UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
Some features are included on all critical paths, such as specific medical diagnosis, the expected length of stay, patient identification data, appropriate time frames (in days, hours, minutes, or visits) for interventions, and patient outcomes. Interventions are presented in modality groups (medications, nursing activity, and so on). The critical path must include a means to identify variances easily and to determine whether the outcome has been met.
Differentiated Practice Differentiated practice is a method that maximizes nursing resources by focusing on the struc- ture of roles and functions of nurses according to their education, experience, and competence. Differentiated practice is designed to identify distinct levels of nursing practice based on defined abilities that are incorporated into job descriptions.
In differentiated practice, the responsibilities of RNs (mainly those with bachelor’s and as- sociate degrees) differ according to the competence and training associated with the two edu- cation levels as well as the nurses’ experience and preferences. The scope of nursing practice and level of responsibility are specifically defined for each level. Some organizations differenti- ate roles, responsibilities, and tasks for professional nurses, licensed practical nurses, and unli- censed assistive personnel, which are incorporated into their respective job descriptions.
Evolving Models of Care Recognizing the need for improving patient care, the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement established a program titled Transforming Care at the Bedside (IHI, 2009). The goal was, and continues to be, to help hospitals achieve affordable and lasting improvements to care (Lavizzo-Mourey & Berwick, 2009). One of its premises is the use of a patient-centered care model.
Patient-Centered Care Patient-centered care is a model of nursing care delivery in which the role of the nurse is broadened to coordinate a team of multifunctional unit-based caregivers. In patient-centered care, all patient care services are unit-based, including admission and discharge, diagnostic and treatment services, and support services, such as environmental and nutrition services and medical records. The focus of patient-centered care is decentralization, the promotion of efficiency and quality, and cost control.
In this model of care, the number of caregivers at the bedside is reduced, but their responsibilities are increased so that service time and waiting time are decreased. A typical team in a unit providing patient-centered care consists of:
● Patient care coordinators (RNs) ● Patient care associates or technicians who are able to perform delegated patient care tasks ● Unit support assistants who provide environmental services and can assist with hygiene
and ambulation needs ● Administrative support personnel who maintain patient records, transcribe orders,