativecontinuing education for nurses and leadership programs focusing on newroles for professional nurses in the changing medical marketplace. Afterdischarge, the patient's symptoms are monitored by the nurse case managerby telephone and personal visits to the home of the patient. Team nursing has been found to provide better and safer care forpatients (Anonymous, 2 2). P., & Mills, M. Whereclear leaders were present, the overall functioning of the teams was farsuperior and patient care improved. The team members must commit to their involvement andresponsibility in achieving that goal for the team to work effectively inreaching the goal. The idea was to effectively prepare nurses for practice,keep them in practice by offering the latest in knowledge and skills, andprovide practice opportunities for faculty of the nursing school. (2 2). Daily work teams were established, with each team consisting of anRN, a surgical technician and an operating room assistant (ORA) (Horstman,Helmick and Sions, 1994). The timing was right for the new institute. Team members need to have a high degree ofinterdependence and mutual accountability, and must all aim for achievingthe same goal. A thorough examination of current models in use may uncoverdeficits in these models, which can be overcome in a new model. K., & Fralic, M. Through this structure, staff nurse aregiven the authority to create standards, control care, and manage systemsthat control care. Fralic arrived at JHH as vice president of nursing, and in 1994, SueK. Congruence between registered nurses' and unlicensed assistive personnel perception of nursing practice. NPMs evolve over time, and there may be differences ofopinion among team members regarding the NPM. The study also found that there needs to be development of a betterrelationship between nurses and physicians (Newhouse and Mills, 2 2).Nurse leaders must work developing collaborative partnerships withphysicians and breaking down barriers, focusing on the welfare of thepatient as the primary goal. A nurse's job iscaring for the patient, to the fullest extent of the word. Whatever theory a nursing model isbased on, it should have care of the patient at its core. Swanson also sees nursing as a caring process, and defined fiveprocesses in the caring relationship: maintaining a belief in others tomake it through difficulties and face a meaningful future; knowing howhumans react to specific health situations and understanding the meaning oflife events to others; being with the patient emotionally; doing forpatients what they would do for themselves; and enabling patients topractice self-care (Saewyc, 2 ). They are exposed to the same organizational objectivesand share common norms and goals, strengthened by ongoing socialinteraction. No doubt if this study proves successful, the model willbe applied to other chronic disease problems as the elderly populationcontinues to climb in the United States. The combination of an aging population and higher survival rates forpatients with coronary artery disease, has made caring for those with CHF amajor medical problem. Holistic Nursing Practice, 13, 61-65.Saewyc, E. Donaldson became dean of JHUSON, and the formation of the IJHN began.It was recognized that merging the talents of nurses and faculty would bevery beneficial for JHH. The situation at Johns Hopkins is an example of a unique nursingmodel designed to meet the challenges of nursing in the changing market ofmanaged care and nursing shortages (Donaldson and Fralic, 2 ). The Johns Hopkins nursing model of bridging an academic nursingprogram with nursing practice at a hospital is an excellent model in thatit allows practicing nurses, and so their patients, to benefit from thelatest advances in medicine, and at the same time, affords opportunitiesfor career advancement for nurses, and practical experience for nurseeducators. Newhouse and Mills (2 2) found that"leadership in professional practice is positively related to establishinga system culture, strategic planning, and resource allocation from theperspective of the nurse administrator." A system culture supportinginterpersonal relationships and providing employee support, along withequitable resource allocation, will enhance professional practice. F. Changes innursing over the years have resulted in nursing teams becoming morecomplex, and they now involve managing patient outcomes as well asproviding patient care. At the core of any nursing modelis quality patient care and how best to achieve it. The Professional Practice Model delineatesfive steps which are necessary for nursing leaders to promote professionaldevelopment in nursing: the support and mentoring of professional growthfocused on commitment to the division beyond the work unit; setting ofexpectations for flexible and innovative use of resources; allowing staffto challenge the status quo and multidisciplinary team cooperation must beencouraged; key values must be adapted as guiding principles; and finally,research findings must be incorporated into practice changes. The model of partners-in-practice seems ideally suited tothis situation. The partnership was established to fillthe gap between nursing service and nursing education which exists for mostnursing schools. To