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Nursing Care Models
Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Models
Order Description
Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Models Paper:
Guidelin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ines
PURPOSE
The purpose of this assignment is to identify nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models utilized in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in today’s various health care settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings and enhance your knowledge of how models impact the management of care and may
in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">influence delegation. You will assess the effectiveness of models and determin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and
staff satisfaction.
COURSE OUTCOMES
Completion of this assignment enables the student to meet the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing course outcomes.
CO#1: Apply leadership concepts, skills, and decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the provision of high quality nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care, healthcare team management, and the oversight and accountability for care delivery in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a
variety of settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings. (PO #2)
CO#2: Implement patient safety and quality improvement in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">initiatives within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the context of the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional team through communication and relationship buildin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. (PO #3)
CO#3: Participate in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the development and implementation of imagin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inative and creative strategies to enable systems to change. (PO #7)
CO#6: Develop a personal awareness of complex organizational systems and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrate values and beliefs with organizational mission. (PO #7)
CO#7: Apply leadership concepts in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the development and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare
delivery. (PO #2, and #3)
CO#8: Apply concepts of quality and safety usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing structure, process, and outcome measures to identify clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical questions as the begin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing process of changin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing current practice. (PO#8)
DUE DATES
This assignment is to be submitted to the Dropbox by Sunday, 11:59 p.m. MT, end of Week 4.
POINTS
This assignment is worth 200 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints.
DIRECTIONS
1. Read your text, Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman (2012), pp- 118- 127.
2. Observe staff in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in delivery of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care provided. Practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings may vary dependin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing on availability.
3. Identify the model of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care that you observed. Be specific about what you observed, who was doin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing what, when, how and what led you to identify the particular model.
4. Write a 5-7 page paper that in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing:
5. Review and summarize two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to the nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model you observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
6. Review and summarize two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that is different from the one you observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
7. Discuss your observations about how the current nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model is bein" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing implemented. Be specific.
8. Recommend a different nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that could be implemented to improve quality of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care, safety and staff satisfaction. Be specific.
9. Provide a summary/conclusion about this experience/assignment and what you learned about nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models.
10. Write your paper usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing APA format. Submit to the Dropbox.
GRADING CRITERIA: NURSING CARE MODELS PAPER
Category Poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints % Description
Identify Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing specifics about who, what when, where, etc. 60 30% Identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model for delivery of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care. Provides specifics.
Besides Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, locate scholarly resources related to Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Models 40 20% In addition to Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, locates four scholarly resources related to Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Models. Summarizes all
resources in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in body of paper.
Implementation and Recommendations 60 30% Describe implementation of current Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model and recommend a different model that could be utilized to improve quality of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care, safety and
staff satisfaction.
Conclusion/ summary 20 10% Summarize what you learned about this experience in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing new knowledge about nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models.
Clarity of writin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing 20 10% Content is organized, logical, and with correct grammar, punctuation, spellin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and sentence structure are correct. APA formattin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is apparent and CCN template is
utilized. References are properly cited within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the paper; reference page in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes all citations; proper title page and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction are present and evidence of spell and grammar check is obvious.
GRADING RUBRIC
Assignment Criteria Outstandin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing or Highest Level of Performance
A Very Good or High Level of Performance
B Competent or Satisfactory Level of Performance
C Poor, Failin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, or Unsatisfactory Level of Performance
F
After an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction paragraph, identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing specifics about who, what when, where, etc.
60 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints After an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction paragraph, thoroughly identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing specifics about who, what when, where, etc.
55-60 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints After an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction paragraph, clearly identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing specifics about who, what when, where, etc.
50-54 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints After an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction paragraph, briefly identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing min" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inimum specifics about who, what when, where, etc.
46-49 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Does not provide an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction paragraph but identifies Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in first or subsequent paragraphs in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing min" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inimum specifics about who, what when, where, etc.
0-49 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints
Besides Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, locate scholarly resources related to Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Models
40 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Thoroughly reviews and summarizes two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to the nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model you observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing; then, reviews and summarizes
two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that is different from the one you observed.
37-40 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Clearly reviews and summarizes two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to the nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model you observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing; then, reviews and summarizes
two scholarly resources (not in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing your text) related to a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that is different from the one you observed.
34-36 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Briefly reviews only one resource (besides text) related to nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and only one resource (besides text) related to a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that is
different from the one you observed.
30-33 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Briefly reviews only one resource (besides text) related to nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model observed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in practice settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing OR only one resource (besides text) related to a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care model that is
different from the one you observed.
