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Identify the nursing care delivery model in this case study and describe its effectiveness. The nursing care delivery model identified in this case study is the primary nursing hybrid: patient-focused in the emergency department (ED), maternity unit and medical-surgical units (non ICU or intensive care units); because in these units the registered nurses (RNs) are the patient’s primary nurses from admission to discharge paired or assisted with unlicensed assistive personnel (UAP) who provide patient-side care (take vital signs, assist with bath and toileting needs, answer call lights and deliver trays among other assigned care activities) according to their scope of practice. The effectiveness of this model developed in the late 1980s is based on the integration of principles of business and industry. The patient-focused care unit include as goals: to improve patient satisfaction and other patient’s outcomes, improving worker job satisfaction, increasing efficiencies and decreasing cost (Yoder-Wise, 2015).

The quality of care that nurses provide is influenced by individual nurse characteristics such as knowledge and experience, as well as human factors such as fatigue. The quality of care is also influenced by the systems nurses work in, which involve not only staffing levels, but also the needs of all the patients a nurse or nursing staff is responsible for, the availability and organization of other staff and support services, and the climate and culture created by leaders in that setting. The same nurse may provide care of differing quality to patients with similar needs under variable staffing conditions and in different work environments.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

• Safety outcomes include rates of errors in care as well as potentially preventable complications in at-risk patients. Safe practices that avoid errors and foreseeable complications of care can be thought of as either a basic element of or a precondition for delivering high-quality care, but are generally thought of as only one component of quality.
• Clinical outcomes (endpoints) of importance vary from patient to patient or by clinical population and include mortality, length of stay, self-care ability, adherence to treatment plans, and maintenance or improvement in functional status. Serious errors or complications often lead to poor clinical outcomes. So far, very few positive clinical outcomes have been studied by staffing-outcomes researchers, probably because of limited measures and data sources.

The sheer number of variables and myriad linkages depicted suggest why precise evidence-based formulas for deploying nursing staff to ensure safe, high-quality patient care are impossible based on the knowledge on hand. In fact, such prescriptions may never be possible. Certainly, evidence-based guidelines for allocating resources to ensure optimal outcomes in acute care and other health care settings cannot be offered until working environments, staffing (beyond head counts and skill mix), patient needs, processes, and outcomes of care can be measured with precision.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Reflecting the charge to the committee, the purpose of this report is to consider reconceptualized roles for nurses, ways in which nursing education system can be designed to educate nurses who can meet evolving health care demands, the role of nurses in creating innovative solutions for health care delivery, and ways to attract and retain well-prepared nurses in a variety of settings. The report comes at a time of opportunity in health care resulting from the passage of the Affordable Care Act (ACA), which will provide access to care for an additional 32 million Americans. In the preceding chapters, the committee has described both barriers and opportunities in nursing practice, education, and leadership. It has also discussed the workforce data needed to guide policy and workforce planning with respect to the numbers, types, and mix of professionals that will be required in an evolving health care environment.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Nursing is in the midst of revolutionary changes. How are these changes affecting the profession today—and how are they likely to affect it in the future? For the premier issue of American Nurse Today, we decided to examine current trends in nursing and healthcare, and predict future developments that could influence nursing in years to come.

For help with our analysis and predictions, we turned to several nursing experts and leaders, as well as pharmacy and future studies experts. We also tuned into the “buzz” in the nursing profession and explored several innovative national programs.

We found that nursing remains a vibrant profession. Yes—we have controversy and divisiveness. But we also see a wealth of positive energy that’s driving change and improving the lives of nurses and patients.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Driving forces

Many forces are driving changes in nursing and healthcare. Healthcare associations continue to issue new guidelines that influence nursing practice. Let’s look at a few other driving forces.

Portability and mobility

Talk to Tim Porter-O’Grady, RN, EdD, for any length of time and you’re likely to hear the words mobility and portability again and again. He sees these features as the basis for any healthcare delivery model. “Portability and mobility are the cornerstones of technotherapeutic interventions,” he states. The growth in freestanding clinics, ambulatory care centers, and other nonhospital settings supports his view.

