Nursing Care Model Assignment
The purpose of this assignment is to identify nursing care models utilized in today's various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation. You will assess the effectiveness of models and determine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and staff satisfaction.Nursing Care Model Assignment
Completion of this assignment enables the student to meet the following course outcomes.
CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)
CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)
CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)
CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7)Nursing Care Model Assignment
CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3)
CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)
Submit by Sunday, 11:59 p.m. MT, end of Week 5.
You are required to use the assignment specific item(s) (article/systematic review/topic/form/templates) or you will earn a "0" for the assignment. In addition, assignments that do not follow the current guidelines or use the required item, as defined above, will be evaluated for evidence of an academic integrity violation.
After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. This includes blank, incomplete, incorrect file, and/or incorrect file format documents. It is your responsibility to submit the correct completed assignment in the correct format to the correct submission area. Your last submission before the due date will be graded.Nursing Care Model Assignment. You may not resubmit after the due date with a different file and incur a late deduction per the Late Assignment policy.
This assignment is worth 200 points.
- Read your text, Finkelman (2016), pp- 111-116. SEE BELOW
- Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.
- Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model.
- Write a 5-7 page paper. Not including the title or References pages
- You are required to complete the assignment using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the ".docx" format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREEby downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page.
- Review and summarize two scholarly resources (not including your text) related to the nursing care model you observed in the practice setting.
- Review and summarize two scholarly resources (not including your text) related to a nursing care model that is differentfrom the one you observed in the practice setting.
- Discuss your observations about how the current nursing care model is being implemented. Nursing Care Model Assignment.Be specific.
- Recommend a differentnursing care model that could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.
- Provide a summary/conclusion about this experience/assignment and what you learned about nursing care models.
- Write your paper using APA format using Microsoft Office 2010 or later.
- Submit your paper no later than 11:59 p.m. MT on Sunday by the end of Week 5.
Please see the grading criteria and rubrics on this page.
, Finkelman (2016), pp- 111-116 is Below
Professional Nursing Practice within Nursing Care Models
The American Nurses Association (2010) defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (66). The American Organization of Nurse Executives (AONE) assumptions for future patient care delivery include the following:
- Assumption 1: The role of nurse leaders in future patient care delivery systems will continue to require a systems approach with all disciplines involved in the process and outcome models.
- Assumption 2: Accountable Care Organizations will emerge and expand as key defining and differentiating healthcare reform provisions that will impact differing care delivery venues.Nursing Care Model Assignment
- Assumption 3: Patient safety, experience improvement and quality outcomes will remain a public, payer and regulatory focus driving work flow process and care delivery system changes as demanded by the increasingly informed public.
- Assumption 4: Healthcare leaders will have knowledge of funding sources and will be able to strategically and operationally deploy those funds to achieve desired outcomes of improved quality, efficiency, and transparency.
- Assumption 5: The joint education of nurses, physicians, and other health professionals will become the norm in academia and practice promoting shared knowledge that enables safer patient care and enhancing the opportunity for pass-through dollars to apply to APRN residencies and/or related clinical education (2010, pp. 1–3).
The five NAM core competencies are interrelated with these assumptions. Also, all of these elements have been discussed in earlier chapters or will be discussed in later chapters, as they are critical aspects of leadership and management. Nursing Care Model Assignment.Intertwined within these critical elements is the recognition of the importance of leadership, autonomy, responsibility, delegation, and accountability.
