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Using nursing care models in diverse healthcare settings

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Using nursing care models in diverse healthcare settings

The main objectives of delivering nursing care includes attainment of desired patient outcomes, enhancing patient satisfaction level and ensuring  high quality services are provided at an affordable cost (Duffield, Roche, Diers, Catling-Paull & Blay, 2010).  Achievement of the objectives depends on the approach applied by the healthcare organization, the available human and material resources and how they can effectively address individual needs of the patients.  

Different models of delivering nursing care are practised in healthcare organizations. Some of the models include team nursing, primary nursing and progressive patient care among others.  Before application of care models in clinical setting, it is important to identify the patient and establish the individual’s specific healthcare needs.  This helps in identifying the roles of various healthcare professionals involved in delivery of care and in allocating the roles to the most competent health provider (Kurtzman, 2013). Allocating healthcare roles to nurses and other health care professionals during caring process of a patient involves transfer of responsibility and accountability to the assigned care provider.  Thus to achieve the desired care objectives it is important for the allocated role to be within the healthcare professional’s scope of practice. This paper examines nursing care delivery models by observing nurses providing healthcare services to patients in a delivery room.

An observation of a care delivery process in an inpatient care setting and specifically in a delivery room represent a team nursing model. During delivery of nursing care, various professionals were involved and they included one nurse practitioner (NP), five registered nurses   and several aides. The nurse practitioner was the supervisor and the overall team leader. The team was responsible for   providing care to a group of pregnant women in various stages of labor .  As the team leader, the nurse practitioner was responsible for coordinating care until the women delivered their children safely. To coordinate the care of the patients effectively, the nurse practitioner allocated diverse   roles to the team of the registered nurses and aides. These included ordering different tests for the women and their unborn babies, prescription of medications and other nursing roles during the delivery process.  

The NP allocated the five registered nurses specific roles to deliver appropriate care to the pregnant women and their unborn children.   The five RNs included labor and delivery nurse, circulating nurse, scrub nurse, charge nurse and post-partum nurse. Labor and delivery nurse was responsible for providing care to women in various stages of labor and the unborn children. The scrub nurse was in charge of assisting the nurse practitioner and the attending physician in surgical processes such as caesarian sections.  This included setting up and preparing operating room, helping the physicians during the surgical process and transferring the mother to recovery room after surgery.   The circulating nurse was assisting in the operating room, but outside the sterilized area where cesarean surgical procedures were being undertaken. 

The roles of the circulating nurse included ensuring the surgical patient was safe by collaborating with anesthesiologists, surgeons, surgical assistants and other members involved in the surgical delivery process. Additionally, the circulating nurse provided expert care to the women before they were taken to the operating room, during surgery and in post-operative period. The post-partum nurse was undertaking various roles, which included providing   expert care to the mothers and new born babies after delivery. This included vaccinating the newborns, ensuring that the mother take the required medications. Additionally, the postpartum nurse was in charge of labeling the newborns, assessing their weight and evaluating their progress and discharge planning.  The charge nurse was another member of the team and as a registered nurse was responsible for ensuring that the safe, professional, ethical, appropriate and high quality nursing care was provided to the pregnant women, unborn babies and to the newly born babies in the various stages of delivery.

The various characteristics observed during the care delivery process that defined it as a team nursing care  model included a team of registered nurses that were directed and supervised by an experienced advanced practice registered nurse (APRN). The nurse leader allocated different roles to individual registered nurse within the team   that was to be provided to a group of patients in delivery room.  Thus, the fact that the care delivery process was designed in a manner that it applied unique and expert skills of individual registered nurse to address the diverse needs of patients in the delivery room makes it an example of team nursing model.

Types of Nursing Care Models

Various research studies have examined the different types of nursing care models applied in diverse healthcare settings. From the research studies, it is evident that nursing care models have unique characteristics, benefits and shortcomings on the setting in which they are applied. A study conducted by Dubois, Danielle, Tchouaket, Clarke, Rivard and Blais (2013) defined team nursing care model as “a group of nurses caring for a large group of patients for one shift” (p.324).  The group of nurses provides a skill mix, to address the various healthcare needs of the patients.   In this regard, the team nursing care models is associated with various benefits concerning its ability to enhance patient outcomes,   patient satisfaction and improve delivery of quality healthcare services.

A study conducted by Erickson and Ditomassi (2011) found that team nursing care model facilitate optimal utilization of individual nurse members skills and expertise.   Additionally nursing team care model is associated with promoting productivity and professional growth of individual members through teamwork. Another benefit associated with nursing team care model is that it provides opportunities for identifying and correcting errors by novice nurses and other healthcare professionals involved in the care delivery.  Moreover, team nursing care model was found to promote satisfaction of team members’ involved,   improve quality of care and a reduction in medication errors in addition to better patient outcomes and low mortality rates (Dubois, Danielle, Tchouaket, Clarke, Rivard & Blais, 2013).

