Page 413 - Encyclopedia of Nursing Research

380 n PATIeNT CONTRACTING

in direct patient care. With the tightening Theory on Human Caring. Other models in
of fiscal belts, cutbacks in Medicare and the acute care arena have elevated the regis-
P Medicaid reimbursement, organizational tered nurses role to a care coordinator over-
mergers, changes in organizational philoso- seeing the patient care of several patients
phy, and the like, except for limited instances whose direct care is being provided by nov-
one might conclude that the all RN staff has ice nurses, lPNs, or nursing assistants. A
largely become a phenomenon of the past. new role has been created from these models
In 2007, the Robert Wood Johnson of care coordinator called the clinical nurse
Foundation funded an original research leader who is a master’s prepared nurse who
project to identify and profile new mod- leads teams of caregivers. examples of the
els of care that could be widely replicated care coordinator models include the patient-
throughout the United States. In collabora- centered care, the primary care coordinator,
tion with Health Workforce Solutions llC the unit-based case manager model, and
and through a broad-based e-mail inquiry, the 12-bed hospital developed at the Baptist
a literature search, and Internet research, 60 Hospital of Miami.
new care delivery models were selected for The care transitions models are designed
in-depth research interviews. to bridge the continuum of care between
The group was narrowed through a acute care and home or outpatient services.
process of comparing the models to criteria This is a model that will meet the needs of
developed by a select group of chief nurs- the new health care reform initiatives. even
ing officers and executives, nurse manag- more critical to future health care models will
ers, and academics from a variety of nursing be the comprehensive care models developed
schools. Twenty-four models were further to focus on people lives from prevention
investigated and selected to be included in and wellness through the entire continuum
a white paper titled Innovative Care Delivery including social programs.
Models: Identifying New Models that Effectively To learn more about each of these mod-
Leverage Nurses, published in 2008 by the els, go to www.innovativecaremodels.com.
Health Works Solutions group. At the same
time, the Robert Woods Johnson Foundation M. Janice Nelson
created a Web site that contains the complete Connie A. Jastremski
profiles of each model described, including
a detailed description, impetus for its devel-
opment, results, consideration for implemen-
tation, and replication and selected tools Patient ContraCting
(http://www.innovativecaremodels.com).
The models are divided into three cate-
gories: acute care models, models that bridge Patient contracting is an intervention for
the continuum of care, and comprehensive promoting patient adherence in practice or
care models. Within the acute care models, research settings. Patient contracting pro-
there are components of earlier care deliv- vides an opportunity for patients to learn
ery models with a more comprehensive role to analyze their behavior relative to their
for the professional nurse. Some incorpo- environment and to select behavioral strate-
rate team nursing (medical–surgical unit gies that will promote learning, changing, or
team nursing, which is an RN–lPN team maintaining adherence behaviors (Boehm,
model; the model RN line model). The nurs- 1992). Patient contracting is relevant to nurs-
ing caring delivery model is a team-oriented ing practice and research because it can assist
primary nursing model for providing inpa- patients to adhere to treatment regimens,
tient and outpatient care based on Watson’s such as medication taking, meal planning,