Mod Ali Ties of Care Written Output

8/4/2019 Mod Ali Ties of Care Written Output

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MODALITIES OF CARE

Modalities of care are ways care is organized and delivered to patients. These models

have been implemented to decrease expenses, to use staff more effectively and to provide high

quality care efficiently and effectively.

Models might also be called nursing or patient care delivery systems.

A. Total Patient Care or Case Method

Oldest mode of organizing patient care.

The registered nurse is responsible for all of the care provided to a patient for a shift.

It is sometimes referred to as the case method of assignment because patients were

assigned as cases, much like contemporary private-duty nursing is carried out.

At turn of 19th

century, total patient care was generally provided in the patient’s home,and the nurse was responsible for cooking, house cleaning, and other activities specific

to the patient and family, in addition to traditional nursing care.

Rarely provided today, except among student nurses who are assigned to provide all of

the case for a patient during the hours that they are in clinical.

Even this case, the students frequently do not provide all of the care as they may not be

qualified to do this.

Each nurse caring for the patient can, however, modify the care regimen.

Therefore, if there are three shifts, the patient could receive three different approaches

to care, often resulting in confusion of the patient.

To maintain quality care, the method requires highly skilled personnel and thus may cost

more than some other forms of patient care.



Advantages

Provides nurses with high autonomy and responsibility.

Assigning patients is simple and direct and does not require the planning that

other methods of patient care delivery require.

Lines of responsibility and accountability are clear.

Patient theoretically receives holistic and unfragmented care during the nurse’s

time on duty.

Disadvantages

Lack of consistency and coordinated care when care is provided in 8 hour

segments.

When the nurse is inadequately prepared to provide total care to the patient.

B. Functional Nursing

Evolved during World War II as a result of a nursing shortage task oriented Best system when there are many patients and professional nurses are few short-term use only

The advantages of functional nursing are:

A very efficient way to deliver care. Could accomplish a lot of tasks in a small amount of time Staff members do only what they are capable of doing Least costly as fewer RNs are required Tasks are completed quickly .Workers gain skill faster in a particular

The disadvantages are:

Care of patients become fragmented Patients do not have one identifiable nurse Very narrow scope of practice for RNs Leads to patient and nurse dissatisfaction

Evaluation of nursing care is poor and outcomes are rarely documented

C. Team Nursing

Team nursing was developed in the 1950s in an effort to decrease the problems

associated with the functional organization of patient care. Many believed, despite a



continued shortage of professional nursing staff, a patient care system had to be

developed that reduced the fragmented care that accompanied functional nursing.

In team nursing, ancillary personnel collaborate in providing care to a group of patients

under the direction of a professional nurse.

As the team leader, the nurse is responsible for knowing the condition and needs of all

patients assigned to the team and for planning individual care. The team leader’s duties vary depending on the patient’s needs and workload. These

duties may include assisting team members, giving direct personal care to patients,

teaching, and coordinating patient activities.

Through extensive team communication, comprehensive care can be provided for

patients despite a relatively high proportion of ancillary staff. This communication occurs

informally between the team leader and the individual team members and formally

through regular team planning conferences.

A team should consist of not more than five people or it will revert to more functional

lines of organization.

Team nursing is usually associated with democratic leadership. Group members are

given as much autonomy as possible when performing tasks, although responsibility and

accountability are shared by the team collectively.

The need for excellent communication and coordination skills makes implementing team

nursing organization difficult and requires great self-discipline on the part of team

members.

Team nursing allows members to contribute their own special expertise or skills. Team

leaders, then, should use their knowledge about each member’s abilities when making

patient assignments. Recognizing the individual worth of all employees and giving team

members autonomy result in high job satisfaction.

Disadvantages to team nursing are associated primarily with improper implementation

rather than with the philosophy itself. Frequently, insufficient time is allowed for team

care planning and communication. This can lead to blurred lines of responsibility, errors,

and fragmented patient care.

Joel (1994) states that, although there is a demonstrated need for assistive personnel,

such personnel should never be assigned to the patient but must always be assigned t

the nurse. For team nursing to be effective, the leader must have good communication,

organizational, management and leadership skills and must be an excellent practitioner.

