Total Patients` Care Delivery Model

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TotalPatients` Care Delivery Model


TotalPatients` Care Delivery Model

Thework done by the registered nurses in health centers is not onlyorganized within a disease-specific population but also the generalage group of patients and the intensity of the care (Dubois, D`amour,Tchouaket, Clarke, Rivard, and Blais, 2013). Structural measures ofcare such as the ratio of nurses to patients, working hours, nurseworkload and nurses` qualification are essential to investigatingpatients` results and the relationship of nurses to theirprofessional duties in the health sectors. Nursing care can beperformed through various processes of organizations. Nursing caredelivery models used are considerably different from one institutionof health care to another according to the set of patients` state toanother. The management of nursing care delivery is influenced adifferent factor that includes financial issues, leadership opinionsand the ability of the institution to sustain its staff. In thedecision, making the evidence obtained from the impacts of caremodels about quality and safety to patients is perceived as theprimary factor. Historically, there are four types of nursing caredelivery models (Elwyn et al., 2014). They include team and practicalnursing which is task-oriented involving the use of a group of nurseswhile primary nursing and total patient care objected to patients andthey depend on the registered nurses for quality delivery care.Despite the many forms of nursing delivery models used, there isstill a dilemma on which model works better. This paper focuses ontotal patients` care nursing {as one of the models}, the personnel itutilizes, their responsibilities and the coordination of the workwithin the model.

Originof Total Patients` Care

Thetotal patients` care model is a technique that involves aprofessional nurse who is accountable for provision and coordinationof health care to an individual patient or a group of patients thatare delegated to him/her during their working period (Dubois et al.,2013). The nurse is in charge of all care needed for the patients,and they may be responsible for the entire duration required toprovide care to patients. This model is the oldest forms oforganizing patients` care. The nurses assume full responsibility forthe assigned patients. The model is at times referred to as a casemethod of an assignment due to patients been assigned as cases.Throughout the 19th century, case method nursing was the mostpreferred in care delivery model. The nursing care was provided tothe patients` residents, and the nurses were accountable for cookingfor the patient, cleaning their houses and other duties that relatedto patients and family care. From the 1930s due to the greatdepression, people could no longer afford to take care of thepatients at their respective homes, and this resulted in the use ofhospitals for delivering health care to patients. During that periodboth the nurses and the students had taken the role of providing careto patients in hospitals and the public health institutes. Totalpatients care emerged as a primary technique of organizing patientscare throughout the 1930s and 1940s as the hospitals continued togrow (Dubois et al., 2013). Total patients` care model is to datewidely used by the hospitals and the healthcare providers. Totalpatients` care has now involved to what is referred to as privateduty nursing.

Personnel`sUtilized In Total Patients` Care Model

Thecase method nursing embraces a nurse who assumes overall dutiesduring the period of work to fulfilling the care needs or demands ofthe delegated patient. The nurse at a shift divides the care intosub-sections such as administrations, medications, and othertreatments. The nurse observes the vital signs from the patients andensures baths are done together with the proper bedding. Thepatients may range from one to six depending on the care needs (Elwynet al., 2014). A registered nurse working on a shift of eight hours aday involves in planning, organizing and performing all healthcareprocesses about the patient.

Rolesand Responsibilities of Nurses in Total Patients’ Care Model

Thenurse in charge must always be aware of the patients` state and planfor their care. The nurse at all times ensures that all delegatedduties and responsibilities contribute positively to the patients`care. The nurses have freedom to use their approaches and change tocare, supervise and affect knowledge on administrative detailstowards the patients (Elwyn et al., 2014). For the model to workeffectively, the nurse must have enough clinical skills, able tocommunicate, have the ability to make decisions, and they must havethe capacity to create a coordinative working environment. The roleof the nurse on the shift is to evaluate, set up and implement theplanned patients` care. It is the role of the unit manager todelegate duties and responsibilities to the nurses according to theirtraining and skills. The charge nurse may assign two aids to help inbaths. Answer call lights, provision of clean water to the patientsand assist in feeding those in acute medication. The nurses alsoadminister all medications and change patients` surgical dressing.They also provide the patients with lessons together with dischargeplanning.

WorkCoordination within the Model

Thecharge nurse ensures that the schedule for the day`s work is providedor prepared so that all patients are served in the best way possible.The unit manager has the responsibility to plan and ensure that thereis coordination between the shift nurses to achieve client`ssatisfactions (Huston and Marquis, 2017). The registered nurse or anyother nurse with lighter duties may help the licensed vocationalnurses {LVNs} to provide care where they may be incapable ofperforming. The nurse in charge has the role to assign each primarynurse to a particular group of patients and assist the LVNs who mayneed some help in complex patients. Decisions concerning thepatients` care are made by the registered nurse over a single shiftor may be done by a charge nurse. The nursing duties are mostlypatient-based. The registered nurse provides the care activities. Theassignments may vary from shift to shift depending on the patients`acuity and geography. Mostly, communication is direct apart from rarecases where registered nurse may be required to reach out thephysicians or other members of healthcare team through a unit manager(Huston and Marquis, 2017). The management of the care environment ispromoted by the departmental managers through the allocation ofnurses with stronger training to assist in decision-making.


Theentire care nursing model consists of registered nurses who reportsdirectly to the charge nurse. The charge nurse is mandated to reportto the unit manager. In the case of caregivers co-assigned to thepatient due to heavy patient load on registered nurses, they reportto the shift nurse. The unit manager possesses more experience andskills than the nurses do. Therefore, the nurses operate under theirrule (Huston and Marquis, 2017).

