Nurses performs many different roles such as educator and advocate to enhance safety and quality patient care. The nurse’s health care method to patient is directly related to nursing care model. Nursing models are developed to enhance or support professional practice. Nursing Care Models assist nurses in providing excellent care to patients. Finkelman (2016) states, “Nursing practice models have been used to implement resource-intensive strategies with the goal of decreasing expenses and using staff more effectively” (p.111). Nursing Care Models have been utilized since the 1920’s with the implementation of Total Patient Care to the Team Nursing approach to deal with the nursing shortage after World War II. As nursing has progressed, nursing care models have evolved to grow with the profession. As time and technology advance, the nursing models have changed significantly, guiding to incorporate team-work, patient-centered care, competency/skill level, quality improvement collaborating with multidisciplinary teams within the healthcare setting (Finkelman, 2016).
Observation
I work in Gastroenterology department. Our team are physician, physician assistant, registered nurse (RN), Licensed vocational nurse (LVN), and Patient care assistant (PCA) in patient transport after discharge. When patients check in for procedure, we perform pre procedure assessments and insert an intravenous line for sedation. In intro procedure, we sedate patient and procedure is performed. After procedure, patient is transferred to recovery room by an RN and give report to recovery nurse. Patients are monitored for at least thirty minutes in recovery and discharge instructions will be reviewed with patient and family by recovery nurse before discharge.
My observation was a patient in distress in procedure room. Patient was taken to procedure room by a nurse assigned to the room. Patient was scheduled for Endoscopic retrograde cholangiopancretography (ERCP) to remove gallstones. The procedure usually takes 60-90 minutes. The physician, licensed vocational nurse and radiology technician was also present. Physician explained the procedure to patient and risk associated with the procedure. Patient agree to proceed and signed consent. Time-out was performed verifying the right patient and procedure. Medications: Demerol and versed were ordered by the physician and administered by the nurse. Patient was stable and ten minutes after the procedure started, patient’s oxygen level dropped to 68%. Patient was placed on oxygen at 4 liters nasal cannula per physician order but the oxygen level stayed at 70%. Patient became unresponsive. Patient was then placed on a non-rebreather mask. Blood pressure dropped down to 72/48 and atrial fibrillation with heart rate of 110. Patient does not have a history of atrial fribillation. Rapid response team was called. Narcan and Romazicon reversals were administered and patient became responsive. By the time the rapid response team arrived, blood pressure increased to 90/40 but patient the heart rate went up to 120. Electrocardiogram (EKG) was performed by the patient care assistant and reviewed by the physician. Rapid response team took over. Patient was stabilized and transferred to the hospital for further assessment of new onset atrial fribillation.
Team nursing model is one of the nursing care models that employs a team approach in which a group of healthcare professionals, including nurses, care for a group of patients in the acute care or inpatient setting. This nursing care model came about in the 1950s and 1960s in response to the growing shortage of nurses because of World War II and nurses leaving hospitals into other healthcare settings. This care model normally consists of a charge nurse, other nurses, and nurse technicians or nurse aides. Under this team nursing model, the charge nurse is responsible for overseeing a unit of the hospital for their assigned shift. They delegate nursing assignments, manage admissions and discharges, support nursing staff, and monitor and order medicines and supplies. Sometimes the charge nurse takes a patient load depending on the acuity of the shift. The registered nurse is responsible for executing the physician's orders, such as administering medications or treatments management, and assessing the client’s responses to the treatment plan. In addition, the nurse is responsible for evaluating the safety the medical care plan before implementing it. The nurse technician or nurse aide is responsible for assisting the patient with activities of daily living, monitoring vital signs or EKG signals, drawing of blood for testing, and assisting nursing staff in administering basic treatments among others. Every team member brings something essential to patient care in the team nursing model.