Nursing Care Delivery Model Research Articles

Implementing a Care-Based Nursing Workforce Model: Implications for Missed Care, Teamwork, and Satisfaction.

Nursing care delivery models may serve as a significant factor contributing to nurse satisfaction, frequency of missed care, and patient outcomes. The nursing leadership team at our institution sought to determine if an adaptation of our primary registered nurse (RN) nursing model would enhance satisfaction of bedside nurses and care of patients. An improvement study introducing a care-based delivery model was implemented between January 2023 and January 2024 on a medical-surgical neurology/spinal unit at our organization. Adoption of a care-based nursing model was supported with the delivery of brief education sessions utilizing in situ simulations for development of competencies in teamwork and delegation. During the pilot period, overall satisfaction with job role improved 23%. Six missed nursing care elements and 7 teamwork elements significantly improved. A care-based nursing model may improve staff satisfaction and quality of nursing care.

Hospital Nurses’ Job Stressors and Social Support Behaviors During the COVID-19 Era: An Online Cross-Sectional Predictive Study

The COVID-19 pandemic changed our lives and psychological health; thus, job stressors are escalating, and they warrant immediate interventions, especially providing social supportive behaviors. This study investigated predictors of job stressors and social supportive behaviors in various Jordanian hospitals during the COVID-19 era. Data were collected utilizing a descriptive cross-sectional study and a convenience snowball sample of 392 nurses from different hospitals in Jordan using an online survey in 2022. This study was consistent with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Nurses’ job stressors occur “occasionally,” and social support behaviors occur “once or twice a month.” The highest and lowest nurses’ job stressors and social support behaviors were ranked were reported. The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance. The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, nursing care delivery model, and marital status; these variables explained 20% of social support behaviors variance. There are many novel findings in the current study, as time commitment is a significant correlate of social support behaviors and marital status is a predictor of social support behaviors. Assessing and managing nurses’ job stressors, including controlling nurses’ workload, are urgently mandated. A staffing policy is needed to promote safe practices and positive patient, nurse, and organizational outcomes.

Using Brainstorming and Affinity Diagramming for Recommending a Care-Based Nursing Workforce Model.

Nursing care delivery models influence nursing workload. Poorly designed nursing workforce models may lead to lack of satisfaction in practice, inability to recruit staff, and nursing turnover. This paper describes a process that our team undertook to evaluate one nursing unit's nursing care delivery model and provides a recommendation for a nursing workforce model that ensures practice to top of scope while maintaining a balanced workload. Team brainstorming and affinity diagramming tools were used. The team findings resulted in a recommendation for an innovative care-based nursing model pilot. The use of brainstorming and affinity diagramming is an effective method for identifying opportunities to improve a nursing workforce model.

The effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes: A systematic review with narrative synthesis.

To synthesize and assess the effectiveness of different care delivery models in a hospital setting, taking into account patient- and nurse-related outcomes. A systematic review with narrative synthesis in which a comparison was made between different care delivery models. The search string consisted of four clusters: 'nursing', 'care delivery models', 'hospital setting' and 'quantitative research designs'. Four electronic databases were searched from the inception of the databases to January 2023: Medline, Embase, CINAHL and Web of Science. In total, 19 studies were included in the systematic review. The most commonly compared care delivery models were functional nursing to primary nursing (n = 6), patient allocation to team nursing (n = 4), team nursing to primary nursing (n = 3) and functional nursing to modular nursing (n = 3). Only one randomized crossover trial was found, other included studies were pretest-posttest designs or quasi-experimental designs. The implementation of a nursing care delivery model was the study intervention. The following aspects of the intervention were not reported or inadequately described by the majority of the authors; tailoring of an intervention, modifications to an intervention and the adherence or fidelity to the intervention. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. Due to a high heterogeneity in outcome measures between the studies, a meta-analysis of the included studies was not possible. All included studies had a high risk of overall bias. This systematic review found mixed evidence, inconsistent reporting of certain elements of the interventions, high heterogeneity in outcome measures and low methodological quality. Although this systematic review could not answer which nursing care delivery model is the most effective or most promising, other important findings from this review may inform future research. There are differences in care delivery model descriptions and a lack of agreement on the strengths and weaknesses of the care delivery models. No clear-cut answer can be given about the effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. This review can support the development of future care delivery redesign strategies. The systematic review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). No patient or public contribution.

How much do we know about nursing care delivery models in a hospital setting? A mapping review.

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta-level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research.

Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models.

Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings. A mechanism to continuously monitor the impact of this staffing change was not available. Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics. The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators. The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Registered Nurses and Practical Nurses Working Together: An Institutional Ethnography

In Canada, different categories of nursing professionals, including registered nurses and practical nurses, often “collaborate” to provide care to patients. How their collaboration is currently conceptualized in the literature varies; and these conceptualizations are not always contextualized by the complex sociopolitical environment in which nursing professionals work. The purpose of this study was to explicate how different categories of nursing professionals (registered nurses and practical nurses) worked together to provide patient care after a provincial health authority implemented a new nursing care delivery model to “optimize” patient care. The authors used Smith’s institutional ethnography to guide the study, and data collection methods included observing, conducting interviews, and identifying the texts activated through the nursing professionals’ work. Data analysis focused on the social organization of the nursing professionals collaboration, while keeping the complex contexts within they completed their daily work in view. The article concludes with recommendations for future research.

