Using Non Traditional Models of Care To

ACADEMIA Letters
Using Non-traditional Models of Care to Improve Staff

and Patient Outcomes: Melhado’s Integrated Model of
Nursing Care (MIMONC, 2021).
Victoria Melhado Daley, Grantham University
Introduction
This paper is an overview of a non-traditional model of care that proposes how senior staff can
mentor new staff (nurses in this context) to achieve confidence and competency. The model
integrates Benner’s novice-expert theory, Goleman’s emotional intelligence theory, and the
Team Approach theory to demonstrate better patient outcomes, leadership development, and
staff satisfaction.
Keywords: non-traditional care models, improved patient outcomes, staff satisfaction, emo-
tional intelligence, novice-expert theory, leadership development
Personal Philosophy of Nursing

Effective and safe nursing care is dependent on nurses who are self-aware, self-regulated,
socially aware, and socially regulated. Nurses mature in their professional roles along the
novice to expert clinical continuum ( Craig, 2021; Davis & Maisano, 2016).
Academia Letters, August 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0
Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

Citation: Melhado Daley, V. (2021). Using Non-traditional Models of Care to Improve Staff and Patient
Outcomes: Melhado’s Integrated Model of Nursing Care (MIMONC, 2021). Academia Letters, Article 2710.
https://doi.org/10.20935/AL2710.
1
Theoretical Frameworks
Patricia Benner’s Nursing Theory
Dr. Patricia Benner is commonly known for her Novice to Expert Theoryof Nursing. She as-
serts that caring practices in nursing transfer knowledge and skill revolving around everyday
human needs. Dr. Benner’s novice to expert model was developed from the Dreyfus Model
of Skill Acquisition and helped present a more objective way for nursing skills and progress
to be evaluated (Dale et al., 2013). The model outlines how individuals begin learning and
performing at a novice level and progressively advance to new levels as new skills and knowl-
edge are acquired. The five stages or phases of proficiency identified are novice, advanced
beginner, competent, proficient, and expert (Benner, 1982; as cited by Davis & Maisano,
2016).
The Novice
The novice is a new individual with no prior experience of the scenario. The new nurse learns
simple, objective skills which are easy to assess. The beginner may find it challenging to
decide which tasks are most relevant and needs further professional growth and mentorship
to develop prioritization skills based on real-life situations (Davis & Maisano, 2016).
The Advanced Beginner

Is a person exposed to several recurring real-world situations that allow them to make ap-
propriate decisions based on previous knowledge and situational experience. The advanced
beginner requires help with prioritizing patient care and identifying potential problems early.
Mentors can play a significant role in supporting and developing the leadership skills of the
advanced beginner by providing constructive feedback (Davis & Maisano, 2016).
The Competent Stage

Benner described the competent nurse or nurse manager as an individual who can prioritize
tasks at hand by using past experiences. This nurse might be in her role for two or more
years and see organizational needs and patient care outcomes as goals or plans. The compe-
tent leader can consciously plan and implement tasks, using abstract and analytical principles
that focus on long-term goals. However, this nurse needs help with multitasking skills and
developing flexibility (Davis & Maisano, 2016).

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The Proficient Nurse
Has a holistic understanding of the situation at hand and general expanded nursing knowledge
that facilitates more improved decision-making processes (Davis & Maisano, 2016).
The Expert Stage

The expert nurse has extensive knowledge of diverse, complex patient care scenarios that cause
colleagues to be confident in their skills, experience, and guidance. This individual can make
competent decisions quickly and offer support and leadership, especially in a crisis (Davis &
Maisano, 2016). It is important to note that achieving this level of expertise can occur quickly
by practicing skills and repeated role exposure. Therefore, a relatively new nurse in years of
experience can mature rapidly in a unit or specified role.
The Team Approach Model of Nursing Care

According to Dickerson & Latina (2017) the Team Nursing Model uses various healthcare
team members’ diverse skills, education levels, and experience backgrounds to deliver pa-
tient care. Team members share responsibility for patient care outcomes and work collabora-
tively. Research has shown that overall satisfaction increases when nurses feel supported. The
team approach improves communication and collaboration in the patient care environment,
enhancing care quality and patient safety (Dickerson & Latina, 2017).
The concept of team nursing first surfaced in the 1950s when several care facilities intro-
duced a team approach nursing model to support new staff and cultural diversity — team nurs-
ing advances interpersonal relations boosting staff morale and job satisfaction. An increased
number of novice nurses requires additional support and mentoring during an orientation pe-
riod or environmental transition. Studies revealed that this team nursing approach provided
a better preceptorship experience for inexperienced staff, improving their clinical confidence
when meeting patient care needs (Dickerson & Latina, 2017).
Team Approach and Benner Case Study

A Transitional Care Unit (TCU) with 18 high-acuity beds, bedside telemetry, step-down mon-
itoring, and an open admission structure; cares for a diverse surgical and medical patient pop-
ulation. The surgical population includes patients with multisystem trauma, complex surgical
issues, and kidney transplants. The medical population includes patients needing acute and
chronic mechanical ventilation, patients with hemodynamic and respiratory instability, some

