Content area
Full Text
Adaptation is the byword in implementing a successful primary nursing system in nursing homes.
How can gerontological nurses assure the delivery of individualized, high quality care which results in therapeutic attainments for the older adult? Nursing's goal in long-term care facilities has been to provide individualized nursing care which guarantees each elderly person the opportunity to reach his or her maximal level of physical, mental, social, and spiritual well-being. This challenge - to develop and implement individualized programs of care incorporating both reactive and proactive interventions - has been ever present. The triumphs and, at times the failures, of health professions to reach this goal within the nursing home field are real.
In the past years, the scandals within the nursing home industry drew national attention to our shortcomings.1,2,3 While one may attribute some of these horror stories to sensationalized reporting, the exposure required the nurse to reflect on the deficiencies and competencies existing within both the practice and delivery systems. In questioning this it was felt an evaluation of the limitations imposed by the "team" modality of delivering nursing care was necessary.
Team nursing, the traditional nursing care delivery system in long-term care, operates by dividing the nursing staff into task-oriented teams aimed at meeting the patient care needs.4 There are some intrinsic difficulties one encounters when operating within this system.
A significant factor that interferes with insuring continuous, responsible nursing care is that the team of people assigned to care for the patient today may not be the same team assigned to care for that patient tomorrow. There may be day-to-day accountability, but no one person is assigned the responsibility for developing and implementing a holistic plan of care for the elderly patient. While the work may get done, the nursing care delivered is often fragmented, with no one nurse responsible for the care delivered.
From a management perspective, the head nurse is generally given the authority and responsibility for insuring the quality of nursing care on a particular unit. Because of this, family members, patients, and mult idi sci pi i nary team members may all seek authence with the leadership person. This frequently leads to an inunduated and ineffectual middle manager.
Attempts to effect change within the team system through...