Nursing Care Delivery Model Research Articles

Primary Nursing: A Call for Clarity, Empowerment, and Accountability.

Registered nurses' (RNs') unique educational preparation, skills, scope of practice, and relationship with those we serve must be articulated and honored. The Primary Nursing care delivery model gives practical, functional life to the relationship of professional trust between RNs and their patients.

Launching Care Partners in Medical-Surgical Nursing

In the wake of health care reform, a large health system developed a new model of medical-surgical nursing care delivery. To facilitate the subsequent culture change, a non-traditional educational approach was used to provide a dynamic experiential venue that included real-time feedback to facilitate nurses' behavioral transformation.

Development and Psychometric Testing of the Technological Competency as caring in Nursing Instrument

The mid-range theory, technological competency as caring in nursing, provides a novel understanding of the harmonious integration of technology and caring in nursing. The quantification of technological competency, reflected in shared expectations of nurses and patients, ultimately informs the best practices requisite in grounding nursing care delivery models in technology, caring, and quality nursing. Theory and practice experts were invited to examine the validity of the Technological Competency as Caring in Nursing Instrument. Item statements were revised or eliminated based on quantitative content validity indices and specific expert feedback. The revised instrument consists of 25 statements inclusive of the five assumptions of the theory. Future work will establish best practices grounded in the perspective of technological competency as in caring nursing.

Integrated Primary Nursing

Care delivery models are an integral component for delivering patient care. Although models may be abstract, nursing care delivery models need to be evolving and reality-based, as they serve to organize the allocation of nursing resources. How nursing resources are allocated is associated with patient and professional RN satisfaction, RN perceived autonomy, and quality outcomes. Care delivery models must be evolving within today's dynamic healthcare environment and must be structured within the context of a professional practice model. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, a blend of traditional primary nursing and the updated relationship-based care has been developed and actualized. This model, Integrated Primary Nursing, exists within the framework of the Hospital of the University of Pennsylvania Nursing Excellence in Professional Practice. The coalescence of the 2 has yielded a care delivery model for the 21-st century RN knowledge worker.

Nurse-Directed Care Model in a Psychiatric Hospital

The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

Non-Value-Added Time

The dual crises of high healthcare costs and the nursing shortage require a better understanding of inpatient nursing unit activities and, more specifically, their costs and the drivers of inefficiencies. This includes knowing not only how staff spend their time but also how much of this time is non-value-added (NVA) because wasted time leads to both high costs and nurse dissatisfaction. The authors discuss a study that determined the NVA time and costs of acute care nursing unit staff, identified drivers of high-cost NVA time, and compared activities and costs by type of nursing unit. These data have considerable implications for developing efficient and effective nursing care delivery models and for implementing process improvement and staff satisfaction initiatives.

The Autonomous-Collaborative Care Model: Meeting the Future Head On

As care needs continue to increase in complexity in inpatient settings, and nurses' scope of practice evolves to keep pace with these changing demands, it is imperative that nurse leaders ensure nursing care delivery models are well aligned to current realities. Older, traditional models of nursing service may no longer foster safe, effective and efficient care or contribute to job satisfaction and high-quality work life for nurses. This paper describes the Autonomous-Collaborative Care Model and its application in a continuing care setting. This innovative and flexible model fosters autonomy and accountability in nursing practice, reduces duplication in the execution of nursing tasks, enhances effective communication and outlines mechanisms for collaboration among various members of the nursing and interprofessional teams. The model has positioned the authors' organization to meet impending shortages of nursing personnel by ensuring that the right category of nurse is assigned to the appropriate patient, by reducing non-nursing work and by supporting nurses' autonomy to practise to their full scope.

Editorial: Organising care delivery: facilitator or impediment to supportive working relationships in nursing

Editorial: Organising care delivery: facilitator or impediment to supportive working relationships in nursing

Implementing the Clinical Nurse Leader Role Using the Virginia Mason Production System

More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors discuss the needs for changes in the nursing care delivery model, the implementation of the role of the CNL using the tools of the Virginia Mason Production System, as well as early outcomes and future opportunities for the expansion of the CNL role.

Practice Change

The authors describe a participative management approach was used to develop and implement a nursing care delivery model for geriatric rehabilitation. This approach led to a sense of shared decision making and established consensus among the majority of staff. An integrated primary and modular nursing model that incorporated a geriatric resource nurse role was developed to maximize accountability and continuity of care. Ongoing evaluation will further clarify the impact of this model on staff and patient outcomes.

In response to: Powell J.

In response to: Powell J.

Application of the Clinical Nurse Leader Role in an Acute Care Delivery Model

The authors describe a 6-month pilot project incorporating a modified version of the American Association of Colleges of Nursing's (AACN) clinical nurse leader (CNL) role as a prelude to implementation of the AACN-defined CNL role. The purpose of the project was to evaluate a new nursing care delivery model on a designated nursing unit, incorporating the modified CNL role. The pilot was evaluated using nurse-sensitive indicators. Results showed positive trends for all indicators.