3
requiring sepsis management, and others in acute alcohol withdrawal. The patient-to-nurse
ratio was generally 2:1 or 3:1 before the implementation of the team nursing approach. The
concept of the team nursing approach arose due to rapid staff attrition and an influx of new
nurse hires. Increasing patient acuity, fluctuating staffing needs, and decreased staff morale
and satisfaction; created an urgent need to provide a more supportive system so these new
nurses could develop their skills and become experts in the TCU (Dickerson & Latina, 2017).
In the study by Dickerson and Latina (2017) a novice nurse shadowed a highly experienced
nurse for her shift in this high-acuity unit while caring for complex patients. The experienced
nurse assisted and guided the novice nurse as necessary. When the shift ended, the novice
nurse expressed gratitude to shadow a knowledgeable professional. She stated that she felt
supported during her shift and was able to take away prioritization and organization skills
while enhancing her assessment and critical thinking skills (Dickerson & Latina, 2017, para.
16).
After implementing the team nursing approach in the unit, there was a record of zero
patient falls after three months. The TCU also achieved a Tier 1 rating on the Press Ganey
Employee Engagement Survey during the same period; this reflected the highest rating a nurs-
ing unit can achieve, suggesting improved engagement and activities that enhanced a patient-
centered culture (Dickerson & Latina, 2017). Additionally, the department met the original
goal of a 10% increase in staff satisfaction and continuity of patient care. Monthly staff sur-
veys indicated an 88% compliance rate in participation with the team nursing approach. Pre-
implementation surveys confirmed that 61% of staff felt supported during their shift. Con-
trastingly, post-implementation surveys showed that 72% of staff felt supported (Dickerson &
Latina, 2017, para. 12).
Pre-implementation survey results also revealed that 38% of staff felt good about being
held accountable by their peers. In contrast, post-implementation results showed that 58% of
staff felt optimistic about being held responsible by their peers. Additionally, staff perception
of continuity of care increased by over 45% throughout the project. The benefits of the team
nursing approach in the TCU reportedly included increased staff satisfaction rates, improved
morale, and increased patient safety (Dickerson & Latina, 2017, para. 13).
Emotional Leadership Enhances Preceptorship

The most influential leader will utilize a variety of leadership approaches ranging from tra-
ditional to contemporary as appropriate. Goleman et al. (2013, as cited by Sullivan, 2017)
proposed the theory of Emotional Intelligence, which guides the Emotional Leadership style.
The emotional leader is holistically poised and exhibits traditional and contemporary leader-

4
ship traits (Sullivan, 2017, p. 48-49). The theory of emotional intelligence (EI) advances that
individuals must master self-awareness, self-management, social awareness, and relationship/
social management.
According to Goleman, an emotionally self-aware leader recognizes their strengths and
limitations, self-worth, and influence on others. Additionally, the emotional leader is success-
ful at self-management by being temperate, transparent, adaptable, taking the initiative, opti-
mistic, and inspiring excellence in self and others. Therefore, the emotional leader achieves
personal competence and simultaneously motivates and influences mutual goals like a trans-
formational leader. Emotionally intelligent leaders also master social competence through
social awareness and relationship management. Emotional leaders display empathy, organi-
zational understanding (abiding by policies and established guidelines). Emotionally intel-
ligent leaders respect and recognize service and attempt to meet patients’ and co-workers’
needs; this may involve monetary compensation, or some form of reward individuals desire
and appreciate. They are with this, displaying traits of a transactional leader (Sullivan, 2017,
p. 48-49).
Furthermore, an emotional leader excels at relationship management through inspirational
leadership, influence, mentoring others, resolving conflicts, building bonds, and encourag-
ing teamwork and collaboration (involving others in decision-making), traits of a democratic
leader. An emotional leader may sometimes necessitate autocratic decisions to be a change
catalyst. The EI leader may decisively lead a medical code or use managerial authority to
mandate personal protective equipment wearing and social distancing until staff becomes so-
cially and institutionally aware of pandemic protocols. A study by Saxena et al. (2017) also
supports Goleman’s EI theory, revealing that medical leaders at different hierarchical levels
display dynamic leadership through various styles depending on their experience, preference,
and situational context.
Melhado’s Integrated Model of Nursing Care (MIMONC, 2021).

The proposed model incorporates Benner’s Novice to Expert Theory, The Team Nursing
Model of Care,and Goleman’s Emotional Intelligence Theory.
The critical elements to improving patient and staff safety and satisfaction through nursing
care are Self Recognition and Regulation and Social Recognition and Regulation. Accord-
ing to Goleman, EI is a cluster of skills and competencies, which focus on developing critical
capabilities in an individual: self-awareness, self-management, social awareness, and social
skills. Goleman further proposed that these four capabilities lay the foundation for the 12
subscales of EI (Craig, 2021; Moore, 2021).