Application of telenursing as a nursing care delivery model in improving treatment adherence and glycemic control: A scoping review

Background: Diabetes mellitus is one of the chronic diseases that cause the highest mortality and high medical costs;, therefore medication adherence and glycemic control are important in disease management, one of which is through telenursing. Purpose: To determine the telenursing model to improve medication adherence and glycemic control in patients with type 2 diabetes mellitus. Methods: This study was designed a scoping review. The databases used are CINAHL, PubMed, ScienceDirect and Google Scholar. Articles published from 2016-2022 with appropriate inclusion and exclusion criteria. Thematic analysis was used based on study design, telenursing communication model, telenursing process, duration of telenursing and results. Results: There were 12 relevant articles out of 2112 articles. We found a telephone call follow up is the most common method used for delivery of telenursing intervention. Telenursing intervention is implemented from at least 3 months until 12 months, and includes the assessment of current disease conditions, assessment of adherence to the prescribed treatment plan, treatment plan information, and solutions or follow-up to current issue. Conclusion: Telenursing can be used as a nursing care delivery model in the diabetes mellitus type 2 patients because it is proven to reduce glycemic control, improve treatment adherence, reduce body mass index (BMI), glycosylated hemoglobin (HbA1c), and cholesterol, and improve diet adherence, physical exercise and self-management.

Clinical Effectiveness of Nursing Care Delivery Models for Patients Following Hip Elective Surgery: Comparative Study

Clinical Effectiveness of Nursing Care Delivery Models for Patients Following Hip Elective Surgery: Comparative Study

The influence of nursing leaders' behavior on nurses' job satisfaction: A quantitative study in Hail, Saudi Arabia

This cross-sectional quantitative study investigates the intricate relationships between the demographic characteristics of nurses and their perceptions of leader behavior and job satisfaction within the healthcare context of Hail, Saudi Arabia. The primary aim is to establish the pertinence of nursing leaders' behaviors in shaping the perceptions and job satisfaction levels of nursing professionals. A sample of 716 nurses was selected using a simple random sampling method, with participants completing questionnaires administered through online software. Two validated instruments were employed: the 19-item Leadership Behavior Description Questionnaire (LBDQ), exhibiting excellent reliability (Cronbach's alpha of 0.955), and the 20-item Minnesota Satisfaction Questionnaire (MSQ), also demonstrating excellent reliability (Cronbach's alpha of 0.968). Results indicate a moderate level of job satisfaction with a significant association observed with respect to age. However, nurses' perceptions of nursing leaders' behaviors did not exhibit significant variations concerning age, education, or experience. Similarly, no substantial correlations were found between job satisfaction, experience, and education. These findings align with previous studies, emphasizing that job satisfaction is primarily contingent on a supportive work environment rather than organizational structure or nursing care delivery models. Consequently, the behavior of leaders towards their staff emerges as a crucial determinant of staff satisfaction, offering a substantial solution for staff retention and fostering a positive work culture. Such improvements can enhance staff competence, skills, and overall quality, ultimately ensuring the provision of safe patient care.

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study.

Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models.

The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].

Response to the Commentary: A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models: The Relationship-Centered Team-Based Nursing Model: The Hidden Solution to Nursing Home Transformation.

Response to the Commentary: A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models: The Relationship-Centered Team-Based Nursing Model: The Hidden Solution to Nursing Home Transformation.

Care Perceptions in two ICU Nursing Care Delivery Models: A qualitative-comparative approach

Objective. Analyzed in compared perspective perceptions about nursing care, nurse-patient interaction, and nursing care outcomes in two ICU nursing staff in a high-complexity hospital institution, whose Nursing are Delivery Models (NCDM) are differentiated by the proportion of nurses and nurse assistants (NA) per team and by the assigned tasks and responsibilities.
 Methods. Particularist ethnography with adaptation to virtual methodologies. It included the sociodemographic characteristics of 19 nurses and 23 NA, 14 semi-structured interviews, review of patients’ clinical records, and a focus group. Coding, categorization, inductive analysis, validation of results with participants were conducted and thematic saturation was achieved.
 Results. Four themes were identified: i) Professionalized care: a nursing of superior value; ii) senses and feelings of care; iii) nursing workload, generating factors and impacts; and iv) nursing missed care as concrete expression of the nursing workload.
 Conclusion. Compared nursing teams perceived nursing care in different ways, since it was experienced based on the assigned responsibilities and the possibilities of interaction with patients. Nursing care in the NCDM of the ICU with prevalence of direct bedside care by nurses with support from NA, it was perceived as holistic, comprehensive, and empathetic; whereas in the ICU with prevalence of delegated care to NA, it was related with administrative leadership and management of the ICU. Regarding the results, the NCDM of the ICU of direct bedside care by nurses showed better performance in patient safety and was closer to the skill level and legal responsibility of the nursing staff.