Autonomy, which focuses on an individual’s ability to make decisions, requires competence and skills that focus on the nurse–patient relationship. It also means that there needs to be an organized assessment method to determine patient care needs and reassigning staff. Nurses also have the right to consult with others as professionals when they provide or manage care. Autonomy, control, and decision making are related, and state Nurse Practice Acts reflect on nurse autonomy. Nurses who feel that they have autonomy know that they have the right to make decisions in their daily practice and also actively participate in developing organizational policy and change. Staff autonomy, however, does not work in organizations in which leaders are authoritarian and when centralized decision making and control are key characteristics of the organization.Nursing Care Model Assignment. 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 Chapter 13. A nursing 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 is discussed in more detail in Chapter 15. Accountability is a term that is typically found in job descriptions and descriptions of organizational structure. “It is related to answerability and to responsibility—judgment and action on the part of the nurse for which the nurse is answerable to self and others for those judgments and actions” (Fowler, 2015, p. 44). “Responsibility refers to the specific accountability or liability associated with the performance of duties of a particular nursing role and may, at times, be shared in the sense that a portion of responsibility may be seen as belonging to another who was involved in the situation” (Fowler, 2015, p. 44). Nurses need to know that when they provide patient care, their work has relevance—it must reach outcomes.
Accountability, autonomy, and responsibility need to be considered when nursing practice models are assessed. Nursing models of care are developed to support or enhance professional practice, and by considering these elements and characteristics, the models will be more effective. Within an HCO, how do nurses provide nursing care? What is a model of care? Are these elements found in the model?Nursing Care Model Assignment. Models might also be called nursing or patient care delivery systems. These models have undergone major changes over the past several decades. Nursing practice models have been used to implement resource-intensive strategies with the goal of decreasing expenses and using staff more effectively. Nursing models help to identify and describe nursing care. The NAM emphasis on the five core competencies could also 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 healthcare delivery.
Historical Perspective of Nursing Models
The following 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.
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 coordinated care when care is provided in eight-hour segments. This type of care is rarely provided today, except among student nurses who are assigned to provide all of the care for a patient during the hours that they are in clinical.Nursing Care Model Assignment. Even 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 maintains 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 teams provide more home care. An RN may coordinate the care and provide professional nursing 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.
The model of functional nursing is a task-oriented approach, focusing on jobs to be done. When it was more commonly used, it was thought to be more efficient. The nurse in charge assigned the tasks (e.g., one nurse may administer medications for all or some of the 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 feeling they are just grinding out tasks. Nursing Care Model Assignment.When different staff members provide care without awareness of other needs and the care provided by others, individualized care may also be compromised. This model is not used much now. It can be found in some long-term care facilities and in some behavioral/psychiatric inpatient services, although in a modified form. In the latter situation, a registered nurse may be assigned the task of medication administration for the unit, and psychiatric support staff may be assigned such tasks as vital signs and safety checks of all patients. In this situation, RNs would still be assigned to individual patients to coordinate their care.
This model was developed after World War II during a severe nursing shortage and other major changes in medical technology occurred. It replaced functional nursing. A nursing team consists of a registered nurse, licensed practical/vocational nurses, and UAP. This team of two or three staff provides total care for a group of patients during an 8- or 12-hour shift. The RN team leader coordinates this care. In this model the RN has a high level of autonomy and assumes the centralized decision-making authority.Nursing Care Model Assignment. Although the past approach to team nursing was thought to use decentralized decision making 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 and other healthcare providers. 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 shifts in organizations and leadership corresponding to the needs for better consistency and continuity of care as well as collaboration and coordination and patient-centered care.
In the late 1970s, care became more complex, and nurses were dissatisfied with team nursing. In the primary nursing model, the primary nurse, who must be an RN, provides direct care for the patient and the family; an associate nurse provides care following the care plan developed by the primary nurse when the primary nurse is not working and assists when the primary nurse is working. The primary nurse needs to be knowledgeable about assigned patients and must maintain a high level of clinical autonomy.Nursing Care Model Assignment. When primary nursing was first used, it was easier to substitute RNs for other healthcare providers as cost was not as much of a focus as it is today. Over time the nursing shortage changed and salaries increased. Implementing primary nursing then became more difficult, and healthcare cost moved to the top of the concerns. Primary nursing is often viewed as a model in which the primary nurse has to do everything, limiting collaborative or team efforts, although it does not have to be implemented in this way.
