Transcript N 493 2009 Class #8 Plan-Managing Self, as the Nurse and Client

Plan-Managing Self, as the
Nurse and Client Care
Class 8
November 4, 2009
Judith Anne Shaw, Ph.D., R.N.
Plan-Managing
• Delegation of Client Care
– Standards for Nursing Practice
– Communication Games
• Models of Care Delivery
– Contemporary
– Traditional
• Monitoring & Evaluating Quality of Care
• Quality Improvement
• Time Management
DELEGATION
• Know person’s
capabilities
• Know job description
DELEGATION
Concept
Skill
Process
Art
(Hansten & Jackson, 2004)
DELEGATION
Direct
Indirect
DIRECT
DELEGATION
Verbal Direction
by
the Registered Nurse
INDIRECT
DELEGATION
Approved list
of activities or tasks
established
in
policies and procedures
within an agency
What is the Difference?
Assignment
vs.
Delegation
Five Rights of Delegation
1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision/evaluation
DELEGATION
NURSING PROCESS
CONCEPT
DELEGATION and the
NURSING PROCESS
1. Assessment
2. Plan
3. Implementation/Intervention
4. Evaluation
Assessment
 Know your world
-Practice
-Organization
 Know yourself
- Barriers
- Benefits
 Know your delegate
- Competency
- Motivation
(Hansten & Jackson, 2004)
Plan
 Know what needs to be done
- Professional
- Technical
- Amenity
- Based on outcome
(Hansten & Jackson, 2004)
Implementation/Intervention
Prioritize &Match the Job to the
Delegate
Know how to communicate
Know how to resolve conflict
(Hansten & Jackson, 2004)
Evaluation
• Know how to give feedback
• Evaluate and problem solve
(Hansten & Jackson, 2004)
Delegation Decisions
• Level of client acuity
• Level of unlicensed assistive personnel
(UAP) capability
• Level of licensed nurse capability
Delegation Decisions
• Possible injury
• Times skill performed by unlicensed assistive
personnel
• Level of decision-making needed for activity
• Client’s ability for self-care
Criteria for Safe Delegation
• Potential for harm to the client
• Complexity of problem solving and innovation
required
• Predictability of the outcome
• Extent of interaction
GAMES
…people may play
Organizational Game
• Karpman Triangle:
– 3 roles
1. Victim
2.
Persecutor
3.
Rescuer
Karpman Triangle
Persecutor
Rescuer
Victim
*Participants move from one to another
Call The Game!
• Refuse to play any
of the roles
• Give an adult
response
Karpman Triangle
Persecutor
Rescuer
Victim
*Participants move from one to another
Models
of
Care
Models
…remember that a picture
(even a word picture)
is worth a thousand words
Traditional Models of Care
Total Care
Functional
Team
Modular
Primary
Total Care
Gains
Losses
1. Extremely client
focused
1. Not most efficient use
of staff
Functional Care Delivery
Gains
Losses
1. Efficient
2. Economical
3. Productive
1. Fragmentation of
care
Team Approach
Gains
Losses
1. Holistic care
1. Time consuming
2. Increased client & 2. Expensive
employee
3. May increase
satisfaction
workload stress
Contemporary Challenge of the
Team Approach
AIM
- Develop a group of individuals into a
cohesive whole
- Share goals, expectations, and behavioural
norms by team members
- Individual differences and contributions
acknowledged
- Develop and promote best practices
TEAMWORK
WORKING TOGETHER
TYPES OF TEAMS
• Multidisciplinary Team
• Interdisciplinary Team
• Transdisciplinary Team
TEAM BUILDING
CHALLENGE
How to build a
well-functioning team?
TEAM
HIGH PERFORMANCE LEVELS
•
•
•
•
•
•
•
Participative leadership
Shared responsibility
Aligned on purpose
Strong communication
Future-focused
Focused on task
Rapid Response
Modular Approach
Gains
Losses
• Located nearer
.Use of
the client
• Efficient
paraprofessionals
. Dependent
on skill of coordinator
Primary Care
Gains
Losses
1. Decreases
fragmented care
2. Increases
accountability &
client
satisfaction
1. Limits number of
clients a nurse can
provide care to2. Client may be in
jeopardy
Mini-Nurse Manager Quiz
Of the traditional models of Care Delivery,
which model do you think optimizes the
provision of quality client care?
Provide explanation for your choice.
Contemporary Models
of Care Delivery
Case Management
Client-Focused
Product Line Management
Differentiated Practice
Case Management
Gains
Losses
1.Continuity of care 1. May be in jeopardy
2. Efficient use of
2. Possibly, limited
resources
prepared staff
3. Professional
development &
satisfaction
4. Holistic approach
Client-Focused Care
Gains
Losses
1. Possible increased
client & staff
satisfaction
1. Possible staff
dissatisfaction &
stress
2. Institutional
licensure
3. Quality of care giver
Product Line Management
Gains
Losses
1. Cost effective
2. Potential for being
more efficient
3. Allow nurses to
provide direct care
1. Potential of not
focusing on client
2.Potential of not being
able to adequately
access client needs
Differentiated Practice
Gains
Losses
1. Potential for nurse
increased satisfaction
2. Potential for cost
benefit for agency
3. Improved client care
1. Potential for limited
use of nurse who has
higher competency
skill level vs.
educational
preparation
Quality Client Care
Monitoring & Evaluating
Structured Care Methodologies
• Guidelines
• Protocols
• Algorithms
• Standards of Care
• Critical (Clinical) Pathways
Critical Pathways
• Outgrowth of nursing care plan
• Multidisciplinary representatives
• Provides a communication &
documentation framework
Critical Pathways
Key Elements
•
•
•
•
•
•
•
Discharge planning
Consultations
Activities
Nutrition
Medications
Diagnostic Tests
Treatments
Quality Improvement
• What to evaluate
– Structure, process & outcomes
• Continuous quality improvement
– Quality Circle at the Unit Level
What To Evaluate
Three
different aspects
of
health care
THREE MUSTS
Comprehensive Evaluation
Program
1.Structure: setting and resources
2. Process: actual activities “carried out” by
the health care provider
3. Outcome: results of the activities
Remember
Outcome Measures
-use measurable
indicators
(objective measures)
Continuous Quality Improvement
Continuously improve the capability of
involving everyone in providing quality
care
Integration into All Aspects of
Health Care Organization
Continuous
Quality
Improvement
Total
Quality
Management
Total Quality Management
[Unit Level]
Assign Responsibilities
Identify Vital Areas
Define Scope of Care
Analyze Area in Terms of:
Aspects
Standards
Indicators
Criteria
Measure Actual Performance
Measure Patient Outcomes
Evaluate Performance and Outcomes
Recommend and Implement Actions
Evaluate Degree of Improvement
Quality Improvement
at the Unit Level
Quality Circle
Quality
Circle
Accreditation of Healthcare
Organizations
. Cost
. Quality
the interest of consumers, healthcare payers,
and healthcare providers.
Time Management
• Scheduling Time ----To What End?
Consider...
It is not important how much activity
can be packed into each day
rather
how much closer we get to achieving
the desired results.
Ask yourself...
“To what end” are you as keeper of your
appointment book filling in the spaces?
Catch a vision…a goal and work towards it!
Each day must
--be planned
with the
end-result in mind!
Nurse Time
35%
20%
-direct client care
-documentation
Remainder - “Other”
Nurses MUST Manage Time
through
effective
time
management
skills.