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Chapter 013
- 1. Chapter 13 Care Delivery Strategies All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.
- 2. Objectives Differentiate the characteristics of nursing care delivery models used in health care Determine the role of the nurse manager and the staff nurse in each model All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 2
- 3. Objectives (Cont.) Summarize the differentiated nursing practice model and related methods to determine competencies of nurses who deliver care. Consider the impact of “Transforming Care at the Bedside” (TCAB) on the delivery of care in a specific nursing unit. Evaluate the effectiveness of transitional care models aimed at reducing unnecessary rehospitalizations. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 3
- 4. Model Selection Considerations to be addressed when selecting a model: Organizational mission and purpose Unit objectives Patient population Staff availability Economic feasibility All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 4
- 5. Care Models Case method Functional nursing Team nursing Primary nursing Case management All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 5
- 6. Other Strategies Patient-focused care Differentiated practice All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 6
- 7. Emerging Practice Models/Influences Magnet™ Recognition The Synergy Model The Clinical Nurse Leader All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 7
- 8. Case Method All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 8
- 9. Role of the Nurse Manager Assess patient needs to determine level of care: RN care RN-supervised care Hiring and management of appropriate staff to provide total care in a cost-effective manner All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 9
- 10. Functional Nursing All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 10
- 11. Functional Nursing (Cont.) Advantages Efficient Assistive personnel can be trained to perform specific tasks. Cost-effective All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 11
- 12. Functional Nursing (Cont.) Disadvantages Fragmented care; task oriented Patient and family needs may be overlooked. Lapses in communication Quality of care may be compromised; holistic view of patient and family may be lacking. Frustrating to professional nurse All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 12
- 13. Team Nursing All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 13
- 14. Team Nursing (Cont.) Advantages Cost effective Decisions made at the “grass roots” level, often by staff caring for the patient Improved patient satisfaction All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 14
- 15. Team Nursing (Cont.) Disadvantages Need a skilled, knowledgeable team leader Need adequate staff with the right skill mix Potential for fragmentation of care Few work settings implement team nursing as originally designed. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 15
- 16. Primary Nursing All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 16
- 17. Primary Nursing (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 17
- 18. Primary Nursing Hybrids Compare and contrast the two hybrids. Partnership model Patient-focused care All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 18
- 19. Nursing Case Management The process of providing comprehensive care for those with complex healthcare problems Improved patient outcomes Decreased length of stay Interfaces with multiple disciplines Care provided across the continuum of illness, often in different institutions All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 19
- 20. Nursing Case Management (Cont.) All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 20
- 21. Nurse Case Manager (NCM) Coordinates patient care throughout the admission process Facilitates access to needed health resources Monitors utilization of resources Measures outcomes and quality Uses Critical Pathways or Care MAPs All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 21
- 22. Nurse Navigator Provides specific services designed to improve care Removes barriers to care All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 22
- 23. Clinical Pathways and Care MAPs How are critical pathways and care MAPs developed? What is the difference between the two? Why are these tools used by the NCM? How is evidence-based practice incorporated into these tools? All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 23
- 24. Differentiated Nursing Practice Describe the education and role of the following: Associate nurse Primary nurse Advanced practice nurse All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 24
- 25. Nurse Manager/Leader Role in Differentiated Nursing Practice Role model Collaborator Coach Teacher Facilitator All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 25
- 26. Clinical Nurse Leader Oversees lateral integration of care for a distinct group of patients May actively provide direct care for complex patients All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 26
- 27. Transitional Care Comprehensive discharge with instruction about medications and warnings of health problems Instruction about medications and warning signs Contact with patients following discharge, emphasizing helping patients manage medications Assist in communication between patient and primary and secondary caregivers All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 27
Editor's Notes
- One of the aspects of health care that leaders and managers need to consider is how care is delivered.
- LEARNING OUTCOMES Differentiate the characteristics of nursing care delivery models used in health care. Determine the role of the nurse manager and the staff nurse in each model. Summarize the differentiated nursing practice model and related methods to determine competencies of nurses who deliver care. Consider the impact of “transforming care at the bedside” (TCAB) on the delivery of care in a specific nursing unit. Evaluate the effectiveness of transitional care models aimed at reducing unnecessary rehospitalizations.
- Several factors must be considered when selecting a model. For example, you might want to provide primary nursing, but the availability of staff and the economics of it are prohibitive. Each of these factors influences the decision about delivery of care.
- Five methods or models for providing care have been developed. Note these for now; we will return to them later. They are: [Read slide]
- Other strategies are available too. You may hear about: [Read slide]
- Several factors influence the way in which care is considered. The Magnet Recognition Program of the American Nurses Credentialing Center doesn’t dictate a particular approach. Rather, it expects that staff and administrators can describe why whichever approach they use is best for their situation. The Synergy Model, developed by the American Association of Critical Care Nurses, is a comprehensive approach to care. It starts with a philosophical approach to care that drives the way care is delivered. A third consideration is the Clinical Nurse Leader, which was developed by the American Association of Colleges of Nursing. This new role is designed to help staff solve problems and improve the quality of care delivered on a clinical unit.
- Let’s look at the main models. The first is the case method.
- The next model is functional nursing.
- It has several advantages.
- It also has several disadvantages.
- Team nursing, or a modification of it, is prevalent in many care settings.
- Team nursing has some distinct advantages. It has these attributes: [Read slide]
- It also has disadvantages. Why is the last statement true? [Discuss]
- Primary nursing is explained in this figure.
- It also has specific disadvantages. How feasible is usage of this model in agencies where students are placed? Why is this so? [Discuss]
- Two primary hybrids exist. They are the partnership model and patient-focused care.
- Nursing case management can be defined as [Read definition]. It results in [Read outcomes].
- This figure represents case management in nursing.
- What populations of patients are best served by utilization of the Nurse Case Management Model? (e.g., cardiac patients—those with CHF; high-risk perinatal patients—particularly those who are on home monitoring; pediatric patients—especially those with chronic illnesses such cystic fibrosis, type 1 diabetes, or AIDS) Important to help students understand that Nurse Case Managers will have a manager/leader. This individual will manage and lead the quality improvement process (including patient feedback surveys), making sure that the paths and MAPs are current and relevant with care practices and reimbursement methods. Provides oversight with case managers to be sure caseloads are appropriate and are effectively managed Interfaces with other disciplines to clarify the role of the NCM. Creates opportunities for staff development. May include individuals from other disciplines.
- Your text discusses critical pathways and care MAPs. Here are some questions to consider.
- The other major hybrid is differentiated practice. What did the text suggest as the primary differences among these roles?
- The nurse leader/manager performs several roles in differentiated practice situations. They are: [Read slide] What leadership theory (Transformational) is related to these role components? Why do you say that?