Nursing Care Models: The Use in Chronic and Primary Care + Examples

Introduction to Nursing Care Models

Inpatient facilities use various nursing care models in their practice, depending on the unique needs of patients and staff. A clinical model in nursing can serve as an evidence-based mechanism to enhance quality and improve outcomes. Although the nursing practice is constantly evolving, theoretical frameworks serve as a fundamental basis for standards and values that are critical to the profession. This paper will describe an observation exercise to inspect a care model in practice. In addition, the essay will summarize scholarly research on other theories used in modern nursing, including the team nursing model, Wagner’s chronic care model, and frameworks guiding patient safety in primary care.

Observation of the Clinical Model in Nursing

For the purpose of this assignment, an inpatient transitional care unit in the large metropolitan hospital was observed, determining that the staff utilized a team nursing model to deliver care to patients. The unit had a patient ratio of approximately three patients to one nurse. However, unlike the standard practice of each nurse being assigned a patient, nurses worked in teams of 2-3 people to provide care.

The nurses shared responsibilities, communicated in detail about patient needs and desires, and held each other accountable for fulfilling required tasks. It was observed that the unit staff had a close relationship working together in this manner. More experienced nurses were usually teamed up with newer staff so that they could form a mentoring relationship. Nursing teams could more efficiently and adequately react to any arising problems or challenges. Meanwhile, patients demonstrated much higher satisfaction and felt that their needs and health were attended to.

Team Nursing Model

The team nursing model was developed in the 1950s as a result of a wide variety of nursing skill mix amongst unit staff. The model consists of creating pairs or groups of nurses who work together as a team to deliver care to patients. Instead of each patient assigned to one specific nurse, a team now works together. This approach allows the utilization of the full diversity of expertise, knowledge, skills, and qualifications of the entire nursing staff.

Studies indicate that facilities that have chosen to adopt a team-based care model report increased levels of nurse satisfaction and communication. Staff morale significantly increases as the team model provides an inherent system of support and alleviates various negative pressures of the nursing profession that may cause isolation, particularly for new nurses. As a result, patients report enhanced quality of care and satisfaction as well (Dickerson & Latina, 2017).

The team care model introduces a collaborative approach to nursing practice by optimizing skill mix and credentials present in an inpatient care unit. The core of the model goes beyond simple staff rotation but introduces an inherently innovative method of healthcare delivery with more focus on patient-centered care. The team model allows providers to implement new care processes or to lead evidence-based practices.

Coordination of staff can lead to better care as RN’s can conduct initial assessments and communicate easily at the bedside during shift rotations, while a certified nursing assistant is able to conduct rounds every few hours to check for minor factors such as pain levels or positioning for patients. This creates a care hub that is efficiently organized and communicative in order for the optimal delivery of care (Hastings, Suter, Bloom, & Sharma, 2016).

Wagner’s Chronic Care Model

Chronic illnesses are becoming increasingly common, causing significant burdens upon individuals and society. The Chronic Care Model was specifically developed with the purpose of developing a comprehensive approach to the delivery of care that would lead to better functional and clinical outcomes. This model consists of 6 interdependent elements including community resources, health system support, self-management support, delivery system design, decision support, and clinical information systems (Gee, Greenwood, Paterniti, Ward, & Miller, 2015).

The fundamental core aspect of the Chronic Care Model seeks to examine the delivery of healthcare in a community context where a patient receives services with all the systems involved in the process. The model especially highlights the importance of self-management that provides a patient with the necessary knowledge and skill to manage a condition over a lifetime, which is crucial with chronic diseases. Overall, a well-established and efficient interaction between a patient and the health system with the purpose of improving outcomes is central to the Chronic Care Model (Gee et al., 2015).

Implementation of the Chronic Care Model has been associated with improved outcomes amongst patients with chronic conditions. While the benefits of the model are evident, there is significant variation in its implementation. Commonly, a combination of the model’s elements is implemented depends on the specific needs of the provider or healthcare system. However, it is noted that even the process of developing interventions for the implementation of the Chronic Care Model allows practitioners to reflect upon priorities and the process of care delivery. A comprehensive system using this model may require significant resources to implement fully but elements of it are helpful in improving health outcomes nevertheless (Davy et al., 2015).

Patient Safety in Primary Care

A model for patient safety in primary care was specifically developed by the Agency for Healthcare Research and Quality (2017) which is part of the U.S. Department of Health and Human Services. The model is known as the “Cycle of Safety” is based on elements of the partnership, teamwork, community, and healthcare environment. The model was developed by identifying structures in inpatient care that could influence or improve safety, particularly through engagement with patients and families. The partnership is the key concept, highlighting that the patients, staff, and clinicians from a relationship during primary care. A strong relationship based on communication, trust, and respect leads to safer care as all three parties engage in collaboration during treatment.

Teamwork is based on involving patients in the process of care as well as engaging them in the continuum of care so that a common goal is achieved. The community concept encompasses local community resources and contributing factors to patient safety, ensuring that a patient has access to aspects such as pharmacies for medication and a place for exercise as an example. Finally, the healthcare environment considers that primary care is affected by external forces such as policy. However, there should be a microsystem in place that primarily focuses on patient safety as one of its priorities (Agency for Healthcare Research and Quality, 2017).

Summary of Nursing Care Models

Nursing care models are essential foundations to practice in order to achieve improved patient outcomes, both on an individual nursing level as well as systemic changes. The observed team nursing model demonstrates that a non-traditional approach to nursing unit care for patients can have benefits for both staff and patients. The Chronic Care Model examined presents a comprehensive method of managing chronic diseases by addressing elements of systemic healthcare delivery.

Finally, the Safety Circle model focuses on patient safety through a collaborative approach between providers, the community, and patients to promote an environment and opportunities that are supportive and safe. Through the examination of a variety of these models, it becomes more apparent how influential frameworks are in developing day-to-day nursing practices and processes.


Agency for Healthcare Research and Quality. (2017). Guide to improving patient safety in primary care settings by engaging patients and families. Web.

Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015). Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Services Research, 15(1). Web.

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

Gee, P. M., Greenwood, D. A., Paterniti, D. A., Ward, D., & Miller, L. M. S. (2015). The eHealth enhanced chronic care model: A theory derivation approach. Journal of Medical Internet Research, 17(4), e86. Web.

Hastings, S. E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC Health Services Research, 16, 245. Web.

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