Innovative Nursing Care Delivery ModelsInnovative Nursing Care Delivery Models

WRITE paper on Innovative Nursing Care Delivery Models for Bachelors Degree Global Health Class
Double Spaced APA
a) SeethePDFfile: This file is at the end of the requirements
Norlander, L. (Ed.). Transformational models of nursing across different care settings. Report: The future of nursing: Leading change, advancing health (Appendix G). Washington, DC: National Academy of Sciences, Institute of Medicine..
This paper describes a variety of innovative or transformational models in nurse-managed care across different care settings. Since the students in this course currently work or have worked in many different health care settings (acute, community, armed services), the focus of your paper will be on the ONE of the following areas of health care (Ignore nursing education/curriculi models):
? Acute Care
? Chronic Care
? Palliative and End of Life Care
? Community Health
? School Health
b) Choose ONE of the listed (bulleted) health care areas above that are described in the paper and read the descriptions about innovative or transformational models of nursing-managed/led care that have been established for that selected care setting. NOTE: Many of the models in the paper are described in more detail in other journal articles. You may want to do a literature search if you are interested in learning more about a particular model.
To assist you in APA formatting, the following is an example of the APA formatted citation/reference for one of the above settings (school health). If you are using a NON-school based setting, use the appropriate authors and article title for that setting.Citation:.(Proskurowski, Newell, & Vandriel, 2011).
Reference: Proskurowski, M., Newell, M., & Vandriel, M. (2011). School nurses, school-based health centers, and private programs successfully improve childrens health. In L. Norlander (Ed.), Transformational models of nursing across different care settings. Report: The future of nursing: Leading change, advancing health (Appendix G). Washington, DC: National Academy of Sciences, Institute of Medicine.
c) Think of your own health care setting (your unit, clinic, etc,) or an interest you may have. This is your chance to adapt a innovative/transformational nurse led/managed model for your current work setting, and/or combine two or more models described in the paper for a new model, and/or develop a completely new model for your setting or another setting. For example, the Agile Team Model is described in the acute care setting. How would you adapt it to your current settingor would you completely scrap it for a new model? Think out of the box. NOTE: If you are not currently working as an RN, choose a clinical setting you worked in as a student or veteran or an interest you may have re: a nurse-managed model.
Innovative Nursing Care Delivery: [Name of Your Model]
i. PAPER HEADING: [Level 1] Introduction How has your previous professional and clinical experiences and/or interests led you to choose or develop this nurse-led/managed model? Choose a name for your model and include it in your paper title.
ii. PAPER HEADING: [Level 2] Description of the [Name of Your Model] Describe the model as it will be incorporated into your work setting and/or community. Health care organizations and communities are unique and adaptations would be required depending on the organizational or community setting. In describing your model, how would you incorporate the following common themes? These themes are crucial to meet the challenges of the future:
a. Nurse led and nurse managed health care. [Level 3]
b. Partnerships and collaboration. [Level 3]
c. Continuity of care across settings. [Level 3]
d. Technology. [Level 3]Always consider cost-effectiveness; you could develop the Cadillac of models, but no one would consider implementing it because the cost would be too high.
iii. PAPER HEADING: [Level 2] Development/Implementation Team for the [Name of Your Model] Organize a team. Who would you select to be on your team to develop and implement the model (titles, not names). What would each of the team members do in your modelhow would they be integrated into your model? What is their unique role? Againthink about the cost effectivenesscould ancillary staff (nurse assistants, licensed practical nurses) be used just as effectively?
iv. PAPER HEADING: [Level 2] Evaluation of [Name of Your Model]: Outcome Measurement Evaluate the model. After implementation of the model, what outcomes would you measure and how and when would you measure those outcomes? Be specific. Look at the outcomes that were measured in other models. Would you look at cost comparisons and/or savings? Patient satisfaction? Staff satisfaction? Fewer ER visits and/or re-hospitalizations?
4) Use the above headings in your paper. In-text citations and a reference list MUST be found in your paper. Fifteen (15) points will be deducted for incorrect citations and/or references. See the Nursing Student Writing Guidelines Checklist for APA formatting.
