Staff Nurses' Experiences of a Change in the Care Delivery Model

Abstract

This qualitative study describes the staff nurses' perspective of change in the care delivery model and skill mix in an intermediate care unit. Data were collected in interviews in focus groups with the registered nurses affected by the change. Two major themes emerged: (1) autonomy and control and (2) interdependence. The nurses emphasized an increased satisfaction (self and patient) with this model. This study confirmed that autonomy, control, connection with the patient, and peer and interdisciplinary support and respect are important for the staff nurse. These findings reinforced the value of involving the staff members in change and the importance of giving voice to their perspective through qualitative research.

Health Care Professionals’ Perceptions and Experiences of Respect and Dignity in the Intensive Care Unit

“…Nurses feel that they have to step in when clinicians from various specialties provide patients or families with different or even contradictory information, or when medical jargon is used. Although nurses in our study and in other studies (Garon et al, 2009) want autonomy and independence, and feel more respected when their input is valued, they do not want to carry the responsibility of being the main communicator of information to patients. As is documented in the literature (Hansen et al, 2009), our nurse-participants experience physician behaviors such as being unavailable, or conveying unrealistic expectations to patients, as disrespectful.…”

“…purposes (Bishop et al, 2014;Cioffi & Ferguson, 2009;Cowin & Eagar, 2013;Garon, Urden, & Stacy, 2009;Hansen, Goodell, DeHaven, & Smith, 2009;Happ et al, 2011;Khademi, Mohammadi, & Vanaki, 2012;Kirchoff et al, 2000;Llenore & Ogle, 1999;Soderberg, Gilje, & Norberg, 1997). For example, a study of resident physicians suggests that the scarcity of time, the drive for effi ciency, and the focus on technology in ICUs interfere with the kinds of behaviors (e.g., listening) that characterize compassionate care (Bishop et al, 2014).…”

“…Evidence from studies of nurse-patient interactions suggests that effective communication is particularly diffi cult in the ICU because many patients are intubated, actions are often time sensitive, and the environment is noisy (Llenore & Ogle, 1999). Communication challenges and barriers within nursing teams and a loss of respect and civility across the healthcare workplace have also been documented (Cowin & Eagar, 2013;Khademi et al, 2012;Soderberg et al, 1997), and nurses report a prevailing sense of lack of control within the ICU (Garon et al, 2009;Hansen et al, 2009;Kirchoff et al, 2000). Taken together, these studies suggest that hierarchy, power imbalance, perceived lack of autonomy, and technocratic management adversely affect communication between nurses and physicians.…”

Practice models

“…Use of such structures helps foster autonomous decision making; professional identity; job satisfaction; high-quality, consistent nursing care; improved patient and family outcomes; and interdisciplinary communication. [4][5][6][7] Practice model attributes A practice model reflects nursing values that exemplify the culture of an organization. The dominant attributes shared among models and featured in Magnet organizations include nursing autonomy; empowerment; and cost-effective, quality care.…”

“…The movement to managed care with hospital downsizing, cost containment, and the use of unlicensed assistive personnel was the impetus for the use of professional models. 4 Nurses possess an understanding of professional practice and a broad knowledge base to provide quality care to patients. 9 If a nurse or an organization subscribes to a practice model, then the positive consequences for patients are healing, comfort, health promotion, wellness, and prevention, leading to increased satisfaction.…”