NR 447 DEVRY WEEK 4 NURSING CARE MODELS PAPER LATEST

Nursing Care Models Paper Rebeka Rizzo Chamberlain College of Nursing NR 447 - Collaborative Health Care January 2017 Nursing care model paper Nursing care models are methods, which nurses practice and provide nursing care. (Finkelman, 2012) “ Nursing practice models have been used to implement recourse-intensive strategies with goal of decreasing expenses and using staff more effectively.” (Finkelman, 2012) There are many different approaches in which nurses practice nursing. Some of these practices include total patient care, functional nursing, team nursing, primary nursing, care service team nursing, complementary model and case management model. (Finkelman, 2012) At the unit where I currently work we use complementary model or skill mix model. We have an unit secretary that answers the call bells and phone, make phone calls to the doctor if is need it, opens the packages that we receive and organizes the unit, we have a patient care assistant (PCA) that does the vital signs, draws blood, make beds and helps with patient care, we have nurses that give medication, preforms physical assessments, we have a lactation consult that aids the mothers with breastfeeding. We also have a hearing screening person that comes to the hospital and does the hearing screening to all the newborns. We are all part of the team that delivers patient care. Skill mix model of care Skill mix approach was used in a critical care unit in a hospital in California due to nurse shortage and complex hospital environment. (Ringerman & Ventura, 2000) In this article the nurses and license vocational nurses (LVN) were paired to work together in a critical care unit. The process was the subsequent first study of the literature about skill mix changes and outcome wanted for this new approach. Next review of the RN and LVN interventions that need it to be done in critical ill patients. The evaluation of the interventions found it that 55 % of the tasks could be delegate to a LVN under the direction of an experienced RN. The RN/ LVN would have the same schedule. The RN would be part of the interview process, work with an educator to prepare a critical care course for the LVNs and serve as clinical preceptors (Ringerman & Ventura, 2000). The outcome variables were the following patient falls, medication errors, nosocomial infection rates, decubiti incidents and mortality rates. Nurses were made aware that if the project didn’t work it would be terminated (Ringerman & Ventura, 2000). An 8-week critical care course was given to LVNs and RNs. The RNs were mentors to the LVNs, however the CNS was responsible for the program. The subjects include the science of delegation, appropriate assignment of patient care distinct RN and LVN, role gathering data for reporting purpose, essential elements of utilization review an case management, the essence and rewards of nursing professionalism, the nurse practice for RN and LVNs and application and worthiness of clinical paths for critical care patients. The program was done in two phases and 8 weeks apart, twelve LVN were interviewed and hired, nine of the twelve LVNs successfully complete the training and started to work with a RN. (Ringerman & Ventura, 2000) The outcome of the project was that physicians and patients satisfaction increases meanwhile nurse satisfaction decreased and labor cost also declined by 18%. LVNs that had previous experience with telemetry participate in future education programs, RNs struggle to disengage from a task-oriented model and need to adapt to the new program. The result of RN- LVN team can be preserved with staff education, communication, and participation is successfully implemented. (Ringerman & Ventura, 2000) Skill mix model of care continuation. In recent years hospitals have reformed their policies as a way to combat nursing staff shortages and exorbitant medical costs. I reviewed an article that explored the impact different nursing staffing models can have on patient outcomes in a respiratory care center (RCC) with respect to cost for the hospital (Yang, Hung, Chen, Hu, & Shieh, 2012) The study examined data that measured nursing care quality, patient records and nursing personnel costs. There were 487 total patients used for the study. 247 patients received a mixed nursing staff, consisting of one RN and two nursing aides. The other group, consisting of 240 patients, received nursing care by two RNs. The study examined cost-effectiveness for each group of patients. (Yang et. Al. 2012) The study focused on the conditions of pressure ulcers, urinary tract and respiratory infections, and bloodstream infections to measure patient outcomes. Each patient’s condition was recorded upon being admitted to the RCC as a way to create a baseline for patient outcome. They were later re-examined when discharged from the center to measure nursing care effectiveness. The hospital accounting office provided the study with nursing cost data over the course of one year. 12 divided the total annual cost for each group as a way to calculate the average monthly nursing cost. (Yang et. Al. 2012) The study reached several conclusions. First, the cost of nursing care between the two groups did not significantly differ. The cost of paying two nursing aides essentially offset the cost of paying one RN. The study determined that substituting RNs with nursing aides increases the occurrence of urinary tract infections. Perhaps most importantly, the st