Nursing

Five elements are essential to successful implementation of case management: ● Support by key members of the organization (administrators, physicians, nurses) ● A qualified nurse case manager ● Collaborative practice teams ● A quality management system ● Established critical pathways (see next section) In case management, all professionals are equal members of the team; thus, […]

Practice partnerships.:DELIVERING NURSING CARE CHAPTER 3 • DELIVERING NURSING CARE 35 In an acute care setting, the case manager has a caseload of 10 to 15 patients and follows patients’ progress through the system from admission to discharge, accounting for variances from expected progress. One or more nursing case managers on a patient care unit

Nursing case management requires: ● Collaboration of all members of the health care team ● Identification of expected patient outcomes within specific time frames ● Use of principles of continuous quality improvement (CQI) and variance analysis ● Promotion of professional practice. Case manager Patient caseload Caregivers CaregiversCaregivers Figure 3-6 • Case management. RN Patients Partner

UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS Integrated Models of Care Practice Partnerships The practice partnership (Figure 3-5) was introduced by Marie Manthey in 1989 (Manthey, 1989). In the practice partnership model, an RN and an assistant—UAP, LPN, or less experi- enced RN—agree to be practice partners. The partners work together with the same schedule and the

Primary nursing also has some disadvantages, including: ● It requires excellent communication between the primary nurse and associate nurses. ● Primary nurses must be able to hold associate nurses accountable for implementing the nursing care as prescribed. ● Because of transfers to different units, critically ill patients may have several primary care nurses, disrupting the

Total patient care. CHAPTER 3 • DELIVERING NURSING CARE 33 The disadvantage of this system is that RNs spend some time doing tasks that could be done more cost-effectively by less skilled persons. This inefficiency adds to the expense of using a total patient care delivery system. Primary Nursing Conceptualized by Marie Manthey and implemented

The advantages of a total patient care system include: ● Continuous, holistic, expert nursing care ● Total accountability for the nursing care of the assigned patient(s) for that shift ● Continuity of communication with the patient, family, physician(s), and staff from other departments Charge nurse RNRNRN Patients Patients Patients Place Your Order Here!

Functional nursing. Charge nurse Team/module leaderTeam/module leaderTeam/module leader RN, LPN, UAP RN, LPN, UAP RN, LPN, UAP Patients Patients Patients Figure 3-2 • Team/modular nursing. 32 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS Advantages of team nursing are: ● It allows the use of LPNs and UAPs to carry out some functions (e.g., making

Disadvantages of functional nursing include: ● Uneven continuity ● Lack of holistic understanding of the patient ● Problems with follow-up Because of these problems, functional nursing care is used infrequently in acute care facilities and only occasionally in long-term care facilities. Team Nursing Team nursing (Figure 3-2) evolved from functional nursing and has remained popular

Job Description of a Floor Nurse (1887) Developed in 1887 and published in a magazine of Cleveland Lutheran Hospital. In addition to caring for your 50 patients, each nurse will follow these regulations: 1. Daily sweep and mop the floors of your ward, dust the patients’ furniture and window sills. 2. Maintain an even temperature