Nursing Patient Care Models PDF

**Chapter 14: Organizing Patient Care** **Total Patient Care Model** - **TEST QUESTION: NEED TO Listen to beginning slide \[something about how patient care changed\]** - **KNOW Going from in-home nursing to hospital nursing** - **KNOW The oldest mode of organizing patient care**...

**Chapter 14: Organizing Patient Care** **Total Patient Care Model** - **TEST QUESTION: NEED TO Listen to beginning slide \[something about how patient care changed\]** - **KNOW Going from in-home nursing to hospital nursing** - **KNOW The oldest mode of organizing patient care** - **One nurse is responsible for all aspects of care for a group of pts during their shift** - **Nurses assume total responsibility for meeting the needs of all assigned patients while on duty** - It is sometimes referred to as the case method of assignment because patients may be assigned as cases - It is still widely used in hospitals and home health agencies - Diagram of total patient care: Charge nurse → caregiver → patients - **KNOW \[KAHOOT\] Mostly seen in ICU/ER** - **KNOW Disadvantage of total patient care: The greatest disadvantage of total patient care delivery occurs when the nurse is inadequately prepared or too inexperienced to provide total care to the patient.** **Functional method of nursing** - **KNOW Work is divided and done through tasks** - **Evolved as a result of World War II** - Uses relatively unskilled workers who have been trained to complete certain tasksCare is assigned by task rather than by patient - **Functional nursing** structure: - Charge nurse → RN med nurse, RN treatment nurse, CNAs, housekeeping → patients - **KNOW \[KAHOOT\] Ex: 1 nurse is administering meds and another is providing tx and doing discharges** - **Advantage** is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities - **Disadvantage**: functional nursing may lead to fragmented care and the possibility of overlooking patient priority needs - Ex. Nursing homes **Team nursing** - **KNOW It requires extensive team communication with licensed & unlicensed personnel & regular team planning conferences** - Ancillary personnel collaborates in providing care to a group of patients under the direction of a professional nurse - It allows members to contribute their own special expertise or skills - **Disadvantages** are associated with improper implementation rather than the philosophy itself - Team nursing structure: Charge nurse → team leader → nursing staff → patients **KNOW \[KAHOOT\] Modular Nursing**: **This type of nursing is practiced in distinct geographic locations of pts** - Modular nursing, mini-team approach, is a method of nursing care delivery that divides a nursing unit into smaller sections/modules. Each module is assigned a team of nurses and other healthcare staff who are responsible for the care of pts within that module - Modification of team and primary nursing **KNOW \[KAHOOT\] Primary Nursing/Relationship-based nursing** - It brings the nurse back to the bedside to provide clinical care - **KNOW The primary nurse plans and monitors care from admission to discharge** - **One primary RN is assigned to oversee the care of a pt throughout their entire stay at the hospital (the RN creates a care plan and coordinates with other nurses and staff who assist in carrying out that plan)** - **KNOW The is the optimal mode of organizing patient care** - It can succeed with a diverse skill mix just as team nursing or any other model can succeed with an all-RN staff - Job satisfaction is high; however, this method is difficult to implement because of the degree of responsibility and autonomy required of the nurse - Disadvantages lie primarily in improper implementation **KNOW Disease management programs** - **KNOW The goal of DM is to address such illnesses or conditions with maximum efficiency across treatment settings regardless of typical reimbursement patterns (book)** - **It is also known as population-based health care and continuous health improvement** - **Provides a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses (ex: cancer, DM, hyperlipidemia, asthma, HTN, acute otitis media, AIDS, stroke, HRT)** - **KNOW \[KAHOOT\] DM is population based and CM focuses on individual patients** - **KNOW \[KAHOOT\] DM focuses on optimum cost effective care for groups and CM doesn't** **Selecting the optimum mode of organizing patient care:** - **KNOW \[KAHOOT\] Not every nurse desires a challenging job with autonomy of personal decision making** **Newer health-care delivery models & nursing roles** - Nurses working in settings that embrace patient and family centered care - **Nurse navigators** help patients and families navigate the complex health-care system by providing information and support **Clinical Nurse-leader \[CNL\], pg 373** - **Experienced nurse, Graduate degree, Clinical leadership of all healthcare settings, Outcome-based practice, Quality improvement strategies, Clinical practice, Creates and manages microsystems, and Responsive health-care needs of individuals and families** - **CNL are expected to:** - Provide clinical leadership at the point of care in all health-care settings - Implement outcomes-based practice and quality improvement strategies - Engage in clinical practice - Create and manage microsystems of care that are responsive to the health-care needs of individuals and families - CNL assume accountability for health-care outcomes for a specific group of clients within a unit **Chapter 15: Employee Recruitment, Selection, Placement, and Indoctrination** **KNOW Achievement of Organizational Goals** - **Staffing management, timely & effective recruitment, and employee selection & orientation** - Staffing is where the leader-manager recruits, selects, orients and promotes personnel development to accomplish goals of the organization **KNOW Factors affecting staffing needs:** - Source of nursing pools. Number of students enrolled in local nursing schools - Usual length of employment of newly hired staff. Peak staff resignation periods - Times when patient census is highest. Patient care delivery system in place - Knowledge level of needed staff. Budget constraints **Is there a nursing shortage?