Second-generation primary nursing clarified some of the issues about this practice model. One of the critical problems with primary nursing was whether or not it required an all-RN staff, which was thought to increase staff costs. The second-generation view of primary nursing noted that the mix of staff was more important than having an all-RN staff. Another concern with primary nursing was a need to develop a clear definition of 24-hour accountability, which was interpreted by some as 24-hour availability. This, of course, is not a reasonable approach, and it really does not apply to primary nursing. When the primary nurse is not working, the associate nurse provides the care. Primary nursing is a responsibility relationship between the nurse and the patient. The primary nurse is not the only caregiver but does have responsibility for planning nursing care and ensuring 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 nursing is not used as much today.Nursing Care Model Assignment
Care and Service Team Models
In the 1980s care and service team models began to replace primary nursing. These models are implemented differently in different hospitals, as is true of most of the models. Key elements of these models are empowered staff, interprofessional collaboration, skilled workers, and a case management approach to patient care—all elements related to the more current views of leadership and management (IOM, 2011). Care and service teams introduced the different categories of assistive personnel (e.g., multiskilled workers, nurse extenders, and UAP). There has been some disagreement as to whether these new staff member roles were complementary or involve the substitution of professional nursing care.Nursing Care Model Assignment
Complementary models began in 1988 by using 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? When nurse positions are changed to nurse extender positions, there is some cost reduction, but this change can impact all nursing staff. Complementary models are not used as much today and have been replaced by substitution models in HCOs. Substitution models tend to use multiskilled technicians to perform select nursing activities, and the RNs supervise these activities.
Another approach is cross-training. This involves training staff to work in different specialty areas or to perform different tasks. For example, a respiratory therapist may be trained not only to perform typical respiratory therapist tasks but also phlebotomy and basic nursing care. This offers much more flexibility in that staff can fulfill many different needs. They can then be used, as staffing adjustments are needed for changes in patient census or acuity. It is critical that this cross-training meet patient needs so staff will be able to deliver quality, safe care and not feel undue stress while delivering the care.Nursing Care Model Assignment.. It is also important that state practice act requirements are met, and this is not always easy to accomplish. It requires HCO education staff to provide support, ongoing educational training, and documentation of competencies, as well as management staff that understand which staff members are qualified to move from area to area. Hospitals and other HCOs have tried to find the best methods for using substitution without compromising quality and safety and yet control costs. As demands change, different models will be required, and nursing leadership to develop these models will be critical.
Case Management Model
As with earlier team models, the RN must spend time coordinating care and the work. The focus of the team is on patient-centered care as opposed to the nurse–patient relationship. The case management model is based on the assumption that patients with complex health problems, catastrophic health situations, and high-cost medical conditions need assistance in using the healthcare system effectively, and a case manager can help patients with these needs (Finkelman, 2011). Case managers may also work with the teams to achieve outcomes, which increases shared accountability. Case management can be viewed as a nursing model when the case manager is a nurse; however, in some HCOs nurses are not used as case managers but rather other healthcare professionals such as social workers serve as case managers. Several healthcare professional organizations and experts have defined case management; however, there clearly is no universally accepted definition for case management. Case management is used in many different types of settings, and the setting also affects the definition.Nursing Care Model Assignment
Examples of Newer Nursing Models
Interprofessional Practice Model
The interprofessional practice model is emphasized in the IOM reports on quality improvement by identifying the importance of all health professions meeting the interdisciplinary or interprofessional competency and emphasizing the need to work in interprofessional teams “to cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable” (2003, p. 4). These teams include providers from different healthcare professions and occupations designed to meet the required patient needs. With increasing 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.Nursing Care Model Assignment
Synergy Model for Patient Care™
This model of care was developed by the American Association of Critical-Care Nurses, but it has been applied in all types of nursing units. The model recognizes the need to match the nurse’s competence with the patient’s characteristics, needs, and the clinical unit (American Association of Critical-Care Nurses, 2014). Patient characteristics incorporated into this model are as follows (American Association of Critical-Care Nurses, 2014):
- Resiliency: the capacity to return to a restorative level of functioning using compensatory/coping mechanisms; the ability to bounce back quickly after an insult
- Vulnerability: susceptibility to actual or potential stressors that may adversely affect patient outcomes
- Stability: the ability to maintain a steady-state equilibrium
- Complexity: the 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 brings to the situation
- Participation in care: extent to which patient/family engages in aspects of care
- Participation in decision making: extent to which patient/family engages in decision making
- Predictability: a characteristic that allows one to expect a certain course of events or course of illness
The Synergy model ties the above patient characteristics with the following nurse competencies (American Association of Critical-Care Nurses, 2014):
- Clinical judgment: clinical reasoning, which includes clinical decision making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experiential knowledge and evidence-based guidelines.
