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Research Proposal: Implications of Nursing Care Delivery Model (NCSM) on the Quality and Safety of Nursing Care Student’s Name Institutional Affiliation

Implications of NCSM on the Quality and Safety of Nursing Care Background Nurses are critical elements in determining the quality of patients, communities, and families’ outcomes. The perceptions that nursing responsibilities positively impact individual and social wellness define professional nursing guideline (Jones, 2016). Also, the motive to make a positive change in the patients’ lives creates a foundation of trust between professionals and their employers. Despite the huge responsibility, there exists inadequate research to determine the actual nurses’ contribution to the improvement of the patients’ wellness (MacPhee, Dahinten & Havaei, 2017). Further, there is little research on the quality of the patients’ outcomes. This is because previous analyses mostly match the quality of patients’ wellness in an individual delivery model overlooking the importance of aligning both models with the nursing practices complementarily. Also, nursing practices are grouped under different care provision models despite the lack of reliable research detailing the most productive model in a particular category of nursing practices. The main component of the NCSM includes the mode of nursing care delivery and the skill mix (SK). Policy formulators integrate the two elements within the nursing practices to develop a comprehensive approach aimed at improving both patients’ and nurses’ health outcomes. The model of nursing care delivery component align specific patients’ needs with the nurse’s or nursing skills to determine the most appropriate professional combination that can handle an individual or group of patient; hence attract quality outputs (Oxelmark, Amorøe, Carlzon & Rystedt, 2017). The SK identifies the different levels of nurses within an institution based on their qualifications. Such grouping assists nursing leaders to place the nurse specialists in different positions based on their qualities to facilitate specialization and sharpen their skills in their various competencies. The rise in the number of individuals suffering from chronic conditions and the increase in the aging population with a wide range of medical complications subject nursing practice to regular changes as they constantly need to develop new integrated techniques to curb the emerging service provision pressure (Salmond & Echevarria, 2017). A combination of SK and the mode of nursing care delivery in policy formulation helps nurses improve the quality of their services, thus promoting patients’ outcome, and also the safety of the nursing care. Significance of the Study Due to the developing pressure within the health industry, the complementary application of principal components of the NCSM is critical. Results from this research will help nursing practitioners and other health specialists to develop more integrated policies to help ease the coordination of nursing practices. Such systems allow for the improvement of the quality of services offered to patients at cost-effective prices. The results will also assist nursing policy formulators in the integration of service delivery with the nurses’ wellbeing to avert the negative implications caused by work overload. Further, the research findings will highlight to the government and other nursing stakeholders the need to fund more research to promote innovation within the nursing strategies; hence, attract inter-disciplinary approaches to strengthen the available national and global health workforce. The findings of the study will present to the relevant institutions the combination of factors needed in the formulation of an interdisciplinary strategy. Such results will also provide the basis for the formulation of an integrated policy in the evaluation and monitoring of newly implemented comprehensive techniques. Purpose of the Study The study aims at establishing the correlation between the Nursing Care Delivery Model (NCSM) and the quality and safety of nursing care. The purpose of the study will be achieved upon analyzing the data collected from a wide range of healthcare stakeholders, including nurses, physicians, and patients. Critical evaluations on stakeholders’ expectations and the consideration of the nurses’ health wellbeing will guide the formulation of a comprehensive strategy incorporating both the SK and the mode of nursing care delivery integrative of the above objectives. Although nursing specialist holds different qualifications, the study aims at establishing an integrated approach to facilitate interpersonal interaction within the healthcare institution to enhance learning and team-based assistance to attract service improvement. Research Question The preliminary research question is: what are the implications of NCSM on the quality and safety of nursing care? Hypothesis The research paper hypothesizes that the interdisciplinary application of NCSM is essential in the improvement of patients’ health outcomes. The comprehensive approach has not been the case based on the result of previous studies. Further, the research also affirms that the inter-personal assistance of the nursing specialists irrespective of their qualifications attracts a positive team spirit, improving their health despite the increasing work-related pressure. In a hypothetical view, it is expected that integrating nursing needs and patients’ expectations, while developing a comprehensive nursing care delivery strategies is essential. Such a broad policy attracts high-quality services to patients and also positively implicate on nurses’ wellbeing. Final research hypothesis: A comprehensive interdisciplinary technique implicates positively on both safety and quality of nursing care, with the existence of the relevant knowledge. Conceptual Framework Comprehensive policies are directly related to the quality of services rendered to patients. Further, an Interdisciplinary approach between different health specialists from a wide range of specialty refers directly to the inter-organization