1. 3
Delivering Nursing Care

2. Learning Outcomes
Describe how the delivery system structures nursing care.
Describe what types of nursing care delivery systems exist.
Discuss the positive and negative aspects of different systems.

3. Learning Outcomes
Describe evolving types of delivery systems that have emerged.
Explain characteristics of effective delivery systems.

4. Nursing Care Delivery Systems
Provide structure for delivering care
Delivery of care includes:
Assessing care needs
Formulating plan of care
Implementing plan
Evaluating patient's responses

5. Nursing Care Delivery Systems
Pros and cons debated
Must optimize nurse’s knowledge, skills
Ensure that patients receive appropriate care
Lower mortality rates in hospitals with good environments for nurses

6. Functional Nursing RNs, LPNs, and UAPs are assigned different tasks
RNs assess patients
Other staff give baths, make beds, take vital signs, and administer treatments

7. Figure 3-1 Functional nursing.

8. Functional Nursing Advantages Disadvantages
Staff become efficient at performing assigned tasks
Disadvantages
Uneven continuity
Lack of holistic understanding of patient
Problems with follow-up

9. Team Nursing
Team of nursing personnel provides total care to a group of patients by diagnosis or provider services.
RN leads team
May include other RNs, LPNs, and UAPs
Leaders must be skilled in delegating, communicating, and problem solving
All members of effective teams are good communicators

10. Team leader time spent in indirect pt care e.g.:
Developing or updating nsg care plan
Resolving problems encountered by team members.
Conducting nsg conferences
Communicating with physicians and other care providers

11. Figure 3-2 Team/modular nursing.

12. Team Nursing Advantages
LPNs and UAPs perform tasks that do not require RN's expertise
Care is more easily coordinated
Saves steps and time

13. Team Nursing Disadvantages
Time needed for communicating, supervising, and coordinating team members
Affect of changes in team leaders, members, and assignments on continuity of care
Total patient not considered by any one person

14. Team Nursing Disadvantages Role confusion and resentment
Less control for nurses over assignments
Possibility of unequal assignments

15. Figure 3-3 Total patient care.

16. Total Patient Care
RN is responsible for all aspects of care for one or more patients

17. Total Patient Care Advantages Disadvantages
Continuous, holistic, expert nursing care
Total accountability
Continuity of communication
Disadvantages
RNs perform tasks that could be done more cost-effectively by less skilled persons

18. Primary Nursing
RN designs, implements, and is responsible for nursing care for duration of the patient's stay on the unit

19. Figure 3-4 Primary nursing.

20. Primary Nursing Advantages Knowledge-based practice model
Decentralization of decisions, authority, and responsibility
24-hour accountability
Improved continuity and coordination of care
Increased nurse, patient, and physician satisfaction

21. Primary Nursing Disadvantages Excellent communication required
Accountability of associate nurses
Patient transfers disrupt continuity of care
Compensation and legal responsibility for staff nurses
Unwillingness of associates to take direction

22. Practice Partnerships
RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients

23. Figure 3-5 Practice partnerships.

24. Practice Partnerships
Advantages
Improved continuity of care and accountability for care
Disadvantages
Decreased ratio of RNs to nonprofessional staff
Potential for junior team members to assume too much responsibility

25. Case Management
Is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within specific period of time
Case manager supervises the care provided by licensed and unlicensed nursing personnel
Critical pathways provide direction for managing care of specific patients

26. Nsg case management requires
Collaboration of all members of the health care team
Identification of expected patient outcomes within specific time frame
Use of principles of continuous quality improvement
Promotion of professional practice

27. Figure 3-6 Case management.

28. Case Management Advantages Disadvantages
All professionals equal team members
Members take ownership of patient outcomes
Disadvantages
Requires qualified nurse case manager, team collaboration, and quality management system
Established critical pathways needed

29. Critical Pathways Provide care strategies to achieve expected outcomes
Used in case management system
Include ways to identify variances easily and whether outcomes have been met

30. Critical Pathways Advantages Disadvantages
Accommodate unique characters, conditions of patients
Reduce costs
Disadvantages
May need revision

31. Differentiated Practice
Structure of roles and functions differentiated by nurses' education, experience, and competence
Roles, responsibilities, and tasks defined for professional nurses, LPNs, and UAPs

32. Differentiated Practice
Maximizes nursing resources
Defined scope of practice and level of responsibility

33. Patient-Centered Care
Nurse coordinates a team of multifunctional, unit-based caregivers
All patient care services are unit-based
Focused on:
Decentralization
Promotion of efficiency and quality
Cost control

34. Patient-Centered Care
Advantages
Promotes efficiency, quality, and cost control
Disadvantages
Requires considerable time for nurse manager
Demands a strong leader to manage staff

35. Synergy Model of Care
Patient characteristics and nurse competencies match
Meets standards for Magnet certification

36. Pt ch:ch include:
Resiliency, vulnerability, stability, complexity, resource availability
participation in care, participation in decision making, predictability

37. The chch of pt should match with nurse competencies
Clinical judgment
Advocacy and moral agency
Caring practice, collaboration, systems thinking, response to diversity, facilitation of learning, clinical inquiry

38. Clinical Microsystems
Small unit of care that maintains itself
Dynamic, interactive, self-aware, and interdependent
Proven to improve teamwork, communication, and continuity of care

39. Evolution of Models for Delivering Care
No system perfect or permanent
Change caused by:
Reimbursement changes
Demands for quality
Technologicial changes

40. Using the System Effectively
Communication skills
Ability to delegate
Problem-solving skills