- Advocacy and moral agency: working on another’s behalf and representing the concerns of the patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting.Nursing Care Model Assignment
- Caring practices: nursing activities that create a compassionate, supportive, and therapeutic environment for patients and staff, with the aim of promoting comfort and healing and preventing unnecessary suffering. Includes, but is not limited to, vigilance, engagement, and responsiveness of caregivers, including family and healthcare personnel.
- Collaboration: working with others (e.g., patients, families, healthcare providers) in a way that promotes/encourages each person’s contributions toward achieving optimal/realistic patient/family goals. Involves intra- and interprofessional work with colleagues and community.
- Systems thinking: body of knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient/family and staff, within or across healthcare and nonhealthcare systems.
- Response to diversity: the sensitivity to recognize, appreciate, and incorporate differences into the provision of care. Differences may include, but are not limited to, cultural differences, spiritual beliefs, gender, race, ethnicity, lifestyle, socioeconomic status, age, and values.
- Facilitation of learning: the ability to facilitate learning for patients/families, nursing staff, other members of the healthcare team, and community. Includes both formal and informal facilitation of learning.
- Clinical inquiry (innovator/evaluator): the ongoing process of questioning and evaluating practice and providing informed practice. Creating practice changes through research use and experiential learning.
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 patient populations have also benefited from patient navigation (Wells et al., 2008). Clinical nurse leaders often hold the position of nurse navigator. Patient navigation focuses on decreasing barriers to better ensure that patients get the care they need when they need it (Finkelman, 2011). This model is “an intervention designed to reduce health disparities by addressing specific barriers to obtaining timely, quality healthcare” (Wells et al., 2008, p. 2010).
The ACA and New Models
The Future of Nursing (Institute of Medicine, 2011) includes content about transformational models of nursing across different care settings. The report notes there are some common themes from the examples reviewed. “In order to meet the challenges of the future, we must embrace technology, foster partnerships, encourage collaboration across disciplines and settings, ensure continuity of care and promote nurse-lead/nurse managed health care” (402). The ANA has also commented on the ACA and its potential impact on nursing models of care. The ANA notes, as do other sources such as the NAM, that the healthcare system is dysfunctional and fragmented. A major goal of the ACA is to rebalance the healthcare system’s resources by identifying several models of care, focusing on primary care, that might help to reach this goal (2010):Nursing Care Model Assignment
- Accountable Care Organization (ACO): Provides a collaborative model for primary care providers and specialists who work together to achieve quality care and control costs. ACOs that are successful receive financial incentives. ACOs are part of the Medicare Program. Providers may include MDs, APRNs, CNSs, and PAs.
- Medical/Health Homes: The focus in this model is on primary care providers coordinating patient care. Financial incentives as well as interprofessional teams may also be part of this model.
- Nurse-Managed Health Clinic (NMHC): This is a clinic that is managed by nurses that provides comprehensive primary care and wellness services and must be associated with a university/college/department of nursing, a federally qualified health center, or an independent nonprofit health or social services agency. This type of clinic is led by APRNs.
Shared Governance and Empowerment
Shared governance is an approach to management that engages staff at all levels in the decision-making process. This does not mean that there are inactive or ineffective leaders and managers, but rather they meet their management responsibilities by ensuring that staff are active in the processes, which increases each nurse’s influence over the organization, empowering staff.Nursing Care Model Assignment
Shared governance can be viewed as a management philosophy, a professional practice model, and an accountability model that focuses on staff involvement in decision making, particularly in decisions that affect their practice. In doing this, the model provides staff with autonomy and control over implementation of their practice—legitimizing control over their own practice. Nurses in these organizations usually feel less powerless and are more efficient and accountable.
