Health Care Delivery Models And Nursing Practice Essay

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment. Health Care Delivery Models And Nursing Practice Essay

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Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.

2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations. Health Care Delivery Models And Nursing Practice Essay

3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.

4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

5)  Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes. Health Care Delivery Models And Nursing Practice Essay

You are required to cite to a minimum of three sources to complete this assignment. Sources must be from GCU library and published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Health Care Delivery Models And Nursing Practice Essay

Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
A majority of Americans experience stress in their daily lives (American Psychological Association, 2017). Thus, an important goal of psychological research is to evaluate techniques that promote stress reduction and relaxation. Two techniques that have been associated with reduced stress and increased relaxation in psychotherapy contexts are guided imagery and progressive muscle relaxation (McGuigan & Lehrer, 2007). Guided imagery aids individuals in connecting their internal and external experiences, allowing them, for example, to feel calmer externally because they practice thinking about calming imagery. Progressive muscle relaxation involves diaphragmatic breathing and the tensing and releasing of 16 major muscle groups; together these behaviors lead individuals to a more relaxed state (Jacobson, 1938; Trakhtenberg, 2008). Guided imagery and progressive muscle relaxation are both cognitive behavioral techniques (Yalom & Leszcz, 2005) in which individuals focus on the relationship among thoughts, emotions, and behaviors (White, 2000). Health Care Delivery Models And Nursing Practice Essay
Group psychotherapy effectively promotes positive treatment outcomes in patients in a cost-effective way. Its efficacy is in part attributable to variables unique to the group experience of therapy as compared with individual psychotherapy (Bottomley, 1996; Yalom & Leszcz, 2005). That is, the group format helps participants feel accepted and better understand their common struggles; at the same time, interactions with group members provide social support and models of positive behavior (Yalom & Leszcz, 2005). Thus, it is useful to examine how stress reduction and relaxation can be enhanced in a group context.
The purpose of this literature review is to examine the research base on guided imagery and progressive muscle relaxation in group psychotherapy contexts. I provide overviews of both guided imagery and progressive muscle relaxation, including theoretical foundations and historical context. Then I examine guided imagery and progressive muscle relaxation as used on their own as well as in combination as part of group psychotherapy (see Baider et al., 1994, for more). Throughout the review, I highlight themes in the research. Finally, I end by pointing out limitations in the existing literature and exploring potential directions for future research. Health Care Delivery Models And Nursing Practice Essay
Guided Imagery
Features of Guided Imagery
Guided imagery involves a person visualizing a mental image and engaging each sense (e.g., sight, smell, touch) in the process. Guided imagery was first examined in a psychological context in the 1960s, when the behavior theorist Joseph Wolpe helped pioneer the use of relaxation techniques such as aversive imagery, exposure, and imaginal flooding in behavior therapy (Achterberg, 1985; Utay & Miller, 2006). Patients learn to relax their bodies in the presence of stimuli that previously distressed them, to the point where further exposure to the stimuli no longer provokes a negative response (Achterberg, 1985).
Contemporary research supports the efficacy of guided imagery interventions for treating medical, psychiatric, and psychological disorders (Utay & Miller, 2006). Guided imagery is typically used to pursue treatment goals such as improved relaxation, sports achievement, and pain reduction. Guided imagery techniques are often paired with breathing techniques and other forms of relaxation, such as mindfulness (see Freebird Meditations, 2012). The evidence is sufficient to call guided imagery an effective, evidence-based treatment for a variety of stress-related psychological concerns (Utay & Miller, 2006). Health Care Delivery Models And Nursing Practice Essay
Guided Imagery in Group Psychotherapy
Guided imagery exercises improve treatment outcomes and prognosis in group psychotherapy contexts (Skovholt & Thoen, 1987). Lange (1982) underscored two such benefits by showing (a) the role of the group psychotherapy leader in facilitating reflection on the guided imagery experience, including difficulties and stuck points, and (b) the benefits achieved by social comparison of guided imagery experiences between group members. Teaching techniques and reflecting on the group process are unique components of guided imagery received in a group context (Yalom & Leszcz, 2005).
Empirical research focused on guided imagery interventions supports the efficacy of the technique with a variety of populations within hospital settings, with positive outcomes for individuals diagnosed with depression, anxiety, and eating disorders (Utay & Miller, 2006). Guided imagery and relaxation techniques have even been found to “reduce distress and allow the immune system to function more effectively” (Trakhtenberg, 2008, p. 850). For example, Holden-Lund (1988) examined effects of a guided imagery intervention on surgical stress and wound healing in a group of 24 patients. Patients listened to guided imagery recordings and reported reduced state anxiety, lower cortisol levels following surgery, and less irritation in wound healing compared with a control group. Holden-Lund concluded that the guided imagery recordings contributed to improved surgical recovery. It would be interesting to see how the results might differ if guided imagery was practiced continually in a group context. Health Care Delivery Models And Nursing Practice Essay
Guided imagery has also been shown to reduce stress, length of hospital stay, and symptoms related to medical and psychological conditions (Scherwitz et al., 2005). For example, Ball et al. (2003) conducted guided imagery in a group psychotherapy format with 11 children (ages 5–18) experiencing recurrent abdominal pain. Children in the treatment group (n = 5) participated in four weekly group psychotherapy sessions where guided imagery techniques were implemented. Data collected via pain diaries and parent and child psychological surveys showed that patients reported a 67% decrease in pain. Despite a small sample size, which contributed to low statistical power, the researchers concluded that guided imagery in a group psychotherapy format was effective in reducing pediatric recurrent abdominal pain.
