2) Models Of Care P.177-179 Flashcards
What models of care are described from the past century?
- Functional nursing
- Team nursing
- Primary nursing
What settings have these models primarily existed in?
- Institutional settings
- Elements may still be seen in practice today
When did functional nursing become popular and why?
- During World War II
- In response to nursing shortage
What are the disadvantages of functional nursing?
- Problems with continuity of care
- Absence of holistic patient view
- Care can become mechanical and fragmented
Despite critiques, what aspect of functional nursing is still seen today?
- Nurses performing “medication runs” in long-term care
When and why did team nursing develop?
- After World War II
- In response to nursing shortage
How does team nursing involve care delivery?
- Coordinated delivery by various staff members
- Led by an RN with team of RNs, RPNs, LPNs, etc.
What can result from team nursing’s task orientation?
- Lack of continuity of care
What advantage does team nursing offer?
- Collaborative style encouraging team support
For effective nursing teams, what is most important?
- RNs and LPNs have strong identity of roles/scope
- RNs lead/support teams, LPNs provide leadership
What does the case management model emphasize?
- Coordination of health services
- Linking services to patients and families
- Streamlining costs while maintaining quality
Who can be case managers?
- Nurses
- Other healthcare professionals
What criticism has the term “case manager” received?
- Impersonal, as patients/families are not “cases” to manage
How is case management defined as it has evolved?
- A collaborative process to assess, plan, implement, coordinate, monitor, evaluate
- Meeting individual’s health needs using resources for quality, cost-effective outcomes
For what types of patients do clinicians provide case management?
- Patients with specific conditions and associated care needs
- E.g. complex nursing and medical problems
What are clinicians usually held accountable for in case management?
- Quality management
- Cost management
What do many case managers use?
- Critical pathways or “care maps”
- Multidisciplinary treatment plans for specific case types
Across what settings do case managers’ roles vary?
- Long-term care
- Home care
- Community mental health
- Acute care institutions
What roles and responsibilities do case managers have across settings?
- Clinical expert
- Advocate
- Educator
- Facilitator
- Negotiator
- Manager
- Researcher
What do emerging models of care emphasize?
- Ways the nursing system operates to provide continuity of care across settings
- Acknowledging RN skills/knowledge are needed at point of care and for team coordination/management
What is happening with nurse-led primary care clinics in British Columbia?
- Provincial government funding implementation
- Goal of establishing team-based care among RNs, nurse practitioners, and other team members
What model is increasingly used by nursing teams and interprofessional teams?
- The collaborative practice model
What are health professional education programs called upon to do?
- Prepare graduates to practice and lead collaborative team approaches to care
Why has a call for collaborative practice development occurred across Canada?
- Viewed as way to ensure all professionals practice to full potential of roles/competencies
- Best way to effectively use health human resources during shortages for quality care
What is collaborative practice also the best way to ensure?
- Health human resources used most effectively for achieving quality care and population health outcomes
What should students in nursing and other healthcare programs learn?
- Competencies associated with collaborative practice
- Focusing on relationships with nurses and others across care settings
What competencies do students and entry-level nurses need?
- Those promoting collaboration among nursing teams and others
- To ensure optimal care is provided
For whom is collaboration an entry-level competency expectation?
- All members of the nursing team (LPNs, RNs, RPNs)
Of what teams is the student nurse an integral member?
- Nursing teams
- Interprofessional teams across healthcare settings
What is one of the first important responsibilities?
- Articulate the role and contribution of nurses
- Learn about roles/responsibilities of other team members
Who are central participants in the collaborative practice model?
- Patient
- Family
- Population
What has the RNAO developed guidelines for?
- Intraprofessional collaborative nursing practice
- Interprofessional collaborative health teams
How do the RNAO guidelines show collaborative practice can be supported?
- At individual, team, organizational, and system levels
What do the RNAO guidelines indicate is needed?
- Transformational leadership
- To support culture of teamwork and collaboration
What does one RNAO guideline focus on for collaborative practice?
- Developing the ability to share power
How do team members demonstrate willingness to share power according to the RNAO guideline?
- Building a collaborative environment by recognizing power’s influence
- Creating balanced power through shared leadership, decisions, authority, responsibility
- Including diverse voices in decision making
- Openly sharing knowledge with each other
- Working collaboratively with patients/families to plan and deliver care
What does building a collaborative environment through recognizing power’s influence involve?
- Understanding how power dynamics can impact everyone involved
- Being aware of power imbalances and hierarchies within the team
- Taking steps to create an environment where all voices are heard
How can balanced power relationships be created through shared leadership?
- Distributing decision-making authority across the team
- Allowing different team members to take the lead on tasks
- Sharing responsibility for outcomes among the team
Why is including diverse voices important for decision making?
- Ensures all perspectives and experiences are represented
- Leads to more well-rounded and inclusive decisions
- Prevents marginalization of certain groups or viewpoints
What are the benefits of openly sharing knowledge within the team?
- Facilitates learning and professional growth for all members
- Builds trust and psychological safety
- Allows team to leverage collective expertise and wisdom
How can nurses provide leadership for collaborative practice in home care settings?
