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Clinical Organization and Process Integration
Overview of Transitions in Structures and Processes <ul><li>Internal structures and processes are often influenced by exte...
The NHA’s Role <ul><li>Understand clinical and adjunct operations </li></ul><ul><li>Take a “hands on” approach in coordina...
Objectives of Process Integration <ul><li>Build a multidisciplinary team that interfaces in all aspects of holistic care d...
Main Components of Integrated Processes <ul><li>Overarching human factors </li></ul><ul><li>Socio-residential component </...
Outcomes of Integrated Processes <ul><li>A total living environment is created </li></ul><ul><li>A patient’s physical, men...
Parson’s Sick-Role Model and Its Implications <ul><li>Relinquish individual control </li></ul><ul><li>Comply with directiv...
Socio-Residential Orientation <ul><li>Control is shared between patients and caregivers </li></ul><ul><li>Medical and nurs...
Total Living Environment of  Holistic Care <ul><li>Each resident’s physical, mental, social, and spiritual needs are addre...
Objectives That Guide the Creation of a Total Living Environment  <ul><li>Holistic health </li></ul><ul><li>Maximized qual...
The Realistic Context - 1 <ul><li>Nursing facilities must function as efficient organizations </li></ul><ul><li>Seeking ef...
  The Realistic Context - 2 <ul><li>Patient autonomy must be pursued, but this pursuit can also be vexatious </li></ul><ul...
Self-Contained Nursing Units <ul><li>Nursing stations </li></ul><ul><li>Bathing rooms </li></ul><ul><li>Dining rooms </li>...
  Nursing Units: Organization <ul><li>To the extent possible, designate units according to clinical criteria, specializati...
Advantages of a Distinct  Non-certified Unit <ul><li>Upgraded amenities can be offered without concern for discrimination ...
Odor Control <ul><li>Enclosed soiled-utility areas </li></ul><ul><li>Removal of heavy wastes from linens </li></ul><ul><li...
Nursing Station <ul><li>Hub of clinical care </li></ul><ul><li>Centrally located to serve a nursing unit </li></ul><ul><li...
Staffing <ul><li>Minimum staff-to-patient ratios are specified by state licensing regulations </li></ul><ul><li>Regulation...
Staffing Considerations <ul><li>Case-mix </li></ul><ul><li>Skill-mix </li></ul><ul><li>Training </li></ul><ul><li>Matching...
Nursing Station Furnishings <ul><li>Call signals </li></ul><ul><li>Medical records </li></ul><ul><li>Pharmaceuticals </li>...
Controlled Substances <ul><li>Governed by the Controlled Substances Act </li></ul><ul><li>Possession and use is illegal ex...
Social Aspects <ul><li>Personal domain </li></ul><ul><li>Public domain </li></ul>
Personal Domain <ul><li>Security </li></ul><ul><li>Autonomy </li></ul><ul><li>Privacy </li></ul>
Security <ul><li>Physical safety </li></ul><ul><li>Freedom from risk, danger, and anxiety </li></ul><ul><li>Safekeeping of...
Autonomy <ul><li>Balancing dependency against self-determination </li></ul><ul><li>Promoting patient rights </li></ul><ul>...
Privacy <ul><li>Privacy of space, time, and person </li></ul><ul><li>Intimacy </li></ul><ul><li>Accommodation of individua...
Public Domain <ul><li>Compatibility </li></ul><ul><li>Dining </li></ul><ul><li>Socializing </li></ul>
Compatibility <ul><li>Room sharing </li></ul><ul><li>Dining </li></ul><ul><li>Other social activities </li></ul><ul><li>Bo...
Dining <ul><li>Making it a social event </li></ul><ul><li>Seating arrangements </li></ul><ul><li>Clinical and social dinin...
Socializing <ul><li>Personal interests </li></ul><ul><li>Social events </li></ul><ul><li>Interior and exterior spaces </li...
Residential Features <ul><li>Homelike </li></ul><ul><li>Design, furnishings, décor </li></ul><ul><li>Emphasis on social st...
Modern Architectural Features <ul><li>Small private rooms </li></ul><ul><li>Elimination of long corridors </li></ul><ul><l...
Cluster Design <ul><li>Replaces the traditional corridors </li></ul><ul><li>Clusters are small residential units (househol...
Nested Single-Room Design <ul><li>A special design that enables small private rooms to be “nested” to conserve space and c...
Safety <ul><li>Federal, state, and local building codes </li></ul><ul><li>Life Safety Code </li></ul><ul><li>Safety practi...
Americans with Disabilities Act (ADA) of 1990 <ul><li>Public accommodations include nursing homes </li></ul><ul><li>Requir...
Other Residential Features <ul><li>Wayfinding </li></ul><ul><li>Enhanced environments </li></ul><ul><li>Positive stimulati...