A critical factor in shared governance is that accountability and responsibility are found in the same person. Accountability should rest in the person who is most likely to be the most effective person to complete the function. For 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.
Transformational leadership enhances shared governance. As was discussed in Chapter 1, an important element of leadership is self-awareness, and it is essential in shared governance. In this type of organizational arrangement, staff members feel committed to the HCO and view themselves
Case Study Does a Nursing Model Make a Difference?
You are the director of staff development in a large university hospital, and 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 nursing model, Synergy Model for Patient CareTM. She tells you it is your job to correct this problem. You leave the meeting overwhelmed. Nursing Care Model Assignment.This seems like a big responsibility to you. The hospital has many nursing students from three schools of nursing that use its services for practicum. All have to attend a four-hour orientation to the hospital, which is already overburdened with content, and the faculty and students have limited time for orientation. The units have also been struggling with applying the model since it was initiated six months ago.
- Why is it important for the students and faculty to understand the model?
- How does the nursing model relate to the organization’s theory or approach?
- How would you describe this model? Consider methods and examples.
- Develop a plan that you will submit to the CNE explaining how you will address this problem. Whom might you include in developing the plan and in implementing it?
as partners in meeting the goals of the HCO. In shared governance nurse managers typically are not directly involved in daily direct patient care, although there are some managers who are still involved in direct care. The typical responsibilities of the nurse manager are staffing, program evaluation, personnel evaluation, coordination, allocation of resources, financial activities, and planning, as discussed in Chapter 1. If patient care outcomes are not met, it is the responsibility of the nurse providing the care to address this issue. The nurse manager may become involved, but it is the direct care provider who should take the lead. In other words, clinical practice is the responsibility of the practitioners. When clinical problems occur, the nurse who provides direct care must be the one to solve these problems, working with the care team. The main factor in shared governance is that decision making is spread over a larger number of staff and is decentralized. Nurses are accountable for not only their management activities but also their practice. Healthcare organizations that use shared governance must have clear communication processes, or the organization will encounter problems and confusion in the decision-making process. The key components of shared governance are practice, quality, education, and peer process/governance.Nursing Care Model Assignment. How are these accomplished? As with any such change, some organizations actually change and others merely appear to change to this model, but in the latter situation, very little has really changed in the decision-making process or in actual practice. Shared governance is associated with collaboration, horizontal relationships, and investment, and these need to be demonstrated in the organization. The change has to be real, and typically when it is, staff are more satisfied.
Organizations that use this model require some type of structure that relates to the shared accountability, such as councils, cabinets, committees, or a combination of these groups or teams that make the decisions. The chain of command is not the same as in traditional organizations. In the shared governance model, these groups make many of the decisions about policies, procedures, and other aspects of getting the work done. How might shared governance be implemented?Nursing Care Model Assignment
Healthcare organizations have been working 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 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 making is now found in many HCOs, and it is frequently associated with participative management strategies such as a shared governance 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 intimately connected with shared governance. It requires staff members who are committed to the organization’s values and goals and demonstrate this by working to meet the goals.
Finkelman, A. (2016). Leadership and Management for Nurses: Core Competencies for Quality Care, 3rd Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323605547/
|Nursing Care Model in Practice
Identify Nursing Care Model in practice including specifics about who, what when, where, etc.
|Scholarly Sources Related to Nursing Care Model
In addition to Finkelman, locates four scholarly resources related to Nursing Care Models. Summarizes all resources in body of paper.Nursing Care Model Assignment
|Implementation and Recommendations
Describe implementation of current Nursing Care Model and recommend a different model that could be utilized to improve quality of nursing care, safety and staff satisfaction.
|Clarity of writing
Content is organized, logical, and with correct grammar, punctuation, spelling, and sentence structure are correct. APA formatting is apparent and CCN template is utilized. References are properly cited within the paper; reference page includes all citations; proper title page and introduction are present and evidence of spell and grammar check is obvious.