Primary nursing is another care model of delivering nursing care, in which one nurse is involved in delivery of holistic and individualized care to a patient in the entire period   of hospitalization.  The main emphasis of primary nursing care model is care continuity, which is ascertained by allocating one nurse the role of addressing all the healthcare needs of a small group of inpatients admitted in a particular caring unit in a healthcare organization until they are discharged (Nadeau, Pinner, Murphy & Belderson, 2017).  In this case, the nurse is responsible and accountable for the patients care during the entire period of hospitalization. 

The main role of primary nurse includes making decisions concerning care of the patient and care coordination, in addition to monitoring the patient for the entire period of hospitalization. This promotes care continuity and consistency. However, the primary care nurse does not necessarily have to be directly involved in delivery of care throughout the period but is entirely accountable for supervising and delegating patient care during the entire period.   One of the major benefits associated with primary nursing care model is that it is focused on the individual healthcare needs of a hospitalized patient, encourages nurse autonomy and facilitates continuity of care. However, it is difficult and costly to implement in healthcare organizations, making it one of the most unpopular model of delivering nursing care (Ritin, Maree, Duong & Charmaine, 2012).

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Using nursing care models in diverse healthcare settings
Using nursing care models in diverse healthcare settings

How to implement nursing care models in healthcare organization

Implementation of team nursing care model in the healthcare organization involved six major steps.  In the first step, the team leader assembled and engaged a group of multidisciplinary healthcare professionals that could be involved in delivery of care. This included registered nurses, physicians and administrative personnel in the organization. In addition, the patients were also involved in the process. In the second step, the particular members that would comprise the team were selected and assigned different caring roles, after determination of the patients’ healthcare needs.  The team members were selected based on their experience, skill set and ability to work in teams in addition to good communication skills.

 The third step involved designing workflows that reflected the nursing team model of care. In this case, the team leader conducted pre-visits to the patients hospitalized in the facility and recorded crucial details about the patient including history and addressed apparent care gaps. The team members then engaged the patient by providing information and answering any questions that the patients asked about the care plan.   In the fourth step, the team leader and the team members discussed   on the various findings after visits, and made necessary changes in the care plans where necessary. 

 The fifth step involved the actual delivery of healthcare services    to the patient. Every registered nurse provided the assigned care roles to patient during the caring process. In the sixth step, the team members were involved in evaluating the care outcomes of the patient and identified areas that require improvement. From the assessment, nursing team care model was effective in promoting attainment of positive patient outcomes and satisfaction of both the patient and the team members involved in the care delivery process.  The allocation of caring roles to the most qualified and experienced healthcare professional ensured delivery of quality healthcare services and minimized medical errors. In this regard, sustaining the team nursing care model is recommended in nursing unit.


Nursing care models applied in healthcare organizations play a critical role in determining the patient outcomes, cost of healthcare and satisfaction of both the patients and nurses involved in care delivery. Some of the various nursing care models applied include team nursing, primary nursing and progressive patient care. While observing delivery of care in the nursing unit, it was evident that team nursing care model was being utilized.  The model involved a team of registered nurses with diverse skills in nursing to provide appropriate care to patients in delivery unit. The team leader assigned every team member distinct role according to individual skills and experience.  The team nursing model enhanced teamwork, patient outcomes and satisfaction.  The success of team nursing model depends on the experience, skills and scope of practice of the various registered nurses involved in delivering of nursing care services to the patients.


Dubois, C., Danielle, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013).  Associations of patient safety outcomes with models of nursing care organization at unit     level in hospitals. International Journal for Quality in Health Care , 25(2):110–117.

Duffield, C., Roche, M., Diers, D., Catling-Paull, C., & Blay, N. (2010). Staffing, skill mix and    the model of care. Journal of Clinical Nursing, 19, 2242-2251.

Erickson, J. I., & Ditomassi, M. (2011). Professional practice model: Strategies for translating   models into practice. Nursing Clinics of North America, 46, 35-44.

Kurtzman , E.(2013). The contribution of nursing to high-value inpatient care. Policy in Nursing   Practice 11:36–61.

Nadeau, K., Pinner, K., Murphy, K., & Belderson, K.(2017). Perceptions of a primary nursing  Care model in a pediatric hematology/ oncology unit. Journal of Pediatric Oncology      Nursing, 34(1): 28-34.

Ritin, F.,  Maree, J.,  Duong , T.,  & Charmaine , M.(2012). Models of care in nursing: a    systematic review.  International Journal of Evidence based Healthcare, 10: 324–337. 

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