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Clinical Orientation Powerpoint

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Clinical Orientation Powerpoint

  1. 1. Clinical Organization and Process Integration
  2. 2. Overview of Transitions in Structures and Processes <ul><li>Internal structures and processes are often influenced by external forces </li></ul><ul><li>Contemporary nursing homes are transitioning from hospital-inspired clinical designs to residential models </li></ul><ul><li>Emphasis on client-centered care that integrates layout and design with empowering residents, families, and staff </li></ul>
  3. 3. The NHA’s Role <ul><li>Understand clinical and adjunct operations </li></ul><ul><li>Take a “hands on” approach in coordinating clinical and adjunct processes </li></ul><ul><li>Develop an organizational culture of interdepartmental communication and cooperation </li></ul>
  4. 4. Objectives of Process Integration <ul><li>Build a multidisciplinary team that interfaces in all aspects of holistic care delivery </li></ul><ul><li>Address all aspects of a patient’s needs without duplicating or disregarding any needed services </li></ul><ul><li>Achieve the highest practicable level of well-being for each patient </li></ul>
  5. 5. Main Components of Integrated Processes <ul><li>Overarching human factors </li></ul><ul><li>Socio-residential component </li></ul><ul><li>- Room and board </li></ul><ul><li>- Amenities </li></ul><ul><li>Clinical component </li></ul>
  6. 6. Outcomes of Integrated Processes <ul><li>A total living environment is created </li></ul><ul><li>A patient’s physical, mental, social, and spiritual needs are met </li></ul>
  7. 7. Parson’s Sick-Role Model and Its Implications <ul><li>Relinquish individual control </li></ul><ul><li>Comply with directives </li></ul><ul><li>Rigid daily routines and “blocking routines” </li></ul><ul><li>Social distance between staff and patients </li></ul><ul><li>The model is inappropriate for care delivery in nursing homes (compare with the integrated model on p. 175) </li></ul>
  8. 8. Socio-Residential Orientation <ul><li>Control is shared between patients and caregivers </li></ul><ul><li>Medical and nursing care needs are addressed in homelike setting </li></ul><ul><li>Residents’ quality of life is maximized </li></ul><ul><li>Structures and processes are designed to support the needs of both residents and their families </li></ul>
  9. 9. Total Living Environment of Holistic Care <ul><li>Each resident’s physical, mental, social, and spiritual needs are addressed </li></ul><ul><li>Efficient delivery of clinical care is achieved while emphasizing individual pursuits and social interaction </li></ul><ul><li>Overarching human factors govern clinical and socio-residential services </li></ul><ul><li>Residential structures are designed to support clinical and social services in a homelike environment </li></ul>
  10. 10. Objectives That Guide the Creation of a Total Living Environment <ul><li>Holistic health </li></ul><ul><li>Maximized quality of life </li></ul><ul><li>The environment itself must promote healing of the body, mind, and spirit </li></ul>
  11. 11. The Realistic Context - 1 <ul><li>Nursing facilities must function as efficient organizations </li></ul><ul><li>Seeking efficiency will dilute social and residential aspects to some extent </li></ul><ul><li>Neither the individual patient nor the society can afford the cost of private-duty care for everyone </li></ul><ul><li>Small-scale conflicts are likely to occur in group living environments </li></ul>
  12. 12. The Realistic Context - 2 <ul><li>Patient autonomy must be pursued, but this pursuit can also be vexatious </li></ul><ul><li>Some level of dependency in a patient is unavoidable </li></ul><ul><li>Adaptation to change does not follow any standard formula </li></ul><ul><li>Different patients’ needs and desires often conflict </li></ul>
  13. 13. Self-Contained Nursing Units <ul><li>Nursing stations </li></ul><ul><li>Bathing rooms </li></ul><ul><li>Dining rooms </li></ul><ul><li>Lounges </li></ul><ul><li>Clean linen closets </li></ul><ul><li>Soiled-utility areas </li></ul>
  14. 14. Nursing Units: Organization <ul><li>To the extent possible, designate units according to clinical criteria, specialization, or complexity </li></ul><ul><li>Match staff skills to patient care needs </li></ul><ul><li>To the extent possible, segregate patients with cognitive impairments or behavioral problems </li></ul>
  15. 15. Advantages of a Distinct Non-certified Unit <ul><li>Upgraded amenities can be offered without concern for discrimination </li></ul><ul><li>The unit is sheltered from certification surveys </li></ul>
  16. 16. Odor Control <ul><li>Enclosed soiled-utility areas </li></ul><ul><li>Removal of heavy wastes from linens </li></ul><ul><li>Linen is deposited in containers with tight closing lids </li></ul><ul><li>Proper ventilation of utility rooms </li></ul><ul><li>Proper sanitation </li></ul>
