Nursing care delivery models are frameworks that help nurses assess, plan, and implement care. There are four nursing care models: functional nursing, team nursing, primary nursing, and total patient care. Team nursing and total patient care would be the preferred models in a given scenario. The DECIDE model is an acronym for six activities needed in the decision-making process. It enables managers to improve their decision-making skills and leads to more effective decisions. For this scenario, identifying the best alternative approach would be the preferred choice. Finally, the best leadership skill for this experience would be leading others, which includes effective communication, developing others, valuing diversity and difference, building and maintaining relationships, and managing effective teams and work groups.
To give a little background on the scenario that was used to choose the above, I was working in a cardiac stroke unit and received a new admission who came from a nursing home with severe dyspnea and shortness of breath. This patient had ALS that was working against them. Being with the patient for 12 hours on both days, I observed a change in their condition without a doubt. When I met this patient, they were unable to speak or walk and were dependent on many of their needs. The most crucial information given to me was that this patient, just two months prior, was driving and independent. That showed me how progressive their disease was moving. When I reported the patient to the nurse who had them the previous day, I relayed that I had a feeling that was not good. That night, I returned to the patient and relayed that the attending came to see them and deemed them “just fine.” This patient was having periods of dyspnea and shortness of breath, along with lethargy. Little did I know the next 6 hours would be busy for me. At the beginning of my shift, after I got the report and my charge nurse finished it, I brought him in to see what I was seeing; with the initial change of condition, the patient and his wife were asked about his code status. A lot of education was provided about his progressive disease and the CPR versus DNR/DNI status and what is entailed in them. Both parties still wanted full resuscitation along with medical treatment.
During the next 6 hours, my charge was brought into the room multiple times, with each change noticed while messaging the hospitalist. I got other nurses and techs to give me their opinions while a page went to the hospital to put eyes on him. Not soon after the page was sent, the patient had an extreme change of condition and a significant decrease in heart rate. As the patient’s direct nurse, I started directing people to get items like the code cart, suction, etc., placing shock pads, and starting the monitor. My charge nurse was next to lead with me, so we began to code him. With my quick leadership skills to direct and communicate with all the surrounding healthcare personnel, we had everything we needed in the room to ensure the required care was completed on time.
During the two days that I participated in caring for this patient, they required total assistance. In the event of a Code, I had to lead the team to ensure that everyone with a job or duty was present and informed about their responsibilities. One person needed to direct, assign, and coordinate the efforts of others, while the rest made room for additional personnel.