teamwork spirit, promoting nurses’ health wellbeing. Definition of Terms Patients’ health outcome- The implications of particular health interventions and investment on patient’s wellbeing. For example, the use of an inter-professional approach to minimize chronic conditions on nurses due to the increasing work pressure. Skills mix- Refers to the nursing specialists’ qualifications, continuous career development, individual experience, and how they interrelate with the knowhow of enhancing the quality of service provision. Comprehensive policies- This refers to the integration of SK and mode of nursing care delivery in the formulation of nursing intervention policies. Also, the comprehensive policy incorporates quality of service delivery and nurses’ wellbeing in the formulation of healthcare services delivery strategies. Mode of care delivery- It is either the nursing independence or collaborative work aimed at providing a direct care to either an individual or a group of patients. It incorporates total patient care and team nursing Team nursing- It is the collaboration between a wide range of professionals, including nurses, to service a patient in a critical condition, for instance, the Inter-professional cooperation between nurses to improve patients’ outcomes in a life-threatening state. Interdisciplinary approach- It is the combination of healthcare specialists’ expectations, who have varied skills in different disciplines, with patients’ expectations to promote interdependence; hence, improve the outcomes. Literature Review The quality of the nursing care delivery model depends on the available SK. Inadequate communication and collaboration between the relevant healthcare specialists can negatively implicate on a patient’s health outcomes (Babiker et al., 2014). In some situations, patients face critical health complications demanding immediate and informed responses from the available specialist. To meet such demands, Hastings, Suter, Bloom, and Sharma (2016) confirmed the need to develop interdisciplinary strategies within a health institution. Based on Suter et al. (2016) findings, research is essential in identifying the most suitable mode of collaboration in the healthcare industry to facilitate inter-professional assistance. Other than responding to patients in acute conditions, a lot of pressure has accumulated in the healthcare industry due to the rising costs and the lack of qualified specialists (Aiken et al., 2017). In response, innovation within the nursing industry is essential to enhance the efficient use of the available human resources while improving quality. Also, health institutions are gradually incorporating team-based organization culture to promote a positive team spirit and attract job satisfaction across all specialists. According to Hastings et al. (2016), a positive teamwork spirit boosts the specialists’ health and also improves the patient’s wellbeing. The existing knowledge is inadequate to elaborate on the best approach to be used while formulating the team-based practices per the nursing care delivery model guidelines. Havaei, Dahinten, and MacPhee (2019) confirmed that an effective human resource management system requires an integrative approach in healthcare provision; hence, demand flexibility within the two NCSM. Further, Dubois et al. (2013) found that despite the critical work-related expectations faced by nurses, a majority of them work under a suboptimal environment. The specialization, which entails grouping the nurses under different care models, adversely implicates nursing practices; hence, poor working conditions. Despite the specialization efforts, there is incomplete knowledge relating to the most viable combination of nursing practices in the relevant care model. Such a knowledge deficit affects the overall productivity of individuals due to misplacement causing job-related stress amongst nursing specialists (Dubois et al., 2013). Based on the negative implications associated with job discomfort to both nurses and patients’ wellness, extensive research is essential to help nurse leaders develop more innovative and collaborative means to facilitate interpersonal mentoring. Under the two models, nursing patient care tasks have been categorized into four groups. The groups include functional nursing, total patient care, team nursing, and primary nursing. Dubois et al. (2013) confirmed that the groups’ description faces inconsistency and other related limitations, making them inadequate to elaborate on the nursing practices organization. The available literature provides evaluators with an inadequate standard of measure to monitor the progress of an implemented interdependent strategy. More research is critical to establish evaluation strategies to help the management detect strengths and weaknesses within the approach to help them settle on the most viable combinations. Dubois et al. (2013) found that the involvement of a wide range of care providers within the healthcare industry overlooks the importance of nurses’ inputs and interventions. To develop nursing-contribution sensitive evaluators, more research is vital. The research findings aim at elaborating tp the nurse leaders the need to create more comprehensive techniques that also incorporate nurses’ safety within the institutions. Despite the increased campaigns on the importance of an interdisciplinary approach in healthcare, inadequate knowledge exists to guide the specialists in delivering per its expectations. According to Nancarrow et al. (2013), the multidisciplinary process is a complicated method because of the wide range of specialists from different fields involved. An intricate and detailed guideline is critical to the formulation of an interdisciplinary approach. The instruction presents all the necessity to make the process successful and identify the means to intervene on possible deviations. Several components contribute to a multidisciplinary formulation including, SK, organization objectives, managerial expertise, the individual relationship, among others (Nancarrow et al. 2013). Previous researches concentrate on the relationship between care and several of the