0-29 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints
Implementation and Recommendations
60 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Thoroughly describes implementation of current Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model and recommends a different model that could be utilized to improve quality of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care, safety and staff
satisfaction.
55-60 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Clearly describes implementation of current Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model and recommends a different model that could be utilized but omits quality or safety or staff satisfaction.
50-54 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Briefly describes implementation of current Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model and recommends a different model that could be utilized but omits two of the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing (quality/safety/staff
satisfaction).
46-49 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Briefly describes implementation of current Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Care Model or recommends a different model that could be utilized. Various elements are missin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing related to improvin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing quality of
nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care, safety and staff satisfaction.
0-45 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints
Conclusion/ summary
20 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Includes conclusion paragraph and thoroughly summarizes what you learned about this experience in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing new knowledge about nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models.
18-20 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Includes conclusion paragraph and clearly summarizes what you learned about this experience in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing new knowledge about nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models.
16-17 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Includes conclusion paragraph but briefly summarizes what you learned about this experience or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes new knowledge about nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models but not both.
14-15 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Does not Include a conclusion paragraph or conclusion/summary is present but difficult to fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ind in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in closin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing paragraphs of paper.
0-13 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints
Clarity of writin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing
20 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Content is organized, logical, and with correct grammar, punctuation, spellin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and sentence structure are correct. APA formattin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is apparent utilizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing CCN template. References are
properly cited within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the paper; reference page in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes all citations; proper title page and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction are present and evidence of spell and grammar check is obvious. Less than three errors
noted.
18–20 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Content is mostly organized, logical and with correct grammar, punctuation, spellin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and sentence structure are correct. APA formattin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is apparent utilizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing CCN template. References
are properly cited within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the paper; reference page in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes all citations; proper title page and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction are present and evidence of spell check and grammar check is obvious. Four to six
errors noted.
16–17 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Content is somewhat organized, logical and with correct grammar, punctuation, spellin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and sentence structure are correct. APA formattin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is somewhat apparent but CCN template was not
utilized. References are properly cited within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the paper; reference page in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes all citations; proper title page and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduction are present and evidence of spell check and grammar check are not
obvious. Seven to 10 errors noted.
14–15 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Content is disorganized and writin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing has numerous grammar, spellin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, or syntax errors and APA formattin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing errors are obvious. Spell check and grammar check are not obvious. More than 11
errors noted.
0–13 poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints
Total Poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Possible= 225 Poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ints Earned = A quality assignment will meet or exceed all of the above requirements.
Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman text readin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing Pages 118-127
PROFESSIONAL NURSING PRACTICE WITHIN NURSING CARE MODELS
The American Nurses Association (2004) defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ines nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing as “the protection, promotion, and optimization of health and abilities, prevention of illness and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">injury, alleviation of sufferin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing through
the diagnosis and treatment of human response, and advocacy in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the care of in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individuals, families, communities, and populations” (p. 7). The American Organization of Nurse Executives (AONE)
emphasizes the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing with patient population as the central core (2005).
• The core of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is knowledge and carin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. (evidence-based practice and patient-centered care)
• Care is user-based. (patient-centered care)
• Knowledge is access-based. (evidence-based practice)
• Knowledge is synthesized. (evidence-based practice; in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">informatics; quality improvement)
• Relationships of care presence-virtual. (patient-centered care)
• Managin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the journey (in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional teams)
The items in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in italic describe how each of the AONE elements relate to the five IOM core competencies. These are all in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interrelated. Also all of these elements have been discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in earlier chapters
or will be discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in later chapters as they are critical aspects of leadership and management. Intertwin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ined within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in these critical elements is the recognition of the importance of autonomy,
responsibility, delegation, and accountability.