5
MIMONC (2021) advances that the novice clinician receives mentorship from expert staff
and a multi-disciplinary team to become self-aware and socially aware. Self-awareness al-
lows beginners to identify their learning needs and effectively engage in nursing tasks repeat-
edly and successfully, developing their self-confidence. As they learn organizational skills
and policies, they understand how to appropriately show empathy and implement patient care
in a culturally sensitive work environment. As the nurse progresses through the various stages
proposed by Benner, she strengthens self-management and social skills. Eventually, she can
assume roles like team leader, charge nurse, nurse manager, and others as she develops, men-
tors, and inspires other nurses in a junior role and secures the confidence of her colleagues in
leading at an organizational level (Craig, 2021; Davis & Maisano, 2016). Therefore, Gole-
man’s EI/ EQ Theory in this integrated model can lead to improved staff and patient care
outcomes in any nursing unit.

6
Improving Patient Outcomes Through Nursing Care
The proposed Melhado’s Integrated Model of Nursing Care (MIMONC, 2021)can improve
quality of care, staff satisfaction, and patient safety in the following ways:
1. Allow new or novice nurses an adequate orientation period or transition to their role as
a new or graduate nurse, with the support and guidance of proficient or expert nursing
colleagues.
2. Facilitate the effective progression of the advanced beginner, competent, proficient, and
expert nurse along the clinical nursing continuum, where their skills, knowledge, and
practice can be developed and supported by the multidisciplinary healthcare team.
3. Develop self-confidence and self-awareness in staff through accurate self-assessment

and emotional sensitivity.
4. Improve the patient-centered care experience by encouraging staff to involve patients

and their families in care activities.
5. Promote a culture of patient-centered nursing by encouraging staff to be flexible, adapt-

able, reliable, trustworthy, and self-motivated.
6. Ensure the patient environment is safe physically and emotionally by providing care-
givers who practice with empathy and organizational awareness of policies and safety
guidelines.
7. Increase staff morale and team spirit by encouraging collaboration, a culture of men-
torship, collegiality, inspirational leadership, and recognition of achievements.
The Uniqueness of MIMONC (2021)

• The model integrates Benner’s theory, Goleman’s EI theory, and the Team Nursing
theory.
• MIMONC (2021) outlines strategies to achieve staff competency, leadership develop-

ment, team nursing, better patient outcomes, staff satisfaction, and staff retention.
• The model applies to other professions outside of the nursing and medical fields.

7
Limitations and Future Considerations
The researcher was mindful of a recommended word limit for this paper. There is room for de-
veloping concepts proposed in this model, and future publications will explore these concepts
further.
Conclusion
Nurses are vanguards to improving professional practice and care standards. 21st-century
nursing challenges like high staff turnover, staff attrition, and increasing patient care needs
require nurses to take innovative approaches to deliver high-quality nursing care. Melhado’s
Integrated Model of Nursing Care (MIMONC, 2021) is an evidence-based model of nurs-
ing care that integrates the theories of Dr. Patricia Benner, Goleman, and Team Nursing
Approach. The three theories provide a strong foundation for an unconventional model like
MIMONC (2021) with practical solutions to improve nursing practice, care quality, patient
safety and satisfaction, staff morale, and retention.
References
Craig, H. (2021). The theories of Emotional Intelligence. Positive Psychology.
Dale, J. C., Drews, B., Dimmitt, P., Hildebrandt, E., Hittle, K., & Tielsch-Goddard, A.
(2013). Novice to expert: The evolution of an advanced practice evaluation tool. Journal of
Pediatric Health Care, 27(3), 195-201.
Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to Expert - A concept whose
time has come (again). Oklahoma Nurse, 61(3), 13–15.
Dickerson, J., & Latina, A. (2017). Team nursing: A collaborative approach improves
patient care. Lippincott Nursing, 47(10), 16-17.
Moore, C. (2021). Emotional intelligence skills and how to develop them. Positive Psy-
chology.
Saxena, A., Desanghere, L., Stobart, K., & Walker, K. (2017). Goleman’s Leadership
styles at different hierarchical levels in medical education. BMC Medical Education, 17(1),
169.
Sullivan, E. J. (2017). Effective leadership and management in nursing (9th ed.). Pearson
Education (US).

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ACADEMIA Letters

Using Non-traditional Models of Care to Improve Staff

Personal Philosophy of Nursing

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

The Advanced Beginner

The Competent Stage

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

The Expert Stage

The Team Approach Model of Nursing Care

Team Approach and Benner Case Study

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

Emotional Leadership Enhances Preceptorship

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

Melhado’s Integrated Model of Nursing Care (MIMONC, 2021).

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

3. Develop self-confidence and self-awareness in staff through accurate self-assessment

4. Improve the patient-centered care experience by encouraging staff to involve patients

5. Promote a culture of patient-centered nursing by encouraging staff to be flexible, adapt-

The Uniqueness of MIMONC (2021)

• MIMONC (2021) outlines strategies to achieve staff competency, leadership develop-

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

Corresponding Author: Victoria Melhado Daley, vmelhadodaley@grantham.edu

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