  17. 17. Nursing Station <ul><li>Hub of clinical care </li></ul><ul><li>Centrally located to serve a nursing unit </li></ul><ul><li>Located to provide adequate supervision </li></ul>
  18. 18. Staffing <ul><li>Minimum staff-to-patient ratios are specified by state licensing regulations </li></ul><ul><li>Regulations do not suggest adequate staffing </li></ul><ul><li>Regulatory staffing levels are arbitrary because they are not based on case-mix </li></ul>
  19. 19. Staffing Considerations <ul><li>Case-mix </li></ul><ul><li>Skill-mix </li></ul><ul><li>Training </li></ul><ul><li>Matching skill-mix to case-mix </li></ul><ul><li>Distribution of staff hours between the three shifts </li></ul>
  20. 20. Nursing Station Furnishings <ul><li>Call signals </li></ul><ul><li>Medical records </li></ul><ul><li>Pharmaceuticals </li></ul>
  21. 21. Controlled Substances <ul><li>Governed by the Controlled Substances Act </li></ul><ul><li>Possession and use is illegal except when medically prescribed by a physician </li></ul><ul><li>Doubled-locked storage </li></ul><ul><li>Recordkeeping and verification </li></ul><ul><li>Destroyed when no longer prescribed </li></ul>
  22. 22. Social Aspects <ul><li>Personal domain </li></ul><ul><li>Public domain </li></ul>
  23. 23. Personal Domain <ul><li>Security </li></ul><ul><li>Autonomy </li></ul><ul><li>Privacy </li></ul>
  24. 24. Security <ul><li>Physical safety </li></ul><ul><li>Freedom from risk, danger, and anxiety </li></ul><ul><li>Safekeeping of personal property </li></ul>
  25. 25. Autonomy <ul><li>Balancing dependency against self-determination </li></ul><ul><li>Promoting patient rights </li></ul><ul><li>Protecting each patient from infringement of rights </li></ul><ul><li>Personalizing individual spaces </li></ul><ul><li>Allowing informed choices </li></ul>
  26. 26. Privacy <ul><li>Privacy of space, time, and person </li></ul><ul><li>Intimacy </li></ul><ul><li>Accommodation of individual preferences </li></ul><ul><li>Freedom from unwanted intrusion </li></ul><ul><li>Dignity </li></ul>
  27. 27. Public Domain <ul><li>Compatibility </li></ul><ul><li>Dining </li></ul><ul><li>Socializing </li></ul>
  28. 28. Compatibility <ul><li>Room sharing </li></ul><ul><li>Dining </li></ul><ul><li>Other social activities </li></ul><ul><li>Bonding with other residents, volunteers, and staff </li></ul>
  29. 29. Dining <ul><li>Making it a social event </li></ul><ul><li>Seating arrangements </li></ul><ul><li>Clinical and social dining areas </li></ul><ul><li>Dining environment </li></ul>
  30. 30. Socializing <ul><li>Personal interests </li></ul><ul><li>Social events </li></ul><ul><li>Interior and exterior spaces </li></ul><ul><li>Seating arrangements </li></ul>
  31. 31. Residential Features <ul><li>Homelike </li></ul><ul><li>Design, furnishings, décor </li></ul><ul><li>Emphasis on social structures </li></ul><ul><li>Safety and accessibility </li></ul>
  32. 32. Modern Architectural Features <ul><li>Small private rooms </li></ul><ul><li>Elimination of long corridors </li></ul><ul><li>Neighborhood living arrangements </li></ul><ul><li>Connection of indoor and outdoor spaces </li></ul><ul><li>Cluster design </li></ul><ul><li>Nested single-room design </li></ul>
  33. 33. Cluster Design <ul><li>Replaces the traditional corridors </li></ul><ul><li>Clusters are small residential units (households, neighborhoods) </li></ul><ul><li>8 to 12 private rooms per cluster </li></ul><ul><li>2 to 4 clusters per nursing unit </li></ul><ul><li>Each cluster is self-contained for the delivery of services which increases efficiency </li></ul>
  34. 34. Nested Single-Room Design <ul><li>A special design that enables small private rooms to be “nested” to conserve space and construction costs </li></ul><ul><li>Nested rooms can be part of clusters which offer the efficiencies of cluster design </li></ul>
  35. 35. Safety <ul><li>Federal, state, and local building codes </li></ul><ul><li>Life Safety Code </li></ul><ul><li>Safety practices to prevent falls </li></ul><ul><li>Elimination of hazards </li></ul><ul><li>Monitoring and supervision </li></ul><ul><li>Security of person and property </li></ul>
  36. 36. Americans with Disabilities Act (ADA) of 1990 <ul><li>Public accommodations include nursing homes </li></ul><ul><li>Requires adaptations be made to provide access to the disabled </li></ul><ul><li>Requires that auxiliary aids for communication be provided for public use </li></ul>
  37. 37. Other Residential Features <ul><li>Wayfinding </li></ul><ul><li>Enhanced environments </li></ul><ul><li>Positive stimulation and distraction </li></ul><ul><li>Minimizing negative distractions </li></ul><ul><li>Aesthetics and comfort: the two must be integrated </li></ul><ul><li>- Lighting </li></ul><ul><li>- Color </li></ul><ul><li>- Furnishings </li></ul>

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