Leadership and Management in Nursing Care Delivery Models

Leadership and Management in Nursing Care Delivery Models A care delivery model is an integral component for delivering patient care. Nursing care delivery model is a way of organizing at the unit level to facilitate the delivery of nursing care to the patients (Tiedeman Lookinland, 2004). Organization of care is a key factor that determines quality of nursing care (Tiedeman Lookinland, 2004). Various types of care delivery models have been designed to meet the goals of efficient and effective nursing care While many different care delivery models are practiced in the wards and departments of the acute care hospital that I work in, it is beyond the scope of this paper to discuss them all. In the 20 bedded medical oncology ward that I work in, nursing care delivery is organised into team and primary nursing. Six beds are allocated to transplant patients. One registered nurse is assigned to be the primary nurse of three transplant patients each. The other fourteen patients are split between two teams of nurses. Each team has a registered nurse, an enrolled nurse and a patient care assistant. Thus, this paper is concerned with these two modes of organization of care. An overview of primary and team nursing models of care will be presented. Thereafter, the experiences of nurses involved in the delivery of care using these models of care will be discussed with regards to job satisfaction and quality of care. Description of Care Delivery Model Primary Team Emerging in the United States in the1960s, the primary nursing model involves patients being allocated to individual nurses (Tiedman Lookinland, 2004). One registered nurse is allocated a number of patients for whose care this nurse is accountable during the patients hospital stay (OConnell, Duke, Bennett, Crawford, Korfiatis, 2006; Tiedman Lookinland, 2004).The nurse-patient relationship is the backbone of primary nursing. The primary nurse collaborates with other health team members, the patient and family to continually assess, plan, implement, and evaluate the patients nursing care (Reed, 1988; Sellick, Russell, Beckmann, 2003; Tiedman Lookinland, 2004). When the primary nurse is unavailable to provide care, associate nurses follow the plan of care developed by the primary nurse, unless a change in patients condition necessitates a modification of the care plan, so as to maintain the continuity of care for the patients (Tiedman Lookinland, 2004). Team Nursing Implemented in the 1940s as a response to the nursing shortage resulting from the World War II, team nursing is based on the premise of collaboration and division of responsibilities for the nursing care of patients (Tiedman Lookinland, 2004). In team nursing, nurses and ancillary staff with different levels of education, skills and licensure are assigned to teams and each team provides total nursing care to the patients assigned to that team (OConnell et at., 2006; Tiedman Lookinland, 2004). Leadership for each team is provided by a team leader, who is an experienced registered nurse responsible for planning and supervising the provision of nursing care for patients cared for by team members. The team leader has overall accountability for coordinating the nursing care provided, while the team members are accountable for completing their assigned tasks and for documenting the care delivered (OConnell et at., 2006). Nursing Staff Job Satisfaction Primary Team One of the most important gains of primary nursing for the nurses interviewed was more contact and enhanced relationships with patients. One nurse said, I know more about each of my patients and do not constantly have to get to know new ones. These views are consistent with Mccleod and Stellas (1992) study where nursing staff on medical and surgical wards were asked what they liked about primary nursing. Participants liked the enhanced relationships and collaboration with patients and other members of the healthcare team. To be able to take care of the same patients day after day was greatly appreciated by the nurses interviewed. This continuity of care led to the development of good relationships between the primary nurse and the patient as well as with relatives. This is an aspect that the nurses found increased their levels of job satisfaction (McCleod Stella, 1992). Primary nursing facilitated an in-depth knowledge of their patients and as a consequence, the nurses felt more able to act as a patients advocate. Nurses verbalised they had additional responsibility and accountability as all duties and responsibilities in taking care of a patient for his or her duration of stay is delegated entirely on a single nurse. The primary nurses interviewed perceived that they had the authority to make clinical judgments and decisions for the benefit of the patient. Their use of phrases such as freedom from control by others, ability to plan and organize the workday, using knowledge to make decisions and advocating for the patient described autonomy. Autonomy refers to the ability to act according to ones knowledge and judgment, providing nursing care within the full scope of practice as defined by existing professional, regulatory, and organizational rules (Gagnon, Bakker, Montgomery, Palkovits, 2010). The nurses noted that through practicing primary nursi ng, their autonomy was increased. There is a substantial body of evidence indicating that nurses perceived autonomy is linked to job satisfaction. A study by Melchior, Halfens, Abu-Saad, Philipsen, van den Berg Grassman (1999) investigated the effects of a primary nursing care delivery system on the work environment among nurses working in long-stay psychiatric care settings. Results showed that as a result of primary nursing, the nurses found more autonomy in their work and thus experienced increased job satisfaction. Similarly, Macguire and Botting (1990) analysed the perceptions of nursing staff, following the introduction of primary nursing into an acute medical ward for elderly people. Nurses reported better communication, improved relationships and increased responsibility after implementing primary nursing. It appeared that both increased autonomy of practice and increased knowledge of specific patients, coupled with a greater continuity of care, gave nurses a high level of satisfaction than did previous meth ods of care delivery (Macguire Botting, 1990). On the downside, some nurses commented that working in a primary care system tends to be isolating and this proved to be particularly difficult when they were looking after a critically ill patient. These experiences mirrored those reported by nurses in the study by Manley, Hamill, and Hanlon (1997). Team Nursing Nurses practicing team nursing commented that working as a team was a lot better, because then they can have somebody else backing them up. According to OConnell et at. (2006), working collaboratively with team members serves to enhance job satisfaction, as many find this to be a learning experience that utilizes the expertise of each team member. This was supported by Rafferty, Ball, and Aiken (2001) who demonstrated that nurses who report a higher level of teamwork are more satisfied with their jobs, plan to stay in them, and are likely to experience less stress. However, enrolled nurses and the patient care assistants interviewed added that they felt the staff nurses were spending too much time with medications and writing reports while they were left to do the heavy manual work. A similar finding was demonstrated by OConnell et al. (2006). In this study, both registered nurses and enrolled nurses felt that the team-nursing model sometimes involved an uneven and unfair division of tasks that overburdened some nurses. The medication responsibilities of registered nurses within the team-nursing model imposed excessive demands on enrolled nurses as they were left with meeting the hygiene needs for the patients in their group without assistance. These tensions led to a decrease in job satisfaction. Quality of Care Primary Team The nurses interviewed felt patients were more satisfied when primary nursing was in place because they received individualized care as a result of continuity and coordination of care. Primary nursing has led to the nurses having a better knowledge of the patient. Nurses pointed out that primary nursing enabled them to know each patient more closely. One nurse remarked, I know my patients like the back of my hand. Therefore, it was easier to find out what each patient needed and to meet those needs appropriately. Jenny and Logan (1992) suggest that greater knowledge of the patient is linked to the increased likelihood of picking up subtle changes in the patients condition. In addition, Perala and Hentinen (1989) found that through primary nursing, doctors received information about patients that was more exact and relevant because nurses knew their patients better. This enabled nurses to provide more applicable and effective patient centred nursing care. In response to this therapeut ic relationship, the patient feels more secure about and satisfied with nursing care (Jenny Logan, 2000). The nurses views were supported by the findings of Radwin (2000). In this study conducted over a 3-year period, oncology patients were asked to identify qualities of nursing care that were important to them. Professional knowledge, joint decision making between the patient and the nurse, individualized treatment plans, promptness to addressing individualized needs and continuity of care were some aspects of care delivery that were identified. Team Nursing Nurses interviewed said that since staff was supervised more closely, the likelihood of missing things out was low. This, they felt, resulted in patients receiving better care. This sentiment was echoed by the nurses in OConnell et al.s (2006) study. Moreover, nurses added that the patients benefitted from the combined skills of the team. According to the study by Cioffi and Ferguson (2009), team nursing made a difference to patient care as it was patient-oriented, all the nurses in the team were familiar with the patients receiving care, care was more complete as things were missed less often and staffs were supervised more closely. This resulted in patients receiving better care. In conclusion, providing care to a group of patients require nurses to be more efficient and use their time more effectively. Nursing care delivery models facilitate this. This paper has provided an overview of primary and team nursing care delivery models. The experiences of nurses were discussed with regards to job satisfaction and quality of care in the two models. Literature supporting the nurses experiences was then explored.