5) EVALUATION: Paper: Innovative Nursing Care Delivery (750 words min) Critical Thinking Skills/Content Development/Organization (60%): Innovative Nursing Care Model; Development/Implementation Team for Innovative Nursing Care Model; Evaluation of Model: Outcome Measurement
Format/Computer Technology Skills (40%)
6) UPLOAD completed paper (file) into the Assignment Turn-It-In folder by the due date.Text:
Transformational Models of Nursing Across Different Care Settings1
Edited by Linda Norlander R.N., B.S.N., M.S. Group Health Home Care and Hospice
From the time of Florence Nightingale when nursing introduced public health and hygiene principals to the care of wounded soldiers, to the 20th century establishment of advance practice nurses, nursing has been at the forefront of health care transformation. We are now challenged as the health care needs of the population change from an acute and infectious disease focus to that of an aging population with chronic disease. The cost of health care is rising and the number of people who are poorly served by our health care system is increasing.
Along with the change in the health care landscape we are facing a nursing workforce shortage and a nursing leadership shortage. By the year 2025, it is estimated that we will have a shortfall of between 300,000 and a million nurses. Four out of every 10 nurses will be over the age of 50 (Buerhaus, 2008). More- over, by 2020, 75 percent of the current nurse leaders will have left the nursing workforce (Hodes Aging Workforce Study, 2009).
The following briefs represent the creative and innovative thinking of nurse leaders to aIDress our current and future challenges. They were prepared for the Robert Wood Johnson Foundation Initiative on the Future of Nursing Institute of Medicine Committee, by fellows of the Robert Wood Johnson Foundation Execu- tive Nurse Fellows program. This is an advanced leadership program for nurses in senior executive roles in health services, public health and nursing education who aspire to help lead and shape the U.S. health care system. The program is
1 The responsibility for the content of this article rests with the authors and does not necessarily represent the views of the Institute of Medicine or its committees and convening bodies.
Copyright National Academy of Sciences. All rights reserved.
The Future of Nursing: Leading Change, Advancing Health
designed to give nursing and nurses a more influential role across many sectors of the economy. Fellows in this program represent the expertise and leadership of today and the leadership of the future. These briefs include background on the needs, evidence-based innovations and most important, recommendations for healthcare in 21st century.
The briefs include the following areas in health care and health care education:
Transformational Partnerships in Nursing Education
Innovative Nursing Education Curriculum
Acute Care
Chronic Care
Palliative and End-of-Life Care
Community Health
School Health
A number of common themes emerge from the briefs. In order to meet the challenges of the future we must embrace technology, foster partnerships, encour- age collaboration across disciplines and settings, ensure continuity of care and promote nurse-lead/nurse managed health care.
Technology. Advances in technology open a new world in the provision of health care. The use of technology includes electronic health records, telehealth, remote monitoring, education through simulation, and a host of as yet undiscovered innovations.
Partnerships and Collaboration. The importance of partnering and collaborating extends beyond interdisciplinary care at the bedside to nursing education-community partnerships, community and business partnerships, and public and private partnerships.
Continuity of Care Across Settings. Our current siloed system leaves significant gaps in care. Smooth transition of patients from set- ting to setting is especially needed with the elderly and chronically ill populations.
Nurse-lead and Nurse Managed Health Care. From the developing model of primary care community based programs to retail-based nurse practitioner clinics, nurses are filling in the primary care gap.
Each brief includes an important set of recommendations specific to the area aIDressed. However, a number of universal recommendations emerge that direct the future of nursing and health care.
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The Future of Nursing: Leading Change, Advancing Health
Education. The current nursing education model is not adequate to meet the needs of the future. Education must develop new partnerships with the community, business and healthcare institutions. More emphasis and resources must be directed to preparing masters- and PhD-level nurses.
Public Policy. Solid funding sources are needed to support nurse prac- titioners, nurse managed community health programs and nursing ed- ucation. Funding must cross settings from acute care to home and community based care. Nurses must be included on local, state, and national health care advisory and policy committees.
