Application of a Nursing Theory: The Nursing Services Delivery Theory

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The theory chosen for this nursing issue is the Nursing Services Delivery Theory (NSDT). Nursing theory affects nursing practices in several ways, which could have significant impacts on nursing practices. Any nursing theory offers a fundamental framework to guide and clarify nursing practice, sustains quality of care to patients and may be applied in various nurse practice areas to ensure that solutions are found to nursing issues. Nursing theories may be applied to resolve different nursing issues in various situations such as patient care and care services (Meyer & O’Brien-Pallas, 2010).

The NSDT has emanated from the Open System Theory as used in large-scale organizations. The NSDT can be used in “administrative practices for nursing service or healthcare delivery subsystems” (Meyer & O’Brien-Pallas, 2010, p. 2828). In this case, the NSDT focuses on the efficacy and efficiency of “administrative practices for nursing service delivery subsystems” (Meyer & O’Brien-Pallas, 2010, p. 2828). By relying on the concepts of the theory, the NSDT offers a theoretical concept for comprehending elements of hospitals, nurse working units and context and combines organization of nursing work and the system design.

Description of the problem or issue

Today in many nations, the quality of healthcare and nursing services face many challenges due to the shortage of nursing professionals. For instance, there have been notable cases of rapid turnover of nurses and nurse managers in ICU departments, which is a critical care area (Smith, 2010). Many strategic multifaceted responses have been formulated to manage the nurse shortage crisis. As a result, healthcare decision-makers and policymakers have preferred to focus on organizational and environments of nursing practice as critical areas for improvements.

Generally, nursing services are acquired through employment opportunities for professional nurses. It is imperative for nurse leaders to understand processes of recruiting, retaining, and deploying scarce nurse professionals effectively. At the same time, they must also understand how to provide quality and cost-effective care. Further, there is also the need to understand the relations between nurse unit structures, nurse staffing management policies, objectives, available resources, work context, and patient outcomes based on nurses’ roles. In this context, the major issue within nursing healthcare practice has been conceptualization and examination of nursing service delivery.

The provision of nursing services takes place in healthcare facility units and sub-units, which depend on nurses and other resources. There are major components of the NSDT. These include characteristics of the healthcare setting. The general features may include the size, location, type, and culture of the facility. Healthcare facilities differ based on their different characteristics such as division, affiliation with other institutions, and source of funding among others.

The NSDT components also consist of care recipient features. These are mainly patient characteristics, health status, nursing conditions, and medical issues. Diversity in patients is also considered in this component.

Nurse characteristics are also part of the theory components. In this case, age, qualification, gender, clinical expertise, nurse employment status, and health status among others are explored under the NSDT.

The NSDT theory is developed from the systems thinking model and nursing management in clinical settings. As a result, the theory focuses on several aspects of nurse staffing issues, nursing studies, and legislation (Wallis, 2013). Specifically, other studies have focused on understanding the theory from a Patient Care System Model in which there are “different professionals; different healthcare facilities considered as inputs, organizational and environmental issues regarded as throughputs; and patient care, patient satisfaction, and personnel satisfaction as outputs” (Meyer & O’Brien-Pallas, 2010, p. 2828). As such, there is notable complexity in interrelationships in nursing, medical issues, environmental factors, nurse factors and expected outcomes. The NSDT has focused on exploring factors that influence differences in nurse requirements for patients with the same medical conditions. It was noted that many factors influenced nursing system outcomes such as the working environments, interventions, structures of facilities and effectiveness of interventions. These elements are viewed within the nursing care delivery subsystems in which nursing interventions are offered.

According to the NSDT, nurses can perform well and produce quality healthcare outcomes. However, healthcare facilities must design their nursing units to support the environment and working conditions of nurses.

Applying concepts and principles from the theory

Many studies and empirical evidence have shown the relationships in structures of the Nursing Services Delivery Theory by relying on “inputs, throughputs, and outputs that are integral to nursing health services research” (Meyer & O’Brien-Pallas, 2010, p. 2828). For instance, a study focused on the relationships between “inputs (patient characteristics), throughput (nursing interventions) and outputs (clinical outcomes)” (Meyer & O’Brien-Pallas, 2010, p. 2828). It was established that patient functional, cognitive status and depression (health factors) were related with the kind of nursing intervention offered (Meyer & O’Brien-Pallas, 2010). Nursing interventions had in part assisted in resolving the issues at functional levels and during discharge. In this case, the roles of healthcare professionals have significant impacts on patient outcomes.

