NCM 118: Patient Care Delivery Systems PDF

Panagsinan State University Bayambang Campus Bayambang, Pangasinan Institute of Nursing NCM 118 (Nursing Leadership and Management)...

Panagsinan State University Bayambang Campus Bayambang, Pangasinan Institute of Nursing NCM 118 (Nursing Leadership and Management) PATIENT CARE DELIVERY SYSTEM The models of patient care delivery have been used for decades to describe different approaches to nursing and patient treatment. It is also known as nursing models and care delivery systems. There are several models commonly used by healthcare providers and professionals. Each model has advantages and disadvantages, and no singel method is ideal. Managers must examine the following when selecting model: Organizational goals, Budget, Staff availability, Unit objectives, Patient population Models of patient care: Total Patient Care/Case Method, Functional Nursing, Team Nursing, Primary Care, Modular Nursing, Nursing Case Management, Innovative/Contemporary Method CASE METHOD  This is one of the oldest models of patient care delivery in use (e.g., Great Depression of the 1930’s), and it involves overseeing almost every aspect of patient care.  Nurses plan individual treatment objectives, working in shifts to cover everything from personal hygiene and medication to emotional support and additional therapies and treatments.  The premise of the case method is that one nurse provides total care for one patient during the entire work period  It focuses on a patient receiving care from one nurse who is replaces by another nurse at the end of a designated shift.  Registered nurse assumes responsibility for a group of patients for a shift - provides all care to the patient. Advantage Disadvantage Continuity for the shift Can be very expensive Clear responsibility Not utilize nurse’s time wisely Generally satisfying for nurses May not be possible with staffing shortage FUNCTIONAL NURSING  Evolved primarily as a result of World War II in 1940s  Underpinned by a hierarchical structure, which involves experienced, highly-qualified nurses, taking care of the most advanced, complex jobs. This requires more junior nurses to oversee basic tasks to free up time for the highly skilled nurses.  One criticism of this model is that it fails to provide holistic care. Holistic treatment focuses on the overall being, rather than targeting specific injuries, symptoms, and illnesses.  This model aim to work as a team to carry out individual elements of the treatment plan, rather than enhancing overall health and well-being.  Staff members are assigned to a specific task or group of tasks for patients (e.g., medication, IV, vital signs) Advantage Disadvantage Incorporate the use of Licensed Practical Can lead to fragmentation and gaps in Nurse and Unlicensed Assistive Personnel patient care  and maximize their skills Can be cost effective Not holistic TEAM NURSING  Developed in the 1950s in an effort to decrease the problems aasociated with the functional organization of patient care.  Is is similar to the functional model, but it operates on a larger scale. At the head of the team, a senior nurse takes charge of delegating task throughout the group. The collective care for a number of patients at the same time and jobs are assigned based on skill level, training, and experience.  This model enables health care professionals with limited experienced to learn from peers with expertise and knowledge, and it also provides support for those with more experience, enabling them to focus on core tasks that match their skill set. Advantage Disadvantage If done well, it can be very satisfying to Require high skill leadership from staff and patients registered nurse Harder to do with high patient acuity and Cost effective inconsistent team members PRIMARY CARE  A cultural revolution occurred in the U.S during the 1960s. The revolution emphasized individual rights which then influenced the nursing profession.  This model favors a more holistic patient care throughout their hospital stay. It is more suitable for patients with more complex needs.  One of the main issues with this model in the modern healthcare setting is the shift towards flexible working arrangements. Many healthcare professionals now choose to work hours that follow patterns of days or nights on duty followed by a period of time off.  Registered nurses assume 24/7 accountability for their primary patients - establish plan of care and coordinate care even in their absence. Advantage Disadvantage Can result in high job satisfaction Requires high R.N mix Difficult to do with today’s flexible Excellent holistic care for patients scheduling Some staff don’t want the accountability All staff are RN (professional staff) and responsibility MODULAR NURSING  A mini-team of 2 to 3 members approach. Members are sometimes called “care pairs”  Modular nursing is a modification of team nursing and focuses on the patient’s geographic location for staff assignments.  The patient unit is divided into modules or districts, and the same team of caregivers is assigned consistently to the same geographic location.  The concept of modular nursing calls for a smaller group of staff providing care for a smaller group of patients  Typically, each module will have access to the medications, supplies, and linens needed within the module. Advantage Disadvantage Costs may be increased to stock each Continuity of care is improved when staff module with the necessary patient care members are consistently assigned to the supplies (medication cart, linens, and same module dressings) Geographic closeness and more efficient Can be difficult to execute with communication save staff time inconsistent team members INOVATIVE OR CONTEMPORARY METHOD  Defines the evolving role of the nurse in treating patient in a technologically advanced setting. Nurse assume role that were formerly ascribe to doctors. Nurses are legally accountable to their actions.  Nurses can be certified registered nurse anethetics, and can prescribe medications  New medical technologies can make life easier for medical professionals and patients alike  Certain technologies can make patient care easier and more efficient for the doctors and nurses who manage a large patient load.  Nursing technologies that are being used: automaged IV pumps, Portable monitor, Portable X-ray, Electronic health records, Centralized command center, Telehealth and other Apps CASE MANAGEMENT  Is a coordinated effort between community-based, often non-profit organizations that work to provide quality healthcare solutions that are customized to a client’s specific and individual needs  There are four basic levels involved with case management - intake, needs assessment, service planning, monitoring, and evaluating Intake  In this step, as much information as possible is gathered with an eye toward creating an accurate picture of client’s current situation. This information is provided by the client and at this stage, the client’s needs are made expressively clear.  Gathering demographic information, identifying immediate needs, establish a relationship with the client, determine if the client can benefit from the organization Needs Assessment  Steps that are taken at this level: Identifying key problems, needs, and interests; Establishments of specific goals - helps to ensure that all parties involved; communicate potential challenges to the client; Reassess needs periodically to make sure that agreed-upon plan is still servicing the client in a way that helps them most Service Planning  The plan is often subject to input from client’s support system and their other health providers. Steps involved in creating a service plan include the following: specific actions are outlined to achieve goals; Development of a timeline for goals; Established metrics to measure progress Monitoring and Evaluating  Monitor established metrics. Ensure quantified data is used rather than anecdotal: rely on data gathered during implementation of the plan with an eye toward using the metrics established. Nursing Process in the Delivery of Nursing Care Services  Assessment - the nurse gathers key information in completing a comprehensive nursing assessment  Diagnosis - the nurse will next identify a nursing diagnosis based on the initial assessment  Planning - plans how to address the problem identified  Intervention - this includes implementing the plan and documenting the care provided  Evaluation - evaluates how effective the nursing intervention were in addressing the nursing diagnosis Patients Classification System  Self Care or Minimal Care - patients who are recovering and normally requires only diagnostic studies, minimal therapy, less frequent observations, and daily care for minor conditions, and are awaiting for elective surgery  Moderate Care - patient is moderately ill or under recovery stage from a serious illness or operation  Maximum Care - patient needs close attention and complete care all throigh the shift  Intensive Care - patient is acutely ill and high level of nurse dependency is required