“Autonomy in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing occurs whenever a nurse makes an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">independent judgment about the presence of a clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical issue and then provides the resolution to nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care” (Ritter-Teitel,
2002, p. 32). Autonomy requires competence and skills that focus on the nurse–patient relationship. It also means that there needs to be an organized assessment method to determin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ine patient care
needs and reassignin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff. Nurses also have the right to consult with others as professionals when they provide or manage care. Autonomy, control, and decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing are related. “Professional
practice implies control over the terms of the work but also control over its content and regulation of its standards” (Ritter-Teitel, 2002, p. 33). Nurses who feel that they have autonomy know
that they have the right to make decisions in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in their daily practice and also actively participate in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in developin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing organizational policy and change. Staff autonomy, however, does not work in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
organizations in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in which leaders are authoritarian and when centralized decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and control are key characteristics of the organization. This situation will quickly lead to conflict. In
addition, the work environment must be conducive to collaboration with physicians and all relevant staff, as is discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Chapter 12. “Responsibility refers to bein" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing entrusted with a particular
function” (Ritter-Teitel, 2002, p. 34). A nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice model that does not address responsibility will not be effective. Along with this is the need to clearly recognize the importance of
delegation. “Delegation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involves transferrin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing responsibility for the performance of the task from one person to another” (Ritter-Teitel, 2002, p. 34). Delegation is discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in more detail in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
Chapter 14. Accountability is a term that is typically found in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in job descriptions and descriptions of organizational structure. In nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing it is particularly important to recognize that
“accountability is the acceptance of responsibility for the outcomes of care” (Ritter-Teitel, 2002, p. 34). Nurses need to know that when they provide patient care their work has relevance—it must
reach outcomes. Magnet hospitals are discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Chapter 6 as examples of organizations that exemplify these characteristics.
The AONE elements and these characteristics, such as accountability, need to be considered when nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice models are assessed. Models of care are developed to support or enhance professional
practice, and by considerin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing these elements and characteristics the models will be more effective. Within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a health care organization, how do nurses provide nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care? What is a model of care?
Are these elements found in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the model? “A model of care is a configuration of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice or pattern of delivery” (Ritter-Teitel, 2002, p. 35). Models might also be called nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing or patient
care delivery systems. These models have undergone major changes over the last several decades. Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice models have been used to implement resource-in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intensive strategies with the goal of
decreasin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing expenses and usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff more effectively. These practice models establish organizational frameworks that provide nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff opportunities to become more committed to their practice
and to be more in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing (Upenieks, 2000, p. 330). A review of multiple nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care models (Beattle, 2009) in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">indicates that many models have common themes:
• Elevatin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the role of nurses and transitionin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing from caregivers to “care in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrators”
• Takin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing a team approach to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional care
• Bridgin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuum of care outside of the primary care facility
• Defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the home as a settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing of care
• Targetin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing high users of health care, especially older adults
• Sharpenin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing focus on the patient, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing an active engagement of the patient and his or her family in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in care plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and delivery, and a greater responsiveness to patient wants and needs
• Leveragin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing technology
• Improvin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing satisfaction, quality, and coast
Others have identified the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing elements that are still relevant today (Brennan, Anthony, Jones, & Kahana, 1998): contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuity of care, participation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in management, collaboration, leadership,
learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing environment, nurse’s role, staffin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing communication, specialization, orientation of temporary staff, and team commitment. O’Rourke (2006) believes that buildin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the professional role is
important and describes a professional practice model with a professional role development emphasizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing self-direction and decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, evidence-based practice, role-based transfer of knowledge,
and role-based provision of care. See Chapter Media Lin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inks for access to website describin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the O’Rourke model.
Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing models“provide an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">infrastructure that decreases variation among nurses, the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interventions they will choose, and, ultimately, patient outcomes. Conceptual frameworks also differentiate
forward thin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing organizations from those where nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing has less of a voice” (Kerfoot, et al., 2006, p. 20). Models help to identify and describe nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care. The IOM emphasis on the five core
competencies could be used for a model and as newer models are discussed later it is easy to see how these five competencies are the key elements of health care delivery. Kimball and Joynt (2007)
identify key factors drivin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innovation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in health care delivery. These factors are described in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Figure 4-2.
HISTORICAL PERSPECTIVE ON NURSING MODELS
The followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is a description of common models, some of which have undergone many changes over the years or are not used anymore, but they have had an impact on newer models. In addition, how
models are implemented in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in an organization can be highly variable.
TOTAL PATIENT CARE/CASE METHOD
In this model, which is the oldest, the registered nurse is responsible for all of the care provided to a patient for a shift. A major disadvantage of this model is the lack of consistency and
coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inated care when care is provided in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in 8-hour segments. This type of care is rarely provided today, except among student nurses who are assigned to
FIGURE 4-2 WHAT IS DRIVING INNOVATION?
Source: Kimball, B. & Joynt, J. (2007). The quest for new in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innovative care delivery models. JONA, 37(9), 392–398. Reprin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inted with permission.
provide all of the care for a patient durin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the hours that they are in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical. Even in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in this case, the students frequently do not provide all of the care as they may not be qualified to do this
and a staff nurse main" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ins overall responsibility for the care. Home health agencies use a form of this model when nurses are assigned patients and provide all the required home care; however,
even this has been adapted as more home care is provided by a team. An RN may coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inate the care and provide professional nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing services, but a home care aide may provide most of the direct care
and other providers such as a physical therapist, dietician, and social worker may be required for specialty care.