** - The shortage of human resources poses the greatest challenge to most health care organizations today - Onset of the COVID-19 pandemic in 2020: wave of earlier-than-planned retirements - Aging of the nursing workforce. Accelerating demand for professional nurses - Inadequate enrollment in nursing programs of study. Nurse faculty shortage **Recruitment vs. Retention** - **KNOW Retention is the key to adequate staffing long term and it occurs then the organization is able to create a work environment making staff want to stay.** - **Recruitment:** The process of actively seeking out or attracting applicants for existing positions - Should be an ongoing process - Recruitment methods: Advertisements, Career days, Literature, and Informal use of members of the organization as examples of satisfied employees - **Factors affecting recruitment:** Financial resources, Adequate nursing pool, Competitive salaries, The organization's reputation, The location's desirability, and The status of the national and local economy - Recruitment is not the key to adequate staffing in the long term. - **When employee retention is a priority the facility can decrease spending on their recruitment budget** **One of the best ways to maintain an adequate employee pool is by word of mouth** - The recommendation of the organization's own satisfied & happy staff **Supply and demand** - **KNOW From a historical perspective -- when the economy improves, nursing shortages occur and when the economy declines, nursing shortage rates decline as well** - This is a direct reflection of supply and demand factors **KNOW Nursing staff diversity (in terms of gender, culture, age, ethnicity, and language) is helpful in meeting the needs of an increasingly diverse client population** - **KNOW \[KAHOOT\] Lacking diversity is linked to health disparities** - Diversity also brings new perspectives to thinking & problem solving - Managers should be alert to gender, culture, ethnicity, age, & language diversity in communities served by organizations & should seek to recruit a staff both sensitive & responsive to diversity **Interviewing strategies** - **KNOW Validity and reliability increases with team approach (that is why it is best to use team approach in interviews)** - **The major defect of the interview is subjectivity** **Tips for the applicant:** - **KNOW Look your best for the interview. Dress conservatively and make sure you are neatly groomed** - Do your homework about the organization you are applying to - Practice the interview and rehearse answers to foreseeable questions about your education and experience - Be prompt on the day of the interview **KNOW Tips for the applicant DURING the interview**: - **The goal is to make a good first impression** - Be on time. Smile, shake hands, and maintain eye contact - Stand until the interviewer invites you to sit. Place personal belongings beside you on the floor - Don't slouch or fidget. Don't chew gum or smoke cigarettes. Bring a paper and pencil to make notes - Answer the questions with confidence and watch the interviewer for nonverbal cues **KNOW Illegal interview inquiries** - It is against federal law for interviewers to ask questions regarding the following topics, and therefore, it is not recommended that interviewees bring them up either: - **Age, Date of birth, Religion** - Marital status, Children Race/ethnicity, Sexual preference, Financial status, Nationality **Chapter 16: Socializing and Educating Staff for Team Building** **Philosophy of Learning Organizations** - Collective learning goes beyond boundaries of individual learning and releases gains for both the individual and the organization - The learning organization promotes a shared vision and collective learning in order to create positive and needed organizational change - **KNOW \[KAHOOT\] Teamwork, collaboration, and commitment to personal improvement are seen in learning organizations** **Key characteristics of Senge's Model of Los include: "SP TMS"** 1. Systems thinking 2. Personal mastery 3. Team learning 4. Mental models 5. Shared vision **KNOW Pedagogy versus Andragogy, table 16.1** - **Pedagogy refers to the methods and practices used in teaching children while andragogy refers to the methods and practices used in teaching adults** - **Pedagogy involves more directive teaching and andragogy focuses on facilitating self-directed learning** - **KNOW \[KAHOOT\] Andragogy, the nurse manager needs to:** - Explain why the adult needs to learn something - Realize that adults need to apply what they've learned quickly - Utilize experiential techniques when teaching - Value the adults learning experience **KNOW Assessing staff learning: learners reaction, behavior change, organizational impact, and cost-effectiveness (book, pg. 423)** **KNOW Implications of Knowles' work for trainers and educators:** - A climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn - Adults enjoy taking part in and planning their learning experiences - Adults should be involved in the evaluation of their progress. Experiential techniques work best with adults - Mistakes are opportunities for adult learning - If the value of the adult's experience is rejected, the adult will feel rejected - Adults' readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem) - Adults need the opportunity to apply what they have learned very quickly after the learning - Assessment of need is imperative in adult learning (explain why it is beneficial for that employee) Obstacles to learning include: - Institutional