Transcript Nursing Care Delivery Models

Staffing and Nursing Care Delivery
Models
Key Concepts
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Staffing for health care organizations
Patient classification systems
Nursing care delivery models
Critical pathways
Nursing case management
Staffing
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Activities to ensure an adequate number
and mix of team members
Staffing considerations
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Patient needs
Staff satisfaction
Organizational needs
Meeting Patient Needs
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Primary considerations
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Number of patients
Intensity of care required
Staff experience and preparation
Patient classification systems/acuity level
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Categorize patients according to care needs
Classification System Considerations
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Age and functional ability
Communication skills
Cultural and linguistic diversities
Severity/urgency of the admitting condition
Scheduled procedures
Ability to meet health care requisites
Availability of social supports
Other specific needs
(Recommended by the American Nurses Association)
Meeting Staff Needs
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Satisfied nurses provide higher quality,
more cost-effective care
24 hour/day, 365 day/year staffing needs
create staffing challenges
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Creative staffing options
Staff input about staffing
Meeting Organizational Needs
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Budget and financial management
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Number of staff
Staff mix
Licensing and accreditation
Customer satisfaction
Quality care
The Number One Challenge
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Appropriate staffing within budget
constraints with well-trained, competent,
professional staff members who are
committed to providing safe, high-quality
care
Nursing Care Delivery Models
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Detail assignments, responsibility, and
authority to accomplish patient care
Determine who is going to perform what
tasks, who is responsible, and who
makes decisions
Match number and type of caregivers to
patient care needs
Classic Nursing Care Models
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Total patient care
Functional nursing
Team nursing
Primary nursing
Total Patient Care
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Nurse is responsible for planning,
organizing, and performing all care
Oldest method of organizing patient care
Typically performed by nursing students
Common use areas—intensive care unit
(ICU) and postanesthetic care unit
(PACU)
Total Patient Care—cont’d
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Advantages
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High degree of autonomy
Lines of responsibility and accountability are
clear
Patient receives holistic, unfragmented care
Disadvantages
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Each RN may have a different approach to care
Not cost-effective
Lack of RN availability
Registered
Nurse
Registered
Nurse
Registered
Nurse
8-hour shift
8-hour shift
8-hour shift
Patient Care
The registered nurse plans,
organizes, and performs all care
Total Patient Care (Case Method) Delivery
Functional Nursing
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Staff members assigned to complete
specific tasks for a group of patients
Evolved during World War II as a result
of a nursing shortage
Unskilled workers trained to perform
routine, simple tasks
Common use area—operating room
Functional Nursing—cont’d
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Advantages
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Care is provided economically and efficiently
Minimum number of RNs required
Tasks are completed quickly
Disadvantages
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Care may be fragmented
Patient may be confused with many care
providers
Caregivers feel unchallenged
Nurse Manager
LPN/
PO Meds
Treatments
RN
Nurse Aide
Nurse Aide
Assessments
Care Plans
Vital signs
Hygiene
Hygiene
Stocking
Assigned Patient Group
Functional Nursing Care Delivery Model
Team Nursing
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RN as team leader coordinates care for a
group of patients
Evolved in the 1950s to improve patient
satisfaction
Goal was to reduce fragmented care
Common use areas—most inpatient and
outpatient areas
Team Nursing—cont’d
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Advantages
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High-quality, comprehensive care with a high
proportion of ancillary staff
Team members participate in decision making
and contribute their own expertise
Disadvantages
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Continuity suffers if daily team assignments
vary
Team leader must have good leadership skills
Insufficient time for planning and
communication
Nurse Manager
RN Team Leader
RN
LPNs
Nursing Assistants
Assigned Patient Group
RN Team Leader
RN
LPNs
Nursing Assistants
Assigned Patient Group
Team Nursing Model
Modular Nursing
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Modification of team nursing
Patient unit is divided into modules or units
with an RN as team leader
The same team of caregivers is assigned
consistently to the same geographic area
Concept evolved to increase RN
involvement in care
Modular Nursing—cont’d
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Advantages
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Continuity of care is improved
RN more involved in planning and coordinating
care
Geographic closeness and efficient
communication
Disadvantages
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Increased costs to stock each module
Long corridors not conducive to modular
nursing
Nurse Manager
Geographic
Patient Unit
Geographic
Patient Unit
Geographic
Patient Unit
Patient Care
Team:
RNs
LPNs
Nurse Aides
Meds
Supplies
Linens
Patient Care
Team:
RNs
LPNs/
Nurse Aides
Meds
Supplies
Linens
Patient Care
Team:
RNs
LPNs/
Nurse Aides
Meds
Supplies
Linens
Modular Nursing Model
Primary Nursing
