Huston_PPT_Ch_14_Student.ppt

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 14
Organizing Patient Care

1. Total patient care
2. Functional nursing
3. Team and modular nursing
4. Primary nursing
5. Case management
The Primary Means of Organizing Nursing
Care for Patient Care Delivery

There is no one “best” mode for organizing patient care.
Many of the newer models of patient care delivery
systems are merely recycled, modified, or retitled
versions of older models
Organizing Patient Care

Changing the Patient Care Delivery Mode—
Questions the Change Agent Must Ask
1. How will the reorganization alter autonomy and
individual and group decision making?
2. How will social interactions and interpersonal
relationships change?
3. Will employees view their unit of work differently?
4. Will the change require a wider or more restricted range
of skills and abilities on the part of the caregiver?
5. Will the redesign change how employees receive
feedback on their performance, either for self-evaluation
or by others?
6. Will communication patterns change?

Total Patient Care or Case Method Nursing
• It is the oldest mode of organizing patient care
• Nurses assume total responsibility for meeting the
needs of all assigned patients during their time on duty
• It is sometimes referred to as the case method of
assignment because patients may be assigned as
cases
• It is still widely used in hospitals and home health
agencies

Diagram of Total Patient Care

The greatest disadvantage of total patient care delivery
occurs when the nurse is inadequately prepared to
provide total care to the patient
Disadvantage of Total Patient Care

Functional Method of Nursing
• Evolved as a result of World War II
• Uses relatively unskilled workers who have been
trained to complete certain tasks
• Care is assigned by task rather than by patient

Functional Nursing Structure

• A major advantage of functional nursing is its
efficiency; tasks are completed quickly, with little
confusion regarding responsibilities
• However, functional nursing may lead to
fragmented care and the possibility of overlooking
patient priority needs
Advantages and Disadvantages of
Functional Nursing

Team Nursing
• Ancillary personnel collaborates in providing care
to a group of patients under the direction of a
professional nurse
• It requires extensive team communication and
regular team planning conferences
• It allows members to contribute their own special
expertise or skills
• Disadvantages are associated with improper
implementation rather than the philosophy itself

Team Nursing Structure

Modular Nursing
• Modification of team and primary nursing
• Similar to team nursing, but uses a smaller team
• Pairs professional nurses with ancillary staff to
deliver care to groups of patients
• Used frequently during the 1980s and 1990s

Primary Nursing/Relationship-Based
Nursing
• It uses some of the concepts of total patient care
• It brings the nurse back to the bedside to provide
clinical care
• It can succeed with a diverse skill mix just as team
nursing or any other model can succeed with an all-RN
staff
• Job satisfaction is high; however, this method is
difficult to implement because of the degree of
responsibility and autonomy required of the nurse
• Disadvantages lie primarily in improper
implementation

Case Management Nursing
• Collaborative process that assesses, plans,
implements, coordinates, monitors, and evaluates
options and services to meet an individual’s health
needs through communication and available
resources to promote quality, cost-effective
outcomes
• It coordinates care through an episode of illness
• The focus is on individual clients, not populations of
clients
• Some feel that the role of case manager should be
reserved for the advance practice nurse or RN with
advanced training

Question
What is the oldest model of nursing?
A. Modular nursing
B. Total patient care
C. Primary care
D. Case management

Answer
Answer:
Rationale:

Question
What kind of care uses relatively unskilled workers who
have been trained to complete certain tasks?
A. Modular nursing
B. Case management nursing
C. Functional nursing
D. Team nursing

Common Features of Disease Management
Programs
• 1. Provide a comprehensive, integrated approach to the
care and reimbursement of common, high-cost, chronic
illnesses
• 2. Focus on prevention as well as early disease detection
and intervention to avoid costly acute episodes but
provide comprehensive care and reimbursement
• 3. Target population groups (population based) rather
than individuals
• 4. Employ a multidisciplinary health-care team, including
specialists

Common Features of Disease Management
Programs—(cont.)
• 5. Use standardized clinical guidelines—clinical pathways
reflecting best practice research to guide providers
• 6. Use integrated data management systems to track
patient progress across care settings and allow
continuous and ongoing improvement of treatment
algorithms
• 7. Frequently employ professional nurses in the role of
case manager or program coordinator