However, in the majority of guided imagery studies, researchers have not evaluated the technique in the context of traditional group psychotherapy. Rather, in these studies participants usually met once in a group to learn guided imagery and then practiced guided imagery individually on their own (see Menzies et al., 2014, for more). Thus, it is unknown whether guided imagery would have different effects if implemented on an ongoing basis in group psychotherapy. Health Care Delivery Models And Nursing Practice Essay
Progressive Muscle Relaxation
Features of Progressive Muscle Relaxation
Progressive muscle relaxation involves diaphragmatic or deep breathing and the tensing and releasing of muscles in the body (Jacobson, 1938). Edmund Jacobson developed progressive muscle relaxation in 1929 (as cited in Peterson et al., 2011) and directed participants to practice progressive muscle relaxation several times a week for a year. After examining progressive muscle relaxation as an intervention for stress or anxiety, Joseph Wolpe (1960; as cited in Peterson et al., 2011) theorized that relaxation was a promising treatment. In 1973, Bernstein and Borkovec created a manual for helping professionals to teach their clients progressive muscle relaxation, thereby bringing progressive muscle relaxation into the fold of interventions used in cognitive behavior therapy. In its current state, progressive muscle relaxation is often paired with relaxation training and described within a relaxation framework (see Freebird Meditations, 2012, for more).
Research on the use of progressive muscle relaxation for stress reduction has demonstrated the efficacy of the method (McGuigan & Lehrer, 2007). As clients learn how to tense and release different muscle groups, the physical relaxation achieved then influences psychological processes (McCallie et al., 2006). For example, progressive muscle relaxation can help alleviate tension headaches, insomnia, pain, and irritable bowel syndrome. This research demonstrates that relaxing the body can also help relax the mind and lead to physical benefits. Health Care Delivery Models And Nursing Practice Essay
Progressive Muscle Relaxation in Group Psychotherapy
Limited, but compelling, research has examined progressive muscle relaxation within group psychotherapy. Progressive muscle relaxation has been used in outpatient and inpatient hospital settings to reduce stress and physical symptoms (Peterson et al., 2011). For example, the U.S. Department of Veterans Affairs integrates progressive muscle relaxation into therapy skills groups (Hardy, 2017). The goal is for group members to practice progressive muscle relaxation throughout their inpatient stay and then continue the practice at home to promote ongoing relief of symptoms (Yalom & Leszcz, 2005).
Yu (2004) examined the effects of multimodal progressive muscle relaxation on psychological distress in 121 elderly patients with heart failure. Participants were randomized into experimental and control groups. The experimental group received biweekly group sessions on progressive muscle relaxation, as well as tape-directed self-practice and a revision workshop. The control group received follow-up phone calls as a placebo. Results indicated that the experimental group exhibited significant improvement in reports of psychological distress compared with the control group. Although this study incorporated a multimodal form of progressive muscle relaxation, the experimental group met biweekly in a group format; thus, the results may be applicable to group psychotherapy.
Progressive muscle relaxation has also been examined as a stress-reduction intervention with large groups, albeit not therapy groups. Rausch et al. (2006) exposed a group of 387 college students to 20 min of either meditation, progressive muscle relaxation, or waiting as a control condition. Students exposed to meditation and progressive muscle relaxation recovered more quickly from subsequent stressors than did students in the control condition. Rausch et al. (2006) concluded the following:
A mere 20 min of these group interventions was effective in reducing anxiety to normal levels Health Care Delivery Models And Nursing Practice Essay
. . . merely 10 min of the interventions allowed [the high-anxiety group] to recover from the stressor. Thus, brief interventions of meditation and progressive muscle relaxation may be effective for those with clinical levels of anxiety and for stress recovery when exposed to brief, transitory stressors. (p. 287)
Thus, even small amounts of progressive muscle relaxation can be beneficial for people experiencing anxiety.
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Combinations of relaxation training techniques, including guided imagery and progressive muscle relaxation, have been shown to improve psychiatric and medical symptoms when delivered in a group psychotherapy context (Bottomley, 1996; Cunningham & Tocco, 1989). The research supports the existence of immediate and long-term positive effects of guided imagery and progressive muscle relaxation delivered in group psychotherapy (Baider et al., 1994). For example, Cohen and Fried (2007) examined the effect of group psychotherapy on 114 women diagnosed with breast cancer. The researchers randomly assigned participants to three groups: (a) a control group, (b) a relaxation psychotherapy group that received guided imagery and progressive muscle relaxation interventions, or (c) a cognitive behavioral therapy group. Participants reported less psychological distress in both intervention groups compared with the control group, and participants in the relaxation psychotherapy group reported reduced symptoms related to sleep and fatigue. The researchers concluded that relaxation training using guided imagery and progressive muscle relaxation in group psychotherapy is effective for relieving distress in women diagnosed with breast cancer. These results further support the utility of guided imagery and progressive muscle relaxation within the group psychotherapy modality. Health Care Delivery Models And Nursing Practice Essay
Conclusion
Limitations of Existing Research
Research on the use of guided imagery and progressive muscle relaxation to achieve stress reduction and relaxation is compelling but has significant limitations. Psychotherapy groups that implement guided imagery and progressive muscle relaxation are typically homogeneous, time limited, and brief (Yalom & Leszcz, 2005). Relaxation training in group psychotherapy typically includes only one or two group meetings focused on these techniques (Yalom & Leszcz, 2005); thereafter, participants are usually expected to practice the techniques by themselves (see Menzies et al., 2014). Future research should address how these relaxation techniques can assist people in diverse groups and how the impact of relaxation techniques may be amplified if treatments are delivered in the group setting over time.