barrier. Time. Self-confidence. Situational obstacles. Family reaction. Special individual obstacles Assets for learning include: - Self motivation. Self directed. A proven learner. Knowledge experience reservoir. Specific individual assets **KNOW Socialization is the learning of the behaviors that accompany each role by instruction, observation and trial and error** - involves a sharing of the values and attitudes of the organization - helps to create a fit between the new staff member and the unit by introducing them to the norms of the group **KNOW Resocialization occurs when individuals are forced to learn new values, skills, attitudes and social rules as a result in changes in the type of work they do, in the scope of responsibility they hold or in the work setting itself** - Transition from expert to novice: go from top dog charge nurse to new NP on unit **Team Building via Role Models, Preceptors, Mentors** - **KNOW Role models**: are experienced, competent employees whose relationship can be passive or nonexistent. - **KNOW Preceptors** are experienced nurses who provide knowledge and emotional support - The relationship is active and purposeful. - **KNOW Coaching** is when one person helps another in order to achieve an optimal level of performance - It is a tool often used to empower subordinates, change behaviors and help in developing a cohesive team. - **KNOW \[KAHOOT\] When a manager works with an employee in order to help them learn time management techniques** - **KNOW Mentors**: Mentors take on an even greater role in using education as a means for role clarification; distinctive interactive relationship between two individuals, occurring most commonly in a professional setting. - They light the way for career goals (book) **Chapter 17: Staffing Needs and Scheduling Policies** **Why is scheduling so difficult in nursing** - Main reasons: staffing, patient acuity, and patient census numbers - doesn't fit the traditional business cycle. There\'s an erratic and unpredictable health-care demand - High-level expertise is required 24/7. Stress of job requires balanced work--recreation schedule **KNOW What is the difference between centralized and decentralized staffing?** - **Centralized** staffing is where staffing decisions are made by personnel in a central office or staffing center - **Staffing is fairer to all employees because policies tend to be employed more consistently and impartially** - **Decentralized** staffing is when the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules. - **Scheduling and staffing lead to increased autonomy and flexibility** - Fair and uniform staffing and scheduling policies must be written and communicated to all staff **KNOW Staffing/Scheduling Options** - 10 or 12 hour shifts. Agency & Travel Nurses. Shift Bidding. **Flextime Scheduling** - **KNOW Flextime is a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.** - Per Diem & Float Pool (Float must be able to perform core competencies of unit to meet their legal and moral obligations as caregivers) - Self- Scheduling (greater staff satisfaction when guidelines are followed). - **KNOW Relationship between nursing care hours, staffing mix, and quality of care/staffing policies** - Relationship is that more nursing care hours and better staffing mix (more RNs) typically lead to higher quality of care. This means pts receive better attention, fever eros occur, and overall pt outcomes improve **The Relationship Between Staffing and Quality of Care** - **Staffing mix:** refers to the mix (percentages) of licensed (registered nurse \[RN\] and licensed vocational nurse \[LVN\]) and unlicensed assistive personnel (certified nursing assistant \[CNA\]/nursing assistive personnel \[NAP\]) working at a given time. The manager must also be aware of the patient\'s acuity so that the most economical level of nursing care that will meet patient needs can be provided. - **Staffing ratios** - **Numbers of staff** **KNOW Staffing and scheduling policies** - Name of person responsible for staffing schedule. Type and length of staffing cycle used - Rotation policies if shift rotation is used. Fixed shift transfer policies - Time and location of schedule posting. When shift begins and ends; day of week schedule begins - Weekend off policy; tardiness policy. Low census procedures **KNOW Closed unit** staffing occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census **KNOW Self-scheduling:** Self-scheduling allows nurses in a unit to work together to construct their own schedules rather than have schedules created by management. With self-scheduling, employees typically are given 4 to 6 week schedule worksheets to fill out several weeks in advance of when the schedule is to begin (book) **Safe staffing:** having the right number of RN with the appropriate skills to care for pts (ensures that each nurse has a manageable workload) **KNOW Challenges in scheduling:** impact on financial costs, retention, productivity, risk management, and employee and patient satisfaction. **KNOW Mandatory overtime: In mandatory overtime, employees are forced to work additional shifts, often under threat of patient abandonment should they refuse to do so. Some hospitals routinely use mandatory overtime in an effort to keep fewer people on the payroll.** - **Consequence: It has a devastating short-term impact with regard to staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity.** - **Mandatory overtime should be a last resort, not standard operating procedure because an institution does not have enough staff (book)** **\[KAHOOT\] Effects of decreased patient care hours demonstrates:** - As RN hours decrease in NCHPPD (nursing horse per patient day), adverse patient outcomes increase. This includes: - Increased medication errors. Increase in patient falls - Decreased patient satisfaction with pain management -