Comparison Of Primary, Cross-Training, And Inter-Professional Models Of Nursing Care

Primary Nursing Model

Over the years, with passage of time, different models of nursing care have been introduced. All types of nursing care have both positive and negative aspects. Different healthcare sectors implement different models according to their visions of the organization to ensure patient safety and patient satisfaction (Hepp et al. 2015). This organization mainly incorporates primary nursing care and therefore this assignment will begin with a summary review of this type of care. This would be followed by explanations of cross-training model of care as well as inter-professional model of care.

Nadeau et al., 2016 are of the opinion that primary care model is highly preferred by a large number of patients and their family members. This was observed when experiments were carried out in pediatric hematology/oncology inpatient unit. The authors have stated that this form of nursing model provides a greater scope of relationship building among the client and nurses and helping in development of trust and confidence in the nurse. However, patients and family members although prefer same nurses to be assigned to them from shift to shift but they hardly care if they get the same quality education and follow up form primary or secondary nurses or non care members. However nurses are of the different opinion stating that primary nurses provide better education and follow up in comparison to non care team members. In short, patient’s family members and nurses suggest that primary nursing model (where a particular nurse provides care) is better for pediatric patients in comparison to primary care teams of nursing. Johansson, Lundstorm and Heiwi (2015) are of the opinion that primary nursing model is very much helpful in haemodialysis. This is because in these units, the patient’s conditions can get altered anytime and even very quickly. Therefore the nurse requires continuous monitoring, assistance and also need to make quick decisions. They need to make close relationship with the patients where they also need to reduce the patient’s psychological stress I order to improve patient satisfaction. Such nurse have to handle lots of responsibilities like highly technical care, deal with patients who are chronically ill, help patients solve their problems, educate them and provide health literacy and others. It also incorporated implementation of different duties lie empowering the patients, handling their emotional aspects which may range from feeling of energizing them to feelings of emotional exhaustion. For all these, the nurses need education in pedagogy, tools for emotional distancing, counseling and handling their stress for so many responsibilities.

Therefore form the above two reviews, it become clear that although they bring positive effects. Nurses cannot handle the stress developed form this model of care. This might have negative impacts on patient’s safety and health.

Paul and McDonald (2014) wanted to test the benefits of cross training nursing model in the healthcare setups. They are of the opinion that this nursing model is of extensive help in meeting the nursing shortages issue. Nursing shortage issue is responsible for potential negative impact on patient safety and mortality. Therefore this model is believed by them to help the healthcare centers to meet the needs of patients and maintain their safety and satisfaction. In this type of model of care, nurses are given training in more than one disciple of caring such as a nurse working in the gynecology department may be taught to handle patients with respiratory distress. When proper experiments were conducted comparing nurses with single specialty and those with cross training, it was seen that those with cross-training helped in saving a huge amount resulting in overall cost savings while similarly meeting the hospital services and quality of care requirements. It helped with optimal utilization of constrained nursing resources and thereby limits the negative implications of the growing nurse shortage crisis. Another article authored by Manelski and Wagner 2013 also showed that when anti-partum nurses were provided cross training, they declared that they had developed new skills, confidence in patient care delivery as well as respect for each other. As the nurses got more skilled and flexible, it resulted in development of confidence in the nurses in their patient care delivery and the patients thereby received optimal care. Novice nurse’s leant new skills and expanded their knowledge base. They also developed their leadership capabilities.

Cross-Training Nursing Model

Nurses in this type of model act as the frontline providers and therefore they are considered a crucial component in delivery of the high patient structured care. The primary nursing model emphasizes one to one nurse patient relationships along with the importance of continuity of care. This model of care depends entirely on the relationship development criteria along with the therapeutic presence. It is also based on therapeutic presence, autonomous, evidence based as well delivery care model. The nurses who follow primary nursing model mainly have four important elements to follow (Korhonen & Kangasniemi, 2014). The first element of this nursing model is the responsibility for relationship building and proper decision making. The second element is work allocation as well as assignment handling in proper ways. The third elements involve the proper communication with the healthcare team. The fourth element is the leadership. Mainly the role of the nurse in this model is based upon responsibility, accountability as well as authority. The responsibility for developing a therapeutic relationship is dependent entirely upon the assigned nurse. Moreover, it also depends on the accountability of the nurse to the patient, family members of the healthcare team (McManus et al., 2015). It involves the authority to develop and implement an individualized plan for ensuring best safety and care to the patients.

