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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.
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.
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
What nursing role is used in the coordination of disease management programs?
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
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.
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
What are some barriers to disease management programs?
Nurse leaders should use one or more models to organize patient care that is best suited to the particular situation.
This includes thinking about:
Organization
Nursing Staff
Patient
Does it satisfy
the needs of patients and
their families?
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
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
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
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
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
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
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
Total Patient Care
Team Nursing
Functional Nursing
Modular Nursing
Primary Nursing
Case Management