The second application of the NSDT involves the use of supporting elements to mitigate unknown nurse staffing requirements. Agency nurses are inputs that could reduce resources used or lower costs. However, they may not yield the desired clinical outcomes in some situations. For instance, in an ICU, nurses may control patient characteristics as they get medical care from nurses. However, clinical status could negatively affect the inputs of agency nurses. This argument is also based on the notion that agency nurses may not have adequate experience in some areas of patient management in the ICU. Moreover, they may also be less familiar with teamwork among nurses and ICU practices.

The third application of the NSDT highlights possible cases of “improving healthcare delivery under inter-professional practice” (Meyer & O’Brien-Pallas, 2010, p. 2828). For instance, a surgery that requires a multidisciplinary team of physicians with high-levels of teamwork tends to be successful and shows enhanced organizational and clinical outcomes. The roles of physicians tend to be concurrent, multidisciplinary in approach and provided within a specified length of time. Teamwork or coordination methods and the number of patients are elements of throughputs. Patient satisfaction reflects outputs in the quality of care and efficiency (Meyer & O’Brien-Pallas, 2010). When nurses understood how to manage diverse patient characteristics, there were notable positive effects on team delivery and outcomes. Teamwork among nurses leads to improved outcomes in healthcare within ICU. This shows that multidisciplinary team enhances benefits of specialization in healthcare settings.

Finally, the NSDT is also applicable in nursing work environments. This is a major priority among nurses and nurse managers. Specifically, it is important in nurse recruitment, retention and deployment within the context of nursing shortages. Nurse graduates who have high-levels of job satisfaction normally report improved nursing outcomes. When nurses with few years of nursing experience get “opportunities, nursing support, information and necessary resources, they are most likely to experience improved work output, fairness, and values” (Meyer & O’Brien-Pallas, 2010). This in turn creates high-levels of nurse work engagement, improved commitment to healthcare facilities and reduced cases of nurse burnout. The NSDT focuses on nurse characteristics, work environment, nurse health and professional outcomes. These factors show the ability of the inclusiveness of the framework and conceptual supporting elements of the NSDT to guide theoretical relations among various elements of nursing services and studies related to work, working conditions and staffing issues.

The NSDT is considered within a broad healthcare organization setup. In this case, the theory recognizes nurses as a part of work groups within specific departments, units or points of care in a large organization. Nurses in ICU, home healthcare or a team at any point of care show a component of nurse service delivery as subsystems. They are responsible for providing nursing services to patients with expected outcomes (Meyer & O’Brien-Pallas, 2010).

The NSDT highlights the influences of healthcare facility suprasystems and their subsystems with the focus on the general trends of work demands on nurses in the delivery of services within their respective units.

From a critical perspective, the NSDT tends to eliminate a general strategy of evaluating nurse staffing issues. It investigates the real role done by nurses at specific units, rather than focusing on general working conditions or components of healthcare facilities.

The theory also accounts for the integrated elements of nursing care facilities when evaluating nursing shortages. In this regard, it focuses on understanding other factors that influence service delivery at various points of nurse-patient contacts.

In the previous era, nursing healthcare service studies have focused on investigating many issues affecting nurses, particularly nurse staffing and working conditions. As a result, there are fragmented outcomes from these studies from perspectives of nursing services delivery and nurses’ roles (Meyer & O’Brien-Pallas, 2010).

The NSDT offers a theoretical ground for diverse studies on the relational structures for nurse staffing and service delivery. The theory can enhance the detection of issues in nurse staffing and develop appropriate study factors for further studies. In addition, the theory provides nurse leaders with insights on areas of importance and assesses certain healthcare factors that could assist in enhancing nursing service delivery, efficiency on a long-term basis. The theory, therefore, provides a supporting way of evaluating and controlling the major elements that affect the provision of nursing services at various units or points of care in healthcare facilities irrespective of their sizes.

Concluding statement

The Nursing Services Delivery Theory (NSDT) shows how nurse staffing shortages can be evaluated within the entire healthcare facility at certain units, and it determines effectiveness, efficiency and sustainability of nursing delivery services.

From this theory, new concepts emerge to aid in understanding nurse staffing shortage and delivery of nursing services. First, healthcare facilities have diverse characteristics that affect nurses and delivery of nursing services. Second, it is imperative to understand nursing within healthcare facilities from specific units of healthcare facilities and elements that affect nursing work in such environments. Finally, the NSDT evaluates structures of service delivery and attempts to reconcile them based on staffing needs, nurse characteristics, patient conditions and working environments to mitigate the rising global nurse shortage at specific point of care such as ICU.


Meyer, R. M. & O’Brien-Pallas, L. L. (2010). Nursing Services Delivery Theory: an open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.

Smith, A. (2010). The Current Nursing Shortage in the United States. Web.

Wallis, L. (2013). Nurse–Patient Staffing Ratios. American Journal of Nursing, 113(8), 21-22.

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