Explain How The Practice Of Nursing And Patient Care Deliver ✓ Solved
Explain how the practice of nursing and patient care delive
Explain how the practice of nursing and patient care delivery will evolve, addressing continuity of care/continuum of care, accountable care organizations, medical homes, and nurse-managed health clinics.
Paper For Above Instructions
The evolution of nursing and patient care delivery is inseparable from broader health system changes that seek higher quality, better outcomes, and more efficient use of resources. Grounded in the Vision for the Future articulated by the Institute of Medicine (IOM, now the National Academy of Medicine) and the Triple Aim framework, nursing leadership is positioned to drive transformative change across care settings, populations, and payers (IOM, 2010; Berwick, Nolan, & Whittington, 2008). As health systems shift from volume-based to value-based care, nurses are increasingly called to assume roles that blend direct clinical care with care coordination, population health management, and system-level improvement. This trajectory aligns with Porter’s emphasis on creating value by measuring outcomes and costs together, rather than solely focusing on process metrics, and with Donabedian’s imperative to improve structure and process to enhance outcomes (Porter, 2010; Donabedian, 1988). The result is a more integrated, patient-centered model of nursing practice that spans the continuum of care (IOM, 2010). (IOM, 2010; Berwick et al., 2008; Porter, 2010; Donabedian, 1988)
Continuity of care—the seamless coordination of care across transitions and settings—emerges as a foundational pillar for the evolving practice. Nurses serve as linchpins in care coordination, ensuring information exchange, medication reconciliation, and follow-up after discharge are timely and accurate (AHRQ, 2013). Interoperable health information technology (IT) systems, standardized handoffs, and shared decision-making protocols enable nurses to track patient trajectories across primary care, specialty services, hospitals, and post-acute facilities. This continuity supports not only safer transitions but also proactive risk assessment and prevention, aligning with the IOM’s call for nurses to lead in quality and safety initiatives (IOM, 2010). In this vision, continued emphasis on evidence-based practice and continuous measurement strengthens accountability and patient outcomes (Donabedian, 1988). (AHRQ, 2013; IOM, 2010; Donabedian, 1988)
Accountable Care Organizations (ACOs) represent a structural shift with implications for nursing roles in governance, care management, and performance improvement. ACOs emphasize shared savings tied to quality and cost controls, incentivizing cross-disciplinary teams to manage populations effectively. Nurses, with expertise in care coordination, symptom management, and patient education, become essential to achieving measurable improvements in chronic disease management, hospitalization rates, and patient experience. The nursing role extends from bedside care to leadership in population health strategies, utilization management, and outcome analytics. This aligns with the broader Health Affairs and JAMA discussions on how accountable care reshapes incentives, accountability, and collaboration across clinicians, institutions, and communities (Rosenthal, 2010; Berwick et al., 2008). As value-based payment structures mature, nursing leadership will increasingly influence network design, care pathways, and measurement frameworks that capture patient-centered outcomes (Rosenthal, 2010; Porter, 2010). (Rosenthal, 2010; Berwick et al., 2008; Porter, 2010)
The medical home model—often operationalized as the Patient-Centered Medical Home (PCMH)—offers a concrete framework for integrating nursing roles into primary care redesign. PCMH emphasizes access, comprehensive and coordinated care, and a patient-centered ethos, with nurses leading care management, chronic disease programs, and preventive services within a team-based model. RNs and advanced practice registered nurses (APRNs) are central to implementing care plans, coordinating services across specialties, and engaging families and communities in health promotion. The PCMH paradigm supports reductions in fragmentation, improves patient satisfaction, and enhances health outcomes when nurse-led care coordination is embedded in robust IT support, performance measurement, and patient engagement strategies (IOM, 2010; World Health Organization, 2010). As with continuity of care, the success of the PCMH hinges on effective communication, reliable access, and alignment of incentives with measurable results (WHO, 2010; AHRQ, 2013). (IOM, 2010; WHO, 2010; AHRQ, 2013)
