Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU
The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by CCNE and AACN using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, their specific care discipline and their local communities.
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As the country focuses on the restructuring of the U.S. health care 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. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
1.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.
2.Share your presentation with nurse colleagues on your unit or department and ask them to offer their impressions of the anticipated changes to health care delivery and the new role of nurses in hospital settings, communities, clinics, and medical homes. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
3.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. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
4.A minimum of three scholarly references are required for this assignment.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Evolving Practice of Nursing and Patient Care Delivery Models
I am a registered nurse and work in medical surgicalmental health unit for more than ten years. I would like to welcome you all in this informal education session. Today, I would like to discuss about the changing role of nurses and concept of continuum of care and the new health care delivery models such as Accountable Care Organizations (ACOs), medical homes, and nurse -managed health clinics. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Evolving practice of Nursing and Health Care Models
Health care system is changing; it is not just focused on the curative care but the disease prevention and wellness. Also, the new healthcare reform has approach to the development of healthcare delivery models with the changes in nursing role from acute care settings to community health care. Patient Protection and Affordable Care Act (PPACA) formed at 2010 support the establishment of ACOs, medical homes and nurse-managed health clinics; also new payment policies. With the formation of Affordable Care Act (ACA), health has transformed from traditional treating approach to the preventive and wellness. Nurse’s role has also changed from front-line caregiver to the care integrators and coordinators and help in providing the health services to the underserved people. All the health models are focused on the concept of continuity of care which is defined as “a concept involving an integrated system of care that guides and tracks patient over time through a comprehensive array of health services spanning all levels of intensity of care” (Evashwick, 1989). It covers the delivery of healthcare over a period of time and for all levels and stages of care. Let’s talk about the three types of health care delivery model. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Accountable Care Organizations (ACOs)
In accordance to the Center for Medicare and Medicaid services, “Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (Cms.gov, n.d.). The ACO is the new unit built by the ACA; the health reform law 2010 which take care of the cost and quality of the care received by the patients. The main aim of ACO is to deliver flawless and high-quality care at the right time to the patients, especially the chronically ill patients. The ACO include the specific group of providers and suppliers assigned by the ACA and they encourage the active participation of nurse practitioners (NPs), clinical nurse specialists (CNSs) etc with physicians and physician assistants. As nursing leadership is encouraged in ACO, registered nurses can lead in quality assurance and develop the improvement initiatives (Nursingworld.org, n.d.). Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Medical Home/Health Home
Medical homes (patient-centered medical homes, PCMH), similar to Accountable Care Organizations are primary health care delivery model focused on the deliverance of the primary care that is patient-centered, managed, synchronized, accessible, ample and believe in quality and safety. “The medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs” (Pcpcc.org, n.d.). This medical health model helps in solving the health care costs problem with the support of primary care providers such as physicians, nurse practitioners and certified nurse-midwives. Nurses being front-line healthcare workers play a vital role in this model as they can actively participate in health promotion and disease prevention, order and interpret laboratory tests and other studies and refer the patients who need specialized care. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Nurse-Managed Health Centers (NMHCs)
NMHC is another initiation developed by ACA to promote the primary care, disease prevention and control of chronic conditions in the medically underserved and rural areas of United States. NMHC’s are managed by the nurses that include all the nurse practitioners, clinical nurse specialists, nurse midwives, and public health nurses. They provide many health services especially in the needed communities such as diagnosis and prescription to illness, pre- and post- natal care and referral to specialists (About Nurse-Managed Care, n.d.). This care model maintain the nurse managed clinics with the aim of enhancing access to primary care in the communities of medically underserved and/ or vulnerable populations, boost up the nursing practice and leadership for the nursing students by serving as clinical training sites and maintain the patient and workforce data.
To conclude, ACOs, medical homes and NMHCs are the concept of new health care delivery model created by the ACA to minimize the issues of health care cost and easy access of quality health care. These models are mainly patient-centered, competent, accessible and cost effective. The establishment of these types of health care delivery models has changed the role of nursing and set new parameter for the nurses. Nurses have advanced beyond the role of front-line healthcare workers to become care coordinators, efficiency experts and prove to be the backbone of most of these delivery care models. Nurse play as a care integrators and focused on the continuum care from the acute care to the community health settings through these models. Moreover, with the advancement of health technology and health reforms, preventive base health care has taken the priority than the curative care and nurse role is very important towards preventive health care too. Therefore, the opportunities for the nurses are increasing and the demand of the educated, skilled and professional nurses are vital during this changing time of health care system. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Thank you for hearing me and participating in this session. If you have any queries, please feel free to ask. I would look forward to hearing your opinion.