Technology will extend patients’ lives—and Porter-O’Grady reminds us that we’re not aging the same way previous generations did. Many Americans are “aging in place,” with communities finding ways to support older people in their homes. Futurist Andy Hines, MS, says, “Baby boomers are going to want to avoid institutions for themselves and their parents.”Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

These forces mean that much of the patient’s healing takes place where nurses don’t typically deliver round-the-clock care—the home. Unfortunately, most nurses have been educated in a hospital-based model, which doesn’t mesh with today’s trends. Porter-O’Grady urges us to remember that patients don’t necessarily benefit from a hospital stay. “There is a direct line from length of stay to increased morbidity and mortality.”

At the same time, Hines remarks, “There’s a shift away from institutional care toward individual responsibility, and a move from hospitals and nursing homes to retail, kiosks, and home.” He adds that consumers want more personal control over their healthcare, so we can expect more self-diagnostic tests and innovative ways to deliver care.

Porter-O’Grady knows it isn’t easy for seasoned nurses to accept these changes. “Some nurses are mourning the loss of all they used to do for patients, but that loss isn’t a bad thing.” He advises hospital-based nurses to focus on helping patients make the transition to where they’ll be healing—at home.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

You can’t turn around in nursing without encountering the term evidence-based practice (EBP). It’s on the lips of everyone from staff nurses in ambulatory care centers to heads of government agencies.

EBP is one reason facilities designated as Magnet hospitals by the Magnet Recognition Program have been so successful: They’ve set up systems that foster evidence-based care, bringing improved patient care and nurse satisfaction. EBP also serves as the foundation for the disease management work done by nurse practitioners (NPs) and many other nurses.

EBP is more than a buzz term, says Porter-O’Grady. “It’s about getting a handle on what we do that is valuable—what difference it makes. Can we do it again, and can we do it even better the next time?”Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Patient safety and quality of care are two trends that have benefited nursing. Rebecca M. Patton, , RN, CNOR, cites the National Quality Indicator Database as an example of a program that’s tracking nurses’ impact on patient care outcomes. This database of nurse-sensitive indicators, with data from almost 1,000 hospitals, is one of several that show nurses’ importance in the delivery of safe, high-quality care in every setting.

Because of the quality push, healthcare workforce leaders may see more pay for performance—payment by third-party or government payors based on the quality of care delivered by the facility. Linda Aiken, RN, PhD, believes nurses must be involved in establishing payment criteria.

High times for high-tech

The explosion of medical technology has led to myriad lifesaving and life-enhancing inventions, including spare body parts ranging from knees to thumbs and dramatically improved sensors and diagnostics. Hines says medical devices are “getting more precise, user friendly, and cost effective.” Here’s a rundown of a few areas where technology is making a big impact.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Genes and stem cells

Researchers are linking more and more diseases to genes, with tremendous implications for educating patients about their conditions—and tremendous potential for ethical dilemmas regarding genetic testing. As for stem cell research, Hines cautions that while such research is yielding exciting knowledge gains, these gains are clouded by the ethical controversy that surrounds this issue.

Robots in the OR

Computer-assisted surgery has moved to the next level. Robots have elbowed their way onto the operating-room bed and into the perioperative team. Although too expensive to use for every surgery, robots have proven their mettle in complex procedures and those that require manipulation in a tight area.

We’ve even seen primitive robots that can help nurses, although their abilities are limited. uses a robotlike automated guided system to deliver supplies, says Linda Burnes Bolton, RN, PhD.
Of course, robots won’t replace surgeons or nurses, but they can enhance their abilities. Robots also can free up nurses to spend more time with patients. And, given our aging population and the extension of lives through medicine and technology, nurses will need every means of support possible.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Nursing workforce

As recently as 2004, a national survey found that 82% of nurses thought there was still a nursing shortage. That’s consistent with others’ perceptions: Earlier that same year, 81% of physicians perceived a nursing shortage where they admitted patients. In 2005, 74% of hospital chief nursing officers and 68% of chief executive officers also perceived a shortage.
For insight into the current state of the nursing workforce, we turned to Peter Buerhaus, RN, PhD. “Clearly the nursing shortage isn’t as intense as in 2001 and 2002, but it has by no means gone away.” But Buerhaus thinks we’re experiencing the calm before the storm. In April 2006, the American Hospital Association reported a vacancy rate of 8.5% in nursing job openings. In his experience, vacancy rates of 9% usually indicate a shortage. He points out that the demand for nurses is rising, with only slow increases in supply, and that nurses’ earnings flattened in 2004 and 2005.