Care Models. We must continue to develop innovative care models based on current successes such as the acute care agile self-directed nursing teams, the rural healthy aging community model and school- based and community-based nurse managed clinics. These models should cross disciplines, foster collaboration and partner with communi- ties, business and other organizations.
The future of health care rests solidly with the strength nursing brings in ho- listic care, ability to collaborate and innovate from the bedside to the community and the ability to adapt to the changing environment. In order to make this happen nursing must adapt education and curriculum to the new century, promote higher education, advocate for innovative models of care and advocate for the health care and education policy to support those innovations.
Buerhaus, P.I. 2008. Current and future state of the U.S. nursing workforce. Journal of the American Medical Association 300(20):2422?2424.
Hodes Aging Workforce Study. 2009. agingworkforce.asp (accessed January 10, 2010).
Copyright National Academy of Sciences. All rights reserved.
The Future of Nursing: Leading Change, Advancing Health
Victoria Niederhauser, Dr.P.H., A.P.R.N., M.S.N., P.N.P.-C. University of Hawaii
Richard C. MacIntyre, Ph.D., R.N., FAAN Samuel Merritt University
Catherine Garner, Dr.P.H., R.N., FAAN American Sentinel University
Cynthia Teel, Ph.D., R.N. University of Kansas
Teri A. Murray, Ph.D., R.N. Saint Louis University
Although the nursing care environment has changed significantly over the past 30 years, little has changed in the educational methods used to prepare new nurses. Since the 1930s, most clinical education in nursing has been structured with a faculty member supervising a small group of students on one or more in-patient units. Students usually move to new settings for each clinical rotation. This traditional model is heavily dependent on nursing faculty and often requires students to wait for direct faculty supervision. Students often are strangers to the registered nurses providing patient care in these settings. This arrangement can compromise the cohesiveness of the nursing team and limit opportunities for building professional relationships between students, registered nurses, and other members of the health care team. Developing a more structured and co- hesive partnership between the registered nurse and the student, both of whom are providing care to the same patients, has the potential to revitalize clinical education in nursing.
Since Buerhaus and colleagues (2000) first documented the nursing shortage facing the United States, educational institutions have been challenged to increase capacity. The most commonly cited reasons for lack of nursing school capacity are a shortage of nursing faculty and availability of clinical sites (AACN, 2005). Over the last decade new partnership models have developed to finance the cre- ation and expansion of nursing programs, create access to nursing education at all levels, expand and support faculty members, and increase capacity toand experiences atclinical sites for students.
Copyright National Academy of Sciences. All rights reserved.
The Future of Nursing: Leading Change, Advancing Health
As early as 1993, the Robert Wood Johnson Foundation provided stimulus grants through Colleagues in Caring, a grassroots, state-by-state initiative to bring together healthcare administrators, academics, state regulators, and legislators. This early dialogue prompted states and health care providers to broaden finan- cial support for colleges of nursing, develop joint simulation training centers, and create new approaches to placing nursing students in clinical settings. The initial support from a major philanthropic organization evolved into centers for nursing workforce expansion in a number of states. The number of graduates has increased, but is still not sufficient for future workforce needs (Buerhaus et al., 2009). New models for accelerated doctoral programs are key to producing more nursing faculty and innovative partnerships are imperative the success of these programs.
Pre-licensure nursing education is a costly endeavor. While health care or- ganizations have contributed to existing schools, others have acquired nursing schools as part of broader hospital acquisitions. Feeling the pressure of nursing shortages as they plan future organizational growth, large health systems have forged partnerships with private universities to open aIDitional schools of nurs- ing. Institutions such as DeVry, Kaplan, the University of Phoenix, and Western Governors University have business models that can respond to market needs with rapid expansion. The International University of Nursing in St. Kitts, West Indies is the first offshore U.S.-based college of nursing. This sector can be expected to grow, especially as states and local communities respond to budget shortfalls in a downturn economy.
