1. By: Peggy Hamm-Johnson
& Kelly Jones

2.  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

3.  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

4.  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

5.  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

6.  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

7.  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

8. From www.studyblue.com

9.  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

10.  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

11. I
control I have no
my control
health! over my
health
Health
Internal Locus External

12.  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)

13.  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)

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

15.  Two influences:
 Cost-containment measures mandated by third-party
payers
 Commitment to providing care that is accessible to
people In their communities

16.  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.

17.  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

18. “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)

19.  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)

20.  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

21. 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)
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