Organization and Prioritization of Client Care (Ch. 14) Flashcards
what essential elements are needed to organize pt care groups?
Top level Mangers
1st & middle level Managers
Unit leader manager
what is the leader’s function in organizing care?
Evaluate effectiveness of structure, support & resources.
Inspire the staff efforts, achievements for education, clinical expertise, competency & differentiated practice
Assure that selected model supports staff, & advances practice.
Maintain congruence in the mission, philosophy,& model
Keep the patient central in PCDS
what is the manager’s function in organizing care?
- Develop work design & activities to meet goals
- Determine the cost drivers conditions & plan care appropriately.
- Select PCDS that maximizes resources, time, & training of NP staff .
- Analyze PCDS based on EBP.
- Determine modalities to improve case managers, clinical leaders, & nurse navigators coordination of care.
what are the modes of organizing patient care?
1) Total patient care
2) Functional nursing
3) Team & modular nursing
4) Primary nursing
** No best mode **
what is total patient care?
Oldest Mode
Total responsibility of all patient care.
Provides nurses high autonomy & responsibility.
Highly skilled personnel
Nurses can modify care regimen.
Disadv: ? Inexperienced/inadequate nurses
how is total pt care organized?
charge nurse oversees RNs that care for pts
what is functional nursing?
- Developed as a result of WWII, & hospital construction.
- Personnel assigned to complete certain tasks. Examples of functional nursing tasks:
- BP, adm. Meds., make bed & bath pts.
- RNs became managers of care and “care through others
- Economical & efficient mode of care.
- Minimum RN’s
- Efficiency in task completion
- Used in OR and long-term facilities.
- High use of UAP
- Disad: Fragmented care, overlooking patient care priorities. UAP feel unchallenged & under-stimulated Requires many hours of supervision
how does functional nursing work?
there is a head/senior nurse that overlooks an RN that is in charge of medication, an RN that is in charge of treatment, a nursing attendant/ Hygenic care, and a housekeeping linen/attendant. all these people under the head nurse care for the pts.
- can deliver large number of clients
- good when there’s a shortage of RN
- to the client, the care can feel disjointed
- the client becomes the sum of tasks of care than an integrated whole.
what is team nursing?
- 1950s
- To decrease the problems associated with functional organization of patient care.
- Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse.
- The RN is responsible for knowing the condition and needs of all patients assigned to the team and for planning individual care.
Democratic leadership.
~ Team leader coordinates team members in the care of a group of inpatients.
~ Group members are autonomous
~ Team shares accountability collectively.
~ Allows members to contribute their own special skills.
- No more than 5 people
- Self-discipline, communication & coordination
- Disadvantages-not enough time to communicate and coordinate
- Team leader needs astute L & M skills
- TL familiar with all patients
how does team nursing work?
two options:
a charge a nurse that overlooks two TL. one of the TLs looks over 2 NA and 1 LVN. The second TL overlooks 2 LVNs and an Aide.
other options:
A Change RN overlooks RN meds & IV, one with LVN skills, an aide who does baths, an aide that addresses call light and H20, and and an Aide that does V/S and Feed pts.
what is modular nursing?
- Modification of team and primary nursing
- Very similar to team nursing, except it uses smaller teams (up to 3)
- Pairs professional nurses with ancillary staff
- Patient care divided into modules or districts
- Requires less communication
what is primary nursing?
- Relationship-based nursing
- Revolutionary principle
- Requires a nursing staff comprised of only RNs.
- The RN primary nurse assumes 24-hour responsibility for the nursing care plan of one or more patients from admission or start of treatment to discharge or end of treatment.
- Hospitals, Home health, & hospice
- PN has clear communication with physician, patient, ANs & other TMs.
- Holistic, high quality care & challenging
- Very similar to total patient care method
- Disadv: Improper implementation,
- Uncomfortable, lack experience
- Limited RNs & logistical issues
what is case management?
- Collaborative process that assess, plans, implements, coordinates, monitors, and advocates options for services to meet an individual’s health needs.
- Focus is on ind. Patients. Critical pathways
- Identifies most cost-effective providers,
- treatments, and care settings for insured.
- Identify barriers & assist with community
- Disadv: Improper implem. Role challenges
what are interprofessional primary health-care teams (IPHCT)?
- Physician, NP, Nurses, PT, OT & SW
- Collaborative/coordinated care
- Improved outcomes
- Disad: Care hurdles, Leader ?, role confusion, what knowledge is important?
- Cross team responsibilities
~ Information resources
what is the leader role in a multipdisciplinary team?
- Group of disciplines (Nurse, Physician, Social worker, P.T, O.T, & others)
- Collaborative, communicative effort to assure, comprehensive & holistic patient care
- Team leadership falls on nurse
- Challenges: Mutual respect, collaboration, role clarification issues
- Multidisciplinary rounds
what is the disease management?
- Population-based health care program
- Focus on groups of patients, clinical pathways
- Comprehensive, integrated approach to the care and reimbursement of high-cost, chronic illnesses.
- Continuum of care which includes early detection and early intervention prevents exacerbations, hospitalizations
- Goal: service the optimal number of covered lives required to reach operational and economic efficiency, contain healthcare costs
which chronic illnesses are often managed with disease management protocols?
Cancer Diabetes Hyper-lipidemia Asthma Hypertension COPD HIV infection Stroke
what should you know about selecting the optimum mode?
Each unit’s care delivery structure should
- Facilitate meeting the goals of the organization
- Be cost-effective
- Satisfy the patient, based on acuity
- Provide role satisfaction to nurses & admin.
- Allow implementation of the nursing process
- Provide for adequate communication among healthcare providers
what should be known about changing the pt care delivery mode- questions the change agent must ask?
- How will the organization alter autonomy and individual and group decision making?
- How will social interactions and interpersonal relationships change?
- Will employees view their unit of work differently?
- 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 performances, either for self-evaluation or by others?
- Will communication patterns change?
what are common themes in successful care delivery models?
- Elevates the role from caregiver to integrator
- Team approach to interdisciplinary care
- Bridges care to primary care facility
- Defining the home as a setting of care
- Targeting high users of health care
- Intensify the focus on the patient
- Leveraging technology
- Impact satisfaction, quality & cost
what are some new emerging roles?
- Nurse Navigators
Assist & support pts through HCDS
Target clinical settings
New insurance Exchanges - Clinical Nurse Leader
Advanced Generalist
Clinical Leadership (Health care outcomes)
Leader of Interdisciplinary Team - Patient & Family Centered Care
Partnership with pt., family, & HCP
Care focused on needs of patient
what should you know about pt and family centered care?
- Partnership between patients, families, & HCP
- Care organized around needs of patients
- Represent change in paradigm of care
- Innovative approach
- Health care redesign
~ Respectful & responsive
~ Patient values guide DM for care
what should be known about integrating L&M in organizing pt care?
- Organize work
- Group activities
- Implement PCDS that meets goals
- Ensures that PCDS provide quality care & staff satisfaction
- Promote a model that reduces costs & improve patient outcomes
- Select PCDS with adequate resources, justification, & effect on cohesiveness
what is the definition of prioritization?
Prioritization is the organization of activities according to the order in which they should be done.
