Evolving Practice of Nursing and Patient Care Delivery Models

Evolving Practice of Nursing and Patient Care Delivery Models

The nursing profession is advancing care management models by evolving strategies to mitigate current challenges and in turn effectively intervening and improving healthcare, especially for chronic diseases. As such, there are a number of continuums of care initiatives set in place to ensure the growth and sustenance of certain strategies such as disease management programs which account for the largest expenditure in the healthcare industry. In addition to disease management programs, the healthcare system has also adopted care coordination and case management strategies to strive to approach a target audience with reference to multimorbidity chronic diseases or complex care situations. In accordance with the provisions of the Medicare Prescription Drug Improvement and Modernization Act of 2003, cost saving, though seemingly elusive in the recent past, should be dealt with to ensure there are quality outcomes in terms of improved services without compromising on the number of nurses working or patients being served.

Patient-Centered Medical Homes (PCMH)

There is reason to do away with fragmentation in health care since it brings poor quality consequences despite the process being costly. As such, if health reform works towards these agendas, it is possible to save at least $271 billion annually, according to the Institute of Medicine’s Roundtable on Evidence-Based Medicine (2009). Therefore, the health reform focuses on patient-centred medical home care that enables care teams to provide a multifaceted need without compromising on comprehensive and coordinated patient-centred health care, states Kaye and Takach (2009). Therefore, PCMHs are mandated to outgrow both structurally and through care delivery innovations such that primary care is reflected as coordinated, first contact, continuous, and comprehensive (Starfield and Shi, 2004).

Accountable Care Organizations (ACOs)

Most influential legislative circles have taken note of ACOs as part of the health reform. ACOs have been proven successful through certain pilot strategies and programs like Geisinger Health System and Kaiser Permanente. This was made possible through data taken from geographic patterns, and taking into consideration current healthcare services, regional patterns are identified and used to envision locally integrated hospital groups and healthcare providers, including nurses (Crosson, 2009a). In addition, ACOs have been seen to control cost by reforming the payment structure where providers now enter into agreements with financiers throughout a defined population to ensure quality and quantity are efficient.

Adopting Health Care Support Technologies

President Obama has signed several economic stimulus legislation since he has been president to propagate the development and expansion of particular healthcare support technologies. The U.S. RN ambulatory workforce has employed over 2.5 million RNs since his assuming office. This kind of investment has the intention of nourishing digital health care to ensure it is well-rooted. This is important considering only 20 per cent of RNs in hospitals have minimal functioning HIT infrastructure with 5 per cent covering the fully wired content (DesRoches et al., 2008). Nonetheless, the system is bound to change considering the efforts being placed on the nursing profession through future training, workforce policies and staffing models. In relation to that HIT is considered the pioneering factor in profound changes within the process of clinical practice, increasing care efficiency to better outcomes, redesigning the roles and skills of portrayed in the healthcare workforce, even in multidisciplinary teams, and starting new paradigms that consider time and place as key factors influencing the delivery of health care.

Reflections/Feedback

The nurses that I shared my presentation with were of the opinion that care was supported by interoperable networks, and in particular digitally enhanced to ensure time and place are taken into consideration. According to one of them, the patient will have to be in the same location if telemedicine is to work. On the other hand, she was of the opinion that nurses will have to understand the essence of home care and go out of their way to ensure they respond to as many cases as possible. However, one of them was able to point out that there could be a challenge for emergency cases.

It was the position of one of the nurses that remote patient monitoring has to be expanded exponentially. This is, considering the increased growth rate of biometric devices, that collection, monitoring and reporting of information in real-time is unavoidable. As such, it would be important that as the healthcare industry reforms, these biometric devices be portable for healthcare professionals to easily be on the move with them. There are already two main machines that have been made portable for this reason, the automated insulin pump as well as the implantable defibrillators.

One of the nurses was concerned with the current statistics on how nurses have been spread out across the country since the current system does not necessarily balance the geographical untethered positioning in the healthcare system today. To make sure the system is fully operational and efficiently functional, it is important that the government is able to balance how HIT works before fully implementing the system. Nonetheless, all the nurses were pleased with the idea of the HIT system and the improved concepts coming with it. As a subset of significance in the healthcare system, the nurses were of the opinion that HIT adoption would realize the effectiveness and efficiency of clinical interactions between target populations as well as individual patients. In addition, they anticipated that EHRs that worked alongside HIT would be able to reduce the cost of services delivered and at the same time improve the quality of care evidenced by HIT achievements and measured outcomes adhering to optimal standards.

The nurses were eager to point out that the current composition, as well as distribution of the RN workforce today, has diverged from workforce need orientations to support the health reform orientations. With reference to how this trend has picked pace over the last decade, it is evident that RN professions have attracted specialists back to hospitals as opposed to other healthcare settings. They also pointed out that only 12 per cent of RNs were available for ambulatory care settings and that it was wise for President Obama to notice the difference and work towards filling the gap once he assumed his office. Moreover, they were hesitant to put it out there that the current payment policy as well as employer behaviour are the main reasons behind a nursing practice model in different healthcare settings. As such, they were pointing out that how a nurse performs is highly related to the setting as opposed to patient-centred. As a result, they were of the opinion that care coordination and management transitions need to be set up to ensure healthcare settings become an integral part of nursing care.

With reference to assisting highlights for future training, one of them proposed that the health reform should consider coming up with clinical curricula that ensure students follow up on patients across institutional settings and time hence being able to build clinical experience with reference to acute inpatient care as well as episodic are even as they train. The nurses agreed that a fully functional PCMH works around a caregiver versus patient engagement with the essence of meeting the patient’s preference. To improve this situation in the current healthcare system, the nurses proposed that information and education be emphasized for medics to promote self-management, including monitoring, reviewing and following up on services provided across different settings without compromising on transitional care.

In addition, they were of the opinion that a reasonable PCMH model should lower the costs by reducing visits to emergency rooms as well as hospital admissions. They also went on further to advise that health reforms should consider patient self-management features that equip the patient for emergency purposes when the nurse is not readily available. The nurses were keen to point out that having care transition projects that ensure partnerships between Medicare and other local stakeholders would develop and help maintain the strategies as envisioned by the government and other stakeholders in the healthcare industry.

References

Crosson, F. J. 2009a. 21st-century health care: The case for integrated delivery systems. New England Journal of Medicine 361: 1324–1325.

DesRoches, C., K. Donelan, P. Buerhaus, and L. Zhonghe. (2008). Registered nurses use of electronic health records: Findings from a national survey, Medscape Journal of Medicin, 10: 164

IOM. (2009). The healthcare imperative: Lowering costs and improving outcomes. Washington, DC: The National Academies Press.

Kaye, N., and M. Takach. (2009). Building medical homes in state Medicaid and CHIP programs. Portland, ME: National Academy of State Health Policy.

Starfield, B., and L. Shi. (2004). The medical home, access to care, and insurance: A review of evidence. Paediatrics 113: 1493–14998.

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As the country focuses on restructuring the U.S. healthcare 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 in your unit or department and ask them to offer their impressions of the anticipated changes to healthcare delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes.

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.

rubrics

Clearly States How the Practice of Nursing and Patient Delivery Will Evolve While Addressing Relevant Concepts That Include Continuity or Continuum of Care, Accountable Care Organizations, Medical Homes, and Nurse-Managed Health Clinics

Evidence of Feedback and Forecasting of Nursing Role From Colleagues