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Nursing 20G - Care of the Medical Client > 2) Models Of Care P.177-179 > Flashcards

2) Models Of Care P.177-179 Flashcards

1
Q

What models of care are described from the past century?

A
  • Functional nursing
  • Team nursing
  • Primary nursing
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2
Q

What settings have these models primarily existed in?

A
  • Institutional settings
  • Elements may still be seen in practice today
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3
Q

When did functional nursing become popular and why?

A
  • During World War II
  • In response to nursing shortage
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4
Q

What are the disadvantages of functional nursing?

A
  • Problems with continuity of care
  • Absence of holistic patient view
  • Care can become mechanical and fragmented
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5
Q

Despite critiques, what aspect of functional nursing is still seen today?

A
  • Nurses performing “medication runs” in long-term care
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6
Q

When and why did team nursing develop?

A
  • After World War II
  • In response to nursing shortage
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7
Q

How does team nursing involve care delivery?

A
  • Coordinated delivery by various staff members
  • Led by an RN with team of RNs, RPNs, LPNs, etc.
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8
Q

What can result from team nursing’s task orientation?

A
  • Lack of continuity of care
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9
Q

What advantage does team nursing offer?

A
  • Collaborative style encouraging team support
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10
Q

For effective nursing teams, what is most important?

A
  • RNs and LPNs have strong identity of roles/scope
  • RNs lead/support teams, LPNs provide leadership
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11
Q

What does the case management model emphasize?

A
  • Coordination of health services
  • Linking services to patients and families
  • Streamlining costs while maintaining quality
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12
Q

Who can be case managers?

A
  • Nurses
  • Other healthcare professionals
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13
Q

What criticism has the term “case manager” received?

A
  • Impersonal, as patients/families are not “cases” to manage
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14
Q

How is case management defined as it has evolved?

A
  • A collaborative process to assess, plan, implement, coordinate, monitor, evaluate
  • Meeting individual’s health needs using resources for quality, cost-effective outcomes
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15
Q

For what types of patients do clinicians provide case management?

A
  • Patients with specific conditions and associated care needs
  • E.g. complex nursing and medical problems
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16
Q

What are clinicians usually held accountable for in case management?

A
  • Quality management
  • Cost management
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17
Q

What do many case managers use?

A
  • Critical pathways or “care maps”
  • Multidisciplinary treatment plans for specific case types
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18
Q

Across what settings do case managers’ roles vary?

A
  • Long-term care
  • Home care
  • Community mental health
  • Acute care institutions
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19
Q

What roles and responsibilities do case managers have across settings?

A
  • Clinical expert
  • Advocate
  • Educator
  • Facilitator
  • Negotiator
  • Manager
  • Researcher
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20
Q

What do emerging models of care emphasize?

A
  • 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
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21
Q

What is happening with nurse-led primary care clinics in British Columbia?

A
  • Provincial government funding implementation
  • Goal of establishing team-based care among RNs, nurse practitioners, and other team members
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22
Q

What model is increasingly used by nursing teams and interprofessional teams?

A
  • The collaborative practice model
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23
Q

What are health professional education programs called upon to do?

A
  • Prepare graduates to practice and lead collaborative team approaches to care
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24
Q

Why has a call for collaborative practice development occurred across Canada?

A
  • 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
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25
Q

What is collaborative practice also the best way to ensure?

A
  • Health human resources used most effectively for achieving quality care and population health outcomes
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26
Q

What should students in nursing and other healthcare programs learn?

A
  • Competencies associated with collaborative practice
  • Focusing on relationships with nurses and others across care settings
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27
Q

What competencies do students and entry-level nurses need?

A
  • Those promoting collaboration among nursing teams and others
  • To ensure optimal care is provided
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28
Q

For whom is collaboration an entry-level competency expectation?

A
  • All members of the nursing team (LPNs, RNs, RPNs)
29
Q

Of what teams is the student nurse an integral member?

A
  • Nursing teams
  • Interprofessional teams across healthcare settings
30
Q

What is one of the first important responsibilities?

A
  • Articulate the role and contribution of nurses
  • Learn about roles/responsibilities of other team members
31
Q

Who are central participants in the collaborative practice model?

A
  • Patient
  • Family
  • Population
32
Q

What has the RNAO developed guidelines for?

A
  • Intraprofessional collaborative nursing practice
  • Interprofessional collaborative health teams
33
Q

How do the RNAO guidelines show collaborative practice can be supported?

A
  • At individual, team, organizational, and system levels
34
Q

What do the RNAO guidelines indicate is needed?

A
  • Transformational leadership
  • To support culture of teamwork and collaboration
35
Q

What does one RNAO guideline focus on for collaborative practice?

A
  • Developing the ability to share power
36
Q

How do team members demonstrate willingness to share power according to the RNAO guideline?

A
  • 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
37
Q

What does building a collaborative environment through recognizing power’s influence involve?

