Chapter 14 Flashcards
Exam 3
Characteristics of Effective Health-Care Delivery Systems
What should be facilitated?
Facilitate meeting the goals of the organization
Characteristics of Effective Health-Care Delivery Systems
How is the cost?
Cost-effective
Characteristics of Effective Health-Care Delivery Systems
Who does it satisfy?
Satisfy the patient
Characteristics of Effective Health-Care Delivery Systems
What does it provide for nurses?
Provide role satisfaction to nurses
Characteristics of Effective Health-Care Delivery Systems
What does it allow implementation of?
Allow implementation of the nursing process
Characteristics of Effective Health-Care Delivery Systems
What does it provide?
Provide for adequate communication among health-care providers
Selecting the Optimum Mode of Organizing Patient Care
What should the mode be based on?
The mode should be based on patient acuity and not economics alone.
Selecting the Optimum Mode of Organizing Patient Care
What should be the true driver in determining appropriate care delivery models?
The knowledge and skill required for particular activities with specific populations should always be the true driver in determining appropriate care delivery models.
Selecting the Optimum Mode of Organizing Patient Care
What does every nurse not desire?
Not every nurse desires a challenging job with the autonomy of personal decision making.
Traditional Models of Patient Care Organization
includes?
Total patient care
Functional nursing
Team and modular nursing
Primary nursing
Case management
Traditional Models of Patient Care Organization
Total patient care
having one nurse provide all the patient’s care.
Traditional Models of Patient Care Organization
Functional nursing
is task focused with specific tasks assigned to specific members of the care team (exp. RN is in charge of medication and CNA is in charge of vitals and linen change, bed making)
Traditional Models of Patient Care Organization
Team and modular nursing
pairing of one registered nurse and one LPN for example provide all the care for a certain number of pre assigned patients that are usually centralized geographically.
Traditional Models of Patient Care Organization
Primary nursing
- Pt. centered care -
One nurse has 24-hour responsibility for care planning and coordination for the patient.
Traditional Models of Patient Care Organization
case management
Individualized per client specific needs and circumstances -identifying the most cost-effective providers, treatments, and care settings possible.
Traditional Models of Patient Care Organization
What is the best mode? How are the newer models?
There is no one “best” mode for organizing patient care.
Many of the newer models of patient care delivery systems are merely recycled, modified, or retitled versions of older models.
Changing the Patient Care Delivery Mode—Questions the Change Agent Must Ask:
How will the reorganization alter autonomy and individual and group decision making?
How will social interactions and interpersonal relationships change?
Will employees view their unit of work differently?
Changing the Patient Care Delivery Mode—Questions the Change Agent Must Ask #2
Will the change require a wider or more restricted range of skills and abilities on the part of the caregiver?
Will the redesign change how employees receive feedback on their performance, either for self-evaluation or by others?
Will communication patterns change?
What is the oldest mode of organizing patient care?
Total Patient Care or Case Method Nursing
Total Patient Care or Case Method Nursing
What occurs? What responsibility do nurses have?
Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty.
Total Patient Care or Case Method Nursing
What is it sometimes referred to as?
It is sometimes referred to as the case method of assignment because patients may be assigned as cases.
Total Patient Care or Case Method Nursing
How often is it used?
It is still widely used in hospitals and home health agencies.
Disadvantage of Total Patient Care
The greatest disadvantage of total patient care delivery occurs when the nurse is inadequately prepared to provide total care to the patient.
Functional Method of Nursing
It evolved as a result of what?
Evolved as a result of World War II
Functional Method of Nursing
What does it use?
Uses relatively unskilled workers who have been trained to complete certain tasks
Functional Method of Nursing
How is care assigned?
Care is assigned by task rather than by patient
Advantages and Disadvantages of Functional Nursing
What is a major advantage of this?
A major advantage of functional nursing is its efficiency;
tasks are completed quickly, with little confusion regarding responsibilities.
Advantages and Disadvantages of Functional Nursing
What is a major disadvantage of this?
However, functional nursing may lead to fragmented care and the possibility of overlooking patient priority needs.
Team Nursing:
Who collaborates? Why?
Ancillary personnel collaborate to provide care to patients under the direction of a professional nurse.
Team nursing:
What does it require?
Requires extensive team communication and regular team planning conferences
Team nursing:
What does it allow for?
Allows members to contribute their own special expertise or skills
Team nursing:
What are disadvantages?
Disadvantages are associated with improper implementation rather than the philosophy itself
Modular Nursing
What is there a modification in?
Modification of team and primary nursing
Modular Nursing
What is it similar to?
Similar to team nursing, but uses a smaller team
Modular Nursing:
What occurs?
Pairs professional nurses with ancillary staff to deliver care to groups of patients
Modular Nursing:
When was it used most?
Used frequently during the 1980s and 1990s
Modular Nursing
What should the modular team leader (RN) do?
The modular team leader (RN) should check the work of the team members.
Modular Nursing
How is care divided? What does this mean about the RN?
Care is divided among the mini-team members, so the RN does not provide every aspect of care to some of the patients, even those who are acutely ill.