- Work closely with the broader healthcare team
- Ensure regular communication among all care providers
- Provide education and support for best practices (safety, emotional support, wound healing)
- Recognize and value each team member’s role
- Support continuity of care for patients/families
What is required for collaborative practice when multiple providers are involved?
- No single professional group dominates
- Leadership is shared among providers
- Differences in knowledge/contributions are understood and respected
- Interprofessional competencies are developed through education
What healthcare providers are often involved in home care delivery?
- Nurses
- Social workers
- Physicians
- Nutritionists
- Physiotherapists
- Other healthcare providers
How is collaborative practice in healthcare defined?
- Multiple providers from different backgrounds
- Working with patients, families, communities
- Providing comprehensive, quality services across settings
What is iPANEL?
- An initiative for nurse researchers to collaborate with nurses, patients, families, other providers
- Aimed to collect evidence addressing pressing palliative care challenges
- Ran from 2011-2018
Why is collaboration across sectors important for 21st century healthcare?
- Nurses must work with healthcare teams and community organizations
- Intersectoral collaboration is a primary healthcare principle
- Allows influencing health in the broadest way
What competencies are needed for cross-professional/organizational collaboration?
- Communication and conflict resolution skills
- Team functioning abilities
- Collaborative leadership capabilities
What is the foundation for effective interprofessional collaboration?
- Deep understanding of one’s own professional role and contribution
- Appreciation of other professionals’ contributions
What types of questions did iPANEL aim to address?
- “What should I say?” - communication challenges
- “Can’t we do better when she is short of breath?” - symptom management
- “What does she want for future care? Is it my role?” - advance care planning
What is an important recommendation for achieving healthy practice environments?
- Involve nurses at all levels in decisions about nursing practice
- Value and amplify the voices of nurses providing direct patient care
- Ensure nurses have influence in healthcare and system-level decisions
What roles should nurse executives have regarding nursing practice?
- Escalate and champion nursing practice issues
- Demonstrate nursing’s unique knowledge contributions
- Enable governance supporting participatory decision-making
- Establish and communicate a vision for nursing in the organization
What is required beyond just having a nurse executive at the leadership table?
- Critical perspective on the nurse leader’s ability to:
- Engage nurses across the organization
- Influence the quality of nursing practice
How can nurse executives support frontline staff?
- Support operational nurse leaders, managers and staff
- Enable governance for collaborative practice models
- Motivate and engage nurses to advance the nursing vision
Why has trauma-informed leadership become highly relevant?
- Nurses’ experiences supporting care during COVID-19 pandemic
- Increasing violence in workplace and community
- Need to build resilience while acknowledging pervasive trauma
What are the aims of trauma-informed leadership?
- Create safety
- Build trust through transparency
- Build collaboration in affirming relationships
- Empower voice and choice
- Critically examine systems perpetuating harm
What is required of nurses to realize nursing’s leadership potential?
- Develop core leadership competencies across healthcare domains
- Recognize leadership as a shared responsibility
- Commit to equity, social justice, quality care environments
- Mentor others in growing leadership skills
What must nurse leaders enable and encourage?
- Decision-making by professionals closest to patient care
- Respect for unique team member contributions impacting patient journey
- Inclusive, evidence-informed staff mix decisions for quality care
What are key competencies for nursing leadership?
- Ability to act courageously and think critically
- Advocacy skills
- Visionary and innovative thinking
- Willingness to be visible in leadership practice
What competencies relate to nursing’s broader role?
- Viewing nursing as more than tasks/acts
- Commitment to ethics
- Connecting research to practice
- Policy skills (analysis, interpretation, development)
What competencies enable leadership in practice environments?
- Commitment to building excellent learning/practice settings
- Influencing policies/regulations shaping healthcare
- Understanding nursing in political/governance contexts
What should guide staff mix decisions?
- Responding to clients’ healthcare needs
- Enabling safe, competent, ethical, quality care
- Considering professional standards and staff competencies
- Using evidence on factors influencing quality care/environments
- Considering client, staff, and organizational outcomes
What organizational support is needed for staff mix decisions?
- Alignment with organizational structure, mission, vision
- Support from all levels of leadership
- Engagement of direct care nurses and nurse managers
What systems enable effective staff mix decision-making?
- Information and knowledge management systems
- Nursing care delivery models based on best evidence
What defines a nurse’s responsibilities?
- Outlined in the position description
- Details duties in patient care and nursing team participation
- Managers must clearly define during changes like care model restructuring
What is autonomy in nursing practice?
- Having authority to make decisions
- Freedom to act per professional knowledge base
- Leads to innovation, productivity, retention, patient satisfaction
What is authority to act for nurses?
- Right to act in areas where nurse has accepted responsibility
- Guided by legislation, standards, code of ethics
- Includes questioning other professionals’ practice in that scope
What does accountability mean for nurses?
- Being answerable for one’s actions
- Meeting standards of nursing practice
- Responsible for patient health outcomes
How do nursing units balance responsibility, autonomy, authority and accountability?
- Collaborate to realize all four elements in decision-making
- Routine team meetings to maintain equality and balance
- Comfortable expressing differing opinions while understanding one’s role
