Exam 8 Flashcards
Formula for nursing care hours per pt-day
NCH/PPD
Patient census (#of pts)
Nursing care hours per pt day
Acuity of pt doesn’t matter
Nursing & ancillary staff
Staffing can be incomplete
Doesn’t present reality of what’s occurring on a nursing unit
Pt classification systems (PCS)
Result of inadequate NCH/PPD AKA workload management Or pt acuity tool Group pts due to acuity Pts are classified once /day
As a pt becomes sicker the acuity level?
Rises
acuity level 1
2.2 hours of care
acuity level 2
2.6 hours of care
acuity level 3
3.2 hours of care
acuity level 4
3.6 hours of care
one FTE (full time equivalent)
40 hours a week for 52 weeks,
one FTE can be filled by one person or a combination of staff
FTE productive hours
hours worked and available for pt care, most orginazations allow 2-15 min breaks which are considered time worked
FTE non productive hours
benefits, orientation, sick & holiday, education time, meal breaks
direct care vs indirect care
direct care is actual hours spent provided hands on care to pt
indirect is spent on activities that are r/t the pt, such as documentation, follow up, consulting with other health care providers
FTE formula
avg. nursing care hours x days in staffing period x pt census
_________________________________
80 (hours worked per FTE)
the process of making the personnel work assignment for a specific period of time
scheduling
centralized scheduling
work days and time off are repeated in regular cycles, such as Q 4 weeks
scheduling made by staffing office
decentralized scheduling
the unit managers are given the authority & assumes responsibility of staffing their own unit, staff feels more in control
self scheduling
coordinated by staff nurse, policies and rules, 4 week process, staff negotiate before and after work, unit manager reviews to make sure of coverage & refinements are met
alternating of rotating shifts
alt. between days and nights, rotating through all shifts, creates stress (sleep wake cycle)
traditional 8 hour shift
work 5 days, 40 hour week
done to decrese risk of errors
10 hour 4 day workweek
14 hours off between shifts, 4 day weekend Q 6 weeks
12 hour shift
3 days on 4 days off
goal of staffing and scheduling
to provide an adequate mix of nursing staff to match care needs
what does joint commision require that organizations determine criteria for what
Rn staffing and provide adequate # of competent staff to meet that criteria
pt classification systems use what
pt needs to determine workload requirements and staffing needs
oldest method of organizing care, take care of one patient and all of their needs “private duty” nursing, nurse is responsible for planning, organizging, and performing ALL care of a pt or group of pts, care provided in home
Total pt care or case model
ICU, PACU, CCU
what are the advantages of the Total pt care or case model
autonomy & responsibility
holistic and unfragmented care
requires skilled nursing
close relationship between RN & pt
disadvantages of total pt care or case model
inexperienced RN, cost (RNs are expensive)
nurses are assigned to TASKS not to pts
functional model or task nursing
characteristics of functional model or task nursing
ancillary staff were needed, bridge gap of nurses, Rn became manager of care rather than direct provider evolved during Depression
advantages of functional model or task nursing
very efficient, accomplish a lot in small amt of time, care was provided by minimal # of RN, staff only did what capable to do
disadvantages of functional model or task nursing
RN time to supervise UAP
care of PT became fragemented
narrow scope of practice for RN
focus was on task not overall result
most common model used, evolved in 50’s, goal was to decrease fragmented care, ancillary personnel provided care under direction of an RN, RN is team leader, requires good communication and coordination
Team model
advantages of team model
each members capabilities are maximized so satisfaction should be high, requires excellent communication, pts have one nurse (team leader), and access to other providers
disadvantages of team model
inadequate time for team care planning and communication, requires team spirit, RN may be tam leader one day and then a team member the next, care is still fragmented, assignments may not be equal if based on acuity
care gien according to geographic area, modification of team nursing, pt unit is divided into modules, concept evolved to increases RN involvement in care
modular model
advantages to modular model
continuity of care, allows RN more time for planning and coordinating care, geographic closeness & efficient communicatoin
disadvantages of modular model
increase cost, long corridors not conducive to modular nursing
one nurse cares for a group of patients with 24 hour accountability, Rn is primary nurse, common in hospice, home health, long term, every expensive
primary model
advantages of primary model
high quiality, holistic care, est. rapport with pt, increase job satisfaction, decentralized of nursing care decisions, authority, and responsibility to the staff nurse
disadvantages of primary model
not cost effective, primary RN must be available. high degree of responsibility and accountability
traditional models of care
total pt care or case model functional model or task nursing team model modular model primary model
integrated models of care
case mangagement
practice partnership model (co-primary)
critical pathways
a stragegy to improve pt care and reduce hospital costs through coordination of care, organize pt care by DRG’s and focuses meeting outcomes with specific time frames, follow pt progress from admission to d/c, do not provide direct pt care, have 10-15 pts
