Test 3 Flashcards
These are the operational mechanisms by which care is actually provided to the client.
models of care delivery
These models have a conceptual framework and philosophy under which the method of delivery of nursing care is a component.
professional practice models
Whose model?
A transpersonal caring relationship corresponds to protecting, enhancing, and protecting, enhancing, and preserving the person’s dignity, humanity, wholeness, and inner harmony.
watson’s caring model
Whose model?
The core concept of the model is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit, or system are matched with a nurse’s competencies.
hardin & kaplow’s synergy model
this is a method of organizing and delivering care to patients and families to achieve desired outcomes
care delivery model
name the 5 nursing models of care
private duty functional team primary case management
- oldest care model
- one nurse caring for one patient
- Great Depression ended most of these jobs
private duty
___ nursing focused on task accomplishment rather than individualized and holistic care. nurses came to work and provided a task such as a “medication nurse” or a “temperature nurse”.
functional
- 1914
- time and motion studies
- economic incentives to get the highest grade of work from the worker.
scientific management theory
this is a delivery of care approach that provides care to a group of clients by coordinating a team of RNs, LPNs, nurses’ aides under the supervision of one nurse called a ___ leader.
team
- developed in 1950’s
- under the supervision of one nurse
- advantage: each member’s capabilities can be used to the maximum.
- oversight of novice nurses & temporary personnel can be facilitated.
- provides care delivery with a limited # of RN’s.
team nursing
this is another type of team nursing based on the physical environmental change of hospitals to module configurations.
modular nursing
___ nursing is an approach in which a nurse has responsibility and accountability for continuous guidance through planning, delivering, and monitoring care of specific clients from admission to discharge.
primary nursing
- 1970’s
- studies found a higher quality of nursing care, higher levels of nurse satisfaction, increased continuity of care, improved nurse retention, and positive client outcomes with ___ nursing. levels of client satisfaction were equal and cost comparisons were inconclusive between the team and this type of nursing.
primary nursing
- pressures for cost containment in the 1990’s lead to the demise of this type of nursing care models.
- shortened lengths of stay
- increased client severity
primary nursing
this is the care coordination to achieve specific client outcomes
case management
- a system of client care delivery that focuses on the achievement of client outcomes within effective and appropriate time frames and resources.
- 1895 Lillian Wald and Mary Brewster
- George Welch of CIGNA-1966
case management
______ care refers to a system-a reimbursement strategy.
managed care
- a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location.
- focus on reducing re-hospitalization rates and enhancing post-discharge care.
transition of care
a ___ is an outline or diagram that documents the process of diagnoses or treatment deemed appropriate for a condition based on practice guidelines.
critical pathway
what’s the 4 steps in case management process?
assessment
planning
facilitation
advocacy
Case Management Process:
____ needs to cover health behaviors, cultural influences, and belief and values systems, negotiating realistic goals.
assessment
Case Management Process:
___ - do this with client, family, health care providers, payers, community. Reevaluation on going. Contingency plans.
planning
Case Management Process:
___-communication, coordination, education
facilitation
Case Management Process:
___-client empowerment, autonomy, self-determination
advocacy
what are the measurements of case management success?
clinical outcomes and financial outcomes
- hospital-based nursing case management.
- client-centered with plans, timeline, and critical paths for the hospital stay.
- outcome focused.
- care team meetings for more-than-acceptable variance.
New England medical center model
- primary goal of the Nursing HMO is to increase the likelihood that clients will receive the right services in proper sequence.
- continuum: hospital to community.
- nurse case managers have a long term relationship with the clients.
Arizona model
this is a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.
disease management
case management vs _____
individual client vs _____
disease management
population group
the discrepancy between the supply and demand for RN’s.
nursing shortage
the number of nurses who left a unit in 1 year compared (divided) to the total number of nurses employed on that unit. it creates a demand.
turnover
explain the current nursing shortage.
-aging of current nurses in the workforce.
-lower numbers of students entering nursing as a career.
-aging of nursing faculty and inability of schools of nursing to meet education demands.
-demand for care by aging U.S. population.
changing health care delivery system
what are strategies to INCREASE supply of nurses?
education-related, regulatory and policy issues, work environment-related strategies
what are some strategies to DECREASE demand for nursing services?
-strengthening primary prevention (NP are really who’s gonna do this).
