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Transcript of Chapter 013
Chapter 13
Care Delivery Strategies
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.
Objectives
Differentiate the characteristics of nursing care delivery models used in health care
Determine the role of the nurse manager and the staff nurse in each model
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Objectives (Cont.)
Summarize the differentiated nursing practice model and related methods to determine competencies of nurses who deliver care.
Consider the impact of “Transforming Care at the Bedside” (TCAB) on the delivery of care in a specific nursing unit.
Evaluate the effectiveness of transitional care models aimed at reducing unnecessary rehospitalizations.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 3
Model Selection
Considerations to be addressed when selecting a model: Organizational mission and purpose Unit objectives Patient population Staff availability Economic feasibility
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 4
Care Models
Case method Functional nursing Team nursing Primary nursing Case management
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Other Strategies
Patient-focused care Differentiated practice
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Emerging Practice Models/Influences
Magnet™ Recognition The Synergy Model The Clinical Nurse Leader
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Case Method
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Role of the Nurse Manager
Assess patient needs to determine level of care: RN care RN-supervised care Hiring and management of appropriate staff to
provide total care in a cost-effective manner
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Functional Nursing
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Functional Nursing (Cont.)
Advantages Efficient Assistive personnel can be trained to perform
specific tasks. Cost-effective
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Functional Nursing (Cont.)
Disadvantages Fragmented care; task oriented Patient and family needs may be overlooked. Lapses in communication Quality of care may be compromised; holistic view
of patient and family may be lacking. Frustrating to professional nurse
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Team Nursing
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Team Nursing (Cont.)
Advantages Cost effective Decisions made at the “grass roots” level, often by
staff caring for the patient Improved patient satisfaction
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Team Nursing (Cont.)
Disadvantages Need a skilled, knowledgeable team leader Need adequate staff with the right skill mix Potential for fragmentation of care Few work settings implement team nursing as
originally designed.
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Primary Nursing
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Primary Nursing (Cont.)
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Primary Nursing Hybrids
Compare and contrast the two hybrids. Partnership model Patient-focused care
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Nursing Case Management
The process of providing comprehensive care for those with complex healthcare problems Improved patient outcomes Decreased length of stay Interfaces with multiple disciplines Care provided across the continuum of illness,
often in different institutions
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Nursing Case Management (Cont.)
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Nurse Case Manager (NCM)
Coordinates patient care throughout the admission process Facilitates access to needed health resources Monitors utilization of resources Measures outcomes and quality Uses Critical Pathways or Care MAPs
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Nurse Navigator
Provides specific services designed to improve care
Removes barriers to care
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Clinical Pathways and Care MAPs
How are critical pathways and care MAPs developed?
What is the difference between the two? Why are these tools used by the NCM? How is evidence-based practice incorporated
into these tools?
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Differentiated Nursing Practice
Describe the education and role of the following: Associate nurse Primary nurse Advanced practice nurse
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Nurse Manager/Leader Role in Differentiated Nursing Practice
Role model Collaborator Coach Teacher Facilitator
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Clinical Nurse Leader
Oversees lateral integration of care for a distinct group of patients
May actively provide direct care for complex patients
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Transitional Care
Comprehensive discharge with instruction about medications and warnings of health problems
Instruction about medications and warning signs
Contact with patients following discharge, emphasizing helping patients manage medications
Assist in communication between patient and primary and secondary caregivers
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