Chapter 13

Care Delivery Strategies

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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

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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.

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Model Selection

Considerations to be addressed when selecting a model: Organizational mission and purpose Unit objectives Patient population Staff availability Economic feasibility

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Care Models

Case method Functional nursing Team nursing Primary nursing Case management

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Other Strategies

Patient-focused care Differentiated practice

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Emerging Practice Models/Influences

Magnet™ Recognition The Synergy Model The Clinical Nurse Leader

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Case Method

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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

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Functional Nursing

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Functional Nursing (Cont.)

Advantages Efficient Assistive personnel can be trained to perform

specific tasks. Cost-effective

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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

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Team Nursing

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Team Nursing (Cont.)

Advantages Cost effective Decisions made at the “grass roots” level, often by

staff caring for the patient Improved patient satisfaction

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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.

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Primary Nursing

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Primary Nursing (Cont.)

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Primary Nursing Hybrids

Compare and contrast the two hybrids. Partnership model Patient-focused care

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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

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Nursing Case Management (Cont.)

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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

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Nurse Navigator

Provides specific services designed to improve care

Removes barriers to care

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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?

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Differentiated Nursing Practice

Describe the education and role of the following: Associate nurse Primary nurse Advanced practice nurse

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Nurse Manager/Leader Role in Differentiated Nursing Practice

Role model Collaborator Coach Teacher Facilitator

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Clinical Nurse Leader

Oversees lateral integration of care for a distinct group of patients

May actively provide direct care for complex patients

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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

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