Modular Nursing
What does modular nursing not involve? What is it more common to happen?
Modular nursing does not usually involve collaboration between two RNs, it is more common for each team to have only one RN, and the RN is usually paired with ancillary staff ( LPN/CNA etc.)
Primary Nursing/Relationship-Based Nursing #1
What does the primary nurse do?
Primary nurse assumes 24-hour responsibility for planning patient care from admission or start of treatment to discharge or treatment’s end.
Primary Nursing/Relationship-Based Nursing:
What does the primary nurse do during work hours?
During work hours, the primary nurse provides total direct care for that patient.
Primary Nursing/Relationship-Based Nursing #1
When the primary nurse is off duty, what happens?
When the primary nurse is off duty, associate nurses follow the care plan established by the primary nurse and provide care.
Primary Nursing/Relationship-Based Nursing #1
What does the primary nurse do?
Primary nursing: The Primary nurse is responsible for care planning for 24 hours per day, the primary RN leads the planning of care but may not carry out the majority of personal care.
The Primary RN plans the care with others’ input.
Primary Nursing/Relationship-Based Nursing #2
Where does it bring nurses?
Brings nurse back to the bedside to provide clinical care
Primary Nursing/Relationship-Based Nursing:
How can it succeed?
Can succeed with a diverse skill mix or an all-RN staff
Primary Nursing/Relationship-Based Nursing #2
How is job satisfaction? Why is this method difficult to implement?
Job satisfaction is high; however, this method is difficult to implement because of the degree of responsibility and autonomy required of the nurse
Primary Nursing/Relationship-Based Nursing #2
What are disadvantages of this method?
Disadvantages lie primarily in improper implementation
Case Management Nursing
Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes
Case Management Nursing
What do they coordinate care through?
Coordinates care through an episode of illness
Case Management Nursing
What is the focus on?
The focus is on individual clients, not populations of clients.
Managing Care With Case Management #1
How do case managers often manage care? (What do they use)
Case managers often manage care using critical pathways and multidisciplinary action plans (MAPs) to plan patient care.
Managing Care With Case Management #1
What is care MAP?
The care MAP is a combination of a critical pathway and a nursing care plan, which indicates times when nursing interventions should occur.
Managing Care With Case Management #1
Who follows the care MAP?
All health-care providers follow the care MAP to facilitate expected outcomes.
Managing Care With Case Management #1
What happens if a patient deviated from the normal care plan?
If a patient deviates from the normal plan, a variance is indicated.
Managing Care With Case Management #2
What do some people feel about the role of a case manager?
Some feel that the role of case manager should be reserved for the advance practice nurse or RN with advanced training.
Common Features of Disease Management Programs #1
What do they provide?
Provide a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses.
Common Features of Disease Management Programs #1
What do they focus on?
Focus on prevention as well as early disease detection and intervention to avoid costly acute episodes but provide comprehensive care and reimbursement.
Common Features of Disease Management Programs #2
Who do they target?
Target population groups (population based) rather than individuals.
Common Features of Disease Management Programs #2
What do they employ?
Employ a multidisciplinary health-care team, including specialists.
Common Features of Disease Management Programs #2
What do they use?
Use standardized clinical guidelines—clinical pathways reflecting best practice to guide providers.
Common Features of Disease Management Programs #3
What do they use? Why?
Use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms.
Common Features of Disease Management Programs #3
Who do they frequently employ in the role of case manager or program coordinator?
Frequently employ professional nurses in the role of case manager or program coordinator.
Illnesses Often Managed With Disease Management Protocols
Cancer
Acute otitis media
Diabetes
Hyperlipidemia
Asthma
Hypertension
COPD
Hormone replacement therapy
AIDS
Stroke
Emerging Care Delivery Models Focus On #1
Role of nurses?
Elevating the role of nurses and transitioning from caregivers to “care integrators”
Emerging Care Delivery Models Focus On #1
Take what kind of approach?
Taking a team approach to interdisciplinary care
Emerging Care Delivery Models Focus On #1
Bridging the continuum of care to where?
Bridging the continuum of care outside of the primary care facility
Emerging Care Delivery Models Focus On #1
How do they want to define the home?
Defining the home as a setting of care
Emerging Care Delivery Models Focus On #2
Who do they want to target (what specific population)?
Targeting high users of care, especially older adults
Emerging Care Delivery Models Focus On #2
How do they focus on the patient?
Sharpening focus on the patient, including an active engagement of the patient and her or his family in care planning and delivery, and a greater responsiveness to the patient’s wants and needs
Emerging Care Delivery Models Focus On #2
What are they leveraging?
What is being improved?
Leveraging technology
Improving satisfaction, quality, and cost
Emerging Care Delivery Models Focus On #3
Who is the nurse navigator?
The nurse navigator assists patients and families to navigate the complex health-care system by providing information and support as they traverse their illness.
The clinical nurse-leader…
The clinical nurse-leader is an experienced nurse possessing a graduate degree who provides clinical leadership in all health-care settings, implements outcomes-based practice and quality improvement strategies, engages in clinical practice, and creates and manages microsystems of care that are responsive to the health-care needs of individuals and families.
