plan-managing self, as the nurse and client care class 8 november 4, 2009 judith anne shaw, ph.d.,...
TRANSCRIPT
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Plan-Managing Self, as the Nurse and Client Care
Class 8
November 4, 2009 Judith Anne Shaw, Ph.D., R.N.
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Plan-Managing
• Delegation of Client Care– Standards for Nursing Practice– Communication Games
• Models of Care Delivery– Contemporary– Traditional
• Monitoring & Evaluating Quality of Care
• Quality Improvement• Time Management
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DELEGATION
• Know person’s capabilities
• Know job description
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DELEGATION
Concept
Skill
Process
Art
(Hansten & Jackson, 2004)
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DELEGATION
Direct
Indirect
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DIRECT DELEGATION
Verbal Direction
by
the Registered Nurse
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INDIRECT DELEGATION
Approved list of activities or tasks
established in
policies and procedures within an agency
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What is the Difference?
Assignment
vs.
Delegation
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Five Rights of Delegation1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision/evaluation
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DELEGATION
NURSING PROCESS
CONCEPT
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DELEGATION and theNURSING PROCESS
1. Assessment
2. Plan
3. Implementation/Intervention
4. Evaluation
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Assessment Know your world
-Practice-Organization
Know yourself- Barriers- Benefits
Know your delegate- Competency- Motivation
(Hansten & Jackson, 2004)
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Plan
Know what needs to be done- Professional- Technical- Amenity- Based on outcome
(Hansten & Jackson, 2004)
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Implementation/Intervention
Prioritize &Match the Job to the Delegate
Know how to communicate
Know how to resolve conflict (Hansten & Jackson,
2004)
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Evaluation
• Know how to give feedback
• Evaluate and problem solve
(Hansten & Jackson, 2004)
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Delegation Decisions
• Level of client acuity
• Level of unlicensed assistive personnel (UAP) capability
• Level of licensed nurse capability
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Delegation Decisions
• Possible injury
• Times skill performed by unlicensed assistive personnel
• Level of decision-making needed for activity
• Client’s ability for self-care
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Criteria for Safe Delegation
• Potential for harm to the client
• Complexity of problem solving and innovation required
• Predictability of the outcome
• Extent of interaction
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GAMES
…people may play
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Organizational Game
• Karpman Triangle:
– 3 roles
1. Victim
2. Persecutor
3. Rescuer
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Karpman Triangle
Persecutor Rescuer
Victim
*Participants move from one to another
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Call The Game!
• Refuse to play any of the roles
• Give an adult response
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Karpman Triangle
Persecutor Rescuer
Victim
*Participants move from one to another
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Models of
Care
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Models
…remember that a picture
(even a word picture)
is worth a thousand words
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Traditional Models of Care
Total Care
Functional
Team
Modular
Primary
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Total Care
Gains
1. Extremely client focused
Losses
1. Not most efficient use of staff
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Functional Care Delivery
Gains
1. Efficient
2. Economical
3. Productive
Losses
1. Fragmentation of care
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Team Approach
Gains
1. Holistic care2. Increased client &
employee satisfaction
Losses
1. Time consuming2. Expensive3. May increase
workload stress
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Contemporary Challenge of the Team Approach
AIM- Develop a group of individuals into a
cohesive whole- Share goals, expectations, and behavioural
norms by team members- Individual differences and contributions
acknowledged- Develop and promote best practices
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TEAMWORK
WORKING TOGETHER
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TYPES OF TEAMS
• Multidisciplinary Team
• Interdisciplinary Team
• Transdisciplinary Team
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TEAM BUILDING
CHALLENGE
How to build a
well-functioning team?
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TEAM HIGH PERFORMANCE LEVELS
• Participative leadership
• Shared responsibility
• Aligned on purpose
• Strong communication
• Future-focused
• Focused on task
• Rapid Response
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Modular Approach
Gains Losses
• Located nearer .Use of
the client paraprofessionals
• Efficient . Dependenton skill of coordinator
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Primary Care
Gains
1. Decreases fragmented care
2. Increases accountability & clientsatisfaction
Losses
1. Limits number of clients a nurse can provide care to-
2. Client may be in jeopardy
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Mini-Nurse Manager Quiz
Of the traditional models of Care Delivery, which model do you think optimizes the provision of quality client care?
Provide explanation for your choice.
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Contemporary Models of Care Delivery
Case Management
Client-Focused
Product Line Management
Differentiated Practice
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Case Management
Gains
1.Continuity of care
2. Efficient use of resources
3. Professional development & satisfaction
4. Holistic approach
Losses
1. May be in jeopardy
2. Possibly, limited prepared staff
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Client-Focused Care
Gains
1. Possible increased client & staff satisfaction
Losses
1. Possible staff dissatisfaction & stress
2. Institutional licensure
3. Quality of care giver
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Product Line Management
Gains
1. Cost effective
2. Potential for being more efficient
3. Allow nurses to provide direct care
Losses
1. Potential of not focusing on client
2.Potential of not being able to adequately access client needs
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Differentiated Practice
Gains
1. Potential for nurse increased satisfaction
2. Potential for cost benefit for agency
3. Improved client care
Losses
1. Potential for limited use of nurse who has higher competency skill level vs. educational preparation
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Quality Client Care
Monitoring & Evaluating
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Structured Care Methodologies
• Guidelines
• Protocols
• Algorithms
• Standards of Care
• Critical (Clinical) Pathways
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Critical Pathways
• Outgrowth of nursing care plan
• Multidisciplinary representatives
• Provides a communication & documentation framework
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Critical PathwaysKey Elements
• Discharge planning
• Consultations
• Activities
• Nutrition
• Medications
• Diagnostic Tests
• Treatments
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Quality Improvement
• What to evaluate
– Structure, process & outcomes
• Continuous quality improvement
– Quality Circle at the Unit Level
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What To Evaluate
Three
different aspects
of
health care
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1.Structure: setting and resources
2. Process: actual activities “carried out” by
the health care provider
3. Outcome: results of the activities
THREE MUSTS
Comprehensive Evaluation Program
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Remember
Outcome Measures
-use measurable
indicators
(objective measures)
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Continuous Quality Improvement
Continuously improve the capability of involving everyone in providing quality
care
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Integration into All Aspects of Health Care Organization
Continuous Total
Quality Quality
Improvement Management
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Total Quality Management [Unit Level]
Assign ResponsibilitiesIdentify Vital AreasDefine Scope of Care
Analyze Area in Terms of:Aspects
StandardsIndicatorsCriteria
Measure Actual PerformanceMeasure Patient Outcomes
Evaluate Performance and OutcomesRecommend and Implement Actions
Evaluate Degree of Improvement
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Quality Improvement at the Unit Level
Quality CircleQuality Circle
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Accreditation of Healthcare Organizations
. Cost
. Quality
the interest of consumers, healthcare payers, and healthcare providers.
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Time Management
• Scheduling Time ----- To What End?
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Consider...
It is not important how much activity can be packed into each day
rather
how much closer we get to achieving the desired results.
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Ask yourself...
“To what end” are you as keeper of your appointment book filling in the spaces?
Catch a vision…a goal and work towards it!
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Each day must
--be planned
with the
end-result in mind!
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Nurse Time
35% -direct client care
20% -documentation
Remainder - “Other”
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Nurses MUST Manage Time
through effective
time
management skills.