FUNCTIONAL NURSING
The model of functional nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is a task-oriented approach, focusin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing on jobs to be done. When it was more commonly used, it was thought to be more efficient. The nurse in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in charge assigned the tasks
(e.g., one nurse may admin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inister medications for all patients on a unit; an aide may take vital signs for all patients). A disadvantage of this model is the risk of fragmented care. In addition,
this type of model also leads to greater staff dissatisfaction with staff feelin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing they are just grin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">indin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing out tasks. Individualized care may also be compromised when patient care is provided by
different staff members who may or may not be aware of other needs and the care provided by others. This model is not used much now. It can be found in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in some long-term care facilities and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in some
behavioral/psychiatric in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inpatient services, although in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a modified form. In the latter situation a registered nurse may be assigned the task of medication admin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inistration for the unit, and
psychiatric support staff may be assigned such tasks as vital signs and checks of all patients. In this situation, RNs would still be assigned to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual patients to coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inate their care.
TEAM NURSING
Team nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, developed after World War II when there was a severe nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing shortage as well as major changes in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in medical technology, replaced functional nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. A nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing team consists of an RN,
licensed practical nurses (LPNs), and nurse aides. This team of two or three staff provides total care for a group of patients durin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing an 8- or 12-hour shift. The RN team leader coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inates this
care. In this model the RN has a high level of autonomy and assumes the centralized decision-makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing authority. Although the past approach to team nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing was thought to use decentralized decision
makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing with decisions made closer to the patient, there actually was limited team member collaboration. In addition, these teams tended to communicate only among themselves and not as well with
physicians. The team concept or model also focused on tasks rather than patient care as a whole. More current versions of the team model are different from this earlier type. Currently, the team
model has been changed to meet changes in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in organizations and leadership correspondin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing to the needs for better consistency and contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuity of care, as well as collaboration and coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination.
PRIMARY NURSING
In the late 1970s care became more complex, and nurses were dissatisfied with team nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. In the primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing model the primary nurse, who can only be an RN, provides direct care for the
patient and the family; an associate nurse provides care followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the care plan developed by the primary nurse when the primary nurse is not workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and assists when the primary nurse is workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
The primary nurse needs to be knowledgeable about assigned patients and must main" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a high level of clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical autonomy. When primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing was first used and well-accepted it was easier to
substitute RNs for other health care providers as cost was not as much of a focus as it is today. When the nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing shortage began to reoccur and salaries in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increased, implementin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing
became more difficult, and health care cost moved to the top of the concerns. There was, however, no research data to support that primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing was more expensive than team nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, but many
hospitals nonetheless felt it was (Gardner, 1991; Gardner & Tilbury, 1991; Glandon, Colbert, & Thomason, 1989; Shukla, 1983). Primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is often viewed as a model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in which the primary nurse
has to do everythin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, limitin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing collaborative or team effort, although it does not have to be implemented in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in this way.
Second-generation primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing clarifies some of the issues about this practice model. One of the critical problems with primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing was whether or not it required an all-RN staff, which was
thought to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increase staff costs. The second-generation view of primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing noted that the mix of staff is more important than havin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing an all-RN staff. Another concern with primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing was a
need to develop a clear defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inition of 24-hour accountability, which was in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interpreted by some as 24-hour availability. This, of course, is not a reasonable approach, and it really does not apply to
primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. When the primary nurse is not workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, the associate nurse provides the care. Primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is a responsibility relationship between the nurse and the patient. The primary nurse
is not the only caregiver but does have responsibility for plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the care and ensurin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing that care outcomes are met. Only registered nurses can be primary nurses. This role and the model require
RNs who are competent and possess leadership skills. Primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is not used as much today.
CARE AND SERVICE TEAM MODELS
In the 1980s, care and service team models began to replace primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. These models are implemented differently in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in different hospitals, as is true of most of the models. Key elements of these
models are empowered staff, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional collaboration, skilled workers, and a case management approach to patient care—all elements related to the more current views of leadership and
management (Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, 2011). Care and service teams in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">introduced the different categories of assistive personnel (for example, multiskilled workers, nurse extenders, and UAP). There has been some
disagreement as to whether these new staff member roles were complementary or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved substitution of professional nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care.
