2.2 Care Delivery Models and Settings

Healthcare delivery models shape how nurses provide care and impact patient outcomes. From primary nursing to team-based approaches, each model has unique advantages and challenges. Understanding these models helps nurses adapt their practice to different settings and deliver effective, patient-centered care.

Care settings range from acute hospitals to community clinics, each with distinct nursing roles. Nurses must tailor their interventions to the specific environment, whether managing complex cases in ICUs or promoting health in schools. Mastering care transitions between settings is crucial for ensuring continuity and patient safety.

Care Delivery Models: Implications for Nursing

Organizational Structures and Patient Care Approaches

• Care delivery models define organizational structures for nursing care provision
  • Determine allocation of resources, staffing patterns, and communication processes
• Primary nursing model emphasizes continuity of care
  • Assigns one nurse responsible for patient's care throughout stay
  • Promotes personalized care and strong nurse-patient relationships
• Team nursing involves collaborative care by nurses with varying skill levels
  • Fosters teamwork and skill development
  • May reduce continuity of care
• Functional nursing model assigns tasks based on skill level and job description
  • Maximizes efficiency
  • Potentially fragments patient care

Patient-Centered and Acuity-Adaptable Models

• Patient-centered care model focuses on individualized care plans
  • Involves shared decision-making between healthcare providers and patients
  • Promotes patient engagement and satisfaction
• Acuity-adaptable care model involves caring for patients in a single room throughout stay
  • Patients remain in same room regardless of acuity level
  • Reduces transfers and improves continuity of care

Impact on Nursing Practice and Patient Outcomes

• Care delivery models affect various aspects of nursing practice
  • Influence job satisfaction and patient outcomes
  • Impact resource utilization and development of nursing skills
  • Shape specializations within nursing field

Healthcare Settings: Advantages vs Challenges

Acute and Long-Term Care Environments

• Acute care settings provide intensive, short-term treatment
  • Treat severe injuries, illnesses, or medical conditions (heart attacks, severe infections)
  • Offer advanced technology and specialized care
  • Can lead to high stress and burnout for nurses
• Long-term care facilities focus on ongoing care for chronic conditions
  • Include nursing homes and rehabilitation centers
  • Allow for relationship-building with patients
  • Present challenges with limited resources and complex care needs (dementia, mobility issues)

Community and Outpatient Care Settings

• Community health settings encompass wide range of services
  • Include home health, public health clinics, and school nursing
  • Offer opportunities for health promotion and disease prevention
  • Require nurses to be adaptable and work independently
• Outpatient clinics and ambulatory care centers provide non-emergency medical services
  • Allow for continuity of care and patient education
  • May limit scope of practice for nurses

Specialized and Emerging Care Environments

• Hospice and palliative care settings focus on end-of-life care
  • Require strong emotional resilience from nurses
  • Offer meaningful patient and family interactions
• Telehealth and remote care settings emerge as important healthcare delivery methods
  • Offer increased access to care (rural areas, mobility-limited patients)
  • Present challenges in technology adoption and maintaining personal connections

Nursing Interventions for Specific Settings

Interventions in Various Care Models

• Tailor nursing interventions to specific care delivery model and setting
  • Consider factors like patient acuity, available resources, and healthcare team structure
• Primary nursing models focus on comprehensive care planning
  • Build strong therapeutic relationships with patients and families
• Team nursing requires effective communication and collaboration skills
  • Ensure coordinated care delivery and appropriate task delegation
• Functional nursing models need clearly defined and efficiently executed interventions
  • Maintain holistic patient care despite task-oriented approaches
• Patient-centered care models actively involve patients in decision-making
  • Emphasize patient education and self-management strategies (diabetes management, wound care)

Interventions in Different Healthcare Settings

• Acute care settings require rapid assessment skills
  • Prioritize interventions based on changing patient conditions and acuity levels
• Community health settings focus on health promotion and disease prevention
  • Adapt to diverse environments and cultural contexts (home visits, school health programs)
• Long-term care interventions emphasize maintaining quality of life
  • Prevent complications and support patients' functional abilities over extended periods

Nurse's Role in Transitions of Care

Coordination and Communication in Care Transitions

• Transitions of care involve movement of patients between healthcare providers or settings
  • Require careful coordination to ensure continuity of care and patient safety
• Nurses play crucial role in discharge planning
  • Assess patients' needs and coordinate follow-up care
  • Provide education to patients and caregivers about post-discharge care requirements
• Effective communication between healthcare providers across settings
  • Nurses often serve as primary point of contact for conveying critical patient information

Medication Management and Patient Education

• Medication reconciliation key nursing responsibility during care transitions
  • Ensure accurate and complete medication information transferred between settings
  • Prevent errors and adverse events (drug interactions, dosing mistakes)
• Patient education during transitions of care crucial for continuity
  • Ensure patients and caregivers understand follow-up care instructions
  • Explain medication regimens and when to seek additional medical attention

Collaborative Approach to Transition Management

• Assess patients' social support systems and home environments
  • Identify potential barriers to care continuity (lack of transportation, financial constraints)
  • Implement appropriate interventions or referrals
• Collaborate with interdisciplinary team members
  • Work with social workers, case managers, and community health providers
  • Facilitate smooth care transitions and ensure comprehensive patient support