nursing delivery system
TRANSCRIPT
Rajeshwari SLecturer Community Health Nursing
SEMINAR ON
Rajeshwari, Msc Nursing (CHN)
Acute care hospital Government hospital Voluntary hospital. For-profit hospital.
Rajeshwari, Msc Nursing (CHN)
Admission Direct Emergency
Scheduled
Rajeshwari, Msc Nursing (CHN)
Meeting Patient Needs
Primary considerations Number of patients Intensity of care required Staff experience and preparation Patient classification systems/acuity level Categorize patients according to care needs
Rajeshwari, Msc Nursing (CHN)
Classification System Considerations
Age and functional ability Communication skills Cultural and linguistic diversities Severity/urgency of the admitting condition Scheduled procedures Ability to meet health care requisites Availability of social supports Other specific needs (Recommended by the American Nurses Association
Rajeshwari, Msc Nursing (CHN)
Meeting Staff Needs
Satisfied nurses provide higher quality, more cost-effective care
24 hour/day, 365 day/year staffing needs create staffing challenges
Creative staffing options Staff input about staffing
Rajeshwari, Msc Nursing (CHN)
Meeting Organizational Needs
Budget and financial management Number of staff Staff mix Licensing and accreditation Customer satisfaction Quality care
Rajeshwari, Msc Nursing (CHN)
The Number One Challenge
Appropriate staffing within budget constraints with well-trained, competent, professional staff members who are committed to providing safe, high-quality care
Rajeshwari, Msc Nursing (CHN)
Nursing Care Delivery Models
Detail assignments, responsibility, and authority to accomplish patient care
Determine who is going to perform what tasks, who is responsible, and who makes decisions
Match number and type of caregivers to patient care needs
Rajeshwari, Msc Nursing (CHN)
Classic Nursing Care Models
Total patient care Functional nursing Team nursing Primary nursing Variations have been adopted to
improve care
Rajeshwari, Msc Nursing (CHN)
Total patient care
Rajeshwari, Msc Nursing (CHN)
Total Patient Care
Nurse is responsible for planning, organizing, and performing all care
Oldest method of organizing patient care Typically performed by nursing students Common use areas—intensive care unit
(ICU) and postanesthetic care unit (PACU)
Rajeshwari, Msc Nursing (CHN)
Total Patient Care—cont’d
Advantages High degree of autonomy Lines of responsibility and accountability are clear Patient receives holistic, unfragmented care Disadvantages Each RN may have a different approach to care Not cost-effective Lack of RN availability
Rajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Functional Nursing
Staff members assigned to complete specific tasks for a group of patients
Evolved during World War II as a result of a nursing shortage
Unskilled workers trained to perform routine, simple tasks
Common use area—operating room
Rajeshwari, Msc Nursing (CHN)
Functional Nursing—cont’d
Advantages Care is provided economically and efficiently Minimum number of RNs required Tasks are completed quickly Disadvantages Care may be fragmented Patient may be confused with many care providers Caregivers feel unchallenged
Rajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Team Nursing
RN as team leader coordinates care for a group of patients
Evolved in the 1950s to improve patient satisfaction
Goal was to reduce fragmented care Common use areas—most inpatient
and outpatient areas
Rajeshwari, Msc Nursing (CHN)
Team Nursing—cont’d
Advantages High-quality, comprehensive care with a high
proportion of ancillary staff Team members participate in decision making
and contribute their own expertise Disadvantages Continuity suffers if daily team assignments vary Team leader must have good leadership skills Insufficient time for planning and communication
Rajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Modular Nursing
Modification of team nursing Patient unit is divided into modules or
units with an RN as team leader The same team of caregivers is
assigned consistently to the same geographic area
Concept evolved to increase RN involvement in care
Rajeshwari, Msc Nursing (CHN)
Modular Nursing—cont’d
Advantages Continuity of care is improved RN more involved in planning and coordinating
care Geographic closeness and efficient
communication Disadvantages Increased costs to stock each module Long corridors not conducive to modular
nursingRajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Primary Nursing
RN “primary nurse” assumes 24-hour responsibility for planning, directing, and evaluating care
Evolved in the 1970s to improve RN autonomy
