Organizing Patient Care Flashcards

1
Q

5 Traditional means of Organizing Nursing and Patient Care

A

Total patient Care

Functional nursing

Team and modular nursing

Primary nursing

Case management

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2
Q

Another name for primary nursing

A

professional practice model

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3
Q

Another name for team nursing

A

partner in care or patient service partners

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4
Q

Total Patient Care

A

Oldest Mode of organizing patient care

“The case method of assignment”

patients are assigned to a caregiver and each caregiver is under a charge nurse

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5
Q

Advantage of total patient care organization

A

provides care givers with high autonomy and responsibility

assigning patients is simple and direct

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6
Q

Disadvantages of total patient care organization

A

each caregiver caring for the patient can theoretically modify the care regimen meaning if there are three shifts then the patient is getting 3 different approaches to care

if a caregiver is inexperienced of inadequately prepared this leads to issues

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7
Q

Functional Nursing

A

method of delivering nursing care and organization

started in WWII

personnel assigned to complete tasks rather than specific patients, and relatively unskilled workers gained task proficiency through repetition

RNs then became managers of care rather than direct care providers (“Care through others”)

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8
Q

Advantage of Functional nursing

A

efficiency - tasks are completed quickly with little confusion regarding responsibilities and allows minimal RN needs

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9
Q

Disadvantage of Functional Nursing

A

can lead to fragmented care and the possibility of overlooking patient priority needs

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10
Q

Team Nursing

A

personnel collaborate in providing care to a group of patients under a direction of a professional nurse

so the charge nurse is above team leaders who direct nursing staff at a specific patient

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11
Q

Advantage of Team Nursing

A

comprehensive care and extensive team communication

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12
Q

Disadvantage of Team Nursing

A

improper implementation rather than the philosophy itself

team leaders have to be excellent practitioners and have good communication, organization, management, and leadership skills

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13
Q

Modular Nursing

A

more modern

mini teams of 2-3 members with at least one member being an RN (Care Pairs)

patients are divided into modules or districts and assignments are based on the geographical location of patients

also try to assign same patients to same team as much as possible

similar to team nursing

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14
Q

Primary Nursing

A

Relationship Based Nursing

A primary nurse has 24 hour responsibility for planning the care of one or more patients from admission to discharge - during work hours the nurse provides total direct care and when not on duty associate nurses follow the primary’s care plan

the primary nurse and patient are then at the center with other personnel like other nurses physicians and such connecting to them

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15
Q

Disadvantage of Primary Nursing

A

Difficult to implement due to degree of responsibility and autonomy needed of the primary nurse

improper implementation preparation or incompetence

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16
Q

Benefit of Primary nursing

A

job satisfaction is high

skills developed well

often feel challenged and rewarded

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17
Q

Interprofessional or Multidisciplinary Health Care Team

A

complex process involving 2 or more health professionals with complementary backgrounds and skills

team members share common health goals in patient care through collaboration, communication, and shared decision making

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18
Q

Primary Health Care Teams (PHCTs)

A

interprofessional teams that include but are not limited opt physicians, NPs, nurses, physical therapists, dentists, occupational therapists, social workers who all work collaboratively to deliver coordinated patient care

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19
Q

Strategies for working with an interdisciplinary health care team

A

know your role and expertise as well as that of your team members

know the end goal / purpose of your interdisciplinary team

communicate compassionately so that all members of the interdisciplinary team feel comfortable voicing their opinions

establish a support structure whereby all members feel like they play an important role

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20
Q

Case Management

A

A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individuals and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes

professional and collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs. It uses communication and availableresources to promote health, quality, and cost-effective outcomes in support of the “Triple Aim” of improving the experience of care, improving the health of populations and reducing per capita costs of health care

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21
Q

What do case managers use to plan patient care

A

critical pathways and multidisciplinary action plans (MAPS)

Maps are combos of nursing care plans and critical pathways

22
Q

Population Based Health Care and Continuous Health Improvement (Disease Management Programs)

A

Comprehensive integrated approach to care and reimbursement of high cost chronic illnesses

disease management = DM

case managers use this and the goal is to address illness or conditions with maximum efficiency across treatment settings regardless of typical reimbursement patterns - this will prevent cost drivers which increase costs over time since early detection and intervention are used

23
Q

The focus of population based health care is…

A

COVERED LIVES (populations of patients rather than on the individual patient)

24
Q

Disease Management programs are efficiency when what happens

A

cost drivers are reduced, whereas patient needs are met

25
Q

Common features of DM programs

A

comprehensive integrated approach to care and reimbursement of common high cost and chronic illnesses

focus on prevention as well as early disease detection and intervention to avoid costly acute care episodes but provide comprehensive care and reimbursement

target population groups rather than individuals

employ a multidisciplinary health care team including specialists

use standardized clinical guidelines - critical pathway reflecting best practice research to guide providers

use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms

frequently employ progression nurses in the role of case manager or program coordinator

26
Q

2 New Emerging Roles in healthcare

A

Nurse Navigators

Clinical Nurse Leaders (CNLs)

