Example Of Nursing Services Delivery Theory Essay

Summary and Review

It is intuitive that nurse staffing practices, physical, organizational and environmental factors affect patient care, patient, and personal satisfaction. Meyer & O'Brien-Pallas (2010) sought to derive the Nursing Services Delivery Theory (NSDT) by applying the open system theory in then context of a large health care organization. This should help meet the need for a clear theoretical framework that draws on financial, organizational, clinical, and outcome variables from a nursing standpoint. Using data from Business Source Premier and CINAHL databases, this article conceptualizes a health care organization as an open system whose characteristics include a dynamic steady state, energy transformation, event cycles, negative entropy, equifinal, coordination and integration, negative feedback and differentiation. NSDT asserts that input, throughput and outcome factors intricately interact to influence the work expectations on nursing workgroups. This theory offers a relational structure to harmonize varied research work on nursing outcomes, work environments and staffing, across different cultures, settings and levels of practice.

Application of the Nursing Services Delivery Theory

While interned at the Ripley Field Memorial, I worked in the chronic diseases care department that had recently lost several of its staff members, five of who had found work elsewhere, while two were still looking for employment. The nurses in the department often complained of heavy work burdens, long working hours (and low overtime pay) and low organizational commitment. The pressure of work meant that we were always on the go, and even at the best working rate, patients complained of negligence and poor quality of care. I encountered incomplete or lost patient records, poor discharge planning, general lack of personal attention to the patients. These negative outcomes are a consequence of the system’s failure to adjust to the environmental factors. The failed adaptation means that the hospital cannot counteract entropy, rendering it vulnerable to environmental shocks during dissolution and disorder.
The inputs at Ripley Field Memorial Hospital include care recipient characteristics, nurse characteristics, and other energic sources. Care recipient characteristics include the extent of patient education in managing chronic health conditions, the demographical factors (age, income, level of education), the extent of the disease’ progression, dissatisfaction, the availability of resources (wards and beds, medical supplies, nurses and doctors, etc.). The nurses’ demographics (age, experience, number of staff education level and income, etc.), professionalism and condition of their health is just as important, and in this case, the facility is understaffed, the nurses have long working hours and heavy workloads, lack organizational commitment and there is high turnover.
Mistakes in the completion of patient records and inadequate discharge preparation is a function of the organization’s lack of proper energic sources (e.g. electronic, clear regulations, staff training and financial resources to invest in the quality of care). These problems are partially brought on by the suprasystemic failures to allocate adequate resources, nurture a good work environment (poor human resources development policies) and organizational culture. Ripley Field Memorial Hospital’s chronic diseases care department is struggling with a failure to optimize on the existent inputs/energy (nurses) and a broken organizational culture that have in turn resulted in the overall systemic malfunction. The chronic care department is a supportive subsystem, the nurses’ core is a production subsystem, and adaptive subsystems include the performance appraisals and supervisors. The consequence of the problems with inputs and the suboptimal throughput environment leads to poor products and services (patient outcomes e.g. patient satisfaction and quality of care), which in turn generate the negative feedback foe the nurses and hospital.

Desired Outcome

Goals and Objectives
Equip the hospital with the latest information technology, to help manage patient records and other aspects of practice
Policies and Procedures
The organization needs to implement a range of urgent changes across several levels in order to ensure that the system and the subsystems work efficiently towards supporting the overall organizational mission and goals. To begin with, the organization must invest in the latest enterprise management systems and medical records to bolster efficiency in the management of the overall functions of the organization, including patient records. Medical records are critical in supporting patient care and administrative functions at the facility. This technology will help to alleviate some problems with discharge planning, but this must also be built into the practice procedures and guidelines.
Evidence-based practice requires adequate nursing staffing in order to ensure that the patient receive basic care, and this need only increases in the case of chronically ill patients. The required nurse-to-patient ratio in the United States is 0.4:1. While Ripley Field Memorial Hospital meets this standard, I established that the high turnover among the nursing staff led to the poor coordination within the team. Most nurses were assigned to irregular shifts and had to cover for colleagues that had left or been assigned to different shifts at short notice. It was impossible to achieve a harmonious production/support subsystem, not only because of the nurses leaving, but also because of the dysfunctional management and lack of facilities. According to Zhu et al. (2012), the most efficient nurse-patient ratio should range between 0.5 and 0.6:1. Effectively, the staffing levels must be brought up to this standard. In addition, the optimal care for chronically ill patients requires a healthy incorporation of self-care, as a way of relieving pressure off the health care facilities and staff. Self-management requires extensive patient education and seamless collaboration between the patient and the health care system. Effectively, self-care needs to be implemented in the Ripley Field chronic care department.
The implementation of these changes should help would uphold the organization’s mission and values and improve the culture and climate. According to the open systems theory, an organization’s performance is driven by the supporting environment for varied inputs to ensure their sustainable processing through the defined production process to yield desirable outcomes. An organization is a live social system, striving to ensure a steady state by ensuring regular energy flow preserves the systems character, and distortions trigger proper adaptive responses. Success and survival are dependent on adaptive neutralization of entropy that stems from the inability to input losses or failure to transform energies. As such, the open systems theory anticipates that by ensuring that the systems is working properly at all levels, including the ability to adapt to different environmental factors, then it would give rise to desirable outcomes, which have the consequence of creating further conditions for success.

Summary/Conclusion

Effectively, Meyer & O'Brien-Pallas (2010) provides a deeper understanding of nursing practice within the context of the production system (i.e. the health care organizational environment), including the division and coordination of nursing tasks. It makes it possible to reconcile nursing practice, work environment, and staffing contribute to the work expectations for nurses. This paper also creates a foundation for future studies to evaluate the ways to attain optimal nursing services delivery and the management of critical system components that lead to the optimal service delivery.

References

Masters, K. (2011). Nursing Theories: A Framework for Professional Practice (Masters, Nursing Theories). Boston: Jones & Bartlett Learning.
Meyer, R. M., & O'Brien-Pallas, L. L. (2010). Nursing Services Delivery Theory: an open system approach. Journal Of Advanced Nursing, 66(12), 2828-2838 doi:10.1111/j.1365-2648.2010.05449.x.
Wills, E., & Kluwer, W. (2010). Theoretical Basis for Nursing 3rd. ed. . New York: Lipincott Williams and Wilkins.
Zhu, X., You, L., Zheng, J., Liu, K., Fang, J., Hou, S., et al. (2012). Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals. Journal Of Nursing Scholarship, 44(3), 266-273.