Abstract
This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.
Highlights
The evolution of the nursing care delivery methods can be understood by analyzing the state-of-the-art evolution of nursing theory
Four dominant methods are mentioned in the literature on the organization of nursing care delivery: functional nursing, individual, team nursing, and primary nursing [4]
It does not allow for personalized care, which dehumanizes them, leading to poor quality care and major flaws in patient safety when compared to other methods; it causes more complaining from patients, who are divided by tasks and, by different professionals, promoting unaccountability; it does not allow the delivery of comprehensive care; it damages the nurse-patient relationship because the patient is not familiar with “his/her” nurse and promotes patient insecurity [6]. It does not allow the application of the nursing process, leading to major difficulties in the identification of patient needs and poor records; it does not promote the continuity of care; it leads to some activities being “forgotten” due to lack of planning; the nurse does not have an overall view of “his/her” patient; it hinders the assessment of care; it increases the risk of healthcare-associated infections (HAIs); it hinders the interaction and the interpersonal relationships between health professionals; it creates poor team spirit and lack of motivation by “routinizing” tasks that are repeatedly performed by the same nurses (Taylorism)
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Organizational methods define how nurses organize and distribute work with the purpose of providing efficient care in an environment where safety issues are a major concern They should not be seen as an assignment of activities and as a way in which nurses choose and adopt a philosophy of care. According to Fowler and colleagues [2], work methods represent the structural and contextual dimensions of nursing practice, determining how nurses organize their work, communicate, interact with team members and other health professionals, and make clinical decisions In this way, care is delivered based on specific communication and coordination patterns. Res. Public Health 2021, 18, 2088 adopted for care organization should reflect the conceptual framework, the perspectives, and the theories which the manager will use to promote the delivery of safe and efficient nursing care. If the nursing team believes that each patient has the right to high-quality care, all nurses are expected to incorporate this vision into their practice, translated into a more demanding method in terms of quality and safety in care delivery and excellent professional performance
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