Across the nation, innovative academic-service partnerships are reenvision- ing the role of the registered nurse as clinical teacher and facilitating 1:1 rela- tionships between nurses and students over extended periods of time (Allen et al., 2007; Joynt and Kimball, 2008; Moscato et al., 2007). In these partnerships, students, faculty, and staff report that students have less unproductive time spent waiting for clinical supervision and better socialization to the professional nurs- ing role (Udlis, 2008). When clinical education is structured to facilitate rela- tionships between students and nursing staff, the faculty role changes as well and includes more involvement with the professional development of nurses as preceptors, coaches, and clinical teachers. Most importantly, students and faculty are not viewed as visitors in the clinical setting, but rather as integral members of the nursing team, committed to building cultures of quality and safety (MacIntyre et al., 2009). Many hospitals are requiring faculty to participate in internal continuing education and competency validation. Innovative partnerships are re- engineering the faculty role to take advantage of what graduate prepared faculty can bring to the clinical setting.
The National Council of State Boards of Nursing (2008) reports a wide varia-
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The Future of Nursing: Leading Change, Advancing Health
tion in clinical hours between schools of nursing. There is no evidence linking any specific number of hours to improved student outcomes. A change in focus from hours to demonstrated competencies, whether in simulation labs or clinical settings, would make more optimal use of the clinical sites available for student experiences and help make education available to more students. Program evalu- ation studies that document the relative worth of breadth verses depth in the clini- cal experience will help academicservice partnerships move from traditional to evidence-based approaches.
Universities and community colleges are increasing their efforts to adopt statewide curriculum models, allowing for seamless transition between pro- grams. These partnerships between associate and baccalaureate nursing programs create more efficient and effective educational advancement pathways for stu- dents. Recognizing the link between improved patient outcomes and baccalaure- ate nursing education (Aiken et al., 2003; Heller et al., 2000) and the need to build efficiencies in nursing educational programs, the state nursing schools in Oregon ( and Hawaii ( created Statewide Nursing Consortiums Curriculums that provide a seamless transition to a bac- calaureate in nursing for nurses with associate degrees in one aIDitional year of full-time study. These programs are creating reusable learning objects (i.e., case studies, simulation scenarios, concept-based clinical learning activities) that are immediate, portable, accessible, and ready for on-demand education, suitable for a technology-savvy student population. Initial outcomes from these programs are promising include an increase in the students national nursing certification rates and positive student learning outcomes (Tanner, 2009).
Innovations in interdisciplinary education on college campuses include new health care models that are designed to produce collaborative learning among stu- dents in nursing, management, journalism and communication, and architecture programs (Melnyk and Davidson, 2009). These nontraditional academic partner- ships bring a variety of perspectives and expertise together that could define the future of education, health, and health care. The dramatic expansion of second- degree programs in nursing is producing a more liberally educated nursing work- force that should facilitate interdisciplinary competence in practice settings.
Partnerships between states are also transforming nursing education by cre- ating access to educational opportunities across state lines. These interstate col- laborations between educational institutions are offering joint programs that increase access to all levels of nursing education in rural and underserved areas in the United States through course sharing and collaborative program develop- ment across educational institutions (i.e., the joint Neonatal Nurse Practitioner program at University of California San Francisco and University of Hawaii and The Nursing Educational Xchange). Although these opportunities are emerging, there is still work to be accomplished on a national level to further support inter- state partnership in nursing education. National nursing licensure at both the RN and Advanced Practice levels would allow the state boards of nursing to focus
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The Future of Nursing: Leading Change, Advancing Health
more on consumer protection in their state rather than the regulatory issues of granting state licenses.
Cultivating partnerships will provide many avenues for building capacity in innovative ways for nursing education. Ten recommendations for the future of nursing education are
Create nontraditional partnerships within and outside of educational institutions;
Explore opportunities for the creation and expansion of nursing pro- grams through private partnerships and health care institutions;
Develop, implement, and evaluate innovative academicpractice partner- ships between nursing programs and acute care, primary care, long-term care, community, and public health settings;
Move from a time-based model of clinical nursing education to a competency-based model, and evaluate the evidence to support this type of learning in nursing education;
Support the implementation and evaluation of statewide curriculum models between universities and community college systems;
Expand interdisciplinary educational opportunities and programs;
Champion interstate partnerships to increase access to educational
Support research for evidenced based educational practices that chal-
lenge existing norms;
Build stronger relationships between nursing students and registered
nurses providing patient care; and
AIDress policy issues that create barriers to the above recommendations.