Week 5: Lesson
Core Competency: Apply Quality Improvement
Introduction—Nurse Leader Exemplar
Click on the play button to listen to a nurse exemplar described by our faculty.
Quality and Safety Initiatives
Quality and safety have been the focus of the Institute of Medicine (IOM) since the 1999 publication, To err is human: Building a safer health system. At that time, the IOM committee reported that 44,000 to 98,000 deaths were occurring in hospitals annually from preventable medical errors. Alarms sounded and the public quickly took notice. In response to the report, all organizations engaged in various activities to promote quality and safety.
How do we promote quality? Some of these activities include: problem solving to improve communication, integration of the IOM quality and safety standards into everyday practice, and dedication to the National Patient Safety Goals in healthcare as implemented by The Joint Commission (2017). Provider curricula were reviewed, and the performance of root cause analysis of errors and near misses became part of strategies. The result has been an improved work environment and increased nursing leadership in these areas.Nursing Care Model Assignment
Nursing is a key collaborative discipline in addressing patient quality and safety concerns. According to the study by Squires, Tourangeau, Spence-Laschinger, and Doran (2010), nurse leaders and managers create a positive safety climate through quality relationships based on fairness and empathy. It seems that the transformational leader, a leadership style introduced earlier in this course, would be driving quality and safety outcomes.
Inspiring Performance Improvement
PI (performance improvement), CQI (continuous quality improvement), TQM (total quality management), QA (quality assurance), QC (quality control), and QI (quality improvement) are all acronyms for programs and initiatives that have been used over the years to monitor the delivery of quality care. Are we dizzy yet with all these acronyms? For the purposes of this Nursing Care Model Assignment. lesson, we will concentrate on QI, or quality improvement. And, who should inspire others in these initiatives?
Inspiring quality improvement is a goal for all nurse leaders. It is geared toward unlocking individual potential and assisting staff to provide high quality, safe care at all times while continuously looking for ways to improve that care, as well as the environment where patients receive that care. QI is about inspiring change, a topic discussed in a previous lesson. Fostering an environment where change is encouraged and improvements are expected must be linked to the mission, vision, and values of the healthcare organization regardless of size, care delivery model, or geographic setting.
Quality and Safety Education for Nurses (QSEN)
In addition to the core competencies designated by the IOM, nursing education has placed an increasing emphasis on quality and safety through the Quality and Safety Education for Nurses (QSEN) initiative funded by the Robert Wood Johnson Foundation (2015). These should sound familiar to you. QSEN provides resources and strategies to facilitate learning as it relates to the five competencies of IOM plus safety.Nursing Care Model Assignment
- Patient-centered care
- Teamwork and collaboration
- Evidence-based practice
- Quality improvement
This initiative has provided nursing programs, as well as staff development and continuing education professionals with many tools to teach these six competencies. Visit http://www.qsen.org (Links to an external site.)Links to an external site. to review the prelicensure KSAs (knowledge, skills, and attributes or abilities) and graduate KSAs. While browsing the site, investigate the teaching strategies section to glean ideas about how to integrate QSEN competencies into your nursing education and staff education endeavors.
The Nurse Leader Ponders
“We have utilized several of these initiatives here. Most staff are involved but how do I need to get more of them involved? I wonder if QSEN was discussed in their nursing education programs. Perhaps this is the frame of reference I should use to get more buy in from the staff.” Nursing Care Model Assignment
Monitoring Organizational Performance
Just as a dashboard in a car tells you at a glance about its performance, so can a dashboard of the organization help you monitor its performance measures. A chart or electronic database can make it easy for the staff to see changes—either positive or negative—at a glance about what is working and what is not working (Hendren, 2009). Dashboards can be customized for a unit, department, division, or organization as a whole.
