Managing Patient Care Chapter_13 -1

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Information about Managing Patient Care Chapter_13 -1

Published on March 16, 2016

Author: dwanfai


Slide1: Chapter 13 Managing Patient Care Objectives: Objectives Differentiate among the types of nursing care delivery models. Describe the elements of decentralized decision making. Discuss the ways in which a nurse manager supports staff involvement in a decentralized decision-making model. Discuss ways to apply clinical care coordination skills in nursing practice. Discuss principles to follow in the appropriate delegation of patient care activities. Footer Text 2 Entry Level Competencies: Entry Level Competencies The National Council of State Boards of Nursing (NCSBN) identified competencies that registered nurses (RNs) and licensed practical/vocational nurses need on entry to practice. Three of these are: Demonstrate nursing knowledge and display confidence in knowledge base. Demonstrate knowledge of roles, responsibilities, and functions of a nurse. Recognize own limitations and see support of validation of decisions as needed. Building A Nursing Team: Building A Nursing Team A strong nursing team V alues mentoring, integrity, and teamwork R equires team building, training , trust, communication, and collaboration Focuses on patient safety An empowering environment B rings out the best in a professional An excellent nurse manager and nursing staff Share a philosophy of care that includes a nursing care delivery model and management structure that supports professional nursing practice Magnet Recognition : Magnet Recognition Magnet hospitals typically have clinical promotion systems and research and evidence-based practice. Nurses have professional autonomy over their practice and control over the practice environment. Magnet hospitals empower the nursing team to make changes and be innovative. This results in a strong collaborative relationship among team members and improved patient quality of care outcomes. Nursing Care Delivery Models: Nursing Care Delivery Models Goal: to help nurses achieve desirable outcomes for their patients Common components include: Nurse-patient relationship Clinical decision making Patient assignments and work allocation Interdisciplinary communication Management of the environment of care Nursing Care Delivery Models (Cont.): Nursing Care Delivery Models (Cont.) Team Nursing Total Patient Care Primary Nursing Case Management Team Nursing: Team Nursing Collaborative care style that encourages each member of team to work with and help the other members Hierarchical communication from charge nurse to charge nurse, charge nurse to team leader, and team leader to team members Decision making occurs at clinical level Total Patient Care: Total Patient Care Registered nurse works directly with patient, family, and health care team members. RN is responsible for patients during shift of care, although care can be delegated. Approach may not be cost-effective owing to high number of registered nurses needed. Patient satisfaction is high. Primary Nursing: Primary Nursing One primary registered nurse assumes responsibility for a caseload of patients. Communication is lateral from nurse to nurse and from caregiver to caregiver. Flexible model uses a variety of staffing levels and mixes. RN works with a limited number of patients. Case Management: Case Management Collaborative process of assessing, planning, facilitating, and advocating for options and services to meet an individual’s health needs Clinicians oversee the management of patients with specific, complex health problems and are usually held accountable for some standard of cost management and quality. Advantages include cost-effectiveness, focus on patients’ complex health needs, efficiency in discharge planning, and multidisciplinary collaboration Decision Making: Decision Making Decentralized management means that decision making occurs at the level of the staff. Encompasses Responsibility: duties and activities an individual is employed to perform Autonomy: independent decisions about patient care Authority: legitimate power to give commands and make final decisions specific to a given position Accountability: answerable for the actions Staff Involvement: Staff Involvement Establishment of nursing practice or problem-solving committees Interprofessional collaboration Interprofessional rounding Staff communication Staff education Leadership Skills for Nursing Students: Leadership Skills for Nursing Students Clinical care coordination Team communication Delegation Knowledge building Clinical Care Coordination: Clinical Care Coordination Clinical decisions Priority Setting Organizational Skills Use of Resources Time Management Evaluation Clinical Decisions: Clinical Decisions Conduct a focused patient assessment Ask what outcomes the patient expects in his or her care Make accurate clinical decisions Be thorough Ask for assistance when needed Priority Setting: Priority Setting Determine which patient’s needs should be addressed first: High priority: immediate threat to patient survival or safety Intermediate priority: nonemergent, non–life threatening Low priority: actual or potential problems may or may not be directly related to patient’s illness or disease Organizational Skills: Organizational Skills Prepare location Prepare equipment and supplies Prepare patient Comfortable Positioned correctly Informed Request assistance if needed Use of Resources: Use of Resources Work cooperatively with staff members Help other staff members Ask for help when needed Recognize personal limitations and use professional resources for assistance Time Management: Time Management Remain goal oriented. Focus on patient priorities. Complete activities with one patient before beginning another. Time management strategies: Create a to-do list Maintain work area readiness Create a time log Practice delegation Limit task interruptions Evaluate: Evaluate Evaluation is an ongoing process. Assess patient needs Begin therapies Immediately evaluate effectiveness of therapies and patient response Revise care as needed Return throughout the day to evaluate care Team Communication: Team Communication Use structured communication techniques Briefings Group rounds Situation-Background-Assessment- Recommendation (SBAR) Set shared expectations Treat colleagues with respect Maintain professionalism in electronic communications Delegation: Delegation Requires knowing which skills are transferable Results in improved quality of patient care, improved efficacy, increased productivity, an empowered staff, and the development of others Transfers responsibility while maintaining accountability for outcomes The Five Rights of Delegation: The Five Rights of Delegation Right Task Right Circumstance Right Person Right Direction Right Supervision Steps to Effective Delegation: Steps to Effective Delegation Assess the knowledge and skills of the person to whom you are delegating. Match tasks to the assistant’s skills. Communicate clearly: Task, outcome, time Listen attentively. Provide feedback.

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