Innovative partnerships between nursing education and nursing practice are essential if the nursing profession is to meet the challenges ahead. The dissemi- nation of successful innovative models in nursing education requires evidence as well as creative and adaptive partnerships that are developed, nurtured, and evaluated.
AACN (American Association of Colleges of Nursing). (2005). Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Sup- ply accessed at on December 3, 2009.
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The Future of Nursing: Leading Change, Advancing Health
Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., and Silber, J. H. (2003). Educational level of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(2), 1617?1623.
Allen, P., Schumann, R., Collins, C., and Selz, N. (2007). Reinventing practice and education partner- ships for capacity expansion. Journal of Nursing Education, 46(4), 170?175.
Buerhaus, P., Staiger, D., and Auerbach, D., (2000). Implications of a rapidly aging nursing work- force. Journal of the American Medical Association, 283(22), 2948?2954.
Buerhaus, P., Auerback, D., and Staiger, D. (2009). The recent surge in nurse employment: causes and implications. Heatlh Affairs, July/August, 28(4): w657?w668.
Heller, B. R., Oros, M. T., and Durney-Crowley, J. (2000). The future of nursing education: Ten trends to watch. Nursing and Health Care Perspectives, 21(1), 9?13.
Joynt, J., and Kamball, B. (2008). Blowing open the bottleneck: Designing new approaches to in- crease nurse education capacity. Retrieved September 14, 2008, from https://championnursing. org/uploads/NursingEducationa/CapacityWhitePaper20080618.pdf.
MacIntyre, R., Murray, T., Teel, C., and Karshmer, J. (2009). Five recommendations for prelicensure nursing education. Journal of Nursing Education, 48, 447?453.
Melnyk, B. M., and Davidson, S. (2009). Creating a culture of innovation in nursing education through shared vision, leadership, interdisciplinary partnership, and positive deviance. Nurs Admin Q, 33(4), 288?295.
Moscato, S., Miller, J., Logsdon, K., Weinberg, S., and Chorpenning, L. (2007). Dedicated education unit: An innovative clinical partner education model. Nursing Outlook, 55, 31?37.
National Council of State Boards of Nursing (2008). Member board profiles: Educational programs. Retrieved April 26, 2008, from
Tanner, C. (2009). Evaluation of the outcomes of the Oregon consortium for nursing educations model to aIDress the nursing shortage in Oregon 5/15/2008-5/14/2009. Annual Narrative Report. Udlis, K. A. (2008). Preceptorship in undergraduate nursing education: An integrative review. Journal
of Nursing Education, 47, 20?29.
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The Future of Nursing: Leading Change, Advancing Health
Mary Ellen Smith Glasgow, Ph.D., R.N., A.C.N.S.-B.C. Drexel University
Lynne M. Dunphy, Ph.D., F.N.P.-B.C. College of Nursing, University of Rhode Island
Rosalie O. Mainous, Ph.D., A.R.N.P., N.N.P.-B.C. University of Louisville
The changing landscape of healthcare in America requires that clinicians be skilled in responding to varying patient expectations and values; provide ongo- ing patient management; deliver and coordinate care across teams, setting, and time frames; and support patients endeavors to change behavior and lifestyle education which is in short supply in todays academic and clinical settings (IOM, 2003). Nursing education needs to innovate at the micro and macro system level for the 21st century. It cannot be business as usual.
In order to truly transform care, practice and education will need to partner on curriculum development and the professional socialization of the new nurse.