Care Perceptions in two ICU Nursing Care Delivery Models: A qualitative-comparative approach.

Analyzed in compared perspective perceptions about nursing care, nurse-patient interaction, and nursing care outcomes in two ICU nursing staff in a high-complexity hospital institution, whose Nursing are Delivery Models (NCDM) are differentiated by the proportion of nurses and nurse assistants (NA) per team and by the assigned tasks and responsibilities. Particularist ethnography with adaptation to virtual methodologies. It included the sociodemographic characteristics of 19 nurses and 23 NA, 14 semi-structured interviews, review of patients' clinical records, and a focus group. Coding, categorization, inductive analysis, validation of results with participants were conducted and thematic saturation was achieved. Four themes were identified: i) Professionalized care: a nursing of superior value; ii) senses and feelings of care; iii) nursing workload, generating factors and impacts; and iv) nursing missed care as concrete expression of the nursing workload. Compared nursing teams perceived nursing care in different ways, since it was experienced based on the assigned responsibilities and the possibilities of interaction with patients. Nursing care in the NCDM of the ICU with prevalence of direct bedside care by nurses with support from NA, it was perceived as holistic, comprehensive, and empathetic; whereas in the ICU with prevalence of delegated care to NA, it was related with administrative leadership and management of the ICU. Regarding the results, the NCDM of the ICU of direct bedside care by nurses showed better performance in patient safety and was closer to the skill level and legal responsibility of the nursing staff.

Experiences and perceptions of final-year nursing students of using a chatbot in a simulated emergency situation: A qualitative study.

The aim of this study is to explore the experiences and perceptions of final-year nursing students on the acceptability and feasibility of using a chatbot for clinical decision-making and patient safety. The effective and inclusive use of new technologies such as conversational agents or chatbots could support nurses in increasing evidence-based care and decreasing low-quality services. A descriptive qualitative study was used through focus group interviews. The data analysis was conducted using a thematic analysis. This study included 114 participants. After our data analysis, two main themes emerged: (i) experiences in the use of a chatbot service for clinical decision-making and and (ii) integrating conversational agents into the organizational safety culture. The findings of our study provide preliminary support for the acceptability and feasibility of adopting SafeBot, a chatbot for clinical decision-making and patient safety. Our results revealed substantial recommendations for refining navigation, layout and content, as well as useful insights to support its acceptance in real nursing practice. Leaders and managers may well see artificial intelligence-based conversational agents like SafeBot as a potential solution in modern nursing practice for effective problem-solving resolution, innovative staffing and nursing care delivery models at the bedside and criteria for measuring and ensure quality and patient safety.

Shifting Nursing Care Models as a Solution for the Increasing Demand on Intensive Care Unit Beds During a Pandemic: A Case Study.

An option appraisal of different nursing care delivery models was presented, which were made in between the first and second COVID-19 waves. The authors wanted to inform colleagues on involving nursing care delivery models in the problem-solving process during a pandemic. In the pre-COVID-19 hospital practice, the nursing care delivery model of primary nursing was applied in the intensive care unit (ICU). However, during the COVID-19 pandemic, this situation could not be upheld because of the increased need for ICU beds and the shortages of available ICU nurses. This study used the literature of an ongoing systematic review on nursing care delivery models and expert meetings between the authors and nursing staff. One standard nursing care delivery model and 3 alternative nursing care delivery models were discussed and compared in this case study. Theoretically, a modular system of team nursing seemed the better model to use during a pandemic. This model leads to an equal distribution of expertise and social distancing between experts. Compared with the other models, a strategic reserve can be created. This case study should be primarily considered as an example on how rethinking and reorganizing the nursing care delivery model could contribute to an enlarged, qualitative capacity, which needs to be organized in a short time span.

Nurse Leaders’ Influence: Implementing a New Model of Care Involving Geographic Clustering of Patient Care Assignments

The purpose of this article is to describe the nurse leader’s role in implementing a new evidence-based nursing care delivery model utilizing geographic clustering of patient care assignments to improve patient safety and patient experience. Nurse leaders on 2 inpatient units from an academic medical center supported and encouraged staff to develop and initiate similar care models; one unit focused on fall reduction, the other focused on improving patient experience. The transformational nurse leaders empowered key stake holders to implement a new and creative care model that resulted in favorable outcomes for both patients and staff, while fostering accountability for the practice change.

Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives.

IntroductionThere are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes.ObjectiveThe aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders.MethodsA qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes.ResultsThe first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses’ scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety.ConclusionNursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.

The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses.

BackgroundInappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses’ health, but also the health of their patients.PurposeTo examine the relationship between nursing care delivery models, nurses’ emotional exhaustion, and quality of nursing care.MethodsA cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care.ResultsParticipants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = −.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = −8.98, P = .011).ConclusionsQuality of nursing care was associated with nurses’ emotional exhaustion rather than models of nursing care delivery. As nurses’ emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.