Exam II Flashcards
total patient care delivery model
- RN is responsible for planning, organizing, & performing all patient care during assigned shift
- Oldest method or organizing pt care (AKA case nursing)
- nursing student typically performs total patient care for assigned pts
- common use: CCU, ICU, PACU
total patient care: advantages
- RN has high degree of autonomy
- line of responsibility & accountability are clear
- patient receives holistic, unfragmented care
- communication at shift change is simple and direct
total patient care: disadvantages
- # of RNs required is very costly
- some tasks could be accomplished by caregiver with < training & at lower cost
- RN shortage will affect availability
functional nursing delivery model
staff members are assigned to complete certain - tasks for a group of patients rather than care for specific patients (task oriented)
lines of responsibility & accountability
- nurse manager assigns responsibility for completion of tasks to group of health care workers
- RN is responsible for planning care & supervising workers
- RN retains accountability for pt care provided
common use: operating room
functional nursing : advantages
- provided economically & efficiently
- minimum # RNs requires for pt care
- tasks completed quickly
- little confusion about responsibilities
functional nursing: disadvantages
- may be fragmented; possibility of overlooking priority pt needs
- pt may be confused b/c of different caregivers
- caregivers may feel unchallenged- perform repetitive tasks
team nursing delivery model
RN functions as a team leader & coordinates care for a small group of patients
common use: inpatient & outpatient settings
Lines of responsibility & accountability
- RN team leader responsible for: planning care, assigning duties, directing, supervising, & assisting team members, giving direct care
- RN retains accountability for all pt care
- RN team leader is responsible for encouraging cooperation & maintaining clear communication.
team nursing: advantages
- high quality, comprehensive care provided with high proportion of ancillary staff
- each member participates in decision making, problem solving
- each member contributes own special expertise or skills
team nursing: disadvantages
- continuity of care may suffer with daily team assignments
- team leader may not have effective leadership skills req’d
- insufficient time for care planning & communication–> unclear goals & fragmented care
modular nursing
- modification of team nursing
- unit divided into modules
- same team of caregivers assigned consistently to same geographic location
- each module has RN team leader
- goal: increase involvement of RN in planning & coordinating care
- modules should have all supplies needed by staff to maximize efficiency.
primary nursing delivery model
- primary RN has 24 hour responsibility for planning, directing, & evaluating pt’s care from admission through discharge
- on duty: primary RN provides total care
- off duty: care provided by associate nurse who follows care plan established by primary RN
- common use: home health, hospice, LTC
Lines of responsibility & accountability: - primary RN has 24-hr responsibility & accountability for pt. care
- associate nurse responsible for following care plan
- RM primary nurse must maintain clear communication among all HCT members.
primary nursing: advantages
- direct pt care provided by small # of nurses–> high quality, holistic
- pt can establish rapport with primary RN, leading to increased pt satisfaction
- high job satisfaction–> RNs practice with high degree of autonomy= challenged and rewarded.
primary nursing: disadvantages
- primary RN has high degree of responsibility & autonomy
- primary RN may not have req’d clinical decision making or communication skills
- RN may not want 24 hour responsibility
- # of RNs req’d may not be cost-effective. may be difficult to recruit and train.
Partnership Model
- RN partnered with LPN or nursing assistant–> work together consistently
- modification of primary nursing–> more efficient use of RN
Lines of responsibility & accountability: - RN responsible for planning care, assigning duties, coordinating care, & supervising partner
- RN accountable for pt care for all assigned patients.
common use: home health, hospice, LTC
partnership model: advantages
- more cost-effective than primary care nursing
- RN can encourage training & growth of partner
partnership model: disadvantages
- RN may have difficult delegating to partner
- consistent partnerships are difficult to maintain due to varied staff schedules.
telehealth nursing
- important method of providing nursing care to pts in ambulatory settings.
- formally used to interact with patients
- AKA telephone triage, telephone nursing, or telehealth.
- encompasses all telecommunication methods.
nurses’ roles in telehealth nursing
- triage
- interventions
- consultation
- surveillance & follow-up
case management & nursing care delivery models
- supplemental form of nursing care
- does not replace the nursing care delivery model
- RN case manager plans & evaluates care. usually not responsible for direct care duties.
- uses: chronically ill; seriously ill or injured; long term, high-cost cases
clinical pathways (AKA critical paths, practice protocols, care maps)
- predetermined written plan of care for specific health problem
- desired outcomes & interprofessional intervention req’d w/i time period for specific diagnosis or health problem.
- differ from clinical practice guidelines
- clinical pathways define key processes & pt goals in day to day management of care
- clinical practice guidelines focus on broader decision making related to performance of a procedure or service.
factors influencing changes in nursing care delivery
- rapid technologic advances
- fast-paced pt turnover in acute care settings
- RNs value in pt safety and quality care
- ongoing RN shortages & other health professionals
- strong focus on care outcomes
- consumer demand for instant access to care & information
- need to focus on underlying determinants of health affected by lifestyle & personal choice.
future of nursing
- traditional nursing care models focused on comprehensive knowledge of pt needs & care over an extended period.
- now RNs may be assigned a new group of pts every shift or > once during shift
- future RNs must conduct focused assessments & set priorities before pt is quickly transitioned to another level of care.
- relationship-based care must be considered in high-tech fast-paced environments
- care must be consistent with nursing values of compassion, caring, & healing
- nurse leaders will be challenged to identify new models: cost effective, improve quality & safety, facilitate relationship-based nursing.
motivation & morale: tasks
- creating harmony in the workplace
- making people feel valued
- focusing on goals
- handling relationships
- reinforcing values that keep positive action alive
- open communication & conflict resolution
- providing role model
decision-making
- a purposeful & goal-directed effort using a systematic process to choose among options
- not all decisions begin with a problem
- ID & selection of options or alternatives. don’t always have to do this in isolation.
- good to have a framework to guide decisions: be consistent, systematic
problem-solving
- a process of focusing on an immediate problem to create resolution between the gap of “what is” & “what should be.”
- involves a decision-making step.
critical thinking
“…actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information gathered from or generated by observation, experience, reflection, reason or communication, as a guide to belief or action.”
decision models
two types of decisions:
- satisficing (good enough, satisfactory)
- optimizing (best possible)
decision-making styles
Autocratic - decide & announce - may be useful in an emergency situation Democratic - group input
arriving at a good decision
- information is factual, complete, & relevant
- decision-makers processed the data
- the decision is defensible (why you came to that decision)
- benefits outweigh liabilities & risks
- there is a fit between the decision and the original need/problem.
- you have to take the time to look at the information and the facts.
steps in problem solving
- define problem
- gather data–> assess & analyze
- develop solutions once all evidence is weighed
- select a solution
- implement
- evaluate result
two types of change
- linear: planned. straight line.
- nonliner: complex. spiral shape.
linear change: Lewin’s Force Field Analysis
Assessment
- barriers: budget, equipment (technology), people who value the status quo, groups who see the change as a threat.
- facilitators: data, community support, buy-in by physicians and nurses, PATIENT SAFETY
Three stages:
- unfreezing
- experiencing the change
- refreezing
change agents & followers
- irrespective of the role an individual holds in an organization, each person is either leading a change or supporting a change…or being an ostructionist.
conflict
A perception of incompatibility
- based on a difference in beliefs, attitudes, goals, priorities, methods, information, ideas, interpretation of reality, personalities, motives, needs, & interests.