above components. More research is needed to correlate the multifactorial nature of the interdisciplinary technique to the patients’ and nurses’ wellbeing. Although there exist several inter-professional methods, including patient sharing, availing necessary information to all relevant stakeholders, among others, prior literature omits the need to develop a systematic and structured multidisciplinary framework acceptable from a global perspective. According to Nancarrow et al. (2013), there is a need for a restructuring of the available workforces’ perceptions and organization values to meet the rapidly changing healthcare industry. While the changes in the healthcare delivery system affect the organization wholly, some departments experience adverse implications compared to the rest. The most affected is the primary care services due to the lack of a clear empirical elaborating what entails an interdisciplinary approach. Further, the diversity of the employees and health specialist involved in primary care affect the harmonization of their undertakings and expectations to a neutral platform acceptable by all. Research is critical to establish the essential characteristic of an integrative, interdisciplinary process within the healthcare industry to act as a standard of measure and an evaluation reference. Knowledge Gap Based on the literature review, a knowledge gap exists in relation to the formulation of the interdisciplinary approach within the NCSM. Although the specialist comprehends the positive outcome associated with an effective teamwork spirit, a majority of the institutions lack enough expertise to formulate an acceptable technique due to the skill and expectation disparity within the industry. There exists a literature gap defining the general composition of a globally acceptable integrative method; hence, there lacks a standard measure for use in the evaluation process. A knowledge gap also exists in the grouping and definition of nursing practices organization. The lack of detailed elaborations of the subgroups under the care models affects the nurses’ grouping process; hence, they miss the productive combinations. The research purposes of filling in the above knowledge gaps promoting an interdisciplinary approach; thus, improve nursing care quality and safety in a global perspective. Methodology Research Design The research will use a qualitative research design to facilitate the presentation of a clear and precise picture of interest. Based on the diversity of the healthcare industry and its dependence on nursing care, the qualitative method will provide the researcher with firsthand information on the interrelationship between NCSM and the quality and safety of the care. Also, a qualitative research design will assist the researcher in coming up with a general understanding of the various dynamics essential in the development of an interdisciplinary strategy. Different qualitative research techniques, including face to face interviews, distribution of questionnaires, among others, will be employed to assist the researcher in the collection of the primary data. Further, the research will use secondary sources from prior studies to help in steering the research continuity per the main objectives. Secondary sources will also aid the researcher in developing the field questions in accordance with the existing gaps to facilitate an introduction of new knowledge on completion. The healthcare industry incorporates a wide range of specialists and patients; hence, random sampling will be used in primary data collection. Various analytical tools will be employed in the analysis of the primary and secondary data to develop a predictable pattern useful in policy formulation. Research Setting The study aims at developing a general relationship between NCSM and the quality and safety of provided care. Mainly, the primary variable is the integration of the main models and the nurses’ and patients’ expectations. Various controls to aids in data collection and analysis will be employed, including structuring common questions depending on the actual target, among others. The study will also involve private interviews to enhance data confidentiality and to facilitate personal space in the course of data collection to attract accuracy. The constant variable is the nurses’ and patients’ health outcomes based on the integrative model’s strategy and relevant patients’ and nurses’ needs.

Study Population and Sampling The target populations of the study will come from nurses in different health facilities from different regions of the nation. Patients with acute conditions, among other chronic diseases, will also take part in the study to provide the researcher with a clear insight into their expectations. Due to the diversity of the target population, it will be difficult to include everyone in the study. A stratified sampling technique will be used to determine the study respondents to enhance uniformity in the representation of the variables. Internal based selection within the healthcare system will use simple random sampling to avert biasness. The researcher will also use sampling with replacement to support the simple random sampling process. Proportionate stratification will be used to ensure the patient and nursing ratios correlate despite their population disparity. Data Collection The research will use face to face interviews scheduled separately for each of the targeted respondents. Different patients with a wide range of health complications will be interviewed. Also, some of the patients with prior experience of nursing care will take part in the scheduled interview. In a separate meeting, nurses with different qualifications will also be interviewed, including the nurse leaders and teambuilding overseers. The second instrument of data collection will be structured questionnaires. Varied questions based on the study objectives will be used, including patients’ expectations from an interdisciplinary strategy implementation, among others. Further, the questionnaires will include an open-ended question to allow the respondent to give their suggestion on the betterment of the care services.

