1 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Chapter 15 The Health Care Organization and Patterns of Nursing Care Delivery

2 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. The Health Care Organization and Patterns of Nursing Care Delivery  Describe challenges facing health care that affect the delivery of nursing care, including:  Evidence-based care  Shortage of health care professionals  Patient/workplace safety  Trace the history of the use of nursing care delivery models

3 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Are Some Important Challenges Currently Facing Health Care?  Increase in costs  Health care costs too much  Strategy used to reduce costs can be described in broad terms as managed care   Shortage of nurses  Patient safety

4 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is Meant by Integrated Health Care Delivery Systems?  Systems offer prevention services, acute- and long-term care facilities, home health care, and hospice services  They may offer high degree of continuity of care

5 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. How Does Case Management Support Managed Care?  Ensures coordination of care while reducing costs  By assessing, planning, implementing, coordinating, monitoring, and evaluating options and services to meet person’s health needs  Effective in providing care, but not all patients need this intensity of interaction

6 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Tools Are Used to Support Case Management?  Clinical pathways  Also known as Care Maps  Disease management Both generally based on clinical guidelines incorporating nationally acceptable ways to care for specific disease

7 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Tools Are Used To Support Case Management? (cont’d)  Clinical pathways—essential elements  Timeline outlining when specific care given  Categories of care/activities and interventions  Intermediate and long-term outcomes to be achieved  Variance record

8 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Tools Are Used To Support Case Management? (cont’d)  Disease management  Supports physician/patient relationship and plan of care  Emphasizes prevention; uses evidence-based practice guidelines; empowers patients  Evaluates clinical, humanistic, and economic outcomes—  Goal to improve overall health

9 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Evidence-Based Practice  Strategy to reduce the amount of time required to integrate new health care findings into practice  Conscientious use of current best evidence in making decisions about client care

10 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Shortage of Nurses  The most recent shortage began in 1998  Nurses are retiring  Wider range of career options now available to young people  A survey found that the average RN vacancy rate in the U.S. was 8.5% and of those nurses who responded, 55% intended on retiring between 2011 and 2020.

11 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Can Be Done to Recruit Nurses to the Profession?  Interactive advertising  Recruitment materials distributed to hospitals, high schools, nursing schools  Improve work environment for nurses

12 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. How Can Health Care Organizations Retain Nurses?  Adequate compensation  Flexible staffing  Allow professional autonomy  Good communication and interpersonal relationships  Work recognition  Adequate benefits  Professional practice  Follow magnet hospital programs

13 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. Patient Safety  To improve health care quality, care must be  Safe  Effective  Patient-centered  Timely  Efficient  Equitable

14 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is the Total Patient Care or Private Duty Model?  When one nurse assumes responsibilities for the complete care of a group of patients on a 1:1 basis, providing total patient care during the shift  Many nurses prefer this method

15 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is Functional Nursing?  Breaks nursing care into a series of tasks performed by many people  LPN, CNA  Can result in fragmented, impersonal kind of care  Can lead to lack of accountability for the total patient

16 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is Team Nursing?  Groups of patients are assigned to a team headed by a team leader (usually RN)  Success of team nursing centers on good communication among team members  Team conference plays vital role

17 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is Primary Nursing?  Nurse plans and directs care of patient over 24 hour period  Relationship-based practice is new name for primary nursing—RN manages and coordinates patient’s care in hospital and the patient’s discharge plan

18 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is Patient-Focused Care?  Traditional nursing interventions handled by ancillary workers under direction of RN  Moves RNs to higher level of functioning

19 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is The Most Effective Model Of Nursing Care?  Several key characteristics were identified in a study researching 30 different nursing care models  RN serves as “primary care manager”  More focus on patient  Greater patient and family involvement → faster recovery and compliance  Specialized tools for assessment  Integration of technology to enhance communication and reduce wasted time  Reliable indicators to measure satisfaction

20 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. What Is the Impact of Staffing Patterns on the Quality of Care?  Lower levels of hospital nursing staffing associated with more adverse outcomes  Patients in hospitals today more acutely ill than in the past, yet skill levels of nursing staff have declined  Higher acuity patients have added responsibilities increasing nurse workload

21 Copyright © 2009, 2006, 2003, 2000, 1997, 1994 by Saunders, an imprint of Elsevier Inc. EVERY PATIENT NEEDS A NURSE