Selecting the Optimum Mode of Organizing
Patient Care
• The mode should be based on patient acuity and not
economics alone
• The knowledge and skill required for particular activities
with specific populations should always be the true driver
in determining appropriate care delivery models
• Not every nurse desires a challenging job with the
autonomy of personal decision making

Common Themes Found Among Emerging
Care Delivery Models
• 1. Elevating the role of nurses and transitioning from caregivers
to “care integrators”
• 2. Taking a team approach to interdisciplinary care
• 3. Bridging the continuum of care outside of the primary care
facility
• 4. Defining the home as a setting of care
• 5. Targeting high users of health care, especially older adults
• 6. Sharpening focus on the patient, including an active
engagement of the patient and her or his family in care
planning and delivery, and a greater responsiveness to the
patient’s wants and needs

Common Themes Found Among Emerging
Care Delivery Models—(cont.)
• 7. Leveraging technology
• 8. Improving satisfaction, quality, and cost

Newer Health-Care Delivery Models and
Nursing Roles
• Nurse navigators
• Clinical nurse-leaders
• Nurses working in settings that embrace patient- and
family-centered care

Core Concepts of Patient- and Family-
Centered Care
• Patient care is organized around the needs of patients
• Patient and family perspectives are sought out and their
choices are honored
• Health-care providers communicate openly and honestly
with patients and families to empower them
• Patients, families, and health-care providers collaborate
regarding facility design and the implementation of care
• The voice of the patient and family are represented at
both the organizational and policy levels as well as in the
health system’s strategic planning

Question
Which of the following is a core concept of patient-centered
care?
A. Patient care is organized around the needs of the
nursing staff
B. Patient perspectives are sought out and patient wishes
respected
C. Health-care providers do not seek open communication
with patients
D. The voice of the patient is not represented in planning

Managing Care with Case Management
• Case managers often manage care using critical
pathways and multidisciplinary action plans (MAPs) to
plan patient care
• The care MAP is a combination of a critical pathway and a
nursing care plan, which indicates times when nursing
interventions should occur
• All health-care providers follow the care MAP to facilitate
expected outcomes
• If a patient deviates from the normal plan, a variance is
indicated

Disease Management
• It is also known as population-based health care and
continuous health improvement
• It is a comprehensive, integrated approach to the
care and reimbursement of high-cost, chronic
illnesses
• The goal is to address such illnesses or conditions
with maximum efficiency across treatment settings
regardless of typical reimbursement patterns
• A continuum of chronic illness care is established that
includes early detection and early intervention

Chronic Illnesses Often Managed with
Disease Management Protocols
• Cancer
• Acute otitis media
• Diabetes
• Hyperlipidemia
• Asthma
• Hypertension
• COPD
• Hormone replacement therapy
• AIDS
• Stroke

Other Primary Features of DM Programs
Include the Following
• The use of a multidisciplinary health-care team,
including specialists in the area
• The selection of large population groups to reduce
adverse selection
• The use of standardized clinical guidelines—clinical
pathways reflecting best practice research to guide
provider practice
• The use of integrated data management systems to
track patient progress across care settings and allow
continuous and ongoing improvement of treatment
algorithms

Clinical Nurse-Leader
• Experienced nurse
• Graduate degree
• Clinical leadership of all healthcare settings
• Outcome-based practice
• Quality improvement strategies
• Clinical practice
• Creates and manages microsystems
• Responsive health-care needs of individuals and families

Characteristics of Effective Health-Care
Delivery Systems
• Elements of the various designs present in the system in
use in any organization
• Facilitate meeting the goals of the organization
• Cost-effective
• Satisfy the patient
• Provide role satisfaction to nurses
• Allow implementation of the nursing process
• Provide for adequate communication among health-care
providers

Work Redesign
• Social interactions
• Degree of autonomy
• Abilities and skills
• Employee evaluation
• Communication patterns

Huston_PPT_Ch_14_Student.ppt

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