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)