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Future research should also examine differences in inpatient versus outpatient psychotherapy groups as well as structured versus unstructured groups. The majority of research on the use of guided imagery and progressive muscle relaxation with psychotherapy groups has used unstructured inpatient groups (e.g., groups in a hospital setting). However, inpatient and outpatient groups are distinct, as are structured versus unstructured groups, and each format offers potential advantages and limitations (Yalom & Leszcz, 2005). For example, an advantage of an unstructured group is that the group leader can reflect the group process and focus on the “here and now,” which may improve the efficacy of the relaxation techniques (Yalom & Leszcz, 2005). However, research also has supported the efficacy of structured psychotherapy groups for patients with a variety of medical, psychiatric, and psychological disorders (Hashim & Zainol, 2015; see also Baider et al., 1994; Cohen & Fried, 2007). Empirical research assessing these interventions is limited, and further research is recommended.
Directions for Future Research Health Care Delivery Models And Nursing Practice Essay
There are additional considerations when interpreting the results of previous studies and planning for future studies of these techniques. For example, a lack of control groups and small sample sizes have contributed to low statistical power and limited the generalizability of findings. Although the current data support the efficacy of psychotherapy groups that integrate guided imagery and progressive muscle relaxation, further research with control groups and larger samples would bolster confidence in the efficacy of these interventions. In order to recruit larger samples and to study participants over time, researchers will need to overcome challenges of participant selection and attrition. These factors are especially relevant within hospital settings because high patient turnover rates and changes in medical status may contribute to changes in treatment plans that affect group participation (L. Plum, personal communication, March 17, 2019). Despite these challenges, continued research examining guided imagery and progressive muscle relaxation interventions within group psychotherapy is warranted (Scherwitz et al., 2005). The results thus far are promising, and further investigation has the potential to make relaxation techniques that can improve people’s lives more effective and widely available. Health Care Delivery Models And Nursing Practice Essay

inated by the team leader, most of the times- RN appointed by the charge nurse.
b) What are their roles/responsibilities?
In team nursing the responsibilities usually divided in between the personnel, so that everyone’s has its own role in patient’s care.
For example, RN might be assigned for patients’ assessments, LPN assigned for certain medication administration and nursing assistant helps with care/bathing and feeding patients. All this done under supervision of a team leader another RN (Currentnursing.com, 2015).
c) How is the work coordinated?
The appointed team leader is coordinating the flow of the work done. The team leader gives directions and instructions in details to team members, he/she is also schedules the care and assigns the tasks in between the team members.
d) What are the reporting relationship? Health Care Delivery Models And Nursing Practice Essay
The team leader utilizes different methods to communicate with each team