Many researchers have noticed that the nurses following primary nursing model do not have the scope to practice to their fullest extent. They have mainly stated that insufficient inter-professional collaboration among healthcare providers from multiple disciplines is the main reason for which the patient is not receiving the best treatment. Inter-professional collaboration can be defined as the collective involvement of various professional healthcare providers who work with patient, caregivers, families as well as communities. They consider and communicate each other’s unique perspectives in delivering the highest quality of care. This models of care makes the registered nurses work along with a team of other nurses, professionals from different healthcare backgrounds and similar others (Regan, Laschinger & Wong, 2016). Specific competencies include establishing actions which helps them to influence policy to promote health of patients, mentor the colleagues, for the advancements of nursing practicing and also ensure better role performance and influence decision making (Sharma & Clocke, 2014). When different professionals provide their expert comments for patients with co-morbid disorders, it helps patients to be handled properly with better expertise and thereby helps in quick recovery. Moreover the workload on a particular nurse gets shared and therefore nurses have less burnout (Ganz et al. 2016).

Conclusion:

From the entire discussion above, it is quite clear that different nursing models of care have different positive and negative impacts. The primary nursing model helps in developing a trustworthy relationship which mentally keeps the patient stress-free, the cross-training models of nursing care helps in empowering nurses with more skills other than their own expertise. This increases their confidence and helps in handling many adverse situations when there is a nurse shortage. However, the inter-professional model of nursing makes the nursing professional work in association with different healthcare experts and other nursing teams where all provide their expertise to care for the patient in various aspects. Therefore this not only prevents the nurses from developing job stress but also helps patients to receive care which ensures all his symptoms are handled efficiently.

References:

Ganz, F. D., Engelberg, R., Torres, N., & Curtis, J. R. (2016). Development of a model of interprofessional shared clinical decision making in the ICU: a mixed-methods study. Critical care medicine, 44(4), 680-689.

Hepp, S. L., Suter, E., Jackson, K., Deutschlander, S., Makwarimba, E., Jennings, J., & Birmingham, L. (2015). Using an interprofessional competency framework to examine collaborative practice. Journal of interprofessional care, 29(2), 131-137.

Johansson, P., Lundström, K., & Heiwe, S. (2015). The primary nursing care delivery system within a haemodialysis context–experiences of haemodialysis primary nurses in Sweden. Clinical Nursing Studies, 3(4), 7.

Korhonen, A., & Kangasniemi, M. (2014). Nurses’ narratives on termination of primary nursing relationship with parents in neonatal intensive care. Scandinavian journal of caring sciences, 28(4), 716-723.

Manelski, M. J., Wagner, S. P., & Norris?Grant, D. M. (2013). The Pearls and Perils of Cross?Training: A Collaboration of Antepartum and Labor and Delivery Room Nurses. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(s1).

McManus, M., White, P., Barbour, A., Downing, B., Hawkins, K., Quion, N., … & McAllister, J. W. (2015). Pediatric to adult transition: a quality improvement model for primary care. Journal of Adolescent Health, 56(1), 73-78.

Nadeau, K., Pinner, K., Murphy, K., & Belderson, K. M. (2017). Perceptions of a primary nursing care model in a pediatric hematology/oncology unit. Journal of Pediatric Oncology Nursing, 34(1), 28-34.

Paul, J. A., & MacDonald, L. (2014). Modeling the benefits of cross-training to address the nursing shortage. International Journal of Production Economics, 150, 83-95.

Regan, S., Laschinger, H. K., & Wong, C. A. (2016). The influence of empowerment, authentic leadership, and professional practice environments on nurses’ perceived interprofessional collaboration. Journal of nursing management, 24(1).

Sharma, U., & Klocke, D. (2014). Attitudes of nursing staff toward interprofessional in-patient-centered rounding. Journal of interprofessional care, 28(5), 475-477.