COMPLEMENTARY MODELS
Complementary modelsbegan in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in 1988 by usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing nurse extenders, such as a unit assistant, who would be responsible for environmental functions. The nurse would then have more time for direct patient
care. Does this reduce costs? Certain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inly, when nurse positions are changed to nurse extender positions there is some cost reduction; however, some hospitals found that overtime, sick time, and on-
call costs rose, particularly with nurse extender staff (Powers, Dickey, & Ford, 1990). Another example is Manthey’s (1989) partners-in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in-practice. Technical assistants signed a partnership agreement
to work with an experienced RN. Reduction in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in costs was in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">initially seen with this model because each partnership could care for the same number of patients as two RNs. Staffin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing costs, however,
contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inued to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increase. Complementary models are not used as much today and have been replaced by substitution models in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in health care organizations. Substitution models tend to use multiskilled
technicians to perform select nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing activities. The RNs supervise these activities.
Another approach is cross-train" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. This in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involves train" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff to work in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in different specialty areas or to perform different tasks. For example, a respiratory therapist may be train" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ined not only to
perform typical respiratory therapist tasks but also phlebotomy and basic nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care. This offers much more flexibility in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in that staff can fulfill many different needs. They can then be used as
staffin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing adjustments are needed for changes in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in patient census or acuity. It is critical that this cross-train" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing meet patient needs so that staff will be able to deliver quality, safe care and not
feel undue stress while deliverin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the care. It is also important that state practice act requirements are met, and this is not always easy to accomplish. It requires education staff to provide
support, ongoin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing educational train" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and documentation of competencies, as well as management staff who understands which staff members are qualified to move from area to area. Hospitals and
other health care organizations are tryin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing to fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ind the best methods for usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing substitution without compromisin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing quality and safety and yet control costs. As demands change, different models will be
required, and nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing leadership to develop these models will be critical.
As with earlier team models, the RN must spend time coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inatin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care and the work. The focus of the team is on patient-centered care as opposed to the nurse–patient relationship. The Case
Management Society of America (CMSA) defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ines case management as “a collaborative process of assessment plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, facilitation and advocacy for options and services to meet an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual’s health
needs through communication and available resources to promote quality cost-effective outcomes” (2002, p. 1). Case management is based on the assumption that patients with complex health problems,
catastrophic health situations, and high cost medical conditions need assistance in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the health care system effectively and a case manager can help patients with these needs (Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, 2011).
Case managers may also work with the teams to achieve outcomes, which in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increases shared accountability. Case management can be viewed as a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing model when the case manager is a nurse; however, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
some organizations nurses are not used as case managers but rather other health care professionals such as social workers are the case managers. “Case management is not a profession but rather a
collaborative and trans-disciplin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inary practice” (Commission for Case Management Certification, 2009, p. 1). Several health care professional organizations and experts have defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ined case management;
however, there clearly is no universally accepted defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inition for case management. Case management is used in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in many different types of settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings, and the settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing also affects the defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inition
(Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, 2010).
CARE MANAGEMENT MODEL
The care management model focuses on the needs of the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrated delivery system. It has many similarities to case management, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in that it in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, assessment, and coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination of health
services. The patient focus, however, is population-based in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">instead of based on an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual patient. The population might be people who live in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a specific geographic area, members of a health
in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">insurance plan, or could be a specific group with similarities, such as patients with diabetes. The goal is to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrate a contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuum of clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical services. Care management is not only concerned with
medical care but also health promotion and disease prevention, costs, and use of resources. Case management is often used within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the care management model. Typical tools used to facilitate care
management are clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical pathways, disease management programs, and benchmarkin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
NEWER NURSING MODELS
INTERDISCIPLINARY PRACTICE MODEL
The in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interdisciplin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inary or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional practice model is emphasized in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the IOM reports on quality improvement by identifyin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the importance of all health professions meetin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the
in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interdisciplin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inary or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional competency emphasizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the need to work in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional teams “to cooperate, collaborate, communicate, and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrate care in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in teams to ensure that care is
contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuous and reliable” (2003, p. 4). These teams in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">include providers from different health care professions and occupations designed to meet the required patient needs. With in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increasin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing complex
patient care needs this model is better able to address needs and to effectively use a mix of expertise and knowledge to reach patient outcomes. Patient-centered care is the focus. The advantages
of usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional teams are as follows (Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman & Kenner, 2010, p. 337):
• Decreased fragmentation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a complex care system
• Effective use of multiple expertise (e.g., medicin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ine, nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, pharmacy, allied health, social work, and so on)
• Decreased utilization of repetitive or duplicate services