counter thisdivisive trend, the Institute for Johns Hopkins Nursing (IJHN) was created,and provides a direct link between the academic faculty at JHUSON and thenurses of the JHDON. Mostmodels have undergone modifications since first conceived, and anyonedesigning a new model can learn from what has and has not worked in othermodels. The RN prioritizes the work flow in the room based onongoing patient assessments and decides the best time for ORAs to takebreaks and complete other departmental activities. This has reduced RNstaffing requirements in high acuity situations. They found thatonly one third of primary health care teams, and only 1 percent ofcommunity mental health nursing teams had a clearly defined leader. Other than nurses who shared appointments atJHUSON and the Johns Hopkins Hospital (JHH), there was no opportunity forfaculty to practice nursing except as it related to teaching. The nursecase manager keeps in close contact with the physicians, and helps thepatient to manage the disease in the outpatient setting. Maintainingcongruence in such situations is the concern of nurse supervisors. A., Boehmer, J., Blaha, C. It was found that team members buffer each other fromthe negative effects of conflicts within the organization in NationalHealth Hospitals. (1994). For teams to work efficientlyand effectively, everyone on the team must share common goals and commonideas of how to accomplish those goals. West Virginia University Hospital, in Morgantown, West Virginia,Surgical Services Division, has created a patient care delivery system thatintegrates the institutional Total Quality Management (TQM) values ofContinuous Improvement Process (CIP), Shared Governance and StaffEmpowerment (Horstman, Helmick and Sions, 1994). They agreed on when nursesand assistive personnel talk, but not about what is discussed: RNs believedUAPs communicated to ask for assistance, UAPs said they communicated onpatient observations. F. Nursing Administration, 25, 95-1 1.Horstman, P., Helmick, L., & Sions, J. Theright to manage quality was given to the direct care givers - the clinicalstaff, with managers as facilitators. Management staff foster professional nurse development, and nurseeducators serve as facilitators to the Professional Practice Council.Ongoing monitoring and evaluation processes are factored into the wholeprogram. Theymay involve a cooperation between different institutions, as in the JohnsHopkins model discussed below, or be confined to a particular area of ahospital, as in the perioperative model. Nursing Administration Quarterly, 26, 67-75.Pugh, L. F. Teammembers must be shown a consistency of team goals and actions towards thosegoals. This showed that for team nursing tofunction ideally, a clear leader must be established who can hold the teamtogether and coordinate its efforts effectively. (2 ). Asystem integration nursing model is needed to promote continuity of careacross the organization through system and network formation. Communication between team members is integral to ateam's performing effectively, and incongruities in how team members seereasons for communication may lead to problems. Watson's metaphysical theory of nursing care is also based on caringas central to nursing, and sets out factors which need to be incorporatedinto models of nursing care: formation of a humanistic/altruistic system ofvalues; instillation of faith/hope in patients; cultivation of sensitivityto self and others; development of a helping-trusting relationship withpatients; acceptance of positive and negative feelings; using scientificproblem-solving methods for decision making; promoting interpersonalteaching/learning; providing a supportive, protective and/or correctivemental, physical, sociocultural and spiritual environment; assisting withthe gratifying of human needs; and allowing forexistential/phenomenological factors (Saewyc, 2 ). (2 ). CHF affects approximately three million Americans, and the cost ofproviding inpatient and outpatient care is approximately $8 billion eachyear. The teams now usually include RNs and unlicensedassistive personnel (UAPs) whose various roles are guided by the structuraland contextural factors present on the nursing unit. The idea is in response to the pressure to control medical costs byfinding new ways for managing health and medical care. At this time, declining nursing school applications and large numbersof unemployed nurses due to hospital cutbacks and closures wereanticipated, motivating the need for non-degree nursing education and astrong leadership image to attract nursing students to JHUSON (Donaldsonand Fralic, 2 ). Nursing Mgmt., 25, 8 A.Newhouse, R. A structural perioperative nursing model was sought to facilitate thepursuit of quality for all members of the Surgical Services Division. The study involvesolder patients with congestive heart failure (CHF), and the partners-in-care intervention comes into play soon after admission to hospital. (1999). Though the example cited here relates to CHF,the model can be applied to any disease in which the patient needsmonitoring after leaving the hospital, and is particularly useful forfollowing elderly patients who are not as capable of managing their medicalproblems after hospital