Patient Care Model/Power

PATIENT CARE MODELS
Where I worked, our patient care model was defined by the physician. Once the physician mapped out the plan of care, nurses came in to fill in the gaps. In order to do this, nurses had several means to help them.

1. Collaborative Practice Guidelines- This was a database full of policies created by evidence-based practice and what is considered to be best practice. This included instructions for minor procedures (such as central line dressing changes), basic nursing care for certain diagnoses (such as diabetes), instructions for care of ongoing interventions (such as indwelling catheters) and more. Nurses were expected to use and follow these guidelines. These are very useful but sometimes don't represent how things are actually done. For instance, Coke is often used to declog NG tubes, but is explicitly prohibited in the CPG. Also, the information is only as useful as much as people actually look at it.
2. Patient Care Plan- The cardex was to be kept in every chart and filled out every shift. The idea is to keep current care up-to-date and easily identifiable. It also helps to see the course a patient has taken and the changes that have been made. The biggest downfall with this system is that nurses usually don't fill it out, and even if they do, they don't use it in their care or in report.
3. Care Management Meetings- each day the primary nurse, charge nurse, case manager, social worker, and pharmacist meet together to discuss primarily non-medical needs (such as discharge planning). This is very beneficial and has helped a lot of people make sure they have the care they need when they are discharged.
4. Teamwork- nurses are expected to work together and help each other. Asking questions and asking for/offering help are essential to quality patient care. Where I worked, this was usually the area our unit excelled in the most. Because everyone worked together so well, we were truly able to offer better care for our patients.

TYPES OF POWER

1. Coercive (formal)- threatening or conveying that a bad outcome will occur if expectations are not met (firing, demotion, etc)
2. Reward (formal)- Promising rewards for compliance (raise, promotion, etc.)
3. Legitimate (formal)- actually having the position within a company that warrants power- and having employees recognize that power.
4. Expert (informal)- power that comes from knowing and possessing skills necessary for the job being done. Others look to you because you have the expertise needed to do a good job
5. Referent (informal)- being liked, trusted and respected; that giving us power to help direct other people

Strategies to increase my power base: Learn how to be more likable. Continue to improve in my knowledge and abilities. Obtain a position of power to better influence others through formal forms of power.

My thoughts about power: Power is an essential characteristic of effective leaders. Without the power to motivate or force others to perform, the leader is not leading anyone. Power is also a very tricky thing, because of its tendency to corrupt. Sometimes, people with a lot of power truly help people, work ethically, care for those under them, and strive for greater accomplishments. Other times, however, the powerful start to believe their power makes them better, and that they need more of it. Then rather than leading people, they try to capture them into a system where they can never leave. They also try to obtain more people to control and expand their power wherever they can. Rather than doing good, their efforts are focused and gaining as much power and controlling as many people as they can.

It is unfortunate that this happens, but it does. Then again, most things have positive and negative things about it. Power is just something that matters a lot because it can influence a lot of people for better or worse depending on whose hands control it.