1. Introductory Medical-Surgical Nursing Settings and Models for Nursing Care

2. Nursing Care Introduction –Caring for: Individual; Family; Groups –Nurse’s role Health education; Prevention; Promotion Attend client needs: Hygiene; Activity; Diet; Medical treatment; Physical, emotional, spiritual comfort

3. Question Is the following statement True or False? If a LPN/LVN has a question regarding client care, they should phone the physician.

4. Answer False. If a LPN/LVN has a question regarding client care, they should initially discuss the issue with their supervisory RN.

5. Nursing Care Nursing Roles –Different educational levels provide care: Licensed Practical/Vocational nurse: Under RN or physician; Determines need to seek out RN RN’s role: Management and coordination of care provided to clients

6. Nursing Care Definitions of Nursing –Clear and comprehensive definition-difficult –Florence Nightingale: “the patient in the best condition for nature to act upon him” –Virginia Henderson: Definition; Regaining independence –Definition of nursing: The American Nurses Association (ANA) Six essential features of contemporary nursing practice

7. Nursing Care Nursing care: Provided in various settings Levels of nurses: Outpatient and inpatient care areas Decreased reliance on hospitals –Client needs determine setting for care –Much interest in determining most cost-effective methods of care

8. Question Is the following statement True or False? Budgetary constraints are the primary determining factor in client care.

9. Answer False. While budgetary constraints can be a factor in determining, the primary determining factor in client care is the need of the client. Frequently nurses advocate for best care for the client.

10. Models for Nursing Care Delivery Case method –One nurse provided all services-particular client required –Provided care in the home; Performed household duties –Evolution: Modern version is private duty nursing

11. Models for Nursing Care Delivery Hospital-Based Nursing: Functional nursing –Task-oriented; Distinct duties - specific personnel; Divided tasks; Several people during shift –Fragments care; Confusing for client Hospital-Based Nursing: Team nursing –Response to fragmented care of functional nursing –Varying education levels and skill; RN - team leader; LP/LVNs; Nursing assistants

12. Models for Nursing Care Delivery Hospital-Based Nursing: Total care –Nurse: Assumes all the care for a small group of clients –Focuses: More on client as a whole rather than the collection of nursing tasks to be accomplished –Often practiced in intensive care units where nurses are assigned one or two clients

13. Question Is the following statement True or False? Team nursing was a model developed in response to functional nursing.

14. Answer True. Team nursing was a model developed in response to functional nursing which resulted in fragmented care which was highly confusing to clients.

15. Models for Nursing Care Delivery Hospital-Based Nursing: Primary Nursing –RN: 24-hour accountability for client’s care; Total nursing responsibility of clients assigned –Secondary nurses: Carry out care in primary nurse’s absence –Expensive; Relies on RNs –Advantage: Client assured of comprehensive, holistic care –Home care settings: Effective use

16. Models for Nursing Care Delivery Hospital-Based Nursing: Patient-focused care –Updated version of primary care and team nursing –RN with one or more assistive personnel care for group of clients –Licensed and unlicensed assistants are cross- trained –RN Role: Resource management and nursing care outcome responsibility

17. Community-Based nursing –Various locations: Nurses practice –Skilled nursing facilities: Acute illness; Invasive procedures –Intermediate care facilities: Nursing homes provide custodial care for people with mental or physical disabilities; No reimbursement from Medicare –Rehabilitation centers: Provide physical and occupational therapy for ADLs Settings and Types of Nursing Care

18. Community-Based Nursing (Cont’d) –Hospices: Terminal illness; Staff trained to help clients with grieving process; Medicare coverage –Community health centers; Community mental health centers - funding –Other facilities: Seniors; Adult; Physical or mental disabilities –Goal-alternative care facilities: Least restrictive, safe, quality living arrangements Settings and Types of Nursing Care

19. Community-Based Nursing: Congregate housing –Independent to minimal assistance: Seniors and disabled adults; Free-standing apartments; Private rooms –Residents: Certain qualifications; Subsidized rent; Meals; Recreational activities; Affordable housing Assured of appropriate housing May lack resources, ability, opportunity to participate in outside activities

20. Settings and Types of Nursing Care Community-Based Nursing: Boarding Homes –Small home: Individual rooms –Residents: Pay for room, board, and minimal nursing services; Have supervision, may relinquish independence and privacy –Share rooms; Common dining area –Oversee employment: Disabled adults –Stable environment: For those who cannot live independently

21. Settings and Types of Nursing Care Community-Based Nursing: Assisted Living –Care: Require assistance with three ADLs; Maximizes independence while maintaining privacy, dignity –Joint Commission on Accreditation of Healthcare Organizations: Developing voluntary accrediting process –Very expensive; May not provide housekeeping, laundry, transportation, and meals

22. Settings and Types of Nursing Care Home health nurses provide specialized care in the client’s home. Figure 2-2. Home health nurses

23. Settings and Types of Nursing Care Home Health Nursing: Cost containment measures –Expansion of home healthcare –Covers health needs: Long-term and short- term; Specialized care; Medications, and chemotherapy –Hospice care –Postcardiac surgery care –Vent-dependent clients

24. Home Health Nursing: Cost containment measures (Cont’d) –RN manages and coordinates care –High level of competency: Assessment, skills, communication, teaching, management, and documentation –Encourages self-care skills with support from community resources Settings and Types of Nursing Care

25. Case Management Models for Nursing Care Delivery Figure 2-3. Functions of the nurse case manager.

26. Case Management –Maximizes fiscal outcomes without sacrificing quality –Careful oversight of client’s healthcare –RN: Bachelor’s or master’s degree –Case manager –Employed: Insurance companies and hospitals –Tools to plan and coordinate care: Clinical pathways; Practice guidelines; Standards of care Models for Nursing Care Delivery

27. Case Management (Cont’d) –Plan and coordinate client’s progress through phases of care Avoid delays, unnecessary diagnostics, overuse of expensive resources Early, thorough discharge planning Models for Nursing Care Delivery