Innovative Nursing Care Delivery Models A.This Website

¶ … Innovative Nursing Care Delivery Models a.This website detailed profiles 24 successful innovative nursing care delivery models. These profiles developed part a research project conducted Health Workforce Solutions LLC (HWS) funded Robert Wood Johnson Foundation (RWJF). Innovative nursing care model: The Care Transitions Intervention Innovative nursing care model I chose the Care Transitions Intervention Model on which to focus because of the increasing importance of geriatric care in the field of nursing.

Although my organization serves the needs of persons of all ages, elderly patients are an increasingly large proportion of the patient base. The Model stresses the need for the empowerment and self-care even of patients with high-risk conditions. The Care Transitions Intervention Model allows elderly patients the maximum amount of mobility and autonomy possible given the limits of the patient's condition and enables them to stay in a home setting as long as possible.

As its name suggests, the model facilitates the transition of the older patient from an acute care setting to a home care setting. As well as being less stressful for the patient, a home-based care setting is also more cost-effective and an increasing necessity within many resource-strapped healthcare organizations. Development team for innovative nursing care model The Model also addresses the need for effective home health care.

For patients with chronic health conditions, having trained staff attend to the patients both in the hospital and at home are vital for a seamless transition from one environment to another. A team of nurses in the hospital who can 'teach' caregivers is important; so is having staff that can support the efforts of caregivers at home.

"This model is designed to help patients more effectively manage significant transitions in their care, primarily from the hospital to home or from the hospital to a skilled nursing facility to home" (Care Transitions Intervention, 2013, Innovative Care Models). Thus, the team must include nurses at the hospital who can orient caregivers and patients in the life skills needed to manage chronic conditions.

However, professional assistance from nurses to the patient's home is likely to be required on a regular basis, given the severity of the medical complaints the model is intended to treat. Typical conditions include "post-discharge SNF or home health care or intensive anticoagulation management" such as "congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease" (Care Transitions Intervention, 2013, Innovative Care Models).

Patients under care via the model also may suffer from "diabetes, stroke, medical and surgical back conditions (predominantly spinal stenosis), hip fracture" and run the risk of "peripheral vascular disease, cardiac arrhythmias, deep venous thrombosis, and pulmonary embolism" (Care Transitions Intervention, 2013, Innovative Care Models). Home caregivers must understand the appropriate precautions to take and must be supported by trained visiting nurse staff that regularly check patient vital signs and give support.

Incorporation of selected model into my work setting Training is required for all staff to understand the worldview conveyed by the model: it is not enough merely to care for patients, it is also important to create a bridge between hospital and home, which means involving all members of the patient's family. An initial orientation in the model is required, specifically designed to prepare staff to convey medical knowledge to laypersons. Change is always difficult for any organization, but for a healthcare organization it can be particularly entrenched.

Often, the focus is simply upon dispensing care rather than teaching others how to give care. Unfortunately, the result of this gap between the ability to convey understanding and knowledge can leave caregivers under-informed. The organizational model of change integration is one in which participants must be convinced of the need for and the value of the change (the unfreezing process); the change process itself; followed by the refreezing process whereby the change become a standard operating procedure of the organization (Kurt Lewin Change Model, 2013, Change Management Coach).

In this instance, gaining buy-in from the nurses who will be providing the care to the patients in the program and orienting the caregivers is essential, since they are on the front lines of the provision of this intensive, home-based treatment. "The key to the problem is to understand the true nature of resistance. Actually, what employees resist is usually not technical change but social change -- the change in their human relationships that generally accompanies technical change" (Lawrence 2013).

Visiting nurses who provide routine home visits must also understand their roles: although they may be called upon to perform certain duties which only medical personnel can provide, whenever possible they should also be aware of the need to show.