Chapter 13

Care Delivery Strategies

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Objectives

Differentiate the characteristics of nursing care delivery models used in health care. Determine the role of the nurse manager and the staff nurse in each model. Describe the implementation of a disease management program.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (contd)

Summarize the differentiated nursing practice model and related methods to determine competencies of nurses who deliver care. Consider the impact of Transforming Care at the Bedside (TCAB) on the delivery of care in a specific nursing unit.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Model Selection

Considerations to be addressed when selecting a model:

Organizational mission and purpose Unit objectives Patient population Staff availability Economic feasibility

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Care Models

Case method Functional nursing Team nursing Primary nursing Case management

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Other Strategies

Disease management programs Patient-focused care Differentiated practice

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Emerging Practice Models/Influences

Magnet Recognition The Synergy Model The Clinical Nurse Leader

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Case Method

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Role of the Nurse Manager

Assess patient needs to determine level of care:

RN care RN-supervised care Hiring and management of appropriate staff to provide total care in a cost-effective manner

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

Functional Nursing

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Functional Nursing (contd)

Advantages

Efficient Assistive personnel can be trained to perform specific tasks. Cost-effective

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Functional Nursing (contd)

Disadvantages

Fragmented care; task-oriented Patient and family needs may be overlooked. Lapses in communication Quality of care may be compromised; holistic view of patient and family may be lacking. Frustrating to professional nurse

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Team Nursing

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Team Nursing (contd)

Advantages

Cost-effective Decisions made at the grass roots level, often by staff caring for the patient Improved patient satisfaction

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Team Nursing (contd)

Disadvantages

Need a skilled, knowledgeable team leader Need adequate staff with the right skill mix Potential for fragmentation of care Few work settings implement team nursing as originally designed.

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Primary Nursing

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Primary Nursing (contd)

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Primary Nursing Hybrids

Compare and contrast the two hybrids.

Partnership Model Patient-Focused Care

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Nursing Case Management

The process of providing comprehensive care for those with complex healthcare problems

Improved patient outcomes Decreased length of stay Interfaces with multiple disciplines Care provided across the continuum of illness, often in different institutions

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Nursing Case Management

(contd)

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Nurse Case Manager (NCM)

Coordinates patient care throughout the admission process

Facilitates access to needed health resources Monitors utilization of resources Measures outcomes and quality Uses Critical Pathways or Care MAPs

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Clinical Pathways and Care MAPs

How are critical pathways and care MAPs developed? What is the difference between the two? Why are these tools used by the NCM? How is evidence-based practice incorporated into these tools?

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Disease Management

Model of care that coordinates care interventions for those with chronic illness

Emphasis is on self-care (education) with the goal of preventing exacerbations and complications. Utilizes best practices for clients with chronic illnesses such as arthritis, congestive heart failure, and diabetes Outpatient follow-up is frequently provided.

Copyright 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

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Differentiated Nursing Practice

Describe the education and role of the following:

Associate nurse Primary nurse Advanced practice nurse

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Nurse Manager/Leader Role in Differentiated Nursing Practice

Role model Collaborator Coach Teacher Facilitator

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