Nursing Care Delivery Patient Centered Care and Team Nursing Brittany Saum Pima Medical Institute Jim Follbaum, RN, MSN/Edu 17th of May 2012 Care Delivery Nursing is ongoing and lifelong, for the nurse and the patient. It is not limited to the time spent in the hospital, but follows the nurse and patient for life. It is the nurse that keeps the patient going and gets to know the patient and it is the nurse that delivers the care to the patient. The importance of the way the nurse delivers this care to the patient can make all the difference to the patients stay at the hospital and whether any teaching will be affective or just overlooked. Health Care Delivery Models And Nursing Practice Essay

This paper is a comparison between two commonly used most effective ways of care delivery: Patient-Centered Care and Team Nursing. Patient Centered Care Patient centered care is simply just as it sounds, care that places the patient first. In even simpler terms, patient-centered care is a model in which hospital providers partner with patients and their families to identify and satisfy the full range of patient needs and preferences, while simultaneously supporting the professional and personal aspirations of their staff (Frampton S. Guastello, Brady, Hale, Smith, & Stone, 2011). Patient centered care is the right care, the highest quality care and the most cost effective care for that one patient (Peraino, Robert A. MD, FACP, 2008). Advantages of Patient Centered Care There are many advantages to patient centered care. The main benefit is continuity of care. Patient centered care also increases nursing autonomy. In turn, it assists with relationships between the patient and nurse as well as the other health care providers involved in the patients care. Health Care Delivery Models And Nursing Practice Essay

Patients and families are able to develop a trusting relationship with the nurse who in turn makes it easier for the patient to recover and be happier during their stay in the hospital. Patient centered care seems to be more effective when teaching the patient as well. It allows the patient and family to be involved in their health care. This makes them more willing and compliant to continue on their regimens and get better sooner. Disadvantages of Patient Centered Care One disadvantage of patient centered care is cost. Health Care Delivery Models And Nursing Practice Essay
The RNs spend time to do what an unassisted licensed personnel employee can do therefore increasing the costs. One other disadvantage is that nurse to patient ratios have to be low in order to ensure there is enough time to meet the patient’s needs. This also affects the costs on the hospital. They require more RNs daily therefore increasing patient’s costs as well as the hospitals. Team Nursing Team nursing care became more popular during the 1950’s. This was a way to ease the shortage of nurses and to address problems with nursing as it was. Team nursing assigns staff into different teams. Health Care Delivery Models And Nursing Practice Essay

A team within this model usually consists of an RN (registered nurse), a LPN (licensed practical nurse), and a UAP (unlicensed assistive personnel), (Zewekh & Claborn, 2009). The team leader supervises and coordinates all the care provided by those on the team. The team leader is in charge of making assignments for team based on client’s needs and acuity, taking in consideration the assigned nurses strengths and weaknesses. Because the team leader is responsible for delegating specific duties to staff, communication among team members is a crucial part of this type of nursing. Health Care Delivery Models And Nursing Practice Essay

The assignments are disscussed at beginning of shift and a meeting at end of shift is held to summerized care given during the shift and questions and comments about the shift can be made at this point. Advantages of Team Nursing “Team nursing evolved as a way to address the problems with a functional approach,” (Zerwekh & Claborn, 2009). Team nursing is focused on making assignments based on client’s needs and the member’s. The team leader plans assignments based on acuity of clients needs by taking advantage of nurses strengths. Health Care Delivery Models And Nursing Practice Essay

This allows for the client to have better care. One other advantage ot this type of nursing is that the client workload is shared among the team members. This makes the work easier on all of the staff. The workload is shared allowing everyone to work smarter, not harder. It reduces room for error. Disadvantages of Team Nursing The main disadvantage or team nursing is that the leader is untimately responsible for everyone on the team. They must continually evaluate and communicate with all members of the team to ensure that everything is running smoothly. Health Care Delivery Models And Nursing Practice Essay

Some team members may not care for this thinking that they are being “babysat” and non accountable. One of the basis of team nursing is to have group meetings and discussions at the beginning of shift and end of shift. This can be very time consuming which can cause problems due to financial restrictions in use of overtime. Conclusion In conclusion, all nursing model types work for different situations. They just need to be tailored to each individual situation. Patient Centered Nursing and Team Nursing both have everyone’s best interest in mind, the patient and the nurse. Health Care Delivery Models And Nursing Practice Essay

If it works for the situation then use the model deemed necessary to make everyone happy. There are advantages and disadvantages to both, and both are needed in every healthcare setting. The decision of which model the facility will use may vary, but the goal will always be the same, excellent nursing care. Health Care Delivery Models And Nursing Practice Essay