• Increased creative or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innovative solutions to complex problems
• Increased learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing for team members about different roles and responsibilities, communication and coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination, and how to better plan care
• Provides motivation and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increased self-esteem in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in team and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual performance
• Greater sharin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing of responsibility
• Empowers members to speak up
SYNERGY MODEL OF PATIENT CARE™
This model of care was developed by the American Association of Critical Care Nurses, but it has been applied in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in all types of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing units. “Synergy results when the needs and characteristics of a
patient, clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical unit, or system are matched with a nurse’s competencies” (American Association of Critical Care Nurses, 2009). Patient characteristics in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">incorporated in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">into this model are as follows
(American Association of Critical Care Nurses, 2009):
• Resiliency: the capacity to return to a restorative level of functionin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing usin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing compensatory/copin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing mechanisms; the ability to bounce back quickly after an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">insult
• Vulnerability: susceptibility to actual or potential stressors that may adversely affect patient outcomes
• Stability: the ability to main" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a steady-state equilibrium
• Complexity: the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intricate entanglement of two or more systems (e.g., body, family, therapies)
• Resource availability: extent of resources (e.g., technical, fiscal, personal, psychological, and social) the patient/family/community brin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings to the situation
• Participation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in care: extent to which patient/family engages in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in aspects of care
• Participation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing: extent to which patient/family engages in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing
• Predictability: a characteristic that allows one to expect a certain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in course of events or course of illness
The Synergy model ties the above patient characteristics with the followin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing nurse competencies (American Association of Critical Care Nurses, 2009).
• Clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical judgment: clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical reasonin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, which in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, critical thin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, and a global grasp of the situation, coupled with nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing skills acquired through a process of
in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integratin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing formal and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">informal experiential knowledge and evidence-based guidelin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ines.
• Advocacy and moral agency: workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing on another’s behalf and representin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the concerns of the patient/family and nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff; servin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing as a moral agent in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in identifyin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and helpin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing to resolve
ethical and clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical concerns within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in and outside the clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
• Carin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practices: nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing activities that create a compassionate, supportive, and therapeutic environment for patients and staff, with the aim of promotin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing comfort and healin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and preventin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing
unnecessary sufferin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing. Includes, but is not limited to, vigilance, engagement, and responsiveness of caregivers, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing family and health care personnel.
• Collaboration: workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing with others (e.g., patients, families, health care providers) in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a way that promotes/encourages each person’s contributions toward achievin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing optimal/realistic
patient/family goals. Involves in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intra- and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional work with colleagues and community.
• Systems thin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing: body of knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient/family and staff, within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in or across health care and
non–health care systems.
• Response to diversity: the sensitivity to recognize, appreciate, and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">incorporate differences in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">into the provision of care. Differences may in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">include, but are not limited to, cultural differences,
spiritual beliefs, gender, race, ethnicity, lifestyle, socioeconomic status, age, and values.
• Facilitation of learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing: the ability to facilitate learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing for patients/families, nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff, other members of the health care team, and community. Includes both formal and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">informal
facilitation of learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
• Clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inquiry (in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innovator/evaluator): the ongoin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing process of questionin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and evaluatin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice and providin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">informed practice. Creatin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice changes through research utilization and
experiential learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing.
PRIMARY CARE TEAM
The Primary Care Team (PCT) is a model that emphasizes differentiated nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing practice from a team perspective (Kimball & Joynt, 2007). The team in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includes an RN care manager, RN or LPN/LVN provider,
and clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical assistant. The patient is actively in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the care process. The team prin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inciples are as follows (Kimball & Joynt, 2007. p. 394):
• Every patient deserves an experienced RN.
• Every novice nurse deserves mentorin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing from an experienced RN.
• Every patient deserves the opportunity to participate in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing of his or her care.
• Every team member is committed to meet the needs of every patient assigned to the team.
• Each PCT member functions within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in his or her defin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ined scope of practice/experience.
• Work in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intensity decreases with improved work distribution processes and team support.
• The model of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care delivery is an important element in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in patient safety and patient, staff, and physician satisfaction.
COLLABORATIVE PATIENT CARE MANAGEMENT MODEL
The Collaborative Patient Care Management Model is an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional, population-based case management model (Kimball & Joynt, 2007). The model focuses on high risk, high volume, and high cost
populations. The team is co-coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inated by a physician and an RN patient care coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inator. The RN leads rounds, and there is an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional plan. This model has been used in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in acute care and
outpatient settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings across the contin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inuum of care services.
