Delivering Nursing Care LMReport

Delivering Nursing Care

BSN IV-6Group 2

Topics

Traditional Models of CareFunctional Nursing (mid1940s)Team Nursing (late1940sTotal Patient CarePrimary Nursing

Topics Integrated Models of Care

Practice PartnershipsCase ManagementCritical PathwaysDifferentiated PracticePatient- Centered CareClinical MicrosystemsOther Innovative Systems

Traditional Models of Care

Functional Nursing

First developed in the 1940’s during a nursing shortage.

This involves the division of tasks with one nurse assuming responsibility for certain tasks (e.g. hygiene and nursing therapies) while another nurse assumes responsibility for others (e.g. medication administration)

Nurses tend to become highly competent with the tasks that are repeatedly assigned to them

Is task focused, not client focused. Communication is not always clear, since no

one nurse is responsible for the overall care of the client.

Functional Nursing

Because of the disadvantages mentioned, this model is used infrequently in acute care facilities and only occasionally in long-term care facilities.

Functional Nursing

Team Nursing Uses a variety of personnel (professional,

technical and unlicensed assistants) in the delivery of nursing care

The registered nurse is leader of the team and is responsible for supervision of the team, as well as planning and evaluating the results of care giving activities.

Classification of pt: diagnoses/ provider services

This management system uses professional nurses for skilled observations and interventions and provision of direct care to acutely ill clients, while licensed practical nurses care for less acutely ill clients, and nursing assistant is responsible in making beds, serving trays and assisting the nurses with other task.

Team Nursing

Advantages: It allows the LPN’s and UAP’s to carry out

some functions that do not require the expertise of an RN

Allows patient care needs more than one staff member ( ex. Patient transfer)

The geographical boundaries saves steps and time

Team Nursing

DisadvantagesTime for communication, supervision and

coordination of team membersContinuity of care may suffer due to changes in

leaders, team members and patient assignments.No one person considers the total patientRole confusion and resentment against the team

leader (seems to be more focused on paperwork)

Functional Nursing

DisadvantagesNurses have less control over their

assignments due to the geographical boundaries of the unit

Assignments may not be equal and monotonous

Functional Nursing

Total Patient Care (Case Method)

Original model of nursing care delivery The nurse works directly with the client,

family, physician and health team members. The model typically has a shift based focus. The same nurse does not necessarily care from shift to shift or day today, this can be a problem if staff do not clearly communicate client needs to one another.

AdvantagesContinuous, holistic, expert nursingTotal accountability for the nursing care of the

assigned patientContinuity of communication with the pt,

family, physician and staff from other department


DisadvantageRN’s spends more time doing tasks that can

be done by less skilled persons


Was developed with the aim of placing RN.s at the bedside and improving the professional relationship between staff

Is a model of care delivery that focuses on the relationships between an RN and his clients.

An RN assumes responsibility for a caseload of clients over time. He selects the clients for his caseload and cares for the same clients during their hospitalization or stay in a health care setting.

The RN assesses the client’s needs, develops a plan of care and ensures that nursing interventions are delivered. In the absence of the primary nurse, associate nurses (e.g. other RNs) follow the prescribed nursing plan of care. If there are differences in opinion as to client needs, associates and primary nurses collaborate to modify the plan.

AdvantagesKnowledge-based practice modelDecentralization of nursing care decisions,

and responsibility to the staff nurse24 hour accountabilityContinuity and coordination of care Increased patient, nurse and physician

satisfaction

DisadvantagesRequires excellent communication bet. Primary and

associate nursePrimary nurse must be able to hold assoc. Nurse

accountable for implementing nursing care as prescribed

Transfers to different unit disrupts continuity of care inherent to the model

Staff nurses are neither compensated nor legally responsible for patient care outside their hours of work

Disadvantages Associates may be unwilling to take

direction from the primary nurse

Integrated Models of Care

Practice Partnership

Introduced by Marie Manthey (1989) RN and an assistant agree to work as

partners Partners work together at the same

schedule and same group of patients Senior partner delegates task less

specialized activities to the junior partner

Compared to Team Nursing:PP offers more continuity of care and

accountability of for pt care Compared to total Nursing care/ Primary

Nursing:PP is less expensive and more satisfying

professionally to the partners

DisadvantagesOrganizations tend to increase the number of

UAPs and decrease the ratio of professional nurses to non-professional staff

There is a potential for the junior member to assume more responsibility than appropriate

Case Management Is a care delivery approach that coordinates

and links health care services to clients and their families, assuming responsibilities from admission through and following discharge.

Is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within a specified period of time

Requirements

Collaboration of all members of the healthcare team

Identification of expected patient outcomes within specific time frames

Use of principles of continuous quality improvement and variance analysis

Promotion of professional practice

A case manager coordinates a client’s acute care in the hospital and then may follow the client’s once he or she is discharged home. Case manager may not provide direct care, instead they collaborate and supervise the care delivered by other staff members.

