Evolvement in Nursing Practice and Patient Care Delivery ModelsChioma OnukwughaGrand Canyon University

Evolvement in Nursing Practice and Patient Care Delivery ModelsChioma OnukwughaGrand Canyon University: NRS-440V
January 29, 2017
Evolvement in Nursing Practice and Patient Care Delivery ModelsThe healthcare system is evolving and transforming and so is the nursing practice. The Affordable Care Act (ACA) has shifted the focus of the healthcare system from treatment of diseases and illness to prevention of diseases, wellness, affordable/accessible quality care. This shift in the healthcare system has influenced the care delivery system as well. Nurses comprises of nearly 80% of the total healthcare workforce; thus, they are considered the front liners in the health care continuum (National Academies of Sciences, 2017). To meet up with the increasing demands of healthcare by the masses, nurses are no longer delivering only bedside care to patients but are found delivering care in other healthcare settings in the community, state and nationwide. Notwithstanding their momentous role in the healthcare system, nurses are mostly not considered equivalent associates in the multidisciplinary healthcare teams. Owing to this, the ACA redesigned the healthcare delivery system to incorporate the nursing scope of practice.
This paper will be discussing the evolving nursing practice with its effects on the continuity of care, accountable care organizations (ACO), medical homes, and nurse-managed health clinics.

Concepts of Continuity of Care
Continuity of care is a patient-oriented type of care delivery system that focuses on services and integrative mechanisms that directs and monitors patient’s wellbeing through a wide-ranging selection of health, mental health, and social services across every level of care intensity (Timothy, 2015). Prior to the health care reform, the healthcare delivery system has been focusing on treatment of acute conditions or diseases. This care delivery system led to high medical costs for reoccurrence of diseases, readmissions in the hospital, frequent emergency room visitations, and complications as continuity of care was absent. The ACA has brought new challenges to the healthcare system as well as changes in the nursing profession. New challenges would include follow-up care with patients, creating a patient/provider rapport, concentrating on disease prevention/wellness and holistic care of patients (Timothy, 2015). With the new challenges, nurses will undertake increased responsibilities in caring for the increased diverse population. Nurses being the largest number in the healthcare workforce will be a great asset in tackling these challenges in the healthcare system. The goal of integrating services that endorse continuity of care is to deliver superior and cost effective care for everybody especially for patients with complex and chronic disease conditions (Timothy, 2015).
Per Timothy (2015), there are four integrative mechanisms that depend on nursing specialists to support continuity of care. They are:
Community-Based Services: Home health nurses promote continuity of care as the visit patients in their home and conduct health assessments and provide other services to them. They also utilize telemedicine or tele psych for assessment, implementation and follow up care of patient in rural areas.

Disease Management Programs: Nurses that have specialization in management of diseases coordinates services for patients that are geared towards modifying behavioral, economic, and environmental barricades to care to encourage healthy behaviors and the self-management of chronic conditions.

Health Information System: Continuity of patient care requires organized information system for all-in-one transition of care. Patient’s data over time and across the various health settings and geographic border should be accessed easily to deliver a superior and cost-effective care. With the presence of nurse informatics in various facilities currently, they would work with other interdisciplinary teams on effective ways of assessing patient data seamlessly globally and can help to design patient-centric systems.
Case Management Services: Patients are most vulnerable during the transition phases of their care. Nursing case managers can proficiently organize transitions of care together with discharge and end-of-life planning.

The ACA has motivated nurses in attaining these positions that will be essential in meeting up with the goals that have been set forth following the health care reform. The healthcare system is evolving so is the nursing profession. Nurses are practically needed in every healthcare setting currently to implement continuity of care to deliver a superior and cost effective care.

This new change in nursing will absolutely bring new viewpoint not for only nurses already in the profession but for people that will likely join the profession.

Accountable Care Organizations
The health care system in the United States needs transformation to meet up with the goals set forth by the health care reform. Nurses need to play a fundamental role with this transformation in collaboration with the government, businesses, health care organizations, professional associations, and the insurance industry (National Academies of Sciences, 2017). Collaboration with inter-professional and interdisciplinary team members would ensure provision of care that is seamless, affordable, accessible, and high-quality that would yield positive health outcomes.
Accountable Care Organizations (ACO) is a partnership between primary care providers, hospitals, specialists and other healthcare providers with acceptance of dual responsibility for the superiority and cost of care delivered to their patients (American Nurses Association, 2010). Monetary bonuses are given to the members if the ACO has met their quality and savings target. The care delivery model recommends inter-professional and interdisciplinary collaboration to deliver seamless, superior, cost effective and care synchronized care plans for their patients. Clinical Nurse Specialists and Nurse Practitioners can be directives inside the organization or become leaders in this care delivery model particularly in the rural areas (ANA, 2010).

