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3 Delivering Nursing Care.

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Presentation on theme: "3 Delivering Nursing Care."— Presentation transcript:

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

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