When the nursing shortage grows more critical again, some will say it’s because nurses aren’t satisfied with their jobs. But a study Buerhaus headed in 2004 found that 83% of nurses were satisfied with their jobs. This rate is similar to that of other professionals—about 80% for lawyers, business executives, and primary care specialists. On the other hand, teachers’ job satisfaction is only at 61%.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Patton sees opportunities in the nursing shortage. “As difficult as it will be for us, it will help us as a profession to redefine the role of every member of the healthcare team. We’ll see better utilization of nursing skills, and we could also see better access” to the nurse.

Greying nurses

Whether or not they’re satisfied with their jobs, nurses will continue to spot grey hairs in the mirror as they age. The physical workplace environment will need to be adapted to keep older nurses in the workforce. “We need their experience,” says Burnes Bolton, “but we need to take the burden out of care.” Technology can help accomplish this. She cites the example of using gurneys as patient beds so nurses can avoid back-straining patient transfers.

As the core of the nursing workforce nears retirement, younger nurses are entering the profession, creating intergenerational teams. Nurses of different age-groups need to understand and accept each other’s perspective and appreciate what everyone brings to the team.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Physician shortages. A shortage of physicians will increase the demand for NPs. “The sense is that the physician shortages are severe,” says Buerhaus, and these shortages aren’t likely to end any time soon. As the demand for healthcare keeps growing, “we’re going to need NPs in huge numbers, and they could take over much of what medicine does today in our lifetime.”
Foreign nurses. Buerhaus foresees more foreign nurses working in the —double or triple today’s number. He speculates that by 2020, as much as 25% of our nursing workforce may have received their nursing education outside the United States.

Hines agrees that foreign nurses are here to stay. He also raises an issue nurses have long faced: How do the standards of one country apply to another? Common standards are needed for the emerging global workforce. At the same time, Patton cautions that using foreign-educated RNs must not detract from the need to offer all nurses a better work environment.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Staffing ratios. Will legislated ratios play a role in the upcoming demand for nurses? Aiken and Buerhaus say no. Aiken believes legislated ratios “will never dominate because most of the institutions in this country are in the private sector; few are government owned.” However, she does think legislation on public reporting will become more common—and these reports may include ratios. She predicts hospitals will increasingly move to better staffing as a result of the evidence.

Buerhaus warns, “If ratios catch on and become federally mandated, it would lead to the demise of the nursing profession. The public would lose trust because they won’t really see better outcomes; the science isn’t there to show it.”

Our panelists concur that although nurses’ work environments are improving, more needs to be done. Hospitals already are working on reconfiguring rooms so nurses don’t have to walk so far and supplies are easily accessible. Some have gone a step further, creating healing spaces—quiet areas with calm colors, meditation rooms, and gardens.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Some hospitals are working to make the environment more personally satisfying by offering mindfulness retreats and posting affirmation messages that nurses can read while on duty. Still others have adopted caring models that refocus nursing delivery on caring.

Seeking a balance

Hines predicts the power will shift from the healthcare institution to the individual nurse as nurses seek to balance work and personal life work. “The schedule and quality of life for many nurses is dreadful,” he says. “You have these long, tiring shifts of 12 hours on your feet, and lots of on-call and overtime. This runs counter to the social trend toward a greater work-life balance. Right now, the institutions have power over the nurses, but that could shift as nurses realize the opportunities outside the institutional setting.”Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

“Nurses spend less than 40% of their time on direct patient care,” says Burnes Bolton. “We’ve designed a system that doesn’t allow them to be with the patient.”

Technology can help turn that around. Burnes Bolton points out that some devices already in use are aimed at “reducing the time nurses spend hunting and gathering and communicating multiple times in getting or giving information to team members.” These products include tools nurses wear to improve communication and monitor patients remotely, and tools that help nurses and other team members get the information they need to make decisions. Many of these devices have “forcing functions,” such as built-in safety checks used on “smart” infusion pumps.