discharge. Anthony, Casey, Chau and Brennan (2 ) used a survey to look atindividual attributes of NPMs different nursing units. Thenurse case manager follows the patient while they are in hospital, focusingon discharge planning and disease management education such as symptomcontrol, diet, activity program, daily weighing, and medication use. These factors areusually referred to as the nursing practice model (NPM). It alsoprovided a revenue-generating partnership which would also generate nursesprepared for leadership roles at JHH. (2 ). Next, theremay be increased tensions as team members try to find their individualroles in the team, conflicts are resolved, and the team falls into place.In the third stage, the team identifies its responsibilities and thepositions of various members within the team, identifies specific teamgoals, establishes functional behavior patterns, and the team developscohesiveness. Teamnursing seems to be one of the most popular and successful models whenapplied properly and managed by knowledgeable nurse supervisors/managers.The team model integrates the activities of different medical personnelinvolved in a patient's care and coordinates them so that the patient isafforded the best care possible. Forging today's practice- academic link: A new era for nursing leadership. They disagreed onthe philosophy of care, accountability for care, and the learningenvironment. Cohesive teams understand their environment, the roles ofindividual members, team activities, relationships among the team members,and team goals. It is a study of a nurse-directed management strategy utilizing nurse case managers in collaborationwith cardiologists and primary care physicians, known as a partners-in-caremodel. In the first stage,a relationship is established for collaboration and communication, duringwhich team members clarify their roles and expectations, identify commonbonds, and try to establish themselves as a functional unit. In the fourth and final stage of development, the team isready to function as a true "team" and individuals must now carry out theirassigned tasks and relate appropriately to the other members of the team.The group moves forward toward its goals, maintaining effective workingrelationships, and is now functioning as a team, with every member clearlyunderstanding their role, relationships within the team, activities of theteam, and its environment. Theproblem with this is that it removes nurses from the practice setting andinto academia, where the emphasis is on scholarly pursuits and research.While the trends in modern medicine make these pursuits desirable, theyremove nurses from the practical side of the profession. RNs and UAPsresponded to a survey which questioned them on 1 factors associated withnursing practice models. C. The results of the studyby Anthony, Casey, Chau and Brennan (2 2) point to some importantdifferences in the views of RNs and UAPs which need to be recognized andaddressed to keep team's running smoothly and effectively, and for the goodof the patients. The responsibility for quality assessment and improvement is onthe nurse managers, and this is passed on to the nursing staff via the TQMstructure. No model is perfect, and examining several models before embarkingon any one, or a new one, is the only responsible approach to selecting anursing model, which will provide the best patient care in any particularcircumstances. JHUSON was established in 1984 to provide a program for a bachelor ofnursing degree (Donaldson and Fralic, 2 ). The partners-in-practice model is aspecific form of team nursing in which nurses are partnered with specificphysicians to provide both inpatient and out patient care to patients witha specific health problem. et al. Team nursing is not a new concept, having originated in the 195 swhen nurses and other staff members worked together, dividing up the tasksof patient care (Anthony, Casey, Chau and Brennan, 2 ). The ORA's daily work assignments are supervised bythe RN circulator. Nursing Economics, 18, 285-293.Donaldson, S. Until 1993, it focusedprimarily on providing this degree program to nurses, and had no facultypractice plan in place. One suchunique offering is provided by the Case Management Academy established atthe institute to address the specific needs of a new and rising field ofnursing. Most nursing care is delivered by individual nurse-patientencounters, but teams are the structure and context within which membersfunction and through which patient care is delivered (Anthony, Casey, Chauand Brennan, 2 ). The one problemencountered by the investigators was a lack of clear team leadership inmany cases, which resulted in poorer patient care, less innovativetreatments, and higher levels of stress in team members. AustralianNursing J., 9, 19.Anthony, M. Team work means coordinating the efforts of several individuals whoplace the team's goals above their own individual goals (Anthony, Casey,Chau and Brennan, 2 ). Hospital stays have been dramatically reduced, butmany older patients have difficulty following complicated medicationregimens at home, resulting in frequent readmissions, reduced quality oflife, and reduced physical abilities. A specific nursing model has been instituted by the Milton S. Although the decline