Five Elements of Successful ImplementationSupport by key members of the organization

(administrators, physicians, nurses)A qualified case managerCollaborative practice teamsA quality management systemEstablished critical pathways (next report)

CASE MANAGEMENT

PRESENTED BY: JOANA MARIE M. ESCUMBIEN

NURSING CASE MANAGEMENT Is a model for identifying, coordinating, and

monitoring the implementation of services needed to achieved desired patient care outcomes within a specified period of time. Nursing case management organizes patient care by major diagnosis – related groups (DRGs) and focuses on attaining predetermined patient outcomes within specific time frames and resources.

Nursing case management requires: Collaboration of all members of the

heaslth care team Identification of expected patient

outcomes within specific time frames Use of principles of continuous quality

improvement (CQI) and variance analysis

Promotion of professional practice

5 elements are essential to successful implementation of case mangement: Support by key members of the

organization (administrator, physician, nurses)

A qualified nurse case manager Collaborative practice teams A quality management system Established critical pathways

CRITICAL PATHWAYS

Critical pathways

• Also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency.

Critical pathways

Successful case management relies on critical pathways to guide care.

The term critical path, also called a care map, refers to the expected outcomes and care strategies developed by the collaborative practice team.

Interdisciplinary consensus must be reached and specific, measurable outcomes determine.

Critical Path

• Provide direction for managing• Useful

– They accommodate the patient and patient’s condition.

• Use resources– Care needed to reduce cost and length of stay.

• Use in every setting where health care is delivered.

Prepared by:Beverly M. Espinosa

Is a method that maximizes nursing resources by focusing on the structure of roles and functions of nurses according to their education, experience, and competence.

Designed to identify distinct levels of nursing practice.

Patient Centered Care

The role of the nurse is broadened to coordinate the team of multifunctional unit-based caregivers

The focus of this model is decentralization, promotion of efficiency and quality and cost control

The number of caregivers at the bedside is reduced but their responsibilities are increased

Patient Centered Care

A typical team consists of:RNPatient care associates or techniciansUnit Support AssistantsAdministrative Personnel

CLINICAL MICROSYSTEMS

BY: Katherine Francisco

Clinical Microsystems are recent addition to care delivery structures. Clinical Microsystems evolved from the belief that decision making is best given to those involved in the smallest unit of care. Thus, a clinical Microsystems is a small unit of care that maintains itself over time.

The clinical Microsystems is being viewed as a positive change in nursing care delivery systems. Top performing units are dynamic, interactive, self aware, interdependent, and led by skilled leaders. A large neonatal intensive care unit developed a Microsystems approach and found a positive effect on patients and staff alike. Specifically, the model improved teamwork, communication, and continuity of care in a 40-bed unit.

WESLEYAN UNIVERSITY- PHILIPPINESCABANATUAN CITY

COLLEGE OF NURSING

10 Essential Elements10 Essential Elementsof TCMof TCM

1. The transitional care nurse (TCN), a master’s prepared nurse with advanced knowledge and skills in the care of this population, as the primary coordinator of care to assure continuity throughout acute episodes of care;

2. In-hospital assessment, collaboration with team members to reduce adverse events and prevent functional decline, and preparation and development of a streamlined, evidenced-based plan of care;

3. Regular home visits by the TCN 3. Regular home visits by the TCN with available, ongoing telephonewith available, ongoing telephonesupport (seven days per week) support (seven days per week) through an average of two monthsthrough an average of two monthspost-discharge;post-discharge;

4. Continuity of medical care 4. Continuity of medical care between hospital and primary care between hospital and primary care providersprovidersfacilitated by the TCN accompanying facilitated by the TCN accompanying patients to first follow-up visit(s);patients to first follow-up visit(s);

5. Comprehensive, holistic focus on 5. Comprehensive, holistic focus on each patient’s goals and needseach patient’s goals and needsincluding the reason for the primary including the reason for the primary hospitalization as well as otherhospitalization as well as othercomplicating or coexisting health complicating or coexisting health problems and risks;problems and risks;

6. Active engagement of patients 6. Active engagement of patients and family caregivers with focus onand family caregivers with focus onmeeting their goals;meeting their goals;

7. Emphasis on patients’ early 7. Emphasis on patients’ early identification and response to health identification and response to health care risks and symptoms to achieve care risks and symptoms to achieve longer term positive outcomes andlonger term positive outcomes andavoid adverse and untoward events avoid adverse and untoward events that lead to readmissions;that lead to readmissions;

8. Multidisciplinary approach that 8. Multidisciplinary approach that includes the patient, family includes the patient, family caregivers and health care providers caregivers and health care providers as members of a team;as members of a team;

9. Physician-nurse collaboration 9. Physician-nurse collaboration across episodes of acute care; andacross episodes of acute care; and

10. Communication to, between, 10. Communication to, between, and among the patient, family and among the patient, family caregivers,caregivers,and health care providers.and health care providers.

Delivering Nursing Care LMReport

Documents