One of the aspects of health care that leaders and managers need to consider is how care is delivered.
LEARNING OUTCOMES
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.
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.
Evaluate the effectiveness of transitional care models aimed at reducing unnecessary rehospitalizations.
Several factors must be considered when selecting a model. For example, you might want to provide primary nursing, but the availability of staff and the economics of it are prohibitive. Each of these factors influences the decision about delivery of care.
Five methods or models for providing care have been developed. Note these for now; we will return to them later. They are: [Read slide]
Other strategies are available too. You may hear about: [Read slide]
Several factors influence the way in which care is considered. The Magnet Recognition Program of the American Nurses Credentialing Center doesn’t dictate a particular approach. Rather, it expects that staff and administrators can describe why whichever approach they use is best for their situation. The Synergy Model, developed by the American Association of Critical Care Nurses, is a comprehensive approach to care. It starts with a philosophical approach to care that drives the way care is delivered. A third consideration is the Clinical Nurse Leader, which was developed by the American Association of Colleges of Nursing. This new role is designed to help staff solve problems and improve the quality of care delivered on a clinical unit.
Let’s look at the main models. The first is the case method.
The next model is functional nursing.
It has several advantages.
It also has several disadvantages.
Team nursing, or a modification of it, is prevalent in many care settings.
Team nursing has some distinct advantages. It has these attributes: [Read slide]
It also has disadvantages. Why is the last statement true? [Discuss]
Primary nursing is explained in this figure.
It also has specific disadvantages. How feasible is usage of this model in agencies where students are placed? Why is this so? [Discuss]
Two primary hybrids exist. They are the partnership model and patient-focused care.
Nursing case management can be defined as [Read definition]. It results in [Read outcomes].
This figure represents case management in nursing.
What populations of patients are best served by utilization of the Nurse Case Management Model?
(e.g., cardiac patients—those with CHF; high-risk perinatal patients—particularly those who are on home monitoring; pediatric patients—especially those with chronic illnesses such cystic fibrosis, type 1 diabetes, or AIDS)
Important to help students understand that Nurse Case Managers will have a manager/leader.
This individual will manage and lead the quality improvement process (including patient feedback surveys), making sure that the paths and MAPs are current and relevant with care practices and reimbursement methods.
Provides oversight with case managers to be sure caseloads are appropriate and are effectively managed
Interfaces with other disciplines to clarify the role of the NCM.
Creates opportunities for staff development. May include individuals from other disciplines.
Your text discusses critical pathways and care MAPs. Here are some questions to consider.
The other major hybrid is differentiated practice. What did the text suggest as the primary differences among these roles?
The nurse leader/manager performs several roles in differentiated practice situations. They are: [Read slide]
What leadership theory (Transformational) is related to these role components? Why do you say that?