Foundations: Fundamentals of Nursing, Chapter 21 Managing Patient Care
Nursing Care Delivery Models
-Registered nurse leads team of other RNs, practical nurses, and unlicensed assistive personnel.
-Team members provide direct patient care under superrvision of RN.
-Team leader develops patient care plans, coordinates care among team members, and provides care requiring complex nursing skills.
Total patient care
-RN is responsible for all aspects of care for one or more patients during a shift of care.
-Care can be delegated.
-RN works directly with patient, family, and health care team members.
-One primary RN assumes responsibility for a caseload of patients.
-When an RN is working he or she provides care for the same patients during their stay in a facility.
-RN assesses patient, develops plan of care and delivers appropriate nursing interventions.
-Communication is lateral from nurse to nurse and caregiver to caregiver.
-Often is an advanced practice nurse
-coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Case management is defined as "a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."
Decision making is moved down to the level of staff.
Elements of decentralized decision making
Refers to the duties and activities that an individual is employed to perform.
freedom of choice and responsibility for the choices. One type of autonomy for nurses is work autonomy. In work autonomy the nurse makes independent decisions about the work of the unit such as scheduling or unit governance.
Legitimate power to give command and make final decision to a given position.
means that nurses are answerable for their actions. It means that they accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing it
A nurse manager encourages decentralized decision making by
-Establishing nursing practice or problem solving committee or professional shared governance councils.
Establishing nursing practice or problem solving committees or professional shared governance councils
-Chaired by senior clinical staff, these groups establish and maintain care standards for nursing practice on their work unit.
-The committees review and establish standards of care, develop policy and procedures, resolve patient satisfaction issues, or develop new documentation tools.
-The committee establishes methods to ensure that all staff have input or participation on practice issues.
Shared governance councils
promotes empowerment in staff nurses and enable them to control their nursing practice.
Nurse/physicians collaborative practice
-Collaboration is a process whereby different perspectives are synthesized to better understand complex problems and an outcome that is a shared solution that could not have been accomplished by a single person or organization
-Inviting the physician to attend the practice council meeting, participating in physician morning rounds, and contacting the physician promptly to discuss patient problems improve nurse-physician collaboration by focusing on strategies that are related to professional practice.
-Improve patients safety and outcomes and reduces errors.
-Emphasis on efficiency in health care delivery brings all members of the health care team together.
Many managers distribute biweekly or monthly newsletters of ongoing unit or agency activities.
planning in service programs, sending staff to continuing education classes and professional conferences, and having staff present case studies or practice issues during staff meetings.
Discuss ways to apply clinical care coordination skills in nursing practice
-use of resources
Deciding which patient needs or problems need attention first.
An immediate threat to a patients survival or safety such as a physiological episode of obstructed airway, loss of consciousness, or psychological episode of an anxiety attack.
Nonemergency, not-life threatening actual or potential needs that the patient and family members are experiencing. (ex. teaching needs of patients related to a new drug and taking measures to decrease postoperative complications).
Actual or potential problems that are not directly related to the patients illness or disease. These problems are often related to developmental needs or long term health care needs. (ex. a patient at admission who will eventually be discharged and needs teaching for self care in the home).
transferring responsibility for the performance of an activity or task while retaining accountability for the outcome.
5 rights of delegation
1. Right Task
2. Right circumstance
3. Right person
4. Right direction/communication
5. Right Supervision/evaluation
is one that you delegate for a specific patient such as tasks that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk.
Consider the appropriate patient setting, available resources, and other relevant factors. In an acute care setting patients conditions often change quickly. Use good clinical decision making to determine what to delegate.
The right person is delegating the right task to the right person to be performed on the right person.
Right Direction/ Communication
You give a clear, concise description of the task, including its objective limits, and expectations. Communication needs to be ongoing between the registered nurse and NAP during a shift of care.
Provide appropriate monitoring, evaluation, intervention, as needed, and feedback. NAP need to feel comfortable asking questions and seeking assistance.
collect all needed equipment for nursing interventions and procedures before going to the patient's room. This prevents the nurse from having to make multiple trips to the supply room or nursing station. Being organized is about being effective and efficient.
is an important aspect of clinical care coordination. Resources in this case include members of the health care team. In any setting the patient care is administered more smoothly when staff members work together. The staff needs to ask for assistance, especially when there is an opportunity to make a procedure or activity more comfortable and safer for the patient.