Anyone working in an acute care environment has probably heard of nurse-sensitive quality indicators. These have been profiled over the past few years as payment restrictions were instituted by the Centers for Medicare and Medicaid Services (CMS) in October of 2009.Nursing Care Model Assignment. Subsequently, insurance companies have followed suit. According to the Managed Care First Report (2011), the no-pay policy is an effort to reduce medical errors. This brought attention to nursing because many of the no-pay situations could be managed or controlled through nursing care. Since then, staffing levels and staff mix have become a major factor in measuring performance.
Lean Daily Management
Somewhat new to the quality scene is Lean Daily Management (LDM). What is it? It is a much disciplined process that gives staff the power to solve problems by providing them with the leadership support and various resources to make improvements in care. On a daily basis, staff make their concerns about workflow problems known to the executive (top) leadership in the organization. Nursing Care Model Assignment.A hallmark of the management process is the Safety Huddle. Many units/departments begin their day with a safety huddle which allows for identification and allocation of resources. Some of these resources can be staffing, acknowledging patient safety issues and concerns from various stakeholders. Prioritization of problems seems to be a hallmark of the safety huddle. Interestingly enough, this is led by the Chief Executive Officer. One cannot argue with a system that involves executive team involvement on a daily basis with the outcomes being directly related to patient safety and quality of care.
Leader’s Role in Just Culture
One cannot complete a lesson on Performance Improvement/Quality/Safety Initiatives without learning more about the term Just Culture. In early 2010 the American Nurses Association Board of Directors adopted its new position statement proposed by the Congress on Nursing Practice and Economics related to Just Culture (ANA, 2010). This updated position statement emphasized the support by the ANA of the Just Culture concept and how it is used in health care to improve safety.Nursing Care Model Assignment. The ANA continues to support collaboration of the various boards of nursing, professional nursing organizations, hospital associations and others in developing Just Culture initiatives. The just culture model (from the aviation industry) provides for an environment where one is encouraged to report mistakes instead of ignoring or hiding them. In this environment practitioners should not be accountable for failures related to systems over which they have no control. It operationalizes a non-blame principle where process improvement is the outcome. Prevention of future errors is a result.
The Nurse Leader’s role in promoting a Just Culture work environment cannot be overestimated. Staff need to know that patient safety is everyone’s responsibility, avoiding blame and supporting a culture of safety for patients, their families and the staff who provide the highest quality care for them.
“This has been a busy week but since my job is all about improving quality in home care, I found the topics very interesting. I still have much to learn and I may share some of this with my Nurse Leader. I know I have one more Assignment to complete but that is not until the end of next week. I have not done a PowerPoint assignment….ever…so I need to use the website that was recommended by my instructor and get started on this.”Nursing Care Model Assignment
This week, we broached the subject of quality improvement, an issue that faces nurses in all practice settings. This core competency is important to all nurses, especially nurse leaders. QSEN was introduced as an initiative providing resources for nurse educators. And, Lean Daily Management and Just Culture were introduced. Becoming more familiar with these topics is important. The emphasis on safety in today’s healthcare environment cannot be ignored. Our patients are counting on us.
Weekly Lesson - References
American Nurses Association. (2010). Position statement: Just culture. ANA. Retrieved from http://nursingworld.org/psjustculture
Centers for Medicare & Medicaid Services (CMS). (2011). CMS is the latest to deny payment for hospital-acquired conditions. Managed Care First Report Daily News. Retrieved from http://www.mccfirstreport.com/show_story.php?newsid=6697
Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.
Hendren, R. (2009). Dashboards help nurses respond to quality data. Health Leaders Media. Retrieved from http://www.healthleadersmedia.com/content/NRS-241918/Dashboards-Help-Nurses-Respond-to-Quality-Data
Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://nationalacademies.org/hmd/reports/1999/to-err-is-human-building-a-safer-health-system.aspx
Quality and Safety Education for Nurses (QSEN). (2015). Competencies. QSEN. Retrieved from http://qsen.org/competencies/
Squires, M., Tourangeau, A., Spence Laschinger, H. K., & Doran, D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management, 18(8), 914–925.
The Joint Commission. (2017). National Patient Safety Goals. TJC. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx .Nursing Care Model Assignment