Patient Care and Nursing

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Growth in the Practice of Nursing and Patient Care Delivery Models

The practice of nursing is expected to continue growing and changing given the reform initiatives that are taking place in the healthcare system. Some of the factors that are contributing to these changes and growth in nursing practice include the restructuring of healthcare delivery system, increased healthcare costs, increase in demand for nurses, nursing shortage, and increase in the patient population. Given these factors, nurses are expected to continue assuming a wide range of healthcare responsibilities because of the complexities in patient care delivery or caring for the sick (Tiffin, 2012). It is expected that as nursing practice continues to change and grow, new models of patient care delivery will emerge. As nurses, we need to understand these changes/growth and the emerging patient delivery models in order to enhance our practice.

One of the patient care delivery models that will emerge because of expected changes and growth in the practice of nursing is Accountable Care Organizations (ACO). ACOs entail the collaboration between healthcare facilities, primary care clinicians, clinical specialists, and other healthcare professionals towards improving the quality and costs of care delivered to patients. Patient care delivery in the future will be dominated by ACOs given the increased shared cost savings between these organizations and Medicare programs (Haney, 2010). ACOs are likely to receive financial rewards and bonuses if they achieve some quality and savings objectives. The dominance of ACOs in future patient care delivery processes will be supported by the leadership roles assumed by their stakeholders towards coordination and implementation of care, especially to disadvantaged populations.

Secondly, patient care delivery in the future will be dominated by medical homes whose role will involve coordinating healthcare services across different settings and between different providers, especially in primary care practice. While medical homes are similar to ACOs, their emphasis will be on care and services that are specifically within the scope of nursing practice. Through medical homes, nurses will be recognized and become crucial leaders and members of the healthcare team. The basis for the emergence of medical homes will be to provide and/or facilitate health promotion and preventive services in the primary care setting.

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Third, the practice of nursing in the future will be dominated by nurse-managed health clinics as patient care delivery models, which are nurse-practice arrangements that are led by advance practice nurses. The focus of nurse-managed health clinics will be the provision of comprehensive primacy care services and ensuring wellness services are provided to vulnerable and disadvantaged populations throughout the country. As the arrangements are linked to educational institutions, social services agencies and other health-related agencies, they will enable nurses to practice to their optimal professional scope. The enhanced nursing practice because of nurse-managed health clinics will in turn contribute to better patient outcomes and value-oriented care practices.

The emergence of these patient care delivery models in the practice of nursing is also based on the concept of continuity of care. Unlike in the conventional healthcare setting, continuity of care in future nursing practice will entail multidimensional approaches because patients' healthcare needs can rarely be met by a single professional in today's healthcare system (Gulliford, Naithani & Morgan, 2006). Multidimensional patient care delivery models will continue to be developed to help in meeting patients' healthcare needs through integrating, coordinating, and sharing information between healthcare providers.

Nurses' Impressions of these Expected Changes/Growth

The above presentation of the expected growth and changes in the practice of nursing and patient care delivery models was well received by the nurse colleagues. The three nurse colleagues stated that they expected the future of nursing to undergo tremendous changes in attempts to enhance patient care delivery and meet the evolving needs of patients. They stated that the enactment of the Patient Protection and Affordable Care Act in March 2010 is an indicator of the changes that have started taking place in the practice of nursing. In their view, nurses will assume an indispensable leadership role in healthcare teams as multidisciplinary care teams are formed to provide patient care.

One of these three nurse colleagues….....

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