“Smart” technology is used in many other ways as well. Some beds detect blood flow in the patient’s legs and alert the nurse to possible deep vein thrombosis. Special patient vests collect physiologic data and transmit it to a healthcare worker’s personal digital assistant. “Smart” technology also is being used to promote medication safety.

These communicating and data-gathering devices allow nurses to interpret information and spend more time with patients. Cedars-Sinai nurses told Burnes Bolton they want access to a continuous flow of patient information in the patient’s room so they can spend time observing, educating, and coordinating care instead of collecting data.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

But all of this technology has a downside: Many of these products don’t “talk” to each other.
Burnes Bolton also is working on efforts to partner with industries to include nurses in developing new technologies for practice. In her view, we need more biometric systems based on individual patients—for instance, a system that automatically knows the patient’s weight and calculates weight-based drug dosages. She encourages nurses to borrow ideas from other fields and industries as well.

Another use of technology is to ensure that patients are informed of surgical risks. Burnes Bolton says Cedars-Sinai uses an interactive product to help patients “really understand what the risks are and what we are going to do to reduce them.”

Who is a nurse?

Students making career choices will increasingly turn to nursing, if they heed official career predictions. The government website Career Voyages (www.careervoyages.com) lists registered nursing as fifth on its list of “hot careers that don’t require a four-year degree.”
But this list’s title reflects one of the biggest controversies in nursing: What entry-level education should be required for nurses? Many of our panelists called for consistency in the basic education of nurses.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

This is more than a theoretical point. Aiken points out that her 2003 study found that hospitals in which a higher proportion of direct-care RNs held BSNs had lower mortality rates, and notes that further research in this area is needed. In her view, “we are falling behind” because many other countries require a baccalaureate degree for entry-level nurses.

“Nurses must be knowledge workers who have the ability to analyze and synthesize data,” says Burnes Bolton. “We need to have an education system capable of producing that type of nurse.”

Jeanette Lancaster, RN, PhD, believes we need a more highly educated workforce because of the complexity of patient care, advances in technology, and patients with chronic illnesses who are living longer and need more specialized and sophisticated care. “There is a need for highly skilled nurses in clinical practice,” she says.

Facing the faculty shortage 

Lancaster believes that in the next 5 to 10 years, nursing schools will face a worsening crisis, with enrollment increasing as more faculty members retire. Faced with this situation, schools are looking for options. “More and more advanced practice nurses in hospitals are participating in the education of students,” says . This partnership benefits both the students and the clinicians, who believe it keeps them on top of their game.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Some schools are developing certificate programs to help nurses prepare to be faculty members. These nurses have a shared teaching/clinical position or alternate periods between practitioner and teacher. “Schools will continue to rely on practice partners for help in educating students,” Lancaster says.

Educational delivery and teaching methods

Content delivery and teaching methods are changing, too.

Delivery. Distance learning has become a popular way to get a nursing degree. Although few people advocate online learning for basic nursing preparation, it has become an increasingly common option for nurses seeking to enhance their education. Schools also are experimenting with the order in which courses are taught. Some are giving all the classroom work up front, then following that with the clinical work—similar to the model used in business schools.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Teaching methods. Patient simulators can help students prepare for complex situations before they ever lay a hand on a patient. These are not the same simulators you may have used as a student. Today, a patient simulator can take a student through a complex scenario without the instructor needing to make multiple setting changes along the way. Such complexity comes with a price—thousands of dollars per simulator. To offset the cost, look to schools, hospitals, and even businesses to partner to create regional patient simulation centers.

Is the nursing process a sacred cow?

Is the nursing process a tool for the future—or a problem-solving process that has outlived its usefulness? “The nursing process is an iterative, industry-based, predigital model,” asserts Porter-O’Grady. “It’s an impediment. We need to suspend attachment to data and think in a multilateral, multifocal, and integrative way.”Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Not so fast, caution other panelists. Patton believes the nursing process “helps to distinguish nursing. It teaches us how to think, plan, act, and evaluate. We use it in our entire life.”
Lancaster believes that no matter what terminology is used in the future, “the bottom line is critical thinking. The nursing process is the foundation of the problem-solving process and has been around for many years. It fits with evidence-based practice.”