Thanks!
Summary of the Feedback
After this author gave the presentation, all the nurse colleagues took part in discussion session about the benefits and changes that new health reforms and the health care models brought in health care system of the country. This paper will summarize the feedback received from three colleague nurses and forecast the role of nursing.
Nurses who took the active participation in the discussion have their own point of view regarding the healthcare reforms and change of nursing role. However, majority of the number have similar point of view about my presentation and support the new healthcare reform. They also appreciate the new health care delivery models and the role of nursing in these care models. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
‘Nurse A’, BSN nurse graduated from Bangladesh and working here in United States at recent times, talked about her experience she had as a nurse back in Bangladesh. She expressed that it was totally different; nurses are the front-line caregivers and are not allowed to take any decision; only follow the orders of the doctors. The role of nurse in health care system differs according the location and time. The emergence of importance of community health is providing the opportunities to the nurses in developed countries like the USA and this new health reform is being following by many developing countries as well. She is very happy and ambitious with this new healthcare reforms and healthcare models. Moreover, the role of nursing has been changing from the front-line caregiver to the care integrators and from acute care settings to the community. Nurses’ role in community settings is the major advancement in healthcare system such as NMHCs. Nurses can work as a leader of the organization in the community setting with self directed, critical thinking, and independent decision making qualities. She focused on NMHCs, where nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. Therefore, new healthcare reforms help to provide nursing role a new perspective and lead to an innovation healthcare system. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
‘Nurse B’ was also very excited about the healthcare reform as it believes on the potential of nurses for the transformation of US health care system. She focused on importance of the new health reform because of increasing chronic disease and cost and also taking on preventive care over the curative care. The new healthcare delivery models (ACOs, NMHCS, medical homes) will enhance the preventive care services leading the management of the chronic diseases in the community settings. This will help in reducing the problem of rising the cost of health services and can make aware about the disease prevention and health promotion. Moreover, preventive care services will require huge number of educated nurse workforce and leadership to improve the community’s health care. She further added up that the nurses are the fundamental to the patient-centered care delivery model. The nurses have the capability of building a strong relationship and coordination with the patients and the health care providers’ team and lead in organizing and functioning of different health care models. According to her, the concept of the new health care delivery model of providing the facilities to the underserved people is commendable. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
‘Nurse C’ has different point of view regarding the healthcare reforms and healthcare models. She expressed her anxiety about the quality of the services provided by the hospitals and healthcare models when large number of people will be flooded into it for the treatment. She explained that Affordable Care Act (ACA) will benefit large number of people causing the crowd that will definitely affect the hospitals and health systems to take care of the influx of the new patients. That is increase in administrative cost, much more paper work, disease and care management, over-seeing and time dealing with Medicare for the millions of newly insured patients. She added that increase in number of patient will imply to the must increase in number of healthcare providers and nurses. If the strong and enough approach are not taken for the fulfillment of the need of nurses and healthcare providers then it will directly affect the quality of care. Moreover, it will affect the status and motivation of the existing nurse workforce. Therefore, she highly looked forward for the high-quality of health services provided to the patient that is she believed in quality rather than quantity.
To conclude, nurses are the major part of health care system and the role of nursing has changed and advanced with the implementation of the health care reform and health care delivery system. These types of reforms and models have transformed the entire health care system of the United States from acute care settings to community and benefitted many underserved people. However, knowledge and information of the health reforms should be given to everyone.
References
About Nurse-Managed Care. (n.d.). Retrieved February 24, 2016, from National Nursing Centers Consortium:
http://nncc.us/index.php/about-nurse-managed-care
Cms.gov,. (n.d.). Accountable Care Organizations (ACO) – Centers for Medicare & Medicaid Services. Retrieved 23 February 2016, from
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Evashwick, C. (1989). Creating the continuum of care.
Health matrix, 7
(1), 30-39.
Nursingworld.org,. (n.d.). Accountable Care Organizations. Retrieved 23 February 2016, from
http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/ACOs
Pcpcc.org,. (n.d.).
