Patient Care Delivery Model

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1 Discuss the distinguishing characteristics of, as well as the pros and cons of the earlier models for organizing of nursing services that were in use (during the 1970s onwards), namely:

A The ‘Team Nursing’ model:
“Team Nursing” model emerged from the British model of a single Head Nurse after the Second World War. It had the following distinguishing characteristics: Characteristics:
1 A Head Nurse oversaw two or three teams of registered nurses RNs and non-licensed personnel 2 Each team consisted of a RN who directed orderlies, licensed practical nurses, and nurse assistants 3 The team was held responsible for the care of the patient. 4 The Head Nurse help the most powerful position on the unit and was responsible for scheduling, staff performance appraisals, and making rounds, but did not have budget responsibilities Negatives:

1 Nurses wanted more responsibility for patient care
2 The Head Nurse, (not the attending RNs), spoke to the physicians about all patients’ medical conditions Positives:
1 A physician decided on a plan of care and it was the nursing staff’s responsibility to carry it out. This avoided any unintended negative consequence B The ‘Primary Nursing’ model:
1 A specific RN (the primary nurse) was responsible about a patient’s condition from admission to discharge. 2 Physician spoke directly to the primary nurse about a patient’s condition instead of conferring only with the Head Nurse 3 The primary nurse then developed a plan of care for each patient which was implemented by RNs or nurse assistants on each shift Positives:

1 The primary nursing model allowed the RNs to develop a relationship with patients similar to that of the physician-patient relationship Negatives:
1 In extreme cases, the primary nurse would be on call for that patient 24 hours a day 2 This model required a high level of cooperation across shifts 3 Increasingly complex medical care, medical technology and nurse schedules made it impossible to maintain a system in which one nurse would be primarily responsible for a patient’s care 4 Nurse shortage resulted in hospital offering competitive salaries and flexible shift options that resulted in complicating the coordination of care C ‘Modified Primary Nursing’ model (from the early 1990s) Characteristics:

1 Each on-duty RN took on the role of primary nurse for three or four patients on a given shift, transferring all patient responsibility to his or her successor on the following shift 2 Information about each patient was communicated in person to the primary nurse on the next shift 3 Nurse Managers replaced the role of the Head Nurse;

4 In addition to staffing and clinical responsibilities, NMs were also in charge of the unit’s budget 5 Primary nurses were dependent on staff from many different centralized departments to assist them in carrying out the patient care agenda Positives:

1 This method helped RNs to take complete responsibility for a patient during his/her shift and helped them to maintain better work-life balance. 2 It helped in solving the problem of shortage of nursing staff Negatives:

1 Patients interacted with as many as 64 medical personnel in a 24-hour period, including multiple physicians. It was difficult for the nurses – who had the most consistent presence on the unit – to coordinate the care of their patients 2 Patients had to be transferred to centralized facilities, whenever required 3 There could arise the possibility of patients getting lost among the bustle of caregivers 4 Primary nurses were dependent on staff from many different centralized departments to assist them in carrying out the patient care agenda

2 Describe the new ‘Patient Care Delivery Model (PCDM)’, developed and proposed by the consultants. What are the goals of the PCDM, and how...
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