Surviving in the new world

We asked our panel what it will take to survive in the nursing world of the future. Being open to change topped the list. “Our work isn’t changing. Change is our work,” Porter-O’Grady says he tells nurses. “If you looked at change like that, it wouldn’t be an enemy.” Like other panelists, Porter-O’Grady emphasizes the need for continual learning, but that doesn’t mean nurses need to know everything. “I need to have a mental model in which I have access to the most current data and information possible.” Patton advises, “See opportunities instead of challenges. There are opportunities for significant reforms in our healthcare system.” Patton adds that nurses need to learn political skills so they can influence others, and should try to understand the business side of healthcare.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Advice for nursing leaders

Several panelists pointed out that some nursing leaders are uncomfortable with change and struggle with transforming the system instead of serving as role models. They fear these leaders may be abdicating their leadership roles. “Unfortunately, you can hear a sucking sound as leaders are pulled out of leadership roles into operations,” Porter-O’Grady says.

What advice does our panel have for nursing leaders? Porter-O’Grady encourages them to make it safe to discuss what nurses can stop doing and make sure they’re letting go of the right things. He urges them to model change and to discourage their staff from saying “I want to do the most I can for my patients,” because there’s no relationship between volume and value.
He believes leaders have to be comfortable with change and with being vulnerable; they have to be comfortable admitting, “I don’t know, but I can find out….I’m not sure how we’ll get there but I’ll be with you. I won’t desert you.”

Burnes Bolton advises nursing leaders to work together during this crucial time. “We have the attention of the federal government and organizations like the Institute of Healthcare Improvement and the Robert Wood Johnson Foundation.” Our panelists express concern about a leadership gap and wonder where the next leaders will come from. While new leaders are emerging, the panelists emphasized they have the responsibility to mentor future nurse leaders. “They know that the more impact they have on their profession and their colleagues, the more service they can provide to patients. It’s a different way to serve,” Porter-O’Grady says.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Moving forward together

As we move forward, nursing will continue to evolve. But some of the basics won’t change—basics such as advocating for patients, seeing how all the pieces fit together for the patient and, most importantly, caring for the patient as a human being. As important new developments continue to affect nursing and healthcare, American Nurse Today will help you understand these challenges and master the skills you need to cope with them. We hope you’ll join us as we explore every facet of the challenging, frustrating—and richly rewarding—profession of nursing.

Americans deserve a healthcare system that provides high-quality care at a reasonable cost. The current system is failing many people, but especially those who have the greatest health needs and the fewest resources to pay for it.

Many solutions have been proposed to better serve the growing number of high-need patients. Unfortunately, efforts have been largely ineffective and sporadically coordinated with social services, resulting in great variations of outcomes and cost. That variation is cause for concern because the result is an underperforming healthcare system—leading to lower-quality care for people who need it most, and threatening the financial sustainability of the overall healthcare system. At the same time, however, the variation suggests that there may be pockets of excellence where better care is being delivered at a lower cost—and this is our great opportunity.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

With 5% of Americans accounting for almost 50% the nation’s healthcare spend, doing better in this key area of healthcare could improve millions of lives and free up wasted resources. To make progress, we need to know more about the people with the most significant healthcare needs and the services they use; identify and validate the care delivery models that generate above-average health outcomes at lower-than-average costs; and transfer the knowledge and know-how to promote their broad adoption so that the models of excellence can become the community standard.

Today, many Americans use Nurse Practitioners (NPs) for much of their health care needs and NPs are now fully accepted by both health care consumers and most other care providers as a critical component of a modern health care system. For more than fifty years, NPs have provided a vast amount of services in both acute, chronic and community settings, making their presence in the health care system essential. Furthermore, expectations are that NPs will become even more crucial to health care delivery as more Americans gain access to broader services through health care reform efforts. This essay discusses several of the major factors involved in the establishment of the nurse practitioner role identifying past and current critical issues revolving around this significant health care provider.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

