Nursing

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 […]

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