Explain care delivery models Discuss models of health and wellness Explain Leavell and Clark’s Agent-Host- Environment Model Explain Dunn’s Levels of Wellness Explain Health Locus of Control Model Explain Rosenstock and Becker’s Health Belief Model Discuss changes in 2013 Explore reasons nursing shortage
Method for organizing and delivering client care Focus is on structure, process, and/or outcomes Uses evidence based practice and adapts to the needs of the client Strives to maintain high standards for quality care and client safety Modern models are based on a psychological structure, the main focus is on clients being satisfied with nursing care and job satisfaction for nurses
Supports health professionals in meeting the health and wellness needs of client Health beliefs influence practice Nurses need to make sure that the plan of care developed relates to the client’s idea of health Nurses need to make sure they grasp their own perception of health Health in a narrow spectrum is to getting the client to regain baseline functioning Health in a broad spectrum is getting the client to the highest level of functioning
Also called epidemiological triangle One of the earliest models Is a conventional approach to health and disease formed to address communicable disease can be used to predict illness This model is beneficial for assessing origins of disease in a client The agent, host and environment interrelate in ways that generate risk factors, the comprehension of these relationships is important for the promotion and preservation of health
Three dynamic interactive elements in the model are: Agent- any environmental factor or stressor it may be present or absent for the illness to occur Host- a person who may or may not be at risk of acquiring a disease or illness Environment- all factors external to the host that may or may not predispose the person to the development of disease Host Agent Environment
Demonstrates the interaction of the environment with the illness-wellness continuum Four health/wellness quadrants: High-level wellness in a favorable environment Emergent high-level wellness in an unfavorable environment Protected poor health in a favorable environment Poor health is an unfavorable environment
Determine whether a client is likely to involve themselves in disease prevention and health promotion activities Useful for the development of programs for assisting client to have a healthier lifestyle
From a social learning theory nurses may consider when determining who is most likely to take action regarding health (whether clients believe they have control over their health or others have control) Can be used to identify which clients are most likely to change their health Internally controlled- clients who have the main impact on their health, are educated about their health, and adhere to healthcare programs Externally controlled- clients who believe their health is largely controlled by outside forces (chance or luck); they will need more assistance to become more internally controlled
Icontrol I have no my controlhealth! over my health Health Internal Locus External
Model is based on subjective beliefs- predicts which clients will or will not use healthcare services Behavior is influenced by multiple interacting beliefs (such as susceptibility and severity, barriers to action, and self- efficacy) Individual perceptions: Perceived susceptibility (family history of a certain disorder) Perceived seriousness (death or have serious consequences?) Perceived threat (combination of perceived susceptibility and seriousness)
Modifying factors: Demographic variables Sociopsychologic variables Structural variables Cues to Likelihood of action: Perceived benefits of the action Perceived barriers to the action (ex. Cost, inconvenience, and lifestyle)
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Two influences: Cost-containment measures mandated by third-party payers Commitment to providing care that is accessible to people In their communities
As the need for reduced spending and increased services in healthcare. The need for models care that provides improved patient care and decreased healthcare. In 2007, the Robert Wood Johnson Foundation funded an original research project by Health Workforce Solutions LLC (HWS) to identify and profile new models of care that could be widely replicated throughout the United States. Using broad-based email inquiry, literature review, and Internet research 60 care models were selected for in-depth research interviews Carefully ranking the care models, down to 24 innovative care delivery models. Complete profiles of each of the 24 models including a detailed description, are published on the Innovative Care website.
The models took a long time to develop. Some took years s and can get buy-in from leadership, they can make important changes.” Goal is for nurses and health care leaders will use models to spark change in their Some of the models are ready to use and some of the models are for generating ideas for change For more information visit www.innovatecaremodels.com
“Eight things found by all of Innovative Care Models 1. Elevating the role of nurses and transitioning from caregivers to “care integrators.” In 23 of the 24 models, the organization created at least one new role for nurses and often elevated the RN role to one of integrating care for the patient. 2. Taking a team approach to interdisciplinary care. 3. Bridging the continuum of care outside of the primary care facility. 4. Defining the home as a setting of care. (Six of the models rely on a patients home as the primary location for care delivery.) 5. Targeting high users of health care, especially older adults. 6. Sharpening focus on the patient, including an active engagement of the patient and her or his family in care planning and delivery, and a greater responsiveness to patient wants and needs. 7. Leveraging technology. 8. Improving satisfaction, quality and cost. All of the models were developed in response to specific problems or concerns about patient quality, patient and provider satisfaction or unsustainable costs and utilization. “(Health Workforce Solutions LLC & Robert Wood Johnson Foundation, 2008)
Pressure to reduce cost will continue Affordable Care Act (ACA) results in new provisions such as penalties for lacking quality, public payer programs, and Medicaid reimbursements will be increase to 100% of the Medicare rates Increase of primary care and advanced practice staff Improvement of electronic health records (which will be more added costs) Increase to our tax bill (as we have seen already)
Reasons for nurses leaving Frustration with inefficiencies and conflicting priorities Environments of “what not to do”, thus impeding that practice that nurses know best Nurses cannot implement their talents that drew them to nursing in the first place Nurses feeling as though they have no voice in quality care Magnet Nursing Services Recognition Program provides recognition to hospitals to attract and retain nurses, as well as incentives for positive workplace change
Blais, K., Hayes, J. (2011) Professional Nursing Practice. Concepts and Perspectives. Sixth Edition. 305-318.Butterworth, M., Kolivras, K., Grossman, L., & Redican, K. (2010). Knowledge, Perceptions, and Practices: Mosquito-borne Disease Transmission in Southwest Virginia, USA. Southestern Geographer, 50(3), 366-385Health Workforce Solutions LLC, & Robert Wood Johnson Foundation (2008). Innovative care models. Retrieved from http://www.innovativecaremodels.com/Nursing Theories (2012, January). Models of prevention. Retrieved from http://currentnursing.com/nursingtheory/modelsofpreventionVerdon, Daniel R., (2013) Top 10 business issues youll face in 2013: efforts to reduce costs, increase efficiencies will challenge you and your colleagues. Medical Economics. 90(10) 12.
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