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RN “primary nurse” assumes 24-hour
responsibility for planning, directing, and
evaluating care
Evolved in the 1970s to improve RN
autonomy
Common use areas—hospice, home
health, and long-term care settings
Primary Nursing—cont’d
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Advantages
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High-quality, holistic patient care
Establish rapport with patient
RN feels challenged and rewarded
Disadvantages
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Primary nurse must be able to practice with a
high degree of responsibility and autonomy
RN must accept 24-hour responsibility
More RNs needed; not cost-effective
Primary Nurse
Physician and
other members
of the health care
team
24-hour responsibility for
planning, directing &
evaluating patient care
Patient
Primary Nursing Model
Associate Nurses
Provide care
when primary
nurse is off duty
Partnership Model
(Co-Primary Nursing)
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RN is partnered with an licensed practical
nurse/licensed vocational nurse (LPN/LVN)
or nursing assistant to work together
consistently
Modification of primary nursing to make more
efficient use of the RN
Partnership Model
(Co-Primary Nursing)—cont’d
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Advantages
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More cost-effective than primary nursing
RN can encourage training and growth of
partner
Disadvantages
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RN may have difficulty delegating to partner
Consistent partnerships difficult to maintain
due to varied schedules
Patient-Centered Care
(Patient-Focused Care)
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Cross-functional teams of professionals and
assistive personnel work together as a unitbased team
Recent development in nursing care delivery
models
More patient oriented than department
oriented
Models vary considerably among facilities
Patient-Centered Care
(Patient-Focused Care)—cont’d
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Advantages
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Patient comes into contact with fewer workers
Workers are unit based and spend more time
in direct-care activities
Team is supervised by an RN
RN is accountable for a wide range of services
and functions at a higher level
Cost-effective
Patient-Centered Care
(Patient-Focused Care)—cont’d
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Disadvantages
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Major change in organizational structure is
required
Departments other than nursing must be willing
to accept nursing leadership
Nurse manager supervises many types of
workers
Nurse Manager
Patient Care
Respiratory Services
Patient Transportation
Housekeeping ECG Admission/Discharge
Phlebotomy
Physical/Occupational/Speech Therapy Dietary Services
Financial Counseling
Supply Management
Patient
Patient-Centered Care Model
Case Management
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First introduced in the 1970s by insurance
companies
Hospitals adopted the model in the 1980s
Value demonstrated through research
Components include:
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Assessment, planning, implementation,
evaluation, and interaction
Case Management—cont’d
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Variations are found in most health care
organizations
Reserved for chronically ill patients,
seriously ill patients, or long-term,
expensive cases
RN assumes a planning and evaluative
role; usually not responsible for direct-care
duties
Supplemental form of care delivery; does
not replace direct-care model
RN Case Manager
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Coordinates the patient’s care throughout the
course of an illness from a payer or facility
perspective
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Employee of the payer (external case
management)
Employee of the health care facility (internal case
management)
Collaborates With
Patient and Family
Onset of
Illness
NURSE CASE MANAGER
Assesses, plans, implements, coordinates,
monitors, and evaluates patient care
options and services to meet health needs
Collaborates with Nursing,
Physicians, Physical/Speech/
Occupational Therapists, Dietary,
and Ancillary Services
Resolution of
Illness
Coordinates Services:
Home Care, Hospice,
Extended /Long-term Care
Ambulatory Care Services
Nursing Case Management Model
Clinical Pathways
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Delineate a predetermined written plan of
care for a particular health problem
Specify desired outcomes and
transdisciplinary intervention
Address a common medical diagnosis
Dictate the type and amount of care given
and thus have financial implications
Clinical Pathways
Terminology
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Patient outcomes
Transdisciplinary intervention
Variance
Trigger
Clinical Pathways
Essential Components
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Consults
Laboratory and
diagnostic tests
Treatments
Medications
Safety
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Self-care activities
Nutrition
Patient and family
education
Discharge planning
Triggers
Choosing a Nursing Care Delivery
Model
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What staff mix is required?
Who should make work assignments?
Work assigned by task? By patient?
How will communication be handled?
Who will make decisions?
Who will be responsible and accountable?
Fit with unit/facility/organization
management?
Influences on Nursing Care
Delivery Model Selection
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Health care setting
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Organizational structure and resources
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Acute care, long-term care, ambulatory care,
home care, and hospice
Management, staffing, supplies, and physical
layout
Patient needs
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Acute, long-term, and chronic
Evaluation of Nursing Care
Delivery Models
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Timely, cost-effective outcomes
achieved?
Patient and families happy with care?
Team members satisfied with care?
Good communication among all team
members?
RNs utilized and challenged
appropriately?