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FORCE 5Professional Models of Care
Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care.
EXECUTIVE SUMMARY FORCE 5: PROFESSIONAL MODELS OF CARE Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care.
The Massachusetts General Hospital Patient Care Services’ Professional Practice Model
(PPM) serves as the blueprint for the delivery of exceptional nursing care. Developed and launched
in 1996 and revised in 2007, this innovative practice model is comprised of nine inter-locking
components to ensure seamless, interdisciplinary, knowledge-based care to MGH patients and
families. These components include: patient centeredness, vision and values, standards of practice,
narrative culture, professional development, clinical recognition and advancement, collaborative
decision-making, research, and innovation and teamwork.
Patient Centeredness is the nucleus of the PPM, reflecting the expectation that superior
patient care requires nurses to be present to patients and families ⎯ to listen, to know, to advocate
for, throughout the healthcare experience. The Patient Care Delivery Model (PCDM) articulates a
state-of–the-art infrastructure for the delivery of patient care: interdisciplinary, patient- and family-
centered within a dynamic, internal health environment which is influenced by the sociopolitical and
professional dimensions of nursing practice. The ultimate authority, responsibility, and
accountability for the nursing care rendered rests with registered nurses. Examples of continuity of
care, system’s improvements and nurse staffing aligned with the PCDM are imbedded throughout
this Force.
Standards of practice are an equally important component of the Professional Practice Model.
They exist to define the scope of practice for the professional nurse and to ensure patients receive
the highest quality of care by providing scientific rationales to support practice. Along with multiple
professional practice standards, the two major documents that influence nursing practice at MGH
are the Massachusetts Nurse Practice Act and Massachusetts Board of Registration in Nursing rules
and regulations. These documents are incorporated into the PCDM through the department’s
nursing policies and procedures. While standards serve an essential role in guiding practice for the
novice nurse, they also guide behavior of more experienced staff nurses, reflecting the organization’s
culture towards care delivery.
As articulated above, the PPM provides the framework to deliver the highest, quality patient
care possible at MGH. Communication of the PPM, the PCDM as well as regulatory and
professional standards is essential and occurs through a number of different venues: the Department
of Nursing orientation, educational programs offered through The Norman Knight Nursing Center
for Clinical & Professional Development and unit-based activities led by Nursing Directors and
Clinical Nurse Specialists. Hospital publications, particularly Caring Headlines, reinforce the
information and reach a large audience.
If questions arise, opportunities also exist for nurses to explore these tenets of practice
through consults with internal or external nurse experts. To address more urgent practice needs,
clinical and reference materials are available as an alternative to staff through on-line access and in
the hospital’s Treadwell Library and the Blum Patient and Family Learning Center. Reference
manuals and professional standards are also available to all staff either in hard copy format and/or
on-line.
Competent, adequate, flexible staffing is essential to actualizing the components of the
Professional Practice Model. The MGH leadership recognizes the impact of nursing in achieving
high quality patient care and has a longstanding history of documenting nursing workload and
supporting the need for additional staff. The MGH Department of Nursing Direct Care Staffing
Guidelines summarize the multi-faceted dimensions involved in effective staffing. Staffing levels are
based on volume and acuity of patients (nursing workload) and factored for distribution of workload
over various time periods, experience and mix of staff, and logistical and support issues. Examples
in this Force describe direct care nurses influence in scheduling practices as well as descriptions of
unit scheduling operations and available monitoring reports.
TABLE OF CONTENTS Volume 4
Force 5: Professional Models of Care
Sources of Evidence 5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
Pages 1-9
Pages 10-26
Pages 27-44
Pages 45-56
Pages 57-76
Pages 77-81
Pages 82-92
Pages 93-109
Pages 110-111
Pages 112-117
Pages 118-130