case mangagement
RN is partnered with an LPN or CNA, work together with the same schedule and same group of pts, modification of primary nursing
practice partnership model
advantages of practice partnership model
more cost effective, RN can enourage training & growth in partner
disadvantages of practive partnership model
Rn may have difficulty delegating to parter, consistent partnership difficult to maintain due to varied schedule
outline a predetermined written plan of care for a particular health problem, address a common medical dx, specify desired outcomes and trasdiciplnary intervention, dictate & type & amt. of care given & thus have financial implications
critical pathways
barriers to female communication skills
more passive, intuitive, emotional and expected to follow orders
barriers to male communication skills
confident, independent, emotionally controlled
female to female relationship problems
more competitive with other women, gossip about others
identifies with male colleagues instead of women, feels superior to other women, can develop an attitude of its my way or else
queen bee syndrome
divides women against each other, verbal attack toward another in an attempt to destroy
trashing syndrome
personality consists of 3 ego states, each state has its though system, feelings, and behaviors
parent: controls and is source of values, opinions and rules (SUPER EGO)
adult: logical thinking, and rational, collects info, sets goals, makes decision, tests reality (EGO)
child: dominated by emotions and the feeling state (ID)
a health individual maintains what with all three ego states
a balance
may not participate in problem solving bc they think they already have the answer and know what is right and wrong
parent dominated ego state
may e borning bc they work really hard and have little time for fun
adult dominated ego state
doesnt engage in rational problem solving, screaming and being emotional has helped them get what they want
child dominated ego state
transactions are when people share opinons with each other
parent to parent
transitions are usually business like or when reasoning together
adult to adult
transactions involves an emotional exchange
child to child
one person takes a psychologically superior position over the other
parent to child
the response to the stimulus is predictable and expected, communication will continue if the transactions are complementary
complementary transactions
results in closing communications, the response may be inappropriate or unexpected, may confuse or threaten the sender
crossed transactions
assigning the blame/instilling guilt, avoids responsibiltiy by being vindictive
see what you made me do
denile of responsibility
to keep everyone looking in the other direction, constantly pointing the finger at the short comings, real or imagined of others
the blemish, fault finding
*kevin
getting away with irresponsibility, uses a handicap real or imagined, to avoid responsibility
wooden leg, Andy
a blaming game, people who feel inadequate will blame others for their inability to achieve
if it werent for you, Amber
demonstrates a lack of respect for ones own needs, at a loss for words, often aplogiizes, feels others can guess their needs, goals are not achieved, want others to guess our needs
passive style
poor eye contact, have strained relationships, avoid making a stand or a decision, over apologize
violates rights of others, loud, makes accusations, blames others, rude, acts superior, uses people, manipulative
aggresive style
stare or glare, hit people or things, slames doors, “dirty look”
true feelings are shared through actions, not words, disconnect between what is said and done, violate rights of others (aggressive), while attempting to llok as though they were placing the rights of others first (passive)
passive aggressive style
stare or roll eyes but deny anything is wrong, verbals and non verbals dont match
communication style that confirms your right to be heard, but in a caring and respectful manner towards others,
assertiveness style
honest expression, try to resolve an issue without conflict, verbals and non verbals match
what is the most important word in beding assertive
“I”
key points of being an assertive leader
speaks clearly and calmly, knows how to defend her actions without arguing, not afraid to say what you mean, peaks up but doesnt hurt others, speaks honestly
a # of indivduals assembled together or haing some unifying relationship
group
is a # of people who work cooperativley with each other to achieve same goal
team
what are the 4 things a team needs
defined objectives
ongoing post. relationships
supportive enviornment
focus to accomplish a specific task
teams are essential in providing
cost effective high quality healthcare
stages of development
forming stage storming stage norming stage performing stage adjourning stage
interpersonal relationships are being formed, anxiousness, leader gives clear directions, try to put ppl at ease
forming stage
arguments can occur, conflict is evident, power struggles, if properly managed, ppl learn to be more trustful of each other
storming stage
group feels more relaxed with each other, est. of rules for group, actions are more productive, more relaxed, have feelings of belonging to a group
norming stage
longes stage, when work is getting done, each person is getting individual tasks done, leader becomes facilitator or resource of groups
performing stage
group comes to an end, has accomplished a goal, celebration at the end, leader gives apprechiation to group
adjourning stage
