Delivering Care Flashcards
What do the models of care describe?
- Which worker will perform each task
- Person responsible for each tasks
- The authority to make decisions
Why do we discuss models of care?
- Provide structure
- Plan efficient proficient care
- Nursing personnel is the largest percent of operating costs so target budget cuts
- Models are influenced by social change
Traditional models of care include
- Total patient care or care models
- Functional model or something task nursing
- Team model
- Modular model
- Primary model
Total patient care model
Takes care of one patient and all of their needs
Characteristics of total patient care or case model
- Florence nightingale
- Oldest method of organizing pt care
- Responsible: planning, organizing, all care
- Care provided in the home including cooking and cleaning
- During the Great Depression- unable to afford home are and began using hospitals.
- Today it is the ICU, PACU,CCU
- Reality shock after graduation
Advantages of total patient care model or case model
- Autonomy and responsibility
- Holistic and u fragmented care
- Required skilled nursing
- Patient needs were quickly met
- Close relationship between patient and RN
Disadvantages of total patient care or case model
- Inexperienced nurses or not adequately prepared
2. Cost! Ran are expensive
Functional model or task nursing
Nurses are assigned to tasks not to patients
Characteristics of functional model or task nursing
Evolved during the Great Depression when RNs went from private nursing to becoming employees of a hospital
WW2 broke out and hospitals were short staffed
Unskilled workers were to perform routine simple tasks such as BP and bathing- cna or lpn
RN became the manager of care rather than the direct care provider
What are advantages of functional model or task nursing
- Efficient way to deliver care
- Accomplish a lot of tasks in a small amount of time
- Staff only did what they were capable of doing and nothing was added that you couldn’t do taut could be done by an assistant
- Care was provided by minimal number of RNs
Disadvantages of functional or task nursing
- RN time to supervise assistants
- Care became fragmented with little holistic understanding of patients
- Patients did not have one identifiable nurse and nurse had no accountability to the pt to the staff doing the work
- Narrow scope of practice
- Lead to patient and hear dissatisfaction
- Focus was on the task not the overall result
What is team model characteristics
- Evolved in the 1950s to improve or satisfaction
- Goal to reduce the fragmented care
- Ancillary personnel provide care under the direction of the RN
- RN functions as a team leader and coordinates a small group
- RN is responsible for know the condition and needs of all patients assigned to the team
- Duties of the team leader are planning care. Assigning duties, directing and assisting team members and giving direct care and teaching and coordinating patient activities
Advantages of team model
- Each team member capabilities are maximized so satisfaction was high
- Each member participates in decision making and problem solving
- Patients have one team leader with access to other providers
- Requires excellent communication
Disadvantages of team model
- Inadequate time for team care planning and communication
- Requires a team spirit and commitment to success
- RN may be a team leader one day and a team member the next day thus lacks continuity
- Care fragmented with only 8-12 hour accountability
5 assignment unequal if based on acuity - Team leader if they are not a excellent practitioner with good management leadership skills most haven’t yet developed these skills
Modular model
Care given according to geographic areas BEEBE
Characteristics of modular modular model
- Modification of team nursing
- Patient unit is divided into modules or units with the RN as team leader
- Same team care giver is assigned consistently to the fame geographic area
- Concept evolved to increase RN involvement care
Advantages of modular model
- Continuity of care is improved
- RN had more time for planning and coordinating care
- Geographic closeness and efficient communication
Disadvantages to modular model
- Increase cost to stock each module
2. Long corridors are not conducive to modular nursing
Primary model
One nurse cares for a group of patients within a 24 hour accountability
Characteristics of primary model
- Evolved in the 1980s to improve RN autonomy
- RN primary nurse assumes 24 hour responsibility for planning directing and evaluations care
- Common use areas are hospice long term and home health
- Primary nurse has 24 hour accountability associated nurse would be there when the RN wasn’t there
- Fully staffed by RN no cna
Advantages of primary model
- High qyality, holistic patient care
- Establish good rapport and increased job satisfaction
- Decentralization of nursing care decisions authority and responsibility to staff nurse
Disadvantages of primary model
- Not cost effective
- Must be able to practice with a high degree or responsibility and accountability
- RN must accept 24 hour responsibility
Integrated modems of care includes:
- Case management
2. Practice partnership model or co primary
Case management
A strategy to improve patient care and reduce hospital costs through coordination of care
Characteristics of case management
- First introduced by insurance companies in the 1970s
- Hospitald adopted the model in the 1980s
organize patient care by the drgs and focus meeting outcomes with specific time frames
Follow Pts progress from admission to discharge
A strategy to improve or care and reduce hospital costs through coordination of care
Coordinating patient care and establishing goals of patient care
Doesn’t provide direct care but supervises the care
Includes identifying core donating monitoring and outcomes
10-15 patients per manager
Used critic pathways and MAP
Practiced partnership model or co primary nursing characteristics
Introduced in 1989
RN partnered with LPN
Worked together with same schedule and same group of patients
Advantages of practiced partnership model
More cost effective than primary nursing
Encourage training and growth of he lpn
Disadvantages of the practiced partnership model
RN may have difficulty delegating to a partner
Consistent partnerships are difficult to maintain due to varied schedules
Critical pathways characteristics
Outline a predetermined written plan of care for a particular health problem
Specific desired outcomes and transdiciplinary intervention
Assess a common medical diagnosis
Dictate the type and amount of care given and thus financial implications
