As patient care delivery systems evolve and facility redesign occurs, innovative models of care delivery require clinicians to possess certain qualities for successful implementation of redesign efforts. Certain specific “CORE” abilities are key for all clinicians, They are: C: the ability to think critically, communicate, and collaborate with patients, families, and other health care team members. O: the need to be outcome-oriented, that is, striving to optimize patient and family outcomes along the continuum, R: realization of the value of research and the ability to use research resources to develop an evidence-based practice. E: the ability to keep abreast of a wide variety of clinical and other health care-related topics. Demonstration of these CORE abilities will increase a clinician’s opportunity to achieve professional success into the 21st century

The traditional acute care health care environment does not meet the needs of chronically ill patients and their families. The classic paternalistic approach encourages dependence on the health care team. This report reviews several innovative types of patient care delivery models, including patient-focused care, family-centered care, cooperative care, and Program Planetree. The core concepts of these various models are described and compared. Related research is presented. A synthesis of these existing models to meet the needs of chronically ill medical patients holistically is proposed. The implementation of the holistic model with chronically ill patients and their families is depicted

Chronotherapy is a relatively new approach in patient care that is based on knowledge of the various biologic rhythms of the body. Treatment is aimed at supporting normal rhythms or altering therapies based on known variations in body rhythms. Application of chronotherapy concepts to the pathology of respiratory diseases is discussed to provide a basis for altering pharmacologic therapy in the care of critically ill patients with respiratory disorders

Tailoring medication administration to obtain the optimal chronobiologic function of individuals with respiratory disorders has been studied by numerous researchers. Integration of chronobiologic concepts into therapeutic regimens for patients with chronic airflow obstruction has been, successful in reducing nocturnal symptoms of reduced airflow. Application of chronotherapeutic concepts in administration of commonly used respiratory medications is presented. Pharmacologic and nonpharmacologic chronotherapeutic implications for providing care for critically ill patients with respiratory disorders are discussed