Acute Care Hospitals

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It is possible to distinguish between different types of healthcare structures, such as functional, divisional, service line, integrated, matrix, and shared governance structures. Depending on their structure, healthcare organizations choose models according to which the care is provided (Schenck & Alcorn, 2012). These models can be general, such as biomedical, biopsychosocial, salutogenic, and holistic models (Lorenzo, 2013).

The traditional models related to nursing include total patient care or case management, primary nursing, and team nursing (Rose, Adams, & Johnson, 2016). In acute care hospitals, it is possible to apply functional, matrix, and service line structures. The relevant models include case management or total patient care, as well as biomedical and biopsychosocial models. Table 1 represents the detailed description of structures and models that are appropriate for acute care hospitals.

Table 1. Structures and Models Appropriate for Acute Care Hospitals.

Acute Care Hospitals
Structures Functional Structure Service Line Structure Matrix Structure
The functional healthcare structure is discussed as an organizational system that is based on the strict hierarchy (Schenck & Alcorn, 2012). Those acute care hospitals that are organized according to the functional structure have several departments headed by managers, and each department is responsible for a certain function. Therefore, these departments are determined according to the performed activities and proposed services. The service line structure is based on the idea of combining all services that are required for performing a certain function in one line (Rose et al., 2016). In acute care hospitals, all specialists who participate in coping with different types of emergencies can work in a certain unit or service line. Thus, in acute care hospitals, lines can include neonatal intensive care and cardiology, for instance. In these lines, specialists are responsible for providing care, surgery, and rehabilitation. The matrix structure combines the elements of functional and product line structures. Specialists belong to separate functional units, but they combine their efforts while working as teams on complicated cases. This structure is based on guaranteeing the collaborative relationship between healthcare providers (Fitzgerald, Wong, Hannon, Tokerud, & Lyons, 2013). In this case, team leaders report to managers who are responsible for administering the work in different units.
Models Case Management/Total Patient Care Medical/Biomedical Model/Functional Nursing Biopsychosocial Model
The total patient care or case management is a model according to which each case is discussed separately, and the unique treatment and care are proposed in order to achieve patient outcomes (Rantanen, Pitkänen, Paimensalo‐Karell, Elovainio, & Aalto, 2016). The focus is on providing services that are appropriate for the individual case. In acute care hospitals, nurses are responsible for coordinating the patient’s progress while making regular assessments and monitoring health care delivery. The biomedical model is used when healthcare specialists are concentrated not on providing patient-oriented care but on coping with symptoms, diagnosing, and planning the most effective treatment. The patient is provided with the high-quality care and treatment that are prescribed after performing the complex diagnosing procedures (Lorenzo, 2013). According to this model, the focus is on a quick recovery. In acute care hospitals, this model can be used to make efficient decisions and provide relevant care in a timely manner. This model is correlated with the principles of functional nursing. The biopsychosocial model is used in acute care hospitals when healthcare specialists focus on social and psychological factors that can influence the patient’s condition. These factors are taken into account when the diagnosis is made (Chapa, Akintade, Son, Woltz, & Hunt, 2014). These aspects also influence the proposed treatment. Much attention is paid to the relationship between the medical staff and patient in order to contribute to the quick recovery.


Chapa, D. W., Akintade, B., Son, H., Woltz, P., & Hunt, D. (2014). Pathophysiological relationships between heart failure and depression and anxiety. Critical Care Nurse, 34(2), 14-25.

Fitzgerald, L., Wong, P., Hannon, J., Tokerud, M. S., & Lyons, J. (2013). Curriculum learning designs: Teaching health assessment skills for advanced nursing practitioners through sustainable flexible learning. Nurse Education Today, 33(10), 1230-1236.

Lorenzo, L. (2013). Partnering with patients to promote holistic diabetes management: Changing paradigms. Journal of the American Association of Nurse Practitioners, 25(7), 351-361.

Rantanen, A., Pitkänen, A., Paimensalo‐Karell, I., Elovainio, M., & Aalto, P. (2016). Two models of nursing practice: A comparative study of motivational characteristics, work satisfaction and stress. Journal of Nursing Management, 24(2), 261-270.

Rose, R., Adams, F., & Johnson, S. (2016). Nurse led, nurse driven service lines: How nurse leaders are navigating change. Nurse Leader, 14(3), 195-197.

Schenck, J., & Alcorn, S. (2012). Guardians of the matrix. Nursing Management, 43(4), 53-55.

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