Delivering Nursing Care

1. 3 Delivering Nursing Care

2. Learning Outcomes • Describe how the delivery system structures nursing care. • Describe what types of nursing care delivery systems exist. • Discuss the positive and negative aspects of different systems.

3. Learning Outcomes • Describe evolving types of delivery systems that have emerged. • Explain characteristics of effective delivery systems.

4. Nursing Care Delivery Systems • Provide structure for delivering care • Delivery of care includes: • Assessing care needs • Formulating plan of care • Implementing plan • Evaluating patient's responses

5. Nursing Care Delivery Systems • Pros and cons debated • Must optimize nurse’s knowledge, skills • Ensure that patients receive appropriate care • Lower mortality rates in hospitals with good environments for nurses

6. Functional Nursing • RNs, LPNs, and UAPs are assigned different tasks • RNs assess patients • Other staff give baths, make beds, take vital signs, and administer treatments

7. Figure 3-1 Functional nursing.

8. Functional Nursing • Advantages • Staff become efficient at performing assigned tasks • Disadvantages • Uneven continuity • Lack of holistic understanding of patient • Problems with follow-up

9. Team Nursing • Team of nursing personnel provides total care to a group of patients by diagnosis or provider services. • RN leads team • May include other RNs, LPNs, and UAPs • Leaders must be skilled in delegating, communicating, and problem solving • All members of effective teams are good communicators

10. Team leader time spent in indirect pt care e.g.: • Developing or updating nsg care plan • Resolving problems encountered by team members. • Conducting nsg conferences • Communicating with physicians and other care providers

11. Figure 3-2 Team/modular nursing.

12. Team Nursing • Advantages • LPNs and UAPs perform tasks that do not require RN's expertise • Care is more easily coordinated • Saves steps and time

13. Team Nursing • Disadvantages • Time needed for communicating, supervising, and coordinating team members • Affect of changes in team leaders, members, and assignments on continuity of care • Total patient not considered by any one person

14. Team Nursing • Disadvantages • Role confusion and resentment • Less control for nurses over assignments • Possibility of unequal assignments

15. Figure 3-3 Total patient care.

16. Total Patient Care • RN is responsible for all aspects of care for one or more patients

17. Total Patient Care • Advantages • Continuous, holistic, expert nursing care • Total accountability • Continuity of communication • Disadvantages • RNs perform tasks that could be done more cost-effectively by less skilled persons

18. Primary Nursing • RN designs, implements, and is responsible for nursing care for duration of the patient's stay on the unit

19. Figure 3-4 Primary nursing.

20. Primary Nursing • Advantages • Knowledge-based practice model • Decentralization of decisions, authority, and responsibility • 24-hour accountability • Improved continuity and coordination of care • Increased nurse, patient, and physician satisfaction

21. Primary Nursing • Disadvantages • Excellent communication required • Accountability of associate nurses • Patient transfers disrupt continuity of care • Compensation and legal responsibility for staff nurses • Unwillingness of associates to take direction

22. Practice Partnerships • RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients

23. Figure 3-5 Practice partnerships.

24. Practice Partnerships • Advantages • Improved continuity of care and accountability for care • Disadvantages • Decreased ratio of RNs to nonprofessional staff • Potential for junior team members to assume too much responsibility

25. Case Management • Is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within specific period of time • Case manager supervises the care provided by licensed and unlicensed nursing personnel • Critical pathways provide direction for managing care of specific patients

26. Nsg case management requires • Collaboration of all members of the health care team • Identification of expected patient outcomes within specific time frame • Use of principles of continuous quality improvement • Promotion of professional practice

27. Figure 3-6 Case management.

28. Case Management • Advantages • All professionals equal team members • Members take ownership of patient outcomes • Disadvantages • Requires qualified nurse case manager, team collaboration, and quality management system • Established critical pathways needed

29. Critical Pathways • Provide care strategies to achieve expected outcomes • Used in case management system • Include ways to identify variances easily and whether outcomes have been met

30. Critical Pathways • Advantages • Accommodate unique characters, conditions of patients • Reduce costs • Disadvantages • May need revision

31. Differentiated Practice • Structure of roles and functions differentiated by nurses' education, experience, and competence • Roles, responsibilities, and tasks defined for professional nurses, LPNs, and UAPs

32. Differentiated Practice • Maximizes nursing resources • Defined scope of practice and level of responsibility

33. Patient-Centered Care • Nurse coordinates a team of multifunctional, unit-based caregivers • All patient care services are unit-based • Focused on: • Decentralization • Promotion of efficiency and quality • Cost control

34. Patient-Centered Care • Advantages • Promotes efficiency, quality, and cost control • Disadvantages • Requires considerable time for nurse manager • Demands a strong leader to manage staff

35. Synergy Model of Care • Patient characteristics and nurse competencies match • Meets standards for Magnet certification

36. Pt ch:ch include: • Resiliency, vulnerability, stability, complexity, resource availability • participation in care, participation in decision making, predictability

37. The chch of pt should match with nurse competencies • Clinical judgment • Advocacy and moral agency • Caring practice, collaboration, systems thinking, response to diversity, facilitation of learning, clinical inquiry

38. Clinical Microsystems • Small unit of care that maintains itself • Dynamic, interactive, self-aware, and interdependent • Proven to improve teamwork, communication, and continuity of care

39. Evolution of Models for Delivering Care • No system perfect or permanent • Change caused by: • Reimbursement changes • Demands for quality • Technologicial changes

40. Using the System Effectively • Communication skills • Ability to delegate • Problem-solving skills