Innovation in academic settings, specifically colleges of nursing is often hin- dered by the pressure to meet educational and regulatory requirements established by national organizations, accrediting agencies, and the state boards of nursing that govern and set standards for nursing practice at both the baccalaureate and graduate levels (Melnyk and Davidson, 2009). These regulations should not be barriers to innovation. Time-honored traditions in nursing education such as the current undergraduate clinical instruction model, a disease and illness-oriented curriculum, and the need for extensive clinical practice before matriculating in doctoral programs should be reexamined. There is a need to embrace technology- infused education, transdisciplinary approaches to care, and translational research. Students need to learn how to effectively assess and manage some of the most significant health problems currently confronting our society (e.g., mental health disorders, obesity, patient safety) and how to innovate changes in our health care system (Melnyk and Davidson, 2009). Furthermore, a very uncomfortable, diffi- cult question needs to be asked: What should be the most appropriate degree for entry into nursing practice? Given the complexity and wide range of knowledge and competencies that will be required of nurses in the 21st century, it is strongly recommended that nurses be prepared at the baccalaureate level for entry into
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The Future of Nursing: Leading Change, Advancing Health
practice. Moreover, the entry into practice debate needs to be resolved in the 21st century (Benner et al., 2010).
Simulation is one very effective tool that exposes students to the complexity of clinical settings without the hazards of real life (Ironside et al., 2009). Future nursing curricula need to develop interdisciplinary simulation scenarios focusing on collaboration and crucial conversations so that students can learn how to deal with ineffective professional relationships and unsafe practice in a controlled environment (AACN, 2005). Transdisciplinary or interprofessional models of simulation and debriefing can examine and dissect failed communication in health professions education and result in a series of recommendations to im- prove health care environments and patient outcomes. The curriculum for the 21st century needs to provide an opportunity for future health care providers to partici- pate in collaborative education to obtain the necessary advocacy skills to promote a safe, healthy work environment for the patients they serve. AIDitionally, with the rapid expansion of knowledge, the development of information appraisal and navigation skills are essential for future nurses (Melnyk and Davidson, 2009).
Transdisciplinary or interprofessional models of education are at the core of new type of dedicated education unit: one that educates nurses, physicians, pharmacists, and other professionals depending on the type of patient needs ad- dressed. Dedicated education units have previously implemented best practices utilizing the staff nurse as educator (Moscato et al., 2007). This new model of education is broader, more inclusive, and seeks to find commonalties in the cultures of both service and academe and may provide an ideal site for faculty practice as well. As a starting point, a hospital environment is chosen as an ex- emplar to demonstrate the feasibility of the model. Chief nursing officers would dedicate select units and develop methods to choose seasoned nurses to work in the new environments as change agents. Clinical educators in nursing and other disciplines would establish daily rounds with input from all students at varying levels based on Benners Novice to Expert (Benner, 1984). More experienced students would mentor the novice. A model of leveled reflective learning has been described in Sweden utilizing different hospitals for different levels of learning within the context of the dedicated education unit (Lindahl et al., 2009).
Nurses, hospitalists, and other health professionals are educated in teaching pedagogy and contribute to the education and evaluation of the students. This innovative model also facilitates a better understanding of what each discipline contributes to the overall plan of health improvement. Students are exposed to multiple faculty members who share responsibility for students and students become a member of the team (Budgen and Gamroth, 2007). Transdisciplinary
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The Future of Nursing: Leading Change, Advancing Health
team meetings will periodically assess the adequacy of the model, the experience of the student, and the areas for growth.
It has been well documented that the nursing profession faces a serious short- age of nursing faculty, as well as a severe dearth of underrepresented minority (URM) faculty (Potempa et al., 2008; Sullivan Commission, 2004), that has dra- matic implications for, and is a threat to, the future of nursing. In order for nursing to be a truly resonating force for health in the 21st century, it is essential that we grow the science of nursing and demonstrate its effectiveness in fostering health. The case can be made that the production of masters and doctorally prepared nurses is more critical than a focus on preparation of Registered Nurses. Difficult decisions must be made. Which educational setting best supports the preparation of different levels of practice? Advanced Practice Nurses across the board are needed; nurse faculty, nurse leaders, and nurse scientists are all in high demand.
Masters Entry into professional nursing progr


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