Task for LPN
The bed bath is a skill and task within the knowledge level and tasks appropriate for a nursing assistant
A Manager set
A philosophy for a work unit, ensures appropriate staffing, mobilizes staff and institutional resources to achieve objectives, motivates staff members to carry out their work, set standards of performance, and makes decisions to achieve objectives.
A Nurse Manager
Encourages decentralized decision making by establishing nursing practice committees, supporting nurse physician and interdisciplinary collaboration, setting and implementing quality improvement plans, and maintining timely staff communication.
Clinical care coordination
involves accurate clinical decision making, establishing priorities, efficient organizational skill, appropriate use of resources and time management skill, and an ongoing evaluation of care activities.
Building an empowered nursing team begins with the nurse executive, who is often vice president or director of nursing. It takes an excellent nurse manager and an excellent nursing staff to make an empowering work environment.
Developed in response to the severe nursing shortage following WWII, by 2000 the interdisciplinary team was a more common model.
Total Patient Care
Delivery was the original care delivery model developed during Florence Nightingale's time.
Model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and the professional relationships among staff members.
Care management approach that coordinates and links health care services to pts and their families while streamlining costs and maintaining quality.
Leadership Skills: Clinical Decisions
Ability to make clinical decisions depends of application of the nursing process. The process requires clinical decision making using a critical thinking approach; if you do not make accurate clinical decisions about a pt, undesirable outcomes may occur.
High Priority Setting
An immediate threat to a pts survival or safety such as a physiological episode of obstructed airway, loss of consciousness, or a psychological episode of an anxiety attack.
Intermediate Priority Setting
Nonemergency, non-life threatening actual or potential needs that the pt and family members are experiencing. Anticipating teaching needs of pts related to a new drug and taking measures to decrease postoperative complications are examples of intermediate priorities.
Low Priority Setting
Actual or potential problems that are not directly related to the pts illness or disease. These problems are often related to developmental needs or long-term health care needs. An example of a low priority problem is apt at admission who will eventually be discharged and needs teaching for self-care in the home.
Implementing a plan of care requires you to be effective and efficient. Effective use of time means doing the right things, whereas efficient use of time means doing things right.
Organizational Skills 2
A well organized nurse approaches any planned procedure by having all of the necessary equipment available and making sure that the pt is prepared.
Changes in health care and increasing complexity of pts create stress for nurses as they work to meet pt needs; one way to mange this stress is through the use of time management skills
Time Management 2
You need to anticipate when care will be interrupted for medication administration and diagnostic testing and when is the best time for planned therapies such as dressing changes, pt edu, and pt ambulation
Keys to Time Management
Priority to-do-list, setting goals to help you complete one task before starting another, keeping your work area clean and clutter free and trying to decrease interruptions.
As part of a nursing team you are responsible for open, professional communication.
Transferring responsibility for the performance of an activity or task while retaining accountability for the outcome. RN in most settings, and LPN in long term care settings; appropriate delegation begins with knowing which skills you are able to delegate.
Five Rights of Delegation
Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation
5 Rights of Delegation: Right Task
One that you delegate for a specific pt such as task that are repetitive, require little supervision, are relatively noninvasive, have results that are predictable, and have potential minimal risk.
5 Rights of Delegation: Right Circumstance
Consider the appropriate pt setting, available resources, and other relevant factors. In an acute care setting pts conditions often change quickly; use good clinical decision making to determine what to delegate.
5 Rights of Delegation: Right Person
Right person is delegating the right tasks to the right person to be performed on the right person
5 Rights of Delegation: Right Direction/Communication
Give a clear, concise description of the task, including its objective, limits, and expectations. Communication needs to be ongoing between the registered nurse and NAP during a shift of care
5 Rights of Delegation: Right Supervision/Evaluation
Provide appropriate monitoring, evaluation, intervention PRN, and feedback. NAP need to feel comfortable asking questions and seeking assistance.