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Organizing Patient Care

why is the organizing model important?

Why is this important?

How activities are organized can impede or facilitate communication, flexibility, and job satisfaction.

Functions should be organized enough to be productive and facilitate meeting the organizations needs

Activities will be unsuccessful if their design does not meet group needs and capabilities.

Leadership Roles in Organizing Care

Leadership

Periodically evaluates the effectiveness of chosen organization model to deliver patient care

Assures congruence between the organizational mission and philosophy and the patient care delivery system selected for use.

Supports the use of nursing care delivery models that maximize the abilities of each member on the team

Assures the patient and family are the focus of patient care delivery, regardless of care model used.

Management Functions in Organizing Care

Management

Makes changes in delivery models to meet organizational goals

Uses a patient care delivery system that maximizes human and physical resources as well as time

Organizes work so that it is as time-and cost-effective as possible

Selects a patient care delivery system that is the most appropriate to the needs of the patients being served as well as the expertise of staffing mix.

Traditional Modes of Organizing Care

Traditional modes of care

There are 5 well-known delivery models, however many more exist

-Total Patient Care

-Functional Nursing

-Team and Modular Nursing

-Primary Nursing

-Case Management

Models are frequently recycled and reinvented to adapt to new technologies and discoveries in care

Choice of use of each model is dependent on staff skills, availability of resources, patient acuity, and nature of work

Total Patient Care

Oldest mode of organizing patient care

Also known as "case method of assignment"

Nurse assumes total responsibility during their time on duty

Still widely used in hospitals and home health agencies

Advantages to Total Patient Care

Advantages

Provides nurses with high autonomy and responsibility

Better opportunities for strong nurse-patient relationships

Assignments of patients is simple and direct

Lines of responsibility and accountability are clear

Patient theoretically receives holistic and unfragmented care during the nurse's time on duty

Disadvantages to Total Patient Care

Disadvantages

Each nurse caring for the patient can modify the care regimen, and the patient can receive different approaches to care, creating confusion for the patient

Requires highly skilled personnel and may cost more than other forms of patient care

Nurses may be inadequately prepared or too inexperienced

Some tasks performed by the primary caregiver could be accomplished by someone with less training at a lower cost

Functional Method of Delivering Care

Functional Method

Evolved as a result of WWII and rapid construction of hospitals

Personnel are assigned to complete specific tasks and gain proficiency through repetition

Functional nursing can be seen as "care through others" rather than direct care from a healthcare provider

Advantages of Functional Nursing

Advantages

Functional nursing is seen as very economical and efficient if quality and holistic care are disregarded

Functional nursing provides the benefit of efficiency since tasks are completed quickly- kind of like an assembly line

Allows care to be provided with a minimal number of RNs

Use of unlicensed assistive personnel frees the nurse to perform more highly skilled duties

Disadvantages to functional nursing

Disadvantages

May lead to fragmented care and the possibility of overlooking patient priority needs

Some workers may feel unchallenged and understimulated in their roles and can result in low job satisfaction

May not be as cost-effective as once thought due to increased need for coordinators

Team Nursing Delivery Model

Team Nursing

Ancillary personnel collaborate in providing care to a group of patients under supervision of a nurse

Team leader is responsible for knowing the condition and needs of all patients and for planning individual care

Advantages of Team Nursing

Advantages

Usually associated with democratic leadership

Members are given as much autonomy as possible when performing tasks

Allows members to contribute their own special expertise or skills and are

Individual worth of all employees is recognized through individualized assignments, and autonomy results in increased job satisfaction

Disadvantages of Team Nursing

Disadvantages

Primarily associated with improper implementation rather than the philosophy itself

Frequently, insufficient time is allowed for team care planning and communication

Insufficient time leads to blurred lines of responsibility, errors, and fragmented care

Modular Nursing Model

Form of team nursing that has been refined as a way to improve the functional/team nursing combination

Uses a mini-team (two or three members with at least one being an RN)

Patient care units are typically divided into modules or districts, and assignments are based on the geographical location of patients

Modular Nursing

Primary Nursing in the Inpatient Setting

Primary Nursing

Also known as relationship-based nursing and uses concepts of total patient care

The primary nurse assumes 24-hour responsibility for planning care from admission to discharge

When primary nurse is not on duty, associate nurses follow the care plan established by the primary nurse and provide care

Feedback is sought from others in coordinating the patient's care

Disadvantages to Inpatient Primary Nursing

Disadvantages

Difficult to implement

An inadequately prepared or incompetent primary nurse

Many nurses may be uncomfortable with the role and responsibilities it comes with

Other challenges include shorter lengths of stay and increasing number of part-time positions and variable shift lengths

Primary Nursing in Medical Homes

Primary Nursing in Medical Homes

Model enacted as part of the Patient Protection and Affordable Care Act

Delivers cost-effective, primary care, utilizing care coordination, ensuring high value and improving health outcomes

Engage patients and families in care coordination

Helps in increasing patient and family-centered care

Case Management Model

Case Management

Defined as a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet health needs

Individualized patient care

Often begins in the inpatient setting

Knowledge required of case manager is extensive, and some have argued it should be reserved for an advanced practice RN

Disease management

Disease

Management

Also known as:

population-based health care

continuous health improvement

Comprehensive approach to the care and reimbursement of high-cost, chronic illnesses

DM is a system of coordinated health care interventions for a patient population with a condition where self-care efforts can be implemented

It empowers individuals, working with their health care providers to manage their disease and prevent complications

Nursing in Disease management

What nursing role is used in the coordination of disease management programs?