TRANSITIONAL CARE MODEL
This model focuses on providin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing “comprehensive in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in-hospital plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, care coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination, and home follow-up for high-risk elders” (Kimball & Joynt, 2007, p. 395). Nurse practitioners lead this model
to ensure that the elders receive the care that they need, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">includin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing post-hospitalization. The model has had a positive impact on decreasin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing time between readmissions, number of readmissions, and
total health care costs. With the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increasin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing number of elders this type of model will become more important.
PATIENT NAVIGATION
Patient Navigation is a model that has primarily focused on patients with cancer who are at risk for poor cancer outcomes though other types of patients populations have also benefited from patient
navigation (Wells et al., 2008). Clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical nurse leaders often hold the position of nurse navigator. Patient navigation focuses on decreasin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing barriers to better ensure that patients get the care
they need when they need it (Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, 2011). This mode is “an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intervention designed to reduce health disparities by addressin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing specific barriers to obtain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing timely, quality health care” (Wells
et al., 2008, p. 2010).
TRANSFORMATIONAL MODEL FOR PROFESSIONAL PRACTICE
This model in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">integrates patient care services (Beckman Institute for Innovation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Patient Care, 1998 as cited in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Wolf, Hayden, & Bradle, 2004). The model has four components: (1) professional
practice: assessment and activation of professional practice relationships, and support with emphasis on transformational leadership, care delivery system, professional growth, and collaborative
practice; (2) the process component: engagement in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in purposeful and deliberate critical thin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, negotiation, and decision-makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing; (3) the primary outcome component: reach targeted outcomes (quality
improvement, patient satisfaction, caregiver satisfaction); and (4) the strategic outcome component: consumer, organizational, professional health).
THE QUALITY-CARING MODEL©
This model emphasizes carin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and evidence-based practice with an emphasis on structure-process-outcomes as dimensions of quality care (Duffy & Hoskin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ins, 2003). It addresses concerns about the need
to build relationships with patients and families—cooperative, collaborative relationships. This is described as nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing’s work rather than a focus on a task oriented biomedical model.
Nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care delivery models have changed over the years due to economic factors, staffin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing shortages or excesses, philosophy and goals, nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing research, tasks that need to be accomplished,
technology, in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">information management, scientific advancements, and new leadership and organization theories and styles. Some models have disappeared (for example, functional nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing). Another example
of a model that is used less often is primary nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, which was popular in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in many areas of the country, but is not used as much now, primarily due to costs and the RN shortage. The total patient
care or case method, although rarely used, may still be used in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in critical care settin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ings and home care, although even here there is a movement toward in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">interprofessional care. Why have the changes
occurred? Some nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing care can be done by others more cost effectively and still be safe, quality care, and staff are available to do these tasks, such as LPNs/LVNs or UAP. Typically, a hospital
will use a combin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination of models.
CASE STUDY DOES A NURSING MODEL MAKE A DIFFERENCE?
As Director of Staff Development in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in a large university hospital, the Chief Nurse Executive (CNE) has met with you to discuss orientation for student nurses and faculty. The CNE is concerned that
students and faculty do not understand the hospital’s new nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing model, Synergy model of patient care™. She tells you it is your job to correct this problem. You leave the meetin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing overwhelmed.
This seems like a big responsibility to you. The hospital has many nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing students from three schools of nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing that use its services for practicum. All have to attend a 4-hour orientation to the
hospital, which is already overburdened with content. The units have also been strugglin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing with applyin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the model sin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ince it was in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">initiated 6 months ago.
QUESTIONS
1. Why is it important for the students and faculty to understand the model?
2. How does the nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing model relate to the organization’s theory or approach?
3. How would you describe this model? Consider methods and examples.
4. Develop a plan that you will submit to the CNE explain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing how you will address this problem. Who might you in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">include in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in developin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the plan and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in implementin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing it?
SHARED GOVERNANCE
“Governance, or self-regulation, has long been recognized as a privilege given to professions that earn the public trust by demonstratin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing accountability for their specialized practices” (Maas &
Specht, 2001, p. 318). How does this relate to shared governance? As a nursin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing management form, shared governance emphasizes nurses’ roles and responsibilities in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing (Anthony, 2004;
Hess, 2004). It thus in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">increases each nurse’s in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">influence over the organization, empowerin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing staff and is based on six dimensions of governance.