in nursing numbers has continued nationwide,enrollment at JHUSON has not declined (Donaldson and Fralic, 2 ). This is particularly important today with such aculturally diverse patient base as is seen in most hospitals. Team development takes time and develops in four distinct stages,according to Anthony, Casey, Chau and Brennan (2 ). Perioperative nursing model redesign. Most practice models include RNs, LPNs and UAPsworking as teams, who usually have similar beliefs about the structure andcontext of the NPM. M. A three-year study of 4 nurses working inprimary health care, community mental health, and secondary care, workingin teams, were less stressed than nurses who worked individually, and theyused more innovative patient care, resulting in lower hospital mortalityrates. Over the past forty years, nursing scholars have developed severaltheories of nursing based on caring as being at the very essence of nursing(Saewyc, 2 ). E. Nursing theories of caring: A paradigm for adolescent nursing practice. It may be that different factors fromdifferent models can be combined to develop a new model for a specificsituation. All team members working within an organization are exposedto the same structural characteristics and processes of the organization,and social interactions among team members leads to shared meanings. Department-based governance councils are comprised ofstaff nurses from all departments within the division of surgical services. Teamwork is good for your health care. Itinvolves a unique relationship between Johns Hopkins Department of Nursing(JHDON) and the Johns Hopkins University School of Nursing (JHUSON), whichare separate corporate entities. Introduction Nursing models define the way nurses care for patients, and as such,need to be tailored to the needs and limitations of the institution inwhich they are practiced. Theybelieve that nurses, in practice or education, are attracted to JHUSONbecause it offers such a unique combination of scholarship and practiceopportunities, and has the prestige of the Johns Hopkins name. The program makes quality a part of the everyday workexperience, and patient care a top priority. This model has beenrefined continually and has evolved to mean participating fully in thenursing experience through communication and release of human feelings. A. Members of the nursing team were found todisagree on several structural and contextual aspects of nursing practice.RNs and UAPs agreed on continuity of care, the extent that physicians valuenurses, how inconsistent information to patients is resolved, reasons staffwork extra shifts, and deployment of temporary staff. Professional activities weredesigned to enrich patient care and to provide enhanced careeropportunities for nurses to combat the declining numbers of graduates andthe numbers of nurses leaving the profession at the time. HersheyMedical Center in Hershey, Pennsylvania and Lehigh Valley Hospital inAllentown, Pennsylvania (Pugh et al, 1999). In recent years, the education of nurses has moved from the practicesetting to the college and university setting for the purpose ofestablishing nursing as a profession (Donaldson and Fralic, 2 ). Strong leadership skills are necessary inorganized delivery systems. Saewyc cites Leininger's culture care theory that "care isthe essence of nursing" which promotes culturally congruent care, i.e.making a holistic appraisal of patients within their environment andculture, developing and understanding and meaningful care patterns withintheir environment and culture, and enhancing healing by using culturallycongruent care. This shared responsibility andaccountability shifted shared governance focus of quality from adepartmental to a divisional one. This study provides important knowledge for nurse supervisors(Anthony, Casey, Chau and Brennan, 2 ). UAPs more than RNs believed that nurses and otherstaff had greater input into budget decisions. Followup through telephone calls andhome visits can significantly reduce readmission rates and lengths ofhospital stays. How well individual teammembers share the team's perception of how nursing care is delivered and inwhat environment determines the congruence of the team, and each teammember's perception of the congruence within the NPM determines whether ornot they will achieve optimal patient care, and nurse and organizationaloutcomes. Most models are based on some form of team work,whether it be just physician-nurse team work or a team consisting ofseveral different members of the staff, such as physicians, case managers,pharmacists, RNs, LVNs, unlicensed support staff, and clerical staff. It offers a counterbalance to the drastic nursing shortagecurrently being experienced in the United States by attracting new nursingstudents, and offering an incentive for graduate nurses to stay in theprofession. Trust must be developed through professional practice andgroup cohesion established through system equity, interpersonalinteraction, and employee support. The institute offers a nursing model which links education withpractice, an essential link to quality patient care in any setting.Conclusion Many nursing models are in use throughout the profession today.
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