-improving chronic disease management.
-adopting different delivery of care models.
increasing use of technology, research, and innovation.
what is the single most important asset in any healthcare organization?
staff (RNs)
explain the cost of retention:
- decrease demand for nurses.
- recruitment and hiring expenses.
- dollars wasted on training and development.
- decreased productivity and increased error.
- lost opportunities to improve processes.
- poor staff morale
- dissatisfied customers
cost of retention:
how much does it cost to replace a med/surg nurse?
how much does it cost to replace a speciality nurse?
$42,000
$64,000 (15 years ago)
A decrease in staff turnover produces ______ (decrease or increase) in patient days or length of stay, and a _____ (decrease or increase) in mortality index.
decrease;decrease
Retention:
Hospitals with a high turnover (22%+) have a ___% higher cost per discharge than hospitals with a turnover of 12% of less.
36%
Results from article:
with every increase of a hospital’s staffing level, there was a __% increase in burnout and a ___% increase in job dissatisfaction.
23;15
results from article:
__% of nurses who report high burnout and are dissatisfied with their jobs intend to leave their current job within the next 12 months.
43%
results from article:
__% of nurses who are not burned out and who remain satisfied with their jobs intend to leave.
11%
what were the control variables in the article study?
size, teaching status, technology
describe the patient sample from the article.
232,342 paitents–> 20 yrs-85 yrs
- general surgical, orthopedic, (and vascular procedures is crossed out)
- 168 hospitals
- between april 1st, 1998 and november 30, 1999.
results from article:
___% experience a major complication.
__% died within 30 days of admission.
the odds of patient mortality ____(increased or decreased) by 7% for every additional patient in the average nurse’s work load.
23.2% ; 2%
which of the following statements is false with regard to care coordination?
A. care coordination is a part of every nursing role.
B. care coordination is a component of all case management models.
C. care coordination involves advocating for the necessary and appropriate care for patients.
D. care coordination is only a function of case managers.
D. care coordination is only a function of case managers.
A case manager develops a document that outlines the care and expected outcomes that must occur during recovery from coronary artery bypass graft surgery. This is an example of: A. case management B. disease management C. care coordination D. clinical pathway
D. clinical pathway
Patient-Nurse ratios affect ___.
nurse retention.
most important: nurse-patient ratio is what’s gonna keep your nurses.
describe the patient workforce management. (3 steps)
- establish an overall vision of a patient care delivery model.
- identify the needs of the patients being cared for and the required nurse interventions to meet these needs.
- creation of a core staffing schedule.
what’s the problem with a staffing grid?
no homogenous patients
the goal of this system is to provide the most valid and reliable information specific to work that needs to be done for patients.
patient classification system
what are some (5) problems with patient classification?
- low validity-failure to account for the full scope of nursing practice, specifically the relational work of nursing.
- lack of trust.
- difficulty in projecting future staff needs.
- failure to use the data generated (acuity creep-nurses creep up their acuity number).
- lack of tool simplicity.
a structured approach to the process of identifying and allocating unit-based personnel resources in the most effective and efficient manner.
staffing management plan
the proportion of direct care RN’s to total nursing staff expressed as a percentage of RN’s/ total nursing staff.
skill mix
___ staffing has a positive impact on teamwork and the ___ shifts have a negative impact on teamwork.
consistent staffing; multiple shifts
too many variations in staff shifts leads to…
patient and staff dissatisfaction
explain ANA Principles for nursing staffing:
Staff:
needs of patients determine clinical competency required for nursing practice in that area.
RN’s must have representation at the operational and executive levels.
Clinical support from experienced RN’s must be available to RN’s with less proficiently.
ANA Principles for nursing staffing:
Organization:
organizational policy should reflect human resources as strategic assets and positions should be filled in a timely manner.
institutions should have documented competencies for nursing staff.
organizational policies should reflect the needs of patients and nursing staff.
Time management tips
take 15-20 minutes each day to plan.
read the syllabus as soon as you get it and note all due dates on your calendar.
develop a list of things to do.
do high-priority items first.
split large tasks into more manageable tasks.
don’t wait until the last minute to complete your projects.
how do you determine how many hours you need to study each week?
study two hours per hour in class for an easy class, three hours per hour in an average class, and four hours per hour in class for a difficult class.
