Exam 1: Chapter 12 Flashcards
Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice is based?
a. Licensure status
b. Experience in the agency
c. Leadership capabilities
d. Education and expertise
ANS: D
Differentiated nursing practice models are models of clinical nursing practice that are defined or differentiated by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision making.
The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse’s:
a. clinical expertise.
b. leadership ability.
c. communication style.
d. conflict-resolution skills.
ANS: A
Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking, clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner (2001), however, identified five stages of clinical competence for nurses: novice, advanced beginner, competent, proficient, and expert. She suggests that competence is typified by a nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively and thus, this assignment overlooks the nurse’s level of clinical expertise and leadership experience.
When interviewing an applicant for an RN position, the nurse manager describes the unit’s care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks and the RNs complete all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a. the case method.
b. functional nursing.
c. primary nursing.
d. nurse case management.
ANS: B
The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients.
You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the:
a. nursing care plan.
b. physician’s orders.
c. critical pathway.
d. clinical practice guidelines.
ANS: C
A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care.
The nurse case manager is working with a client admitted for end-stage renal disease. The case manager’s major goal during this hospitalization for this patient is to:
a. implement the care pathway on admission.
b. provide direct nursing care throughout the hospitalization.
c. supervise the nursing staff members who implement the care map.
d. prevent additional hospitalizations resulting from complications of the client’s disease.
ANS: D
The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective?
a. Functional method
b. Case management method
c. Primary care method
d. Team method
ANS: B
Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.
In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager’s main responsibility is the needs of the:
a. department.
b. unit.
c. staff.
d. patient.
ANS: D
In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
a. Baccalaureate
b. Associate
c. Diploma
d. LPN/LVN
ANS: A
Because of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.
In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model?
a. RN and LPN/LVN
b. RN and RN
c. RN and medication assistants
d. RN and certified nurses’ aides
ANS: C
The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules.
The case method of care delivery could be best justified in which of the following scenarios?
a. Stable patient population with long-term care and family needs
b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures
c. Pediatric intensive care unit that heavily involves families as well as patients
d. Home healthcare environment with patients at varying levels of acuity
ANS: C
This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.
During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
a. Case method
b. Team nursing
c. Functional nursing
d. Nurse case management
ANS: A
The case method may involve total patient care provided by a registered nurse, which, in today’s costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model.
A patient complains to the charge nurse that she has no idea who “her nurse” is on any given day. “I ask one nurse for my pills and
she says, ‘That’s not my job.’ I ask the pill nurse about my lab tests and she says that I should ask another nurse.” The nursing care delivery model most likely employed in this situation is:
a. differentiated practice.
b. team nursing.
c. functional nursing.
d. case management.
ANS: C
Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A
disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift.
These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each
other about the patient’s progress.
For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is:
a. rotation of task assignments.
b. frequent opportunities for in-service education.
c. orientation to job responsibilities and performance expectations.
d. team social events in off hours.
ANS: A
Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.
In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model:
a. can be effective in recognizing individual strengths and backgrounds of staff.
b. promotes autonomy and independence for the RN.
c. avoids conflict because of role clarity.
d. is efficient in delivering care to a large group of patients, utilizing a staffing mix.
ANS: A
Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.
To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:
a. be able to effectively communicate with patients.
b. build relationships with physicians.
c. be able to adapt to daily changes in staffing.
d. adapt in communicating information to her supervisor.
ANS: C
A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.