Validation of the Questionnaire The questionnaires will be validated to enhance the accuracy and relevance of the information collected. Copies of the questionnaires will be given to the health care management and the relevant stakeholders’ representative for validation. Examples include the research supervisor and nurse leaders. After an assertion, proposed changes will be made before settling on the final draft. The draft will also be subject to pilot testing to provide an insight into the expected respondent responses. Responders’ reactions will guide the structuring of the final field questionnaire, which has integrated thoroughly different stakeholders’ expectations. Data Analysis Content analysis will be employed to analyze face to face interview data. The method will assist the researcher in effectively handling the diversity of the data collected and also provide an insight into its relevance to the research hypothesis. The researcher will develop a code framework portraying the main themes and subthemes of the study. Coding will help the researcher to categorize the data in relation to specific research objectives to facilitate quantities analysis. Coding will also assist the researcher in identifying the relevance of the data and its distribution within the specified area of study. SPSS will be used to develop a correlation of the data to the research question to assist in pattern development. Generated patterns are useful in mapping the relationship, attracting the most preferred intervention techniques within the research field. Despite the advantages, content analysis is subject to errors due to human misinterpretation. This is due to the generalization concept arriving at unreliable conclusions. Ethical Consideration The study will be subject to different ethical issues. During the pilot study, a majority of participants will have the opportunity to air their concerns regarding confidentiality, among other issues. Based on the nature of the research, which involves patients and nurses, the type of question will follow a general view to avoid getting too personal. A written assurance will be provided to the target parties to assure the participant that the information is only for studies and its subject to privacy and protection. Further, the participant who accepts to take part in the survey will be confirmed through a one to one debrief followed by a signed document of acceptant. The purpose of debriefing and signing of the letter of acceptance is to elaborate to the participant that they will take part in the interview voluntarily; hence are free to withdraw at will. A highly structured consent form will be provided to the subject target and their relevant stakeholders, detailing the varied methods of data collection to be used. The form will be written in English and later translated to the participant’s local language to facilitate clarity and understandability. Conclusion The survey endeavors to establish how NCSM and the quality and safety of care correlate. To demonstrate the correlation, the research will identify how interdisciplinary approach, which integrated the two main models, enhances the improvement of quality of services and positively affects the health outcome of the nurses. The research also aims at providing reliable information on how to develop an inclusive interdisciplinary model to act as an evaluation reference and as a standard of measure of adherence. Integrative techniques also assist nurse leaders amongst other relevant leaders in promoting a positive team spirit within the health institution, enhancing job comfort; hence, promote stakeholders’ wellbeing. By affecting the proposed methodology, it is possible to establish the correlation, attracting positive responses from the policy formulators and the other relevant stakeholders. Results from this research will help nursing practitioners and other health specialists to develop more integrated policies to help ease the coordination of nursing practices. Such systems allow for the improvement of the quality of services offered to patients at cost-effective prices. The results will also assist nursing policy formulators in the integration of service delivery with the nurses’ wellbeing to avert the negative implications caused by work overload. Further, the research findings will highlight to the government and other nursing stakeholders the need to fund more research to promote innovation within the nursing strategies; hence, attract inter-disciplinary approaches to strengthen the available national and global health workforce. The findings of the study will present to the relevant institutions the combination of factors needed in the formulation of an interdisciplinary strategy. Such results will also provide the basis for the formulation of an integrated policy in the evaluation and monitoring of newly implemented comprehensive techniques.

References Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., & Sermeus, W. (2017). Nursing SK in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Qual Saf, 26(7), 559-568. Retrieved from https://qualitysafety.bmj.com/content/26/7/559.short Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., ... & Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care. Sudanese journal of paediatrics, 14(2), 9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949805/ Dubois, C. A., D'amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal for Quality in Health Care, 25(2), 110-117. Retrieved from https://academic.oup.com/intqhc/article/25/2/110/1857020 Hastings, S. E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC health services research, 16(1), 245. Retrieved from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1507-2 Havaei, F., Dahinten, V. S., & MacPhee, M. (2019). Effect of NCSM on Registered Nurse Outcomes. SAGE Open Nursing, 5, 2377960819869088. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/2377960819869088 Jones, T. (2016). Outcome measurement in nursing: Imperatives, ideals, history, and challenges. OJIN: The Online Journal of Issues in Nursing, 21(2). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No2-May-2016/Outcome-Measurement-in-Nursing.html MacPhee, M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7. Retrieved from https://www.mdpi.com/2076-3387/7/1/7 Nancarrow, S. A., Booth, A., Ariss, S., Smith, T., Enderby, P., & Roots, A. (2013). Ten principles of good interdisciplinary team work. Human resources for Health, 11(1), 19. Retrieved from https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-11-19 Oxelmark, L., Amorøe, T. N., Carlzon, L., & Rystedt, H. (2017). Students’ understanding of teamwork and professional roles after interprofessional simulation—a qualitative analysis. Advances in Simulation, 2(1), 8. Retrieved from https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-017-0041-6 Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36(1), 12. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/