Nursing Care Models

Introduction

Team nursing was developed by Eleanor Lambertson in the 1950s at Columbia University. It emerged as a concept that would bring change to the often-criticized functional method. Many believed that functional nursing demonstrated fragmented care, which did not allow achieving the desired quality of patient health outcomes. Team nursing was aimed to address that focusing on collaboration within the multidisciplinary team of medical professionals would better attend to the needs of patients (Gausvik, Lautar, Miller, Pallerla, & Schlaudecker, 2015). Under the team nursing model of care, a team of 4-6 professionals is deployed to care for a single patient. Such a team has a leader who allocates tasks and instructs others in order to better coordinate the efforts of the group.

Literature Review

Team Nursing

Dickerson and Latina (2017) recently conducted one of the prominent researches in the field of team nursing. Therefore, they positively evaluate the impact the model brought to practice. Those care institutions that implemented a team approach to patient care have managed to receive a substantial increase in the quality and effectiveness of the work process.

The experiment was conducted in an 18-bed transitional care unit that was primarily occupied with surgery tasks of varying difficulty. The experiment was a result of a need for effective training of newly hired personnel and the feedback received from the existing staff members. After the 90 days of the experiment, employee satisfaction, chosen as the primary evaluation criteria, rose by more than 11% (Dickerson & Latina, 2017). The researchers also note that for three months no significant failures were documented. Most of the team felt supported and responsible before others and the team leader. The authors conclude that the model has proven itself successful and has high potential due to its adaptability, novice-friendly, and patient-friendly. Among negative sides, a lengthier patient handoff procedure was noted.

Cioffi and Ferguson (2011) also dedicated their research efforts to explore the benefits and drawbacks of the team nursing model. Their study was staged in acute care settings. As in the above-described study, the authors here focused on the nurses’ experiences. Cioffi and Ferguson (2011) note that many studies also document the positive effect of the model on patient satisfaction. However, further investigation is needed as many of the results feature procedural flaws. Continuity of care, effective use of clinical leadership, and responsibility were mentioned as the key positive sides of team nursing that the researchers expected to yield from integrating the model into three acute care hospitals. The sample consisted of 15 registered nurses with two or more years of experience divided into 5 groups to provide care to the elderly in acute settings.

The results were acquired through a series of a personal interviews with each of the participants. The key takeaways suggested that better preparation is needed to provide a smooth transition from the previous model. The absence of role descriptions was also a factor that many considered disorganizing. On the other hand, the awareness of each specialist on the team about the whole complexity of the diseases and comorbidities was regarded as a positive factor. In addition, the team approach created a supportive environment and resulted in less stress among nurses. An increased degree of responsibility was also noted.

Primary Nursing

Payne and Steakley (2015) describe the primary nursing care model as a partnership of a medical professional and a patient in order to establish a positive relationship and progress towards better health outcomes. This model, as the authors note is aimed to relieve hospitals from a shortage of nurses by transitioning from team nursing that is resource-dependent towards a more optimal approach. A single nurse cares for several or, ideally, one patient providing holistic care from admission to discharge. 24-hour care is delivered through the delegation of certain care tasks to a secondary nurse. Payne and Steakly (2015) recommend surveying and reviewing the results of the survey for each patient to receive a clear picture of his disease. The personalized and dynamic approach is also valuable. The model is dependent on the skills and education of nurses, therefore, hiring policy should be toughened.

Nadeau, Pinner, Murphy, and Belderson (2016) assess the effectiveness of the primary care model in a pediatric unit. Under their research, 57 nurses and 59 patients became a part of the testing of the new system of patient-nurse relationships. After four weeks both patients and nurses responded to an online survey that evaluated their satisfaction with the new approach. The results revealed that the overwhelming majority (93.2%) of the patients were rather pleased with this approach. Among nurses, the satisfaction was lower and constituted 63%. Nurse’s name safety concerns the main barrier for the new model, as, during the absence of a primary nurse, a secondary nurse might make a mistake due to the lower knowledge of the patient’s condition.

Implementation and Recommendations

The implementation of team nursing should be preceded by the education of the staff. Nursing managers and other key people who would be responsible for the team need to be aware of the process of the future operation. Teams should be chosen to preserve the balance of skill and experience in order not to harm the patient in the transitional period where interns could fail to perform. Appropriate evaluation and information sharing need to be present in the team to manage the teams’ resources more accurately. In addition, feedback from patients and nurses should be given high regard. Team nursing requires a considerable amount of trained and experienced teams. Therefore, recruiting strategies might need to be changed in order to have the necessary human resources for a change of care model.

If the team nursing model does not provide the anticipated level of patient/staff satisfaction, primary care nursing might be implemented as an alternative. The implementation should also include a certain period of education and instruction, in order to guarantee smooth role transactions. Communication between primary and secondary nurses should be given a priority, as there are concerns for patient safety. It is also thought best to align primary nurse shifts with their assigned patients. Several assessment stages need to be present such as pre-, mid-and post-intervention evaluation.

Conclusion

Team nursing and primary care nursing are excellent care models that may be implemented in a variety of settings and can be adjusted for the needs of the unit. Team nursing yields the most benefit from the multidisciplinary approach and is best for educating the new workforce. Primary care nursing utilizes the skills and knowledge of each professional to optimize the use of human resources in the unit. Both of them are able to provide solid satisfaction levels among workers and patients. Thorough preparation, education, and recruitment are paramount to ensure the models perform to their full capacity and achieve the best health results for the patients.

References

Cioffi, J. & Ferguson A., L. (2011). Team nursing in acute care settings: Nurses’ experiences. Australian Journal of Advanced Nursing, 28(4), 2-12.

Dickerson, J. & Latina, A. (2017). Team nursing. Nursing, 47(10), 16-17.

Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare, 8, 33–37.

Nadeau, K., Pinner, K., Murphy, K., & Belderson, K. (2016). Perceptions of a primary nursing care model in a pediatric hematology/oncology unit. Journal of Pediatric Oncology Nursing, 34(1), 28-34.

Payne, R. & Steakley, B. (2015). Establishing a primary nursing model of care. Nursing Management, 46(12), 11-13.

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