Nursing Care Models and Principles

Introduction

Nursing care modes are designed to guide nurses to provide a high quality of care through established principles. The better the model is adjusted to the setting in which a nurse is operating, the better health outcomes they may provide. Therefore, there is a necessity for adequate choice and investigation into the models of nursing care implemented in workplaces and the alternative ones.

Patient-Centered Care Model

Patient-centered care (PCC) became the nursing model observed in the clinical setting. PCC is an approach that places patients’ experience and health outcomes above all else (Kitson, Marshall, Bassett, & Zeitz, 2013). Kitson et al. (2013) review the core elements that PCC consists of by reviewing different sources devoted to this care model. The systematic review revealed that most articles defined PCC through patient participation, patient-caregiver relationship, and regard for the context of treatment (Kitson et al., 2013). Thus, PCC ensures that the patient complies with the treatment plan through being tailored with respect to the patient’s self-expressed needs, values, and preferences (Finkelman, 2015). In the framework of this model, a patient receives all necessary information about the procedures they undergo, health metrics, and medications (Kitson et al., 2013). This model also cares for the physical and mental comfort of the patient together with ensuring easy access to care.

Rathert, Wyrwich, and Boren (2013) concentrated their research effort on studying the outcomes of PCC through a systematic review of 40 articles. The study revealed that most of the researchers observed positive results. Thus, some found that PCC is associated with stronger patient satisfaction and self-management, while others were inclined to believe that this care model positively influenced the clinic’s financial management. Rathert et al. (2013) identified family involvement as one of the principles of patient-centered care, but the level of scientific interest in it was rather insignificant. As a result, Rathert et al. (2013) concluded that patient satisfaction and self-management were the most commonly identified features of the PCC model.

Team Nursing Model

There is also another model that is quite different in nature from PCC. Team nursing (TN) focuses on teamwork and diversity that allows benefiting from various backgrounds and mindsets in order to deliver well-balanced care. In the TN model patients are serviced by a team of several nurses guided and supervised by a team leader, usually the most experienced nurse. They implement collective decision-making in order to devise a plan, implement it through several stages performed by various team members, and evaluate the performance and patient outcomes. The team is usually comprised of various personnel in order to care for most of the needs matching the skill set of one team.

Ferguson and Cioffi (2011) devoted their research to evaluating TN outcomes in the acute care setting. They used self-reported data gathered from interviews with five nurse managers. Three main topics were discussed with each manager including adaptation to the new model, positive outcomes, and challenges. The interviews revealed that most of the managers positively evaluated TN. The process of familiarization with the new work order became a challenge for older nurses as they felt the increase in their responsibilities, while younger ones accepted it faster (Ferguson & Cioffi, 2011). On the positive side, many mentioned the increased level of attention each patient receives and prospects of more experienced nurses educating less skilled. Also, managers feel that the quality has risen because each decision is supervised by excellent professionals. Among the challenges, they named poor communication within the team, and with other medical staff (Ferguson & Cioffi, 2011).

Fairbrother, Chiarella, and Braithwaite (2015) reviewed the literature devoted to various nursing care models in order to compare TN with them and reveal its effectiveness. The critical analysis of sources discovering primary nursing, functional nursing, individual patient allocation, and TN revealed that the latter despite its decline in 1980 is still in use in many clinics around Australia and the U.S. The reason for its revival in Australia authors attributes to the challenges that new nurses face. Team nursing allows them to get accustomed to the profession and develop necessary skills faster and easier with support from more experienced colleagues. Individual nurse-patient relationships seem to have vanished, but the patient outcomes have, nevertheless, improved (Fairbrother et al., 2015). However, the latter is very much dependent on the atmosphere within the team. Provided the relationships are professional and supportive, the outcomes are positive.

Observations of Patient-Centered Care Model

Having seen PCC in action, it occurred to me that the care receives enjoy their increased attention and the fact that nurses explain their decisions. Many patients, especially, the elderly population, seemed less suspicious about the medication the nurses gave them. Most were also satisfied with seeing a familiar face and often engaged in conversation, which seemed natural and friendly.

Nurses had different feelings about this model. Some identified that patients become friendlier, understanding after the former started explaining, and educating them about their health. Others, however, noted that more time is now needed to serve each patient. Interns and less experienced nurses faced challenges communicating with patients while their more proficient colleagues did not regard this as something skill-demanding. However, remembering their first experience, they recollected having issues with translating medical terms to the general public.

Recommendations

Judging from what I saw in the clinic, PCC seems to be working fine, but some adjustments would be helpful. In particular, I would consider introducing some organizational courses for younger nurses to practice their speaking skills as in PCC patient satisfaction depends on it significantly. Also, I would place an emphasis on the patient’s family as well, especially in managing older patients. Often, relatives are more cognizant of the poor health outcomes, and delivering bad news to them should better be left to their close ones.

If another model were chosen, I would advise in favor of team nursing. This model utilizes the strong sides of the nursing personnel and levels up the poor-performing interns (Fairbrother et al., 2015). Regarding patient outcomes, the supervision of each decision and inter-disciplinary practice will prove to have a positive influence on patients’ health. In addition, such supervision would increase patient safety.

Conclusion

All things considered, investigation of the performance of PCC was a positive experience, which allowed me to understand the advantages and disadvantages of this care model and juxtapose it to theory. Researching other theories as well allowed me to build stronger theoretical support for my future practice. I learned that PCC and TN are neither the worst nor the best practices, but all have their pluses and minuses. However, judging from what I found, I am inclined to argue that TN is a better practice for beginners and I would definitely want to start in a clinic that employs it.

References

Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: Where does team nursing sit? Australian Health Review, 39(5), 489-493.

Ferguson, L., & Cioffi, J. (2011). Team nursing: Experiences of nurse managers in acute care settings. Australian Journal of Advanced Nursing, 28(4), 5-11.

Finkelman, A. (2015). Leadership and management for nurses: Core competencies for quality care. New York, NY: Pearson.

Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient‐centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), 4-15.

Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-centered care and outcomes: A systematic review of the literature. Medical Care Research and Review, 70(4), 351-379.