Common use areas—hospice, home health, and long-term care settings
Rajeshwari, Msc Nursing (CHN)
Primary Nursing—cont’d
Advantages High-quality, holistic patient care Establish rapport with patient RN feels challenged and rewarded Disadvantages Primary nurse must be able to practice with a high
degree of responsibility and autonomy RN must accept 24-hour responsibility More RNs needed; not cost-effective
Rajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Partnership Model (Co-Primary Nursing
RN is partnered with an licensed practical nurse/licensed vocational nurse (LPN/LVN) or nursing assistant to work together consistently
Modification of primary nursing to make more efficient use of the RN
Rajeshwari, Msc Nursing (CHN)
Partnership Model (Co-Primary Nursing)—cont’d
Advantages More cost-effective than primary nursing RN can encourage training and growth of partner Disadvantages RN may have difficulty delegating to partner Consistent partnerships difficult to maintain due to
varied schedules
Rajeshwari, Msc Nursing (CHN)
Patient-Centered Care(Patient-Focused Care)
Cross-functional teams of professionals and assistive personnel work together as a unit-based team
Recent development in nursing care delivery models
More patient oriented than department oriented
Models vary considerably among facilities
Rajeshwari, Msc Nursing (CHN)
Patient-Centered Care(Patient-Focused Care)—cont’d
Advantages Patient comes into contact with fewer
workers Workers are unit based and spend more
time in direct-care activities Team is supervised by an RN RN is accountable for a wide range of
services and functions at a higher level Cost-effective
Rajeshwari, Msc Nursing (CHN)
Patient-Centered Care(Patient-Focused Care)—cont’d
Disadvantages Major change in organizational
structure is required Departments other than nursing must
be willing to accept nursing leadership
Nurse manager supervises many types of workers
Rajeshwari, Msc Nursing (CHN)
Rajeshwari, Msc Nursing (CHN)
Case Management
First introduced in the 1970s by insurance companies
Hospitals adopted the model in the 1980s
Value demonstrated through research Components include: Assessment, planning, implementation,
evaluation, and interaction
Rajeshwari, Msc Nursing (CHN)
Case Management—cont’d
Variations are found in most health care organizations Reserved for chronically ill patients, seriously ill
patients, or long-term, expensive cases RN assumes a planning and evaluative role; usually
not responsible for direct-care duties Supplemental form of care delivery; does not replace
direct-care model
Rajeshwari, Msc Nursing (CHN)
RN Case Manager
Coordinates the patient’s care throughout the course of an illness from a payer or facility perspective
Employee of the payer (external case management)
Employee of the health care facility (internal case management)
Rajeshwari, Msc Nursing (CHN)
Patient centered care
Rajeshwari, Msc Nursing (CHN)
Managed care
Rajeshwari, Msc Nursing (CHN)
Differentiated practice nursing
Rajeshwari, Msc Nursing (CHN)
Shared goverance
Rajeshwari, Msc Nursing (CHN)
Clinical Pathways
Delineate a predetermined written plan of care for a particular health problem
Specify desired outcomes and transdisciplinary intervention
Address a common medical diagnosis Dictate the type and amount of care
given and thus have financial implications
Rajeshwari, Msc Nursing (CHN)
Clinical PathwaysTerminology
Patient outcomes Transdisciplinary intervention Variance Trigger
Rajeshwari, Msc Nursing (CHN)
Clinical PathwaysEssential Components
Consults Laboratory and diagnostic tests Treatments Medications Safety Self-care activities Nutrition Patient and family education Discharge planning Triggers
Rajeshwari, Msc Nursing (CHN)
Choosing a Nursing Care Delivery Model
What staff mix is required? Who should make work assignments? Work assigned by task? By patient? How will communication be handled? Who will make decisions? Who will be responsible and accountable? Fit with unit/facility/organization management?
Rajeshwari, Msc Nursing (CHN)
Influences on Nursing Care Delivery Model Selection
Health care setting Acute care, long-term care, ambulatory care, home
care, and hospice Organizational structure and resources Management, staffing, supplies, and physical layout Patient needs Acute, long-term, and chronic
Rajeshwari, Msc Nursing (CHN)
Evaluation of Nursing Care Delivery Models
Timely, cost-effective outcomes achieved?
Patient and families happy with care? Team members satisfied with care? Good communication among all team
members? RNs utilized and challenged
appropriately?
Rajeshwari, Msc Nursing (CHN)