NPs (also referred to as Advanced Practice Registered Nurses or APRNs) are one of the four roles that encompass advanced practice nursing: nurse mid-wife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. All four roles require graduate degrees in order to qualify as a practitioner. In most states, NPs must be registered nurses, graduates from accredited graduate programs, and hold certification that reflects the specialized nature of the graduate program (e.g. primary care certification if graduating from a primary care nurse practitioner program).  In addition, as NPs become more commonplace in health care settings, the licensure, accreditation, and certification requirements continue to evolve in response to changing needs. In the United States, each state sets its own requirements for practice, and NPs must meet the particular state’s criteria in which they work. Because different practice requirements are confusing and in some cases can lead to inefficiencies in care, recent efforts on the part of nurse practitioner groups have been directed towards creating standards that are national in scope. For example, a new regulatory document finalized in 2008 and released by the National Organization of Nurse Practitioner Faculties, called the Consensus Model, set new national standards for core competencies, roles, and six population-based foci (individual/family health across the life span: adult-gerontology, pediatrics, neonatal, women’s health/gender, and psychiatric/mental health). Currently, states are in the process of revising practice acts, and schools of nursing are examining their APRN or NP programs to reflect the new model, which is expected to be nationally implemented by 2015 for new practitioners.[1]​​Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

A major factor that supported the development and evolution of the Nurse Practitioner role in the 1960s was lack of access to health services. The American public’s struggles to gain access to primary care and preventive services are certainly nothing new, and this need crosses socioeconomic lines. Although health reform efforts promise to bring over 30 million previously uninsured people into the health system, those currently without health care access are not the only ones who sometimes have difficulty finding quality services. For instance, insured Americans find they cannot get urgent care or primary care health services when needed. Nurse practitioners are situated to provide greater access to high quality, reasonable cost care if allowed by state regulations to practice to the fullest extent of their knowledge and skills.  Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

NPs are part of the constant change, however subtle, in how the public decides who has the authority to provide health care. Physicians traditionally were considered the normative providers of medical services by patients and the state. Indeed, it is the physicians’ perspective that guides much of what is understood about patients, health policies, and institutions. However, as access to physicians has dwindled, it has been midwives, nurse practitioners, and physician assistants that have emerged as primary care providers within the mainstream health care system. For example, independent nurses and lay providers were and are the norm in many rural clinics, but, until recently, not in urban academic institutions or in places with many physicians. One of the only consistencies across types of practices is the satisfaction of patients with nurse practitioner services which has always been and remains quite high.

Over the years, the role of the nurse has expanded in response to advances in scientific knowledge and changes in health care needs. As a consequence of the broadening of the role of the nurse within health care, the need for additional formal education and training became more commonplace. Such was the case with the development of the advanced practice nurses.[2] Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

Many contextual factors supported the development and growth of the nurse practitioner clinical role. For instance, by the 1960s, American medicine had become highly specialized with growing numbers of medical students moving into more economically and socially lucrative specialty practices. The general practitioner, long a staple for primary care in suburban and rural communities, was slowly disappearing from the health care landscape. At the same time, the demographics of the American public were changing and marked by an aging population as well as a growing number of chronically ill adults and children. Medical education, situated primarily in academic acute care hospitals, failed to reconceptualize​ medical education and residency offerings in a way that could offset the specialization trend. Even the development of family practice specialties and medical schools that focused on community-based medicine could not counterbalance a trend that was supported by higher payment and status for specialists. At the same time, nurses were looking for ways to apply the skills and knowledge they already possessed through experience or their own education programs. Nursing’s growth occurred organically in clinics, as well as visiting nurse associations and private offices, where daily interactions with physician colleagues facilitated a vast amount of new and advanced knowledge and skills.  Over time, it became clear that many in the nursing profession were particularly eager to formalize further and expand their clinical practice responsibilities. In pockets across the country, in poor rural and urban areas, individual nurses and physicians began to work together in response to the shortage of primary care physicians, growing numbers of people with health insurance, and population changes to improve patient care. Soon, formal education and training programs followed at the University of Colorado, spearheaded by nurse Loretta Ford and pediatrician Henry Silver; at the University of Kansas, with Barbara Resnick and Charles Lewis and at the University of Rochester, with nurses Joan Lynaugh and Harriet Kitzman and physicians Barbara Bates and Evan Charney—the latter funded by the Division of Nursing of the U.S. Public Health Service.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