Medical/Health Homes
Medical homes provide coordinated and interdisciplinary care to patients across various care settings (ANA, 2010). This innovative healthcare system is endorsed through an excise imbursement or financial incentives to health professionals to inspire preventative care and chronic care management, reduction in medical costs and emergency care (ANA, 2010). The providers could be nurses, doctors, dieticians, social workers, pharmacists, psychiatrists, etc. The Patient Protection and Affordable Care Act (PPACA) mandates the health team to cooperate with resident primary care professionals and present state/community based resources to coordinate disease prevention, chronic disease management, transitions between health care providers/settings and case management for patients (ANA, 2010). The success of this care delivery model depends on nurses. Nurses should be recognized, vital leaders and members of the health team (ANA, 2010). Nurses play a very vital role in the healthcare system which includes care coordination during transition of care, delivery of holistic quality care both in acute and outpatient care settings, information technology, leadership roles, educators, practitioners, etc. Nurses are vital to providing such services, as they are consistent with the profession’s core scope of practice that includes patient evaluation and education, assuring continuity and coordination of care across settings and providers, and communicating effectively within the health care team and the patient and patient’s relatives/representatives (ANA, 2010).

Nurse-Managed Health Clinics
With the creation of the Nurse-Managed Health Clinics (NMHC’s), comprehensive primary care and wellness services are provided and made accessible to people that are vulnerable or with low socioeconomic status (ANA, 2010). Care is delivered to people in the community without considering their financial status. This is a community-based primary and wellness care center and care is mostly provided by nurses and other health care professionals. The advanced practice registered nurses (APRN’s) can manage or be leaders in this type of setting in the healthcare industry. This type of clinic makes provision for clinical placements for nursing students and gives them the opportunity to integrate their classroom learning with the community-based care. Nurses especially nurse practitioners (NP’s) have the skills to reframe the primary care delivery method and as well reduce cost and enhance patient outcomes (ANA, 2010). APRN’s can deliver care that is affordable, accessible and safe. Some studies have confirmed that primary care delivered by nurse practitioners is very cost-effective (ANA, 2010).

Feedback from Three Co-Workers
Nurses are very important health professionals though at times other health professionals look down on them. Nurses are the only health team members that devote the greatest time with patients in comparison with other health professionals. The bond and develop great relationship with their patients and relatives and serve as great advocates for their patients. The always work within their nursing scope of practice which includes delivering holistic, quality and competent patient-centered care. They also are great supporters in continuity of care as the deliver home health care, coordinate transitions of care, and utilize feedbacks in improving patient outcomes.
The nursing profession has transformed from what it was before. Today, nurses are strong partners with other health team members and not just delivering care at the bedside. Nurses are becoming leaders, educators, practitioners, informatics, researchers etc. The advancement in nursing education has given nurses more job opportunities to be leaders in NMHC’s, give directions in organizations and redesign patient-centric systems. It is great that nurses can manage or be leaders in NMHC’s. Nurses should continue to attain advanced degrees and put themselves out there. They should not be hiding behind closed doors as they are smart professionals. The government and leaders should help in motivating and empowering nurses as many nurses don’t know that they have a huge influence in achieving the goals that are set forth by the health care reform.

APRN’s should not be restricted in their practice. These restrictions only limit the service or care they can provide to the increasing diverse population. One of the goals of the healthcare reform was to allow nurses to practice their profession to the fullest. Restricting their license or scope of practice can only be a disservice to the healthcare system.

Feedbacks from the writers co-workers are consistent with the discussion in this paper. Nurses are the front liners in the healthcare industry and are very important. They are great assets in achieving the goals set by the ACA. However, the barriers that are preventing nurses from exceedingly delivering care to the rapidly evolving diverse population needs to be addressed in other to effectively achieve the ACA set goals in the healthcare system.
American Nurses Association. (2010). New care delivery models in health system reform: Opportunities for nurses and their patients. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf.

National Academies of Sciences. (2017). The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
Timothy, H. (2015). Different nursing roles in the continuum of care. Retrieved from http://www.americansentinel.edu/blog/2015/07/21/nursings-role-in-the-continuum-of-care/