Nurse-managed health clinics (NMHCs) illustrate how nursing leadership can extend high-quality care into communities with limited access to primary care. NMHCs leverage nursing expertise to provide preventive services, management of chronic conditions, and health promotion in settings that may be geographically or economically underserved. They demonstrate how nurse autonomy, scope of practice, and collaborative practice models contribute to improved access, lower emergency department utilization, and better health outcomes for underserved groups. The NMHC model integrates with PCMH and ACO structures to address social determinants of health and create more equitable care delivery. Empirical work and policy discussions, including nursing economics and health services research, support the role of NMHCs in expanding coverage and improving outcomes for vulnerable populations (Naylor et al., 2012; ANA, 2015). (Naylor et al., 2012; ANA, 2015)
Forecasting the nursing role in these evolving models requires explicit mechanisms for feedback, reflection, and adaptive leadership. Effective forecasting depends on engaging frontline nurses in forecasting activities, leadership development, and formal channels for professional input into policy and practice decisions. Evidence of feedback from colleagues—coupled with reflection and personal insight—contributes to more accurate projections of workforce needs, educational requirements, and the development of new competencies in care coordination, data analytics, and patient engagement. Such feedback loops align with quality-improvement principles and the Donabedian framework for assessing structure, process, and outcomes (Donabedian, 1988; IOM, 2010). When forecasting is integrated with continuous learning, organizations can anticipate skill gaps, adapt curricula for nursing education, and implement scalable workforce models that sustain high-quality care across the continuum (IHI, 2008; IOM, 2010). (Donabedian, 1988; IOM, 2010; IHI, 2008)
In terms of language and terminology, the evolving practice requires consistent usage of concepts such as continuity of care, accountable care organizations, patient-centered medical homes, and nurse-managed health clinics. Clear vocabulary supports interprofessional collaboration, patient communication, and policy advocacy. Beyond terminology, the practice must be grounded in the principles of patient-centeredness, safety, equity, and value—the core elements that underlie modern health systems reforms. These principles are echoed in foundational work on quality and value, which emphasize the linkage between structure, process, and outcomes as the pathway to sustained improvement (Donabedian, 1988; Porter, 2010). (Donabedian, 1988; Porter, 2010)
Education, policy, and leadership considerations are essential to realizing this evolution. Nursing education must emphasize care coordination, health systems science, informatics, population health, and collaborative practice; continuing education should address new care models, data analytics, and patient engagement strategies. Policy and regulation should support expanded scope of practice where appropriate, enable team-based models, and protect patient safety. Financial incentives aligned with value-based care must recognize the central role of nursing in achieving improved outcomes and reduced costs. Finally, healthcare leaders should cultivate cultures that value interdisciplinary teamwork, continuous learning, and patient-centered outcomes, leveraging evidence from the nursing, medical, and public health literatures (IOM, 2010; Berwick et al., 2008; Rosenthal, 2010; Donabedian, 1988). (IOM, 2010; Berwick et al., 2008; Rosenthal, 2010; Donabedian, 1988)
In sum, the practice of nursing and patient care delivery is poised to evolve toward integrated, value-driven models that emphasize continuity of care, accountable care structures, patient-centered medical homes, and nurse-led clinics. By positioning nurses as leaders in care coordination, quality improvement, and population health, health systems can deliver higher-quality care, with better outcomes and more equitable access. This trajectory is supported by a robust theoretical and empirical foundation, including the IOM/NAM agenda for nursing, the Triple Aim, and the broader movement toward value-based care that recognizes the indispensable role of nursing in modern health care (IOM, 2010; Berwick et al., 2008; Rosenthal, 2010; Porter, 2010; Donabedian, 1988). (IOM, 2010; Berwick et al., 2008; Rosenthal, 2010; Porter, 2010; Donabedian, 1988)