27
Q

Common Themes of newer care delivery models

A

elevating the role of nurses and transitioning from caregivers to care integrators

taking a team approach to interdisciplinary care

bridging the continuum of care outside of the primary care facility

defining the home as a setting of care

targeting high users of health care, especially older adults

sharpening focus on the patient including an active engagement of the patient and his or her family in care planning and delivery and a greater responsiveness to the patients wants and needs

leveraging technology

improving satisfaction, quality, and cost

28
Q

Nurse Navigator

A

new role

helps patients and families navigate the complex health care system by providing information and support

helpful in areas like oncology where the nurse helps guide a patient through the course of the illness

needs further definition to set apart from case manager

29
Q

Clinical Nurse Leader (CNL)

A

advanced generalist nurse with a masters in nursing - is a leader in the health care delivery system in all settings in which health care is delivered - practices across settings

NOT A ROLE OF ADMINISTRATION OR MANAGEMENT - assumes accountability for patient care outcomes through the assimilation and application of EBP information to design implement and evaluate patient care processes and models of care delivery

a provider and manager of care at the point of care to individuals and cohorts of patients anywhere healthcare is delivered and plays a key role in collaborating with interdisciplinary teams

30
Q

Historically, nursing has developed models of patient care delivery based on what`

A

societal events like nursing shortages and war rather than on well researched models with proven effectiveness and that promote professional practice

31
Q

Is there one widely accepted definition of case management

A

no it is a specialty practice with no one standardized definition

32
Q

Professional Case Management requires…

A

wisdom, judgment, and critical thinking

33
Q

Before 1983, how did reimbursement work…

A

hospitals were reimbursed per day, there was no concern for length of stay and continuing costs

34
Q

DRG

A

Diagnostic related groups payment system

as standardized payment system that encourages cost containment initiatives

reimbursement by diagnosis not length of stay

occurred in 1983

35
Q

Is national certification required for case management

A

encouraged after 2 years but not required

36
Q

Responsibilities of a Case Manager

A
  1. Medical Necessity for the Patient - Does the patient need to be in the hospital, can the care be done in a less intensive setting, observation vs inpatient, LoS (length of stay)
  2. Provide clinical information to insurance companies (payor) via clinical intelligence software (xsolis)
37
Q

What is done during Assessment of Discharge planning by the CM

A

use current or historical medical records

look at results of tests and procedures

verbal reports from providers, other clinicians, and/or healthcare organizations

patients and/or support systems looked at

38
Q

26 Billion is spent on what regarding acute care medicare patients yearly

A

poor transitions of acute care patients

39
Q

The planning phase of the nursing process for a CM involves

A

discharge and transitions of care

40
Q

Discharge and Transitions of Care Standards

A

process of transferring a patients care from one setting or level of care to another (hospital to home or skilled nursing facility).

Particularly vulnerable points in the health care continuum occur here!!!

41
Q

Discharge planning is initiated…

A

within 24 hours of admission by the case manager and it is reassessed regularly to ensure needs of the patient have not changed

42
Q

Barriers to Discharge Planning

A

patient ability to participate in plan

lack of support network

lack of payor or payor approved services

complexity of the discharge needs-wound care, IVAB, etc

limited availability of resources - skilled nursing facilities, home care, etc

43
Q

Implementation and Evaluation of discharge planning means you have to ID patients at risk for poor transitions by looking at what?

A

the 6 social determinants of health

44
Q

6 Social Determinants of Health

A

Financial limitations

poor health literacy

housing and food insecurity

lack of social support

unreliable transportation

unhealthy behaviors

45
Q

Task for the CM during the implantation phase of discharge planning

A

Complete a comprehensive transition assessment:

review health utilization and insurance benefits

patient, family, caregiver goals and potential care needed are looked at

evaluate and document patient, family, caregiver understanding

assess self management abilities and activity’s of daily living (ADLs)

ID designated decision maker and advanced directives

46
Q

What is highly important to do for the CM before discharge

A

accurate review of medications on admission and discharge and changes as well as doses

47
Q

Tasks involved in establishing a care management plan

A

send referrals online to home care/skilled nursing facilities

arrange equipment needed; oxygen, wound vac, IVAP, BiPap

Assistance providing medications if needed - meds to beds, transitional care pharmacist

48
Q

What is important for the CM to do across the continuum of care

A

communicate essential care transition information to key stakeholders like pharmacy, physicians, EMS, palliative care, home care, community support, long term care, etc

make follow up appointments, insurance approval, provide needed documentation etc

49
Q

Challenges for CM in the COVID-19 Pandemic

A

availability of safe care environments

transportation issues

prevention of exposures to other people and communities

timely access to care

staffing shortages

surge capacity

patient throughput

social media misinformation

lack of education on spread of disease and vaccines

fear

isolation

50
Q

Hospital Care at Home Program

A

prevents or decreases number of days in the hospital

improves hospital throughput

daily virtual visits with a provider

nurse navigator calls daily

provides O2, EKG, X ray, Labs, Pulse Ox, Med management, patient monitoring, virtual visits, and understanding of CDC guidelines and quarantine protocols