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Wednesday, February 19, 2014

The Medical Model vs. The Nursing Model

The Medical Model vs. The Nursing Model

It was none other than Florence Nightingale (1859) who thought medicine and nursing should be differentiated from one another. Even in the 1970's, physicians were still lecturing nurses about nursing. Strikingly, BSAVA Congress reported veterinary surgeons lecturing nurses about nursing in 2005! In 1985, Stockwell defined a "model" as a "simplified way of organising a complex phenomenon." The medical and nursing models are some of the most widely talked about topics in PA, NP, and medical interviews. However, it is up to the student to do much of the research about these topics and truly understand their profession and the basis behind the practice they are about to commence. Although difficult to understand and convoluted, the medical and nursing models are strikingly unalike in the most basic ways. I hope this article brings light to just that for you and that you may begin to see the true differences.

The Medical Model (PA and MD/DO)

Medical and PA schools both follow a disease-model that appears to be well illustrated with more pathology, clinical medicine, pharmacology, pathophysiology, differential, treatment, etc. Specifically, it emphasizes anatomical, physiological and biochemical malfunction as the causes of ill health and by doing so encourages a disease -oriented approach to the patient. The medical model treats the human body as a "complex set of anatomical parts and physiological systems," if you will (Aggleton & Chalmers, 2000). The content of many PA programs also focuses on caring for patients across their entire life span and is designed to prepare PAs for practice in multiple care settings - primary care, emergency/acute care, the operating room, inpatient and outpatient settings.

The medical model is believed to be derived out of diagnosis of a psychiatric patient with a mental illness who was given a clinical diagnosis based on behavior, rather than physical pathology. The medical model followed a workflow of diagnosis and then diagnostic examination and ancillary testing. Stipulations on the derivations of the medical model are ongoing.

The medical model does not account for much of lifestyle-teaching or cultural considerations like the nursing model. Instead, it is an evidence-based approach to the treatment of diagnoses, based upon the gathering of a history and physical alone.

The Nursing Model (NP)

The nursing model focuses on patient’s mental, emotional, and physical needs and could be expressed as immediate care leading into long term effects. "It is a mental or diagrammatic representation of care, which is systematically constructed, and which assists practitioners in organising their thinking about what they do, and in the transfer of their thinking into practice for the benefit of the patient and the profession (McKenna, 1994)". Essentially, the nursing model accounts for the whole patient, not just the disease or condition requiring treatment. It allows nurses to deliver care to patients using a systematic approach of assessing, planning, implementing and evaluating patient care - this is a cyclic nursing process with detailed guidance for each step of care.  

Nurses believed that the medical model was not a focus of their discipline, but with the advent of university educated nurses and the quest for professional recognition, the nursing model evolved. Nursing is sometimes called "holistic practice" or "integrative medicine" and this could be because NPs often take courses in therapeutic communication.This type of medicine focuses on health and wellness of the overall patient rather than treating the disease itself and focusing on the patient-physician relationship. NP programs are grounded in the nursing model and help students master competencies required for the care of multiple populations (adults, children, and families).

Nurses (RNs) come from a background of “care plans” where they associate nursing assessments for their patients, but not medical diagnoses. Detailed assessments are necessary to establish the individuality of the patient. Planning is done to prevent recurrence of treated problems. Goals are set so that evaluation can be measured or tested. Plans are made for intervention to achieve goals. Evaluation is done to analyze whether improvement was made. Once complete, effective care is believed to be given. However, this is a nursing process, incomplete without a scientific foundation or a systematic construction.

The nursing model itself has a different structure. Roper, Logan, and Tierney (2000) describe the five parts of the nursing model as:
  1. Activities of Living (communication, breathing, eating & drinking, elimination, etc.)
  2. The Patients Life Span
  3. Dependence-Independence Continuum (parts of life when pt. cannot perform activities of living independently)
  4. Factors Influencing the Activities of Living (Biological, Psychological, Sociocultural, Environmental, Politico-economic)
    1. Ex. NP must be aware of psychological stressors on Activities of Living and impacts on patient. Patient suffering from anxiety may withdraw from communication, refuse to eat and drink and be unable to sleep.
  5. Individuality in Living (Each patient may do them differently, expressing themselves as an individual)

A PA, physician, and NP work side by side and do the same things in the same ways. Most can perform line removals, manage medications, perform H&Ps, etc. Although there are differences, there is also lots of crossover in both models. It is crucial that you realize there are good and bad physicians, PAs and NPs all around and it is important to recognize that we cannot pinpoint one poor practitioner’s mistakes on an entire group of providers. Even though we may be trained in different models, come from various backgrounds, have unequal amounts of experience, etc. we are all responsible for the same patients and the same goals. We work as a team to ensure patient safety and life longevity.

Sources:
The Nursing Worklife Model: Extending and Refining a New Theory (Manojlovich et al., 2007)
Crisis Theory and Intervention: A Critique of the Medical Model and Proposal of a Holistic Nursing Model (Narayan et al., 1980)
Moving Away from the Medical Model, an IV Workshop Lecture (Jeffery, 2011)
Georgetown.edu - Nursing Model
Marco-LearningSystems.com
Nursing Models & Nursing Practice (Aggleton & Chalmers, 2000)
Nursing Theories & Models (McKenna, 2000)
The Roper, Logan & Tierny Model of Nursing (Roper et al., 2000)

6 comments:

  1. Well, when it comes to medical model vs nursing model, often it' crucial to realize there are good and bad physicians, PAs and NPs all around and it's important to recognize that one cannot pinpoint one poor practitioner’s mistakes on an entire group of providers.

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  2. This is great! Thanks for differentiating the roles of practitioners by their learning models. It helps tremendously especially when so many of the responsibilities/roles overlap as you said among NPs/PAs/MDs/DOs at the primary care level. Really appreciate it especially for someone that is trying to decide which career path to take!

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  3. TY so much for taking the time to research and share these insights. I'd like to add one piece of info and point out what I believe to be a contradiction. The nursing process is first well outlined as a systematic approach to a persons whole health needs and then you state that it is unsystematic and not founded on science, meaning it is not "evidence-based". Please refer to the Nursing Science Quarterly which is a publication that has been around for many years and dedicated solely to nursing research and science. Nursing is a unique science, that has earned its place among the professions. We have a body of knowledge that advances our practice that is informed by but different from medicine. Because we deal with the human experience our research is often more qualitative. Nursing is interested in how patient's experience things with the aim of providing help that is valued by the individual. . The research is harder because understanding what is important to people is complex, but it is indeed important and a scientific approach is the only way to go in my book. Research costs money. I am optimistic that nursing professionals will continue to amaze and benefit people, worldwide. TY for starting a dialogue.

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  4. Thank you for this blog post! I'm a PA and was trying to answer a potential PA student's question on this topic. What a nice, concise summary.

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  5. Medical and nursing, when it comes to base, they both have different aspects. Yes in the end professionally we can compare them but at ground level. there is difference.

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  6. Hello Paul, first thanks for this post. From the post, it would seem that since physicians and PAs both abide by the medical model, their day to day practice would be very similar. I've been under the impression (whether it's incorrect or not) that the PA profession is mainly clinically focused, not involving as much consideration of the pathophysiology behind procedures and treatment, as it's the duty of the MDs to focus on that. Is this the case? I enjoy studying the physiology and biochemistry of the human body, and was worried that PA practice wouldn't deal much if at all with those things. But I've also heard that since MDs and PAs are both clinicians, neither deal with those things on a day to day basis anyway. I'd appreciate your thoughts, thank you.

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