Question

Goal

Goal

To address illnesses or conditions with maximum efficiency across treatment settings regardless of reimbursement patterns

Common high-cost & high-resource utilization diseases are identified and targeted for implementation to a program

To service the optimal number of covered lives required to save the most amount of money.

Cost drivers are reduced when patient needs are met

Effectiveness

Effectiveness

Programs prevent/reduce:

Hospitalizations

Disease exacerbation

Acute episodes

Usage of expensive resources

Question:

Give an example of a preventative or proactive case management tool and why it is effective.

Common Features

Common

Features

1. Provide an integrated approach to the care and reimbursement of common high-cost illnesses

2. Focus on prevention and early disease detection

3. Target population groups rather than individuals

4. Employ a multidisciplinary health-care team, including specialists

5. Use best practice research to guide providers

6. Use data management systems to track patient progress

7. Employ nurses as case managers or program coordinators

Question

What are some barriers to disease management programs?

Question

Selecting the Optimum Mode:

Nurse leaders should use one or more models to organize patient care that is best suited to the particular situation.

This includes thinking about:

  • skill and expertise of the staff
  • availability of nurses
  • economic resources
  • patient acuity
  • complexity of the task

Selecting the Optimum Mode

Organization

Organization

  • Is the method providing the level of care stated in the organization's missions and values?

  • Is it cost-effective?

  • Will communication patterns change?

Nursing Staff

Nursing

Staff

  • Does it provide some degree of fulfillment and role satisfaction?

  • Does it allow use of the nursing process?

  • Does it support nursing as both independent and interdependent?

  • How will social and interpersonal relationships change?

  • Will employees view their unit of work differently?

  • Will change require wider or more restricted range of skills and abilities?

Patient

Patient

Does it satisfy

the needs of patients and

their families?

Nurse Navigators

Commonly used in targeted clinical settings such as oncology

Act as a guide, resource, advocate, educator

Help patients and families by providing information and support

Coordinate appointments and schedules while keeping patient and family actively involved in plan of care

Similar role of case manager, however nurse navigators more specialized

Ex: Breast cancer nurse navigator

New

Roles

What is the difference between a clinical nurse leader and a clinical nurse specialist?

Question!

Clinical Nurse Leaders

Clinical Nurse

Leaders

Advanced generalist with a master's degree in nursing

Have advanced knowledge and education in general practice as opposed to one primary discipline

Role is to provide clinical leadership, implement quality improvement strategies, engage in clinical practice, and manage micro-systems of care

Role is not one of administration or management, but instead assumes accountability for health-care outcomes for a group of clients

Core Concepts of Leaders in

patient-centered care

Leaders in

Patient-Centered care

Care is organized around the needs of the patient

Patient and family perspectives are recognized

Communication is open and honest with patients and families

Collaboration is needed with patient, family, and health-care providers for implementation of care

Voice of patient and family are represented

organizing is an important management function

Integration

Work must be organized so that organizational goals are achieved

The integrated leader-manager is responsible for choosing and implementing a patient care delivery system that aids the accomplishment of unit goals

All members of the work group should be assisted with role clarification when work is redesigned

Team effort in work activity increases productivity and worker satisfaction

Emphasis on seeking solutions to poor organization of work rather than finding fault

Integration (cont.)

Integration (Cont.)

There is no one "best" mode for organizing patient care

Integrating leadership roles and management functions ensures that the type of patient care delivery model selected will provide quality care and staff satisfaction

The change in the mode of delivery will not be attempted without adequate resources

The leadership role demands that the primary focus of patient care delivery promotes a professional model that reduces costs and improves patient outcomes

Integration (cont.)

Integration (Cont.)

Due to health-care shortages, many health-care organizations are concerned there will be too few workers to deliver care using the same models

Health care agencies must begin to explore how newer nursing roles can be used to better integrate and coordinate care

To change the future of health care, it is the duty of health care professionals to think outside the box to discover methods to organize and deliver care that is patient and family-centered

what are some features of effective health-care delivery?

question?

  • be cost-effective
  • satisfy the patient
  • provide role satisfaction to nurses
  • allow implementation of the nursing process
  • provide adequate communication among health-care providers.

Current Best Practice

What is the Best Mode to Organize patient care?

why?

There is no Best Model of Care Delivery!

Each model of care delivery comes with it's own benefits as well as disadvantages

The model of care used is completely dependent on the unit or facility

How well each model is implemented is also dependent on the person implementing

Answer

Where might each model Be used in settings we're Used to?

Models

Total Patient Care

Team Nursing

Functional Nursing

Modular Nursing

Primary Nursing

Case Management

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