Health Care Delivery System Influences Changes in Nursing Educational Materials

The changing health care delivery system has affected nursing care delivery models. To meet the needs of these shifting sands, health-related professions must examine curricula preparing new graduates. An exploratory, descriptive survey design was employed to discover motivators for and types of curricular changes occurring in nursing programs and determine what supportive educational materials are needed. One hundred sixty-seven (26%) of the 651 surveys mailed to a sample of the whole of U.S. baccalaureate nursing programs were returned. Relationships between and among categories of nominal data culled from the participants' experiences were compared using nonparametric statistics. Findings demonstrated why and what changes were made and what educational materials are needed to support new curricula. Results also indicated that blurring of boundaries between community and general acute care nursing is necessary, and changes throughout curricula, including educational materials, must reflect the real-life community aspects of the health care needs of all individuals.

Organizational factors, nurses' job satisfaction, and patient satisfaction with nursing care.

For this research study, the authors explored differences and relationships among the job satisfaction of registered nurses, patient satisfaction with nursing care, nursing care delivery models, organizational structure, and organizational culture. There were no differences in nurses job satisfaction or patient satisfaction with nursing care in different organizational structures or where different nursing care delivery models were used. A supportive environment was most important to the job satisfaction of nurses.

A blending of health strategies in a community-based nursing center.

In today's changing healthcare climate, there is a need for a paradigm shift from a goal-driven model of care to a resource-driven model of care. This proposal describes a nursing center model that attempts to create a framework involving the community in determining the priority of its healthcare needs. Although it is desirable to offer all services to all people, it is apparent that costs will play a major role in determining service availability. Participation, support, and cost-effective outcomes are likely to be greater if residents of the community are involved in the services and programs provided. The advanced practice nurse (APN) is well suited to assist communities in determining priorities and meeting health needs in a cost-effective manner. The proposal submitted is based on a theoretical foundation that articulates a nursing framework and includes specific examples of services provided. It is flexible and can be adapted to any community. Modern scientific care, alternative therapies, education, and programs specific to the community's needs are also discussed. The presentation offers a nursing care delivery model in the community and discusses phases of implementation that have been initiated.

Primary Partnership: A Blended Model for Patient Care in the Psychiatric Unit

This article documents the experience with restructuring as it relates to the develop ment and implementation of a new blended nursing care delivery model and the be ginning steps toward shared governance. The reorganization process was stimu lated by the merger of two small psychiatric units into one large 28-bed neuro-gero psychiatric inpatient service. This change required a modification of the nursing care delivery system, major changes in roles, and in practice philosophy . This entire pro cess of analyzing the current system and developing and implementing the new nurs ing care delivery model is described. (J AM PSYCHIATR NURSES Assoc [1995]. 1, 97-101)

Changes Related to Care Delivery Patterns

Nurse administrators, faced with a need to increase productivity and reduce costs in response to lower inpatient volumes and increased competition, are restructuring systems of care delivery. A survey of acute care hospitals was conducted to determine the extent of changes in nursing care delivery models, skill mix, assignment of non-nursing personnel to the nursing department, use of unlicensed assistive personnel, and registered nurse role changes in healthcare delivery systems employing unlicensed personnel.

Nursing care delivery models in ambulatory oncology.

Oncology nurse leaders are challenged to design ambulatory nursing care delivery models that are cost-effective, efficient, and facilitate positive patient outcomes. Many of the models used in the inpatient setting can be adapted to the ambulatory setting. Whatever model is implemented, it is important to delineate practice expectations.

Parish Nursing

Parish nursing is a current nursing care delivery model that practices holistic health care. Parish nurses provide care to a faith community, emphasizing the relationship between faith and health. Specific nursing activities address physical, emotional, and spiritual health and well-being, closely attending to the inseparability of these dimensions. Parish nurses may assume one or more roles associated with this practice to accomplish parish nursing activities and achieve the holistic health and well-being of individuals, families, and groups within the faith community. The five broad categories of client, health, nurse, environment, and nursing process provide a framework for organizing the concept of parish nursing for future nursing theory, research, and practice.

Models of nursing care in a changing environment: current challenges and future directions.

The last decade of health care in America has been characterized by elements that converged to mandate the need for restructuring health care delivery, which included rising costs, the prospective payment system, consumer expectations, patient care monitoring, the quality movement, and the nursing shortage. This changing environment has resulted in an array of nursing care delivery models to restructure care to assure quality of care, patient satisfaction, and cost containment. Some of the models include paired practice, case management, patient-focused care, cross-training, and product line management. To meet the challenges of future health care delivery, nurses need to be aware of predicted future trends: decreasing specialization of health care personnel, flexibility of the traditional nursing role, increased community-based care, and expanded roles for nurses.