Virginia Woolfs Mrs. Dalloway :: Woolf Mrs. Dalloway Essays

Mrs. Dalloway Selection: "How many million times she had seen her face, and always with the same imperceptible contraction! She pursed her lips when she looked in the glass. It was to give her face point. That was her self-pointed; dartlike; definite. That was her self when some effort, some call on her to be her self, drew the parts together, she alone knew how different, how incompatible and composed so for the world only into one centre, one diamond, one woman who sat in her drawing-room and made a meeting-point, a radiancy no doubt in some dull lives, a refuge for the lonely to come to, perhaps; she had helped young people, who were grateful to her; had tried to be the same always, never showing a sign of all the other sides of her-faults, jealousies, vanities, suspicions, like this of Lady Bruton not asking her to lunch; which, she thought (combing her hair finally), is utterly base! Now, where was her dress?" (37). Discussion: The 'diamond' metaphor in the preceding passage is striking and fresh. A diamond is clear but not transparent; it attracts light, yet reflects and refracts it. The diamond possesses many sides but is organic, one whole thing. When Clarissa is 'in the world,' she draws "the parts (of herself) together," she is whole and unified but doesn't show "the other sides of her," as though the social side of Clarissa takes precedence; all others are part of her being but the side she presents to the world best represents the whole. Amazingly, she is aware of this process and one gets the feeling that Clarissa feels that this one-pointed unification represents her at her best, her strongest, and her most real. The diamond is a metaphor for a certain type of human consciousness. The diamond and it's qualities of clarity and many-sided wholeness are alluded to in several places in Mrs. Dalloway. Peter Walsh talks of his own life in terms of holding something in his hand: "The compensation of growing old...[is that] one has gained...the power of taking hold of experience, of turning it round, slowly, in the light" (79); This quote speaks of both satisfaction and detachment.