1. Control over professional practice
2. Influence over organizational resources that support practice
3. Formal authority granted by the organization
4. Committee structures that allow participation in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing
5. Access to in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">information about the organization
6. Ability to set goals and negotiate conflict
Shared governance can be viewed as a management philosophy, a professional practice model, and an accountability model that focuses on staff in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involvement in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, particularly in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
decisions that affect their practice. In doin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing this the model provides staff with autonomy and control over implementation of their practice—legitimizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing control over their own practice. Nurses in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
these organizations usually feel less powerless and are more efficient and accountable.
A critical factor in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in shared governance is that accountability and responsibility are found in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the same person. Accountability should rest in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the person who is most likely to be the most effective
person to complete the function. For in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual staff to be accountable and responsible for a function or task, staff must also have the authority to make sure that the right decisions are made.
“Within" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the professional context, then, the statement that the professional is accountable for his or her practice has meanin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing only when the necessary authority, which is part of that
accountability, is transferred to the in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">individual who assures compliance and who is capable of takin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing corrective action in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the absence of compliance” (Porter-O’Grady & Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">innigan, 1984, p. 80).
Shared governance is also a surrogate term for collaboration. “It is an organizational arrangement with a highly participatory staff empowered to function cooperatively with both management and
colleagues, and leadership that empowers staff. The organization can be referred to as a learnin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing organization” (Sullivan, 1998, p. 471). Transformational Leadership enhances shared governance. As
was discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in Chapter 1, an important element of leadership is self-awareness, and it is important in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in shared governance. In this type of organizational arrangement staff members feel committed
to the organization and consider themselves to be partners in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in meetin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the goals of the organization. Staff members should not feel that they are workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing alone, but rather workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in teams to meet
specific goals (Hess, 2004).
In shared governance nurse managers typically are not directly in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in daily direct patient care, although there are some managers who are still in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in direct care. The typical
responsibilities of the nurse manager are staffin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, program evaluation, personnel evaluation, coordin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination, allocation of resources, fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inancial activities, and long-range plannin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing discussed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in
Chapter 1. If patient care outcomes are not met, it is the responsibility of the nurse providin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the care to address this issue. The nurse manager may become in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">involved, but it is the direct care
provider who should take the lead. Clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical practice is the responsibility of the practitioners. When clin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inical problems occur, the nurse who provides direct care must be the one to solve these
problems, workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing with the care team. The main" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in factor in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in shared governance is that decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is spread over a larger number of staff and is decentralized. Nurses are accountable for their
practice. Health care organizations that use shared governance must have clear communication processes, or the organization will encounter problems and confusion in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the decision-makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing process.
Typically, this model leads to greater staff satisfaction with the job and the organization—staff feels empowered (Caramanica, 2004). The key components of shared governance are practice, quality,
education, and peer process/governance. How are these accomplished? As with any such change, some organizations change for “real” and others appear to change to this model, but in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the latter
situation very little has really changed in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the decision-makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing process or in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in actual practice. Shared governance is associated with collaboration, horizontal relationships, and in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">investment and need
to be demonstrated in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in the organization. The change has to be real.
Organizations that use this model have some type of structure that relates to the shared accountability, such as councils, cabin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inets, committees, or a combin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ination of these groups or teams that make
the decisions. The chain" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in of command is not the same as in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in traditional organizations. In the shared governance model these groups make decisions about policies, procedures, and other aspects of
gettin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing the work done. How might shared governance be implemented?
Health care organizations have been workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing for several years to create leaner and more effective organizations. It is important to recognize that to move toward a shared governance model the
organization must take a comprehensive change approach and not an in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">incremental approach. All parts of the organization and all staff must be expected to change. This is very difficult to accomplish,
but if shared governance is the goal, it is necessary.
Decentralized decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is now found in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in many health care organizations, and it is frequently associated with participative management strategies such as a shared government model. This
approach to organizational structure and process is associated with the economy, job satisfaction, and retention. For decentralization to be effective staff must have autonomy to make decisions.
All of this is in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">intimately connected with shared governance. It requires staff members who are committed to the organization’s values and goals and demonstrate this by workin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing to meet the goals.
Magnet hospitals also share these common shared governance characteristics (see Chapter 6). “Whatever the process of changin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing structure, locus of control, decision processes, and team-based
in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">initiatives are called, they are essential to the future of doin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing health services busin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">iness. From shared governance to shared leadership, shared decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing, empowerment, poin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">int-of-service
accountability, or whatever other name might be attached to the dynamic, shared decision makin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing is an essential element of work of reconceptualizin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing and configurin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">ing health care for the future”
(Porter-O’Grady, 2001, p. 473).
Fin" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">in" rel="nofollow">inkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care (2nd ed.). Boston, MA: Pearson.
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