Defining the Medical Home | Patient-Centered Primary Care Collaborative
. Retrieved 24 February 2016, from
https://www.pcpcc.org/about/medical-home
Researches argue out that healthcare forms a big basis to how a country will develop economically if the overall state of healthcare delivery is good. A streamlined healthcare delivery ensures that the populace receives nursing in time and also reduces health sicknesses and consequently this reflects in the population by less health complications thus a healthy labor force. A healthy labor force reflects to improvement in the country’s economy. The practice of nursing and patient delivery has evolved greatly for the past decade. This has been made possible by the introduction of technology into healthcare which has improved the delivery of care to the patients. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
Continuum of care is a conception which involves an incorporated structure of healthcare whereby it directs and trails patient over a spread out time during an inclusive assortment of health services across every level of concentration of care. This concept provides a structure to show day-to-day management/decision making and presenting a structure for delivering of finest healthcare to all the sick citizens. Fundamentally, what this denotes is that this system consents to an individual like a sick person to have his or her healthcare administered efficiently from indispensable care, for instance making appointments and prescriptions, to further highly developed care, resembling the critical care and in-hospital (Spath, n.d.).
The complete concept of continuum of care in the setting of healthcare is described to be inclusive of rehabilitation, Alzheimer’s care, skilled nursing care, assisted living, and also independent living. This model generates a medical community whereby the ancillary staff together with doctors who are involved in a patient treatment all converse concerning their treatments, procedures, and diagnoses. It connects all the patient services and evades replicating them. Thus patient primary care commands tests that the health professionals don’t replicate. The model enables everybody to see the whole thing and hence allowing for improvedtreatments (Spath, n.d.).
An Accountable Care Organization commonly denoted ACO is a health care delivery organization which is described by a care delivery and payment model that look to bind provider repayments in order to value metrics and lessening in the whole price of healthcare for an allotted populace of patients. Groupings of coordinated care suppliers create an ACO, then they offer healthcare to a collection of patients. The ACO makes use of a variety of imbursement models ranging from symmetric/asymmetric shared savings, fee for service, or even capitation. The ACO model is entirely responsible to the sick people with the 3
rd
party financier for the efficiency, appropriateness, and quality of the healthiness care supplier (Gold, 2011). Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
The ACO concept has the planning around flexibility, and its build amid three sub-concepts. First of all, it brings out healthcare providers who have a strong stand of prime care and are jointly responsible for worth and full per capita charges transversely through the whole continuum of healthcare for a specified populace of patients. Secondly, the care payments are coupled with the quality improvements of the healthcare and this minimizes the overall costs in healthcare. Also, the concept revolves around dependable and increasingly more stylish performance dimension, to maintain enhancement and offer assurance that savings are realized in the course of improvements in healthcare (Gold, 2011).
The medical home model was first introduced into the country in 1967 by the American Academic of Pediatrics (AAP) with the aim of creating a core of children medical records. The prime aim of this concept was to give care to children with special concern needs. With time the concept evolved to capture every child’s medical and non-healthcare. In fact, currently the model has changed to even cover adults’ needs. The medical home has cultured affiliation amongst the primary provider, family, together with the patient in collaboration with professionals and support frrom the society. The focal point surrounding this model is the family and patient, and this concept of medical home is put up about this center (Fiore, 2012). Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.
The medical home is defined through several principles or rather called sub-concepts. For instance, every sick person has his/her personal physician where they have an association together with the aim of the doctor providing comprehensive and continuous care, together with giving first contact. Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU. The care delivery is integrated and coordinated all through the multifaceted healthcare system. The safety and quality of health care makes the features of the medical home model. Decision making is guided by medical decision support and evidence based medication. A medical home is an imperative method for connecting the several sections of a child’s healthcare, as well as oral and behavioral health, in order to achieve these objectives (Fiore, 2012).
A nurse managed health clinic gives healthcare examinations in regions which are medically underserved especially in countryside and town locales in the U.S. where care accessibility is limited. This model of care delivery strongly puts lots of emphasizes on supervision of persistent illnesses like diabetes, hypertension, and asthma, disease prevention, and wellness promotion. The nurses in these care centers have equal practice scope as primary care doctors in terms of prescription privileges. These clinics have evolved considerable over time as they are generally allied with independent non-profit groups, universities, or even nursing institutions (Turton et al., 2010).
Nurse managed health clinics are well known for offering care at a considerably lesser cost in comparison to those of physician’s workplace or an imperative healthcare facility. This model has extensively improved the nursing and patient care delivery with its cost effective strategy. It has also improved the accessibility of primary care especially in regions where there are shortages of primary care givers (Turton et al., 2010). Evolving Practice of Nursing and Patient Care Delivery Models Essay GCU.