A
  • 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
38
Q

How can balanced power relationships be created through shared leadership?

A
  • Distributing decision-making authority across the team
  • Allowing different team members to take the lead on tasks
  • Sharing responsibility for outcomes among the team
39
Q

Why is including diverse voices important for decision making?

A
  • Ensures all perspectives and experiences are represented
  • Leads to more well-rounded and inclusive decisions
  • Prevents marginalization of certain groups or viewpoints
40
Q

What are the benefits of openly sharing knowledge within the team?

A
  • Facilitates learning and professional growth for all members
  • Builds trust and psychological safety
  • Allows team to leverage collective expertise and wisdom
41
Q

How can nurses provide leadership for collaborative practice in home care settings?

A
  • 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
42
Q

What is required for collaborative practice when multiple providers are involved?

A
  • No single professional group dominates
  • Leadership is shared among providers
  • Differences in knowledge/contributions are understood and respected
  • Interprofessional competencies are developed through education
43
Q

What healthcare providers are often involved in home care delivery?

A
  • Nurses
  • Social workers
  • Physicians
  • Nutritionists
  • Physiotherapists
  • Other healthcare providers
44
Q

How is collaborative practice in healthcare defined?

A
  • Multiple providers from different backgrounds
  • Working with patients, families, communities
  • Providing comprehensive, quality services across settings
45
Q

What is iPANEL?

A
  • 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
46
Q

Why is collaboration across sectors important for 21st century healthcare?

A
  • Nurses must work with healthcare teams and community organizations
  • Intersectoral collaboration is a primary healthcare principle
  • Allows influencing health in the broadest way
47
Q

What competencies are needed for cross-professional/organizational collaboration?

A
  • Communication and conflict resolution skills
  • Team functioning abilities
  • Collaborative leadership capabilities
48
Q

What is the foundation for effective interprofessional collaboration?

A
  • Deep understanding of one’s own professional role and contribution
  • Appreciation of other professionals’ contributions
49
Q

What types of questions did iPANEL aim to address?

A
  • “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
50
Q

What is an important recommendation for achieving healthy practice environments?

A
  • 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
51
Q

What roles should nurse executives have regarding nursing practice?

A
  • 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
52
Q

What is required beyond just having a nurse executive at the leadership table?

A
  • Critical perspective on the nurse leader’s ability to:
  • Engage nurses across the organization
  • Influence the quality of nursing practice
53
Q

How can nurse executives support frontline staff?

A
  • Support operational nurse leaders, managers and staff
  • Enable governance for collaborative practice models
  • Motivate and engage nurses to advance the nursing vision
54
Q

Why has trauma-informed leadership become highly relevant?

A
  • Nurses’ experiences supporting care during COVID-19 pandemic
  • Increasing violence in workplace and community
  • Need to build resilience while acknowledging pervasive trauma
55
Q

What are the aims of trauma-informed leadership?

A
  • Create safety
  • Build trust through transparency
  • Build collaboration in affirming relationships
  • Empower voice and choice
  • Critically examine systems perpetuating harm
56
Q

What is required of nurses to realize nursing’s leadership potential?

A
  • 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
57
Q

What must nurse leaders enable and encourage?

A
  • 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
58
Q

What are key competencies for nursing leadership?

A
  • Ability to act courageously and think critically
  • Advocacy skills
  • Visionary and innovative thinking
  • Willingness to be visible in leadership practice
59
Q

What competencies relate to nursing’s broader role?

A
  • Viewing nursing as more than tasks/acts
  • Commitment to ethics
  • Connecting research to practice
  • Policy skills (analysis, interpretation, development)
60
Q

What competencies enable leadership in practice environments?

A
  • Commitment to building excellent learning/practice settings
  • Influencing policies/regulations shaping healthcare
  • Understanding nursing in political/governance contexts
61
Q

What should guide staff mix decisions?

A
  • 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
62
Q

What organizational support is needed for staff mix decisions?

A
  • Alignment with organizational structure, mission, vision
  • Support from all levels of leadership
  • Engagement of direct care nurses and nurse managers
63
Q

What systems enable effective staff mix decision-making?

A
  • Information and knowledge management systems
  • Nursing care delivery models based on best evidence
64
Q

What defines a nurse’s responsibilities?

A
  • Outlined in the position description
  • Details duties in patient care and nursing team participation
  • Managers must clearly define during changes like care model restructuring
65
Q

What is autonomy in nursing practice?

A
  • Having authority to make decisions
  • Freedom to act per professional knowledge base
  • Leads to innovation, productivity, retention, patient satisfaction
66
Q

What is authority to act for nurses?

A
  • 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
67
Q

What does accountability mean for nurses?

A
  • Being answerable for one’s actions
  • Meeting standards of nursing practice
  • Responsible for patient health outcomes
68
Q

How do nursing units balance responsibility, autonomy, authority and accountability?

A
  • 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

Nursing 20G - Care of the Medical Client (3 decks)

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