Page 412 - Encyclopedia of Nursing Research

PATIeNT CARe DelIveRY MODelS n 379

hierarchical structure of the Nightingale
Patient Care Delivery model. Within this context, each team is
composed of a mix of RNs, licensed practical P
moDels nurses (lPNs), and certified nursing assis-
tants (aides) responsible for a single group
of patients. The number of teams on a given
It could be stated without argument that the patient unit is obviously determined by the
first nursing care delivery model was initi- size of the unit. The onset of the advanced
ated by Florence Nightingale (c. 1859) during practice nurse, such as the clinical nurse spe-
the Crimean War. It was Nightingale who cialist and/or the nurse practitioner, has had
differentiated between the “head” nurse (she a major impact on professional practice in
who did the thinking, planning, and direct- the organizational setting, while giving
ing of patient care) and the “floor” nurse, new meaning to the concept of team nurs-
who in essence was the provider of that ing. Although the nurse practitioner is gen-
care (Nightingale, 1859). Thus, a hierarchi- erally thought of as providing primary care
cal model for the delivery of patient care that to a group of clients outside the hospital set-
prevailed for nearly a century in english and ting, many are employed within hospital-
American health care facilities was born. operated ambulatory care setting or within
In the early years following the turn of the hospital itself, many times providing
the twentieth century, professional nursing the initial physical assessments of patients
was dominated by private-duty nurses who required by regulating agencies such as the
were employed through a “registry.” These State Health Department and the Centers for
nurses cared for a single patient in the home Medicare and Medicaid Services. Primarily
or in the hospital (before the introduction of prepared at the Master’s level, these nurses
intensive care units). Oftentimes, the director in advanced practice roles serve as consul-
of the nursing school also was the director tants to the nursing staff; they fill roles such
of nursing in the hospital; nursing “pupils” as staff educator, researcher, administrator/
provided the care of patients “on the wards,” manager, and, in many instances, as master
and nursing faculty provided the supervision clinician.
of these students in their clinical rotations. Primary nursing in its truest form assigns
After the stock market crash of 1929, when a “caseload” to the professional nurse, who is
families could no longer afford private duty then responsible for each of his or her patients
nurses, hospitals began to staff the wards “around the clock,” as it were. It is the respon-
with graduate nurses (new graduates not yet sibility of the primary nurse to make clinical
licensed) utilizing the original Nightingale rounds and to prescribe appropriate nursing
hierarchical model. interventions depending on client diagno-
In an effort to recruit and retain profes- sis. In the case of a hospital admission, the
sional nurses, little by little, models such as primary nurse maintains responsibility for
team and primary nursing as well as all RN the client(s) from admission to discharge;
staffs began to evolve in health care settings in a community health or long-term care, or
and advanced practice roles such as the clinical home care setting, it is possible that the pri-
nurse specialist and the nurse practitioner— mary nurse maintains responsibility for the
which had an impact on the effective deliv- client over an extended period of time.
ery of clinical nursing services, regardless of An all RN staff is expensive but self-
the setting. These models were popular in explanatory. Within this model, professional
the second half of the twentieth century. nurses provide all dimensions of direct
Team nursing is undoubtedly one of patient care whereas ancillary personnel
the earliest models designed to replace the are responsible for those tasks not involved