Do Soap Operas reflect life in the 21st Century? Essay

Soap operas are very popular. All ages watch soaps, from young children to retired grandparents. People are interested in soaps because they reflect life in the 21st century. They reflect life in the 21st century by making the characters seem real and by making he setting like an average town or part of town. I think that soaps are popular because they offer a chance for people to escape from the real world. Soaps make peoples problems seem small. People think that their problems can never be as bad as peoples problems in soaps because characters in soaps have such extreme problems which makes people feel a little better about themselves. Another reason that people like soaps is because it conveys society in a dramatic way, they cut out all of the small talk and everyday routines which nobody is interested in. Most people are interested in other peoples business and know that soaps aren’t real. The way soaps are made give it some reality so watching soaps is the same as knowing other peoples business but soaps mix the extreme with everyday life. As the soap characters problems are dramatic and usually major, people become absorbed into the story and soaps usually finish with a cliffhanger, which leaves you with half a story so that you will have to watch the next episode(s) to find out how the story ends. Soaps have many different characteristics, which are peculiar such as the fact that the show is ongoing; the only repeats are on channels such as UK gold. The characters have peculiar characteristics too. The characters are extreme. They are extremely nice people in soaps and then there are evil people. The characters also forget things very quickly. Things that happened two months ago aren’t mentioned now. Soaps are like a microcosm, the problems are bigger than usual and more focused on. The characters problems are also never ending, as soon as one ends another begins or a new problem arises at the worst possible time. Compared to a drama there are no central characters, a few peripheral characters, and the setting is always the same, there is no travelling outside the setting. I think that soaps for fill a social purpose because when people watch sops they know that they don’t want some of the things that happen on soaps to happen to them. People may subconsciously receive messages about life, for example teenage pregnancy. If a teenager has seen the consequences of unsafe sex perhaps they won’t make the same mistake. On the other hand people may think that things that happen in soaps can never happen to them. The language in Eastenders tries to be realistic. Because it is a soap this is impossible to make it the same as real life speech. The reasons for this are time and the fact that it would make the soaps boring. People in soaps don’t talk about the weather because it’s not what people want to hear. Characters in soaps don’t stutter or hesitate because it wastes time as there is only half-hour to squeeze everything in. Characters don’t swear as much as they would in real life because of the time it is shown. The way soaps try to be realistic is by using some slang, having background noise and the use of accents although some accents are obviously put on, It also isn’t very realistic because speech is very structured. Everybody has immediate responses in soaps and that isn’t how the real world works. Different soaps are aimed at different people but generally speaking soaps are aimed at teenagers and families. I can tell this because of the times soaps are shown at, the characters in soaps and the issues in soaps. There are all sorts of characters in Eastenders and issues about teens and about adults. It is on after people get home from work but before children go to bed. This information shows that Eastenders is a family soap. Soaps change with the times so I can see changes in soaps in the future. Soaps change because the world changes. The big issues in the world are reflected in soaps so as the world’s problems change, soaps change. Soaps can also teach us morals such as things can only get better. Characters in soaps are strong teaching us to be strong. When bad things happen to bad characters its showing us that people get their just desserts. I think that soaps can’t really affect our lives unless you are easily influenced but it can affect our lives in the way I mentioned earlier. It can make us more aware of problems and make us not want to be in that situation. Since working on this my attitude towards soaps has changed a little. I’m not a big fan of soaps but doing this essay has made me a little interested in soaps. This may be because I’m more aware of what goes on in soaps. In my opinion soaps do reflect life in the 21st century because they have the same problems as real life people but it isn’t realistic because if it were too real people wouldn’t be interested. This is why the characters are more extreme and why there are a lot more problems for one character than in real life.

The Mental Health Service Act - 1949 Words

Mental health illnesses have been around since interrelated relationships have been present in society. The treatment of this illness has evolved immensely throughout history. Early on, those who were mentally ill were demonized and thought to be an all mighty evil, which had the ability to be passed on to others. Due to this ideology, many people shunned, and banished those who were thought to be mentally handicapped. In order to protect society from these â€Å"beasts† many people imprisoned mentally ill individuals and were stripped of the ability to live their lives. Fortunately, as society progressed and different ways of treating the mentally ill were established through scientific advancements. Along with these advances, treatment for†¦show more content†¦Mental illness dates back to the 1800’s. Most who were determined to have a mental illness were placed in prisons, or chambers to protect society as they were seen as wild and dangerous. There was no re al change to the treatment of mentally ill individuals until Dorothea Dix, a schoolteacher and American activist, began a movement to change the way the mentally ill were seen and treated in society. Centers, or institutions were built to reside mentally ill individuals to fully care and provide treatment for them. Unfortunately, many of these institutions were closed down due to improper care of the patients by the staff, an uneven staff to client ratio, and the institutions were underfunded. Society began to realize that this particular population was unable to fully care for themselves as many of those who were deinstitutionalized from the institutions were left homeless, broke and untreated. An individual, Clifford Beers, who experienced first hand the abuse and maltreatment of those who were institutionalized, sparked a mental health reform movement with an autobiography, A Mind That Found Itself, which tells about the time he spent within the institution. His autobiography beg an the movement towards many historic Acts that would help