Literature Review: Partnership Care Delivery Model
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Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths. Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
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Literature Review: Partnership Care Delivery Model
- 1. Literature Presentation By: Oluwatosin A. Ola-Weissmann
- 2. Introduction • Healthcare in the US has become very fragmented, expensive, and disjointed • Patient deaths in the hospital setting has increased in recent years • The cost of healthcare has also increased • The partnership care delivery model serves to unify healthcare
- 3. Nursing Concept: Patient Safety • Patient safety is a primary nursing goal • Patient deaths has increased due to the fragmented healthcare system • Nurse no longer the primary coordinator of care • The only constant in the care management now is the patient
- 4. Partnership Care Delivery Model Patient Other Disciplines e.g. Speech, PT, OT, RT, Family Pharmacy, Nutrition, etc. Doctor Nurse
- 5. Conceptual Model • Margaret Newman’s Health as Expanding Consciousness • Three stages of nursing growth – Formative – Normative – Integrative: PCDM falls in this area
- 6. Application to Nursing Practice • Patient safety can be improved by; – Proper handoff report – Applying nursing judgment to physician orders – Encouraging patient to be a partner in the care plan – Mutually collaborating with physician, patient, nurse, and other disciplines in a collaborative environment – Patient needs to be knowledgeable on their illness
- 7. Choice of Article • Applies directly to current nursing practice • Surgery care is a fragmented yet fast paced environment that can create errors and unsafe patient situations • Every member of the team is accountable • PCDM can help promote patient safety and collaboration
- 8. Conclusion • The Partnership Care Delivery Model can be used extensively in most healthcare environments. • The patient is at the center of this model • The nurses’ role is to facilitate collaboration, safety, and communication
- 9. References American Heritage Dictionary. (2012). American Heritage Dictionary. Houghton Mifflin Company. Boston, MA. George , J. B. (2011). Nursing Theories: The Base for Professional Nursing Practice, 6th ed. Retrieved from University of Phoenix library database. Getty Images (2012). Keywords, “Nursing”, “Health,” “Patient”. Retrieved October 21, 2012 from http://gettyimages.com Institute of Medicine (2000). To Err is Human: Building a Safer Health System. National Academy Press, Washington, DC. Walker, L. O. & Avant, K. C. (2005). Strategies for Theory Construction in Nursing, 4th ed. Pearson Education Inc., Upper Saddle River, NJ. Wiggins, M. (2006) The Partnership Care Delivery Model. Journal of Nursing Administration, 36 (8), 341–345. Wiggins, M. (2008). The partnership care delivery model: an examination of the core concept and the need for a new model of care. Journal of Nursing Management, 16(5), 629-638. doi:10.1111/j.1365-2834.2008.00900.x
Notas do Editor
- Hello everyone, my name is Tosin Ola-Weissmann, and I’m very excited to explore a new nursing model with you.
- Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths. Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
- The Institute of Medicine released a report stating that deaths within the hospital setting have climbed to 44,000-95,000 annually in recent years due to communication errors in the healthcare continuum (Institute of Medicine, 2000). This is more than the deaths in car accidents, AIDS, or breast cancer.Today, the care of patients that are hospitalized during the most acute phase of illness has become very complex. “Nurses are required to deal with multiple interacting systems andprocesses as well as increased technology. Hundreds of health care professionals can be involved in providing care in one patient’s hospital episode” (Wiggins, 2008, p. 631). The nurse is no longer the primary coordinator of care for the whole hospital stay because of nursing schedules of 12-hour days, constant patient transfers and room rotations, and cost-saving measures across the healthcare continuum. The only constant in the care management continuum is now the patient. As a result, they should be incorporated into the conceptual model of patient care (Walker & Avant, 2005).
- The Partnership Care Delivery Model is founded on the assumption that a series of partnerships need to be in place to optimize care (Wiggins, 2006). This is very similar to Margaret Newman’s theory of Health. “For Newman, the process of nursing is one of coming together as partners during a time of chaos when the client is at a choice point” (George, 2011, p. 443). The primary partnership is that of the patient and their family with the nurse. “That relationship is key and the basis of the model because it is in this relationship that the patient will have the most opportunity to learn about health and illness and the interventions necessary to move toward optimum outcomes” (Wiggins, 2008, p. 634).Another partnership required is that of the nurse and the doctor. “The physician and the nurse each play an important and complementary role in care delivery. Together, in partnership with the patient, they can create clear goals, and establish a plan of care to share with the entire health care team” (Wiggins, 2008, p. 635).Patient care is delivered by multiple disciplines, such as physical therapists, respiratory therapists, dieticians and pharmacists, each educated in their respective professions, and providing complex therapies requiring specialized knowledge. Each of these professionals isalso engaged in partnership with the patient, the physician and the nurse (Wiggins, 2008). The nurse can work collaboratively with these experts to coordinate care. This ensures that the multiple components of care are effectively incorporated into the overall plan of care at the right time.
- The shift to a care delivery model with partnerships at its core is a natural direction for nursing and resembles what Margaret Newman claims is the Final stage of the evolution of the profession (Wiggins, 2008). Newman discusses nursing as presenting with three stages of growth. During the first formative stage, nursing was in the process of becoming, of establishing its identity, and individual practitioners were responsible for their own practice (George, 2011). In the second or normative stage, nursing lost some of its authority and was more competitive and persuasive in relation to the environment. It was at this time that nursing moved primarily into the hospital setting and nurses became employees. In the third integrative stage, nursing will relate to other health care providers and to clients as partners in a cooperative, mutual manner. The professional nursing role in this phase is the primary integrative role (George, 2011).
- “In this model the patient is respected as the expert in their life who has the ability to maintain health or adapt to illness” (Wiggins, 2008, p. 632). The clinician is respected as having knowledge and expertise in his or her clinical specialty. Together, in partnership, the patient and the nurse/health care provider engage in dialogue about all the possibilities in order to learn from each other’s perspectives (Wiggins, 2008). In doing so, they develop a sense of trust that enables them to mutually decide on the goals of care and to develop the plan to achieve those goals.Patient safety can be improved by proper communication through handoff report; and all the elements noted on the slide above.
- This article was chosen because it applies directly to nursing practice. In the surgical setting, patients are often first admitted via the Pre-operative area, sent to the OR, to the Recovery Room, then to the ICU or Surgical Unit. This has led to a very fragmented and fast paced moving system that can be hard to grasp, an environment where pertinent information can be lost. There have been several experiences in the Surgery Center even though we practice safe handoffs and time out, mistakes HAVE been made. If these errors were not caught in time, there is an increased risk of patient harm. Such fast moving environment has the probability to create an environment for unsafe patient care. By incorporating PCDM into the surgery center, each member of the team is essential, and must collaborate with everyone else. Every member of the team is accountable to a safe hospitalization for the patient. The relationships with the patient, family, nurse, surgeon, CRNA, and ancillary staff are essential to the success of the surgery center.
- Forming a partnership with the patient, family, nurse, physician and ancillary care providers is essential to safe patient care. The nursing professional has extensive knowledge of health care information and the patient knows their own life story, interests and purpose. The nurses’ role is to facilitate collaboration, safety, and communication. Acting in a partnership the nurse and the patient can achieve optimal and realistic health care goals.
- Thank you for taking the time to look at this presentation. I hope that one will be able to apply it in your own practice.