The Dynamic Nursing Care Model (DNCM) is a schematic depiction of the framework for professional nursing practice at RPCI. This model demonstrates a process which is both fluid and dynamic because of the ever-changing needs of the oncology patient and family. This model combines the RPCI mission, vision and values with nursing practice, evidence-based practice, workforce group relationships to foster a dynamic environment for the professional growth and development of the nurse with the ultimate outcome of quality patient care. Quality indicators, nursing evaluation and research are used to measure outcomes for the patient, family, community, nursing and RPCI.
The Dynamic Nursing Care Model features the patient and the family in the center of the model because they are the primary focus for the delivery of nursing care. The healthcare team forms the next ring around the patient and family and includes nurses, physicians, nutritionists, physical therapists, pharmacists and other healthcare providers. The healthcare team is the liaison between the patient and family and the community. The last ring of the model is comprised of the values that we embrace and live on a daily basis in our interactions with patients and family, other healthcare providers and the community. The values we model include: innovation, integrity, commitment, respect and compassion and teamwork. Similar to the DNCM, the Care Delivery System at RPCI is changeable and based on the needs of the patient and family. The Care Delivery System is customized to the patient and the situation and takes into consideration the culture, learning needs as well as the physical, emotional and spiritual needs of the patient and family.
At RPCI, the Care Delivery System is integrated in the Dynamic Nursing Care Model. The Care Delivery System positions the patient and the family as the focus of the delivery of nursing care. The DNCM provides the framework for a nursing care delivery system that is supported by a philosophy of compassion and respect in an environment that values optimum patient outcomes. Professional nursing practice at RPCI centers on the interaction of nurses with the patient and family. Value is placed on the dynamic and therapeutic collaboration between the patient, family and the nurse.
Roswell Park Cancer Institute functions on a patient-centered model as the basis for delivery of care for the patient population at RPCI. In the patient centered model of care, patients are active participants in their own plan of care and receive multidisciplinary services designed to address their individual needs and preferences. In addition the multidisciplinary team provides advice to counsel. The nurse plays an essential role in coordinating the care of the patient and ensuring that the patient’s needs are met. When patients and care providers have a choice among treatment plans, a patient-centered approach is preferred by both. Examples of such “preference-driven” conditions are benign enlargement of the prostate. In such cases, the best treatment strategy depends on the patient’s preferences for the various treatment plans that exist. Treatments for this type of condition may vary from any number of options such as: wait and watch, radioactive seed implants, traditional surgery, robotic surgery, chemotherapy, hormonal replacement therapy and radiation. The patient is provided with information on all the options and makes informed decisions on which approach is best for him.
At RPCI the model of care as well as the nursing care which is delivered is patient and family centered and specific to the patient. The care delivery model is utilized in both the inpatient units and in ambulatory clinics. Although the outpatient population may be considered less acute, the patient and family centered care which is received is a total type of care rather than a primary care concept. With total patient care a registered nurse provides care that includes “total management” for their patient but it is not necessarily the same nurse each visit.
The premise is to make everyone who touches patients and their families a vital link in delivering efficient medical treatment, relying on nurses to provide the care coordination.
The total patient care concept is felt to better improve the quality of care for the patient. This opinion prevails during any one of the many weekly multidisciplinary conferences in which everyone, from attending physicians to residents and from respiratory therapists to social workers, had to work as a team in treating patients. This model represents the values and mission of RPCI through the outcomes in the care which our patients receive.
Because caregivers rotate in and out during a patient’s hospital stay, the responsibility of coordinating care and constantly screening for changing patient needs rests with the bedside nurse. On some units, this pivotal role falls to the charge nurse; on others it might be the nurse practitioner. But whatever the title, the nurse is the one constant presence.