By: Peggy Hamm-Johnson

& Kelly Jones

Explain care delivery models

Discuss models of health and wellness

Explain Leavell and Clark’s Agent-Host- Environment Model

Explain Dunn’s Levels of Wellness

Explain Health Locus of Control Model

Explain Rosenstock and Becker’s Health Belief Model

Discuss changes in 2013

Explore reasons nursing shortage

Method for organizing and delivering client care

Focus is on structure, process, and/or outcomes

Uses evidence based practice and adapts to the needs of the client

Strives to maintain high standards for quality care and client safety

Modern models are based on a psychological structure, the main focus is on clients being satisfied with nursing care and job satisfaction for nurses

Supports health professionals in meeting the health and wellness needs of client

Health beliefs influence practice Nurses need to make sure that the plan of care

developed relates to the client’s idea of health

Nurses need to make sure they grasp their own perception of health Health in a narrow spectrum is to getting the client to

regain baseline functioning

Health in a broad spectrum is getting the client to the highest level of functioning

Also called epidemiological triangle

One of the earliest models

Is a conventional approach to health and disease formed to address communicable disease can be used to predict illness

This model is beneficial for assessing origins of disease in a client

The agent, host and environment interrelate in ways that generate risk factors, the comprehension of these relationships is important for the promotion and preservation of health

Three dynamic interactive elements in the model are: Agent- any environmental factor or stressor it may be present

or absent for the illness to occur Host- a person who may or may not be at risk of acquiring a

disease or illness Environment- all factors external to the host that may or may

not predispose the person to the development of disease

Host

Agent Environment

Demonstrates the interaction of the environment with the illness-wellness continuum

Four health/wellness quadrants:

High-level wellness in a favorable environment

Emergent high-level wellness in an unfavorable environment

Protected poor health in a favorable environment

Poor health is an unfavorable environment

From www.studyblue.com

Determine whether a client is likely to involve themselves in disease prevention and health promotion activities

Useful for the development of programs for assisting client to have a healthier lifestyle

From a social learning theory nurses may consider when determining who is most likely to take action regarding health (whether clients believe they have control over their health or others have control)

Can be used to identify which clients are most likely to change their health

Internally controlled- clients who have the main impact on their health, are educated about their health, and adhere to healthcare programs

Externally controlled- clients who believe their health is largely controlled by outside forces (chance or luck); they will need more assistance to become more internally controlled

HealthLocus ExternalInternal

I control

my

health!

I have no control over my health

Model is based on subjective beliefs- predicts which clients will or will not use healthcare services

Behavior is influenced by multiple interacting beliefs (such as susceptibility and severity, barriers to action, and self- efficacy)

Individual perceptions: Perceived susceptibility (family history of a certain

disorder) Perceived seriousness (death or have serious

consequences?) Perceived threat (combination of perceived

susceptibility and seriousness)

Modifying factors: Demographic variables

Sociopsychologic variables

Structural variables

Cues to

Likelihood of action: Perceived benefits of the action

Perceived barriers to the action (ex. Cost, inconvenience, and lifestyle)

Southeastern Geographer Volume 50, Number 3, Fall 2010 pp. 372 | 10.1353/sgo.2010.0003

Two influences: Cost-containment measures mandated by third-party

payers

Commitment to providing care that is accessible to people In their communities

As the need for reduced spending and increased services in healthcare. The need for models care that provides improved patient care and decreased healthcare.

In 2007, the Robert Wood Johnson Foundation funded an original research project by Health Workforce Solutions LLC (HWS) to identify and profile new models of care that could be widely replicated throughout the United States.

Using broad-based email inquiry, literature review, and Internet research 60 care models were selected for in-depth research interviews

Carefully ranking the care models, down to 24 innovative care delivery models. Complete profiles of each of the 24 models including a detailed description, are published on the Innovative Care website.

The models took a long time to develop. Some took years s and can get buy-in from leadership, they can make important changes.”

Goal is for nurses and health care leaders will use models to spark change in their

Some of the models are ready to use and some of the models are for generating ideas for change

For more information visit www.innovatecaremodels.com

“Eight things found by all of Innovative Care Models

1. Elevating the role of nurses and transitioning from caregivers to “care integrators.” In 23 of the 24 models, the organization created at least one new role for nurses and often elevated the RN role to one of integrating care for the patient.

2. Taking a team approach to interdisciplinary care.

3. Bridging the continuum of care outside of the primary care facility.

4. Defining the home as a setting of care. (Six of the models rely on a patient's home as the primary location for care delivery.)

5. Targeting high users of health care, especially older adults.

6. Sharpening focus on the patient, including an active engagement of the patient and her or his family in care planning and delivery, and a greater responsiveness to patient wants and needs.

7. Leveraging technology.

8. Improving satisfaction, quality and cost. All of the models were developed in response to specific problems or concerns about patient quality, patient and provider satisfaction or unsustainable costs and utilization. “(Health Workforce Solutions LLC & Robert Wood Johnson Foundation, 2008)

Pressure to reduce cost will continue

Affordable Care Act (ACA) results in new provisions such as penalties for lacking quality, public payer programs, and Medicaid reimbursements will be increase to 100% of the Medicare rates

Increase of primary care and advanced practice staff

Improvement of electronic health records (which will be more added costs)

Increase to our tax bill (as we have seen already)

Reasons for nurses leaving Frustration with inefficiencies and conflicting priorities Environments of “what not to do”, thus impeding that

practice that nurses know best Nurses cannot implement their talents that drew them

to nursing in the first place Nurses feeling as though they have no voice in quality

care

Magnet Nursing Services Recognition Program provides recognition to hospitals to attract and retain nurses, as well as incentives for positive workplace change

Blais, K., Hayes, J. (2011) Professional Nursing Practice. Concepts and Perspectives. Sixth

Edition. 305-318.

Butterworth, M., Kolivras, K., Grossman, L., & Redican, K. (2010). Knowledge, Perceptions,

and Practices: Mosquito-borne Disease Transmission in Southwest Virginia, USA.

Southestern Geographer, 50(3), 366-385

Health Workforce Solutions LLC, & Robert Wood Johnson Foundation (2008). Innovative care

models. Retrieved from http://www.innovativecaremodels.com/

Nursing Theories (2012, January). Models of prevention. Retrieved from

http://currentnursing.com/nursingtheory/modelsofprevention

Verdon, Daniel R., (2013) Top 10 business issues you'll face in 2013: efforts to reduce costs,

increase efficiencies will challenge you and your colleagues. Medical Economics. 90(10)

12.