As reports of these experiments were published, the number of programs for nurse practitioners grew rapidly, supported in part by federal funding through the Nurse Training Acts in the next two decades, and through the largesse of private foundations which supported new types of service models and training programs. Nursing education responded to both the opportunity for funding and to the numbers of nurses demanding access to nurse practitioner programs. The number of programs increased, and so did specialization. Early on, pediatrics and gerontology programs were the most common programs, but by the 1990s, NPs specialized in oncology, neonatology, and cardiology. Certification programs that focused on training the practitioner to work in a specific field followed specialization, and were sometimes tied to state licensure requirements.

By the early 1980s, nurse practitioner education moved into graduate programs and by 1981, most states required graduate degrees for nurse practitioner practice.  In response to the scientific knowledge explosion, programs kept adding new courses, expanding their length and their credit loads. By the turn of the 21^st century, most nurse practitioner programs credit hours far exceeded those in other graduate programs. At the same time there was a growing movement towards practice doctorates in other professions and this led educators to think about new types of nurse practitioner programs. By 2005, the Doctorate of Nursing Practice (DNP) became the newest level of practitioner training, giving credit for the breadth of content in the nurse practitioner programs.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

The primary objective of the committee in fulfilling its charge was to define a blueprint for action that includes recommendations for changes in public and institutional policies at the national, state, and local levels. This concluding chapter presents the results of that effort. The committee’s recommendations are focused on maximizing the full potential and vital role of nurses in designing and implementing a more effective and efficient health care system, as envisioned by the committee in Chapter 1. The changes recommended by the committee are intended to advance the nursing profession in ways that will ensure that nurses are educated and prepared to meet the current and future demands of the health care system and those it serves.

Research investigating links between hospital nurse staffing and patient outcomes began with studies examining patient mortality. Reviews now include research examining a broad range of outcomes, including specific adverse events other than mortality. Although many studies support a link between lower nurse staffing and higher rates of negative nurse-sensitive safety outcomes,^25–27 reviews of two decades of research revealed inconsistent results across studies.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

The importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”¹ (p. 92). Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety.

The purpose of this chapter is to summarize and discuss the state of the science examining the impact of nurse staffing in hospitals and other health care organizations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

As the country focuses on the restructuring of the U.S. health care delivery system, nurses will continue to play an important role. It is expected that more and more nursing jobs will become available out in the community, and fewer will be available in acute care hospitals. Write an informal presentation (500‐700 words) to educate nurses about how the practice of nursing is expected to grow and change. Include the concepts of continuity or continuum of care, accountable care organizations (ACO), medical homes, and nurse‐managed health clinics. Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper
In 800‐1,000 words summarize the feedback shared by three nurse colleagues and discuss whether their impressions are consistent with what you have researched about health reform. A minimum of three scholarly references are required for this assignment. While APA format is not required for the body of this assignment, solid academic writing is expected and in‐text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Evolving Practice of Nursing and Patient care Delivery models.
In the nursing practice, the obligations of tasks of nurses are going to be affected by the changes in the future in the United States. Because the health care system are reformed and also have to give Services that will gain the community, nurses are demanded to take on more various roles continues care. Cost effective which is centered on the patient can be provided by health clinics and medically based homes have nurse managers. In the endless and total care of the, responsible care Organizations are helping nurses to take accountability. The additional concentrated care for the patient is expected from a nurse instead of the traditional way of providing care. In order to deliver a continue care for lifelong of the patient, as indicated by the changes in the health care, nurses will be in the front.
Community Care Concepts.

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Looking in to the future of health care nurses are supposed to provide care continuously due to the

Nursing accountabilities and roles should have changed during the past and will remains to change. Evolving Practice Of Nursing And Patient Care Delivery Models Essay Paper

The nurse should be stationed in a community based services. Mutually in acute settings and

Comprehensive care settings, this will aid the nurse to change the method of care provided.

A rise in the number of nurses always should happen in both doctor’s offices and in clinics so the needs

Of the increasing health care and delivering suitable care to patients happens much sooner and easier.