EducationalRequirement for Members

Theunit manager is required to have at least a bachelor degree innursing or have a baccalaureate degree. The demand for the nursemanager varies from one institution to another some employers willallow experienced registered nurse to take up the role of a unitmanager without completing a baccalaureate degree. The AmericanNurses` center came up with a magnetic program that recognized theexcellence in nursing (Elwyn et al., 2014). On another instance, anurse with two years` experience as a unit manager may be promoted tothe position. For one to become a charge nurse, it does not necessarytake education and training but more of experience, performance,personality and ambition. Legally, to qualify for that position anurse must be a licensed and professional in nursing. The procedureinvolves becoming a registered nurse by acquiring a nursing degreeand performs in the national council of examination. The educationalrequirement for a nurse only requires a licensed practical orregistered nurse to process post-secondary education or anAssociate/bachelor`s degree in nursing. For an individual to become acaregiver technician, he/she needs to undertake training within aspan of a few months (Elwyn et al., 2014). The student must take acertificate in the nursing related field. The completion ofcompetency examination is an importance credential.

TheEffects of Total Patients` Care Model on Cost, Quality of Care andPatients` Satisfaction

Themodel is an improving sector in healthcare, and it has significantbenefit to patient rationing from the responsible decisions tocritical conditions that uplift access, and decreases the cost ofhealth care. Although these benefiting factors have been associatedwith total patients` care model, the evidence for the effects of thisprocess on patients` satisfaction remains undefined (Dubois et al.,2013). The aim of the design is to improve the patients` carethrough coordination of nurses and the patients, facilitatingquality, secure and fulfilling the patient needs. The merit of nursescoordinating to perform on an individual patient is well recorded.The cooperation between nurses on shifts works towards monitoringvital signs and experiences from patients with an objective ofexamining and improving their welfare. The interaction betweenpatient and different nurses influences additional experience to theclient. Several factors are important in the relations betweenconditions of the care offered by nurses. Well-trained nursescoordinative working relationship, remediated nursing practices,management support and patient culture are among the many factorsthat correspond to actual patients` satisfactions and qualityservices (Dubois et al., 2013). Due to the variety of nurses requiredby an institution to operate shift schedule the model was discoveredto be limited to cost effectiveness.

ResourcesAvailability on Total Patients` Care Model

Themanagement of nursing care delivery is influenced by diverse factorsthat include financial issues, leadership opinions and the ability ofthe institution to sustain its staff. The organization shouldconsider the activities that ensure the sufficient number of nurses.The shift nurse should be aware of the needs of patients, the otherstaff demands, and the organizational satisfactions (Quil andAbernethy, 2013). The models should also consider the numbers ofpatients to attend to, the intensity at which care is required andthe experience of the nurse professionals. The charge nurse shouldalso look on the procedure of classifying patient according to thecare demands, the functional ability, and availability of socialsupports, the scheduled procedures and the urgency of the patient toattendance. The employed nurses should deliver quality andcost-effective healthcare within the specified time. It is alsoimportant to consider the budget and financial aspects of staffstogether with appropriateness to staffing within the set budgetconstraints to hire qualified, competent and professional nurses whoprovide risks free care (Quill and Abernethy, 2013).

JobSatisfaction on Nursing Model

Jobsatisfaction is closely related to patient satisfaction when chargenurse can coordinate all primary nurses towards achieving the setgoals. Shift nurses are satisfied when they accomplish the specifictasks that they were assigned, and the results improve the patient`scare (Elwyn et al., 2014). Customer satisfaction is achieved when thenurses on duty deliver a quality and subsidized services to theirclients.

Prosof Total Patients` Care Model

Totalpatients care model ensures that every nurse in a shift contributesan important objective in providing an improvement to patients care.The working schedule starts with a delegation of duties from a nursein charge to the other employees (Huston and Marquis, 2017). The mostsignificant pros of total patients care model is that theorganization equips nurses with a high autonomy and accountability. Adelegation of patients to nurses is direct and not limited toplanning methods. The duties performed by nurses are clear, andpatients receive un-fragmented care during the nurse`s shift.

Consof Total Patients` Care Model

Thebiggest challenge in total patients’ concerns model occurs if thenurse is not well prepared or has limited experience to offercomplete care to patients. Each shift nurse has the capability tomodify the care regimen during their working period that forces thepatient to receive different approaches to care resulting patients`confusion (Huston and Marquis, 2017). The operation of this modelrequires high-trained nurses thus becoming costly compared to otherforms of care delivery.


Thetotal patients care model is structured and oriented to deliverquality care to clients and offer experiences to registered nursesthat enable students to gain practical skills and training. The modelis characterized by the utilization of various nurses enhancing theircoordinative power in delivering quality services. The organizationstructure of this model establishes clear lines of accountability andresponsibility to meet the objectives of health care.


Dubois,C. A., D`amour, D., Tchouaket, E., Clarke, S., Rivard, M., &ampBlais, R. (2013). Associations of patient safety outcomes with modelsof nursing care organization at the unit level inhospitals.&nbspInternationalJournal for Quality in Health Care,mzt019.

Elwyn,G., Lloyd, A., May, C., van der Weijden, T., Stiggelbout, A.,Edwards, A., &amp Grande, S. W. (2014). Collaborative deliberation:a model for patient care.&nbspPatientEducation and Counseling,&nbsp97(2),158-164.

Huston,C. J., &amp Marquis, B. L. (2017).&nbspLeadershiproles and management functions in nursing.Wolters Kluwer.

Quill,T. E., &amp Abernethy, A. P. (2013). Generalist plus specialistpalliative care—creating a more sustainable model.&nbspNewEngland Journal of Medicine,&nbsp368(13),1173-1175.