D. Primary Nursing

Also known as relationship-based nursing

It is a one-to-one relationship between the Registered Nurse and the patient

It requires a nursing staff made up only of RN

This structure lend itself well to home health nursing, hospice nursing and other health

care delivery enterprises



Primary Nurse

Is a registered nurse

assumes a 24-hours responsibility for planning the care of one or more patients

From admission to discharge

During working hours: provides total direct care to the patient Must be knowledgeable and must have high level of clinical autonomy

Establish communication among the patient, physician, associate nurses and other

health team members

Associate Nurse

Takes care o the patient when primary nurse is not on duty

Follows the care plan established by the primary nurse

Primary Nursing: Advantages

Holistic, high-quality patient care is achieved through a combination of clear,

interdisciplinary group communication, and consistent, direct patient care

Job satisfaction is high

Nurses feel challenged and rewarded

Primary Nursing: Disadvantages

Job satisfaction is high but difficult to implement because of the degree of responsibility

and autonomy required

Improper implementation: Inadequately prepared, incompetent and lack experience

nurses

E. Care and Service Team Models

1980, care and service team models began to replace primary nursing.

Key elements: empowered staff, interdisciplinary collaboration, skilled workers, and a

case management.

Care and service teams introduced the different categories of assistive personnel.

Complementary models

o Begun in 1988 by using nursing extenders, such as a unit assistant, who would

be responsible for environmental functions.

Substitution modelso Tend to use multiskilled technicians to perform select nursing activities.

Cross-training

o It is another more prevalent approach today

o This involves training staff to work in different specialty areas to perform

different task.

Case management



o Can be viewed as a nursing model when the case managers is a nurse

o The focus of the team is on patient-centered care as opposed to the nurse-

patient relationship.

F. Care Management Model

Goal: To integrate a continuum of clinical services

Description: Focuses on the needs of the integrated delivery system

Includes planning, assessment, and coordination of health services

Not only concerned with medical care but also health promotion and disease prevention, costs,and use of resources

instead of based on individual patient

Population may be:

the entire population

members of a managed care plan

Specific group with similarities (e.g. patients with diabetes)

TYPICAL TOOLSused to facilitate care management

Disease Management Programs

Clinical Pathways

Benchmarking

Disease Management Programs

help guide the care of patients with chronic health problems appear to improve the quality of health care.

Clinical Pathways

standardized, evidence-based, multidisciplinary management plans, which identify anappropriate sequence of clinical interventions, time frames, milestones and expected outcomesfor an homogenous patient group.

BENCHMARKING



It is a systematic approach and has been described as the "search for the best practices thatwill lead to superior performance" (Camp, 1989).

involves comparisons between practices that have been achieved.

G. THE INTERDISCIPLINARY TEAMWORK SYSTEM MODEL:

The Interdisciplinary Teamwork System described by Drinka (2000) provides further development of the concept of collaborative team practice. It utilizes several identified methods of team practice in a"fluid system" that changes to match the health care problem with the most appropriate practicemethod. In this teamwork system the universe of health care professionals and health care –relatedprofessionals and non-professionals is large.

Drinka defines the Interdisciplinary Health Care Team (IHCT) as "a group of individuals with diversetraining and backgrounds who work together as an identified unit or system. Team membersconsistently collaborate to solve patient problems that are too complex to be solved by one disciplineor many disciplines in sequence. In order to provide care as efficiently as possible, an IHCT creates

"formal" and "informal" structures that encourage collaborative problem solving. Team membersdetermine the team’s mission and common goals: work interdependently to define and treat patientproblems; and learn to accept and capitalize on disciplinary differences, differential power andoverlapping roles. To accomplish these they share leadership that is appropriate to the presentingproblem and promote the use of differences for confrontation and collaboration."

For an Interdisciplinary Health Care Team to function well, it must have the capacity to adapt tochanging and complex situations.

Methods of Interdisciplinary Health Care Practice: Six methods of team practice are outlinedthat can function as a system for providing efficient health care when understood and utilized

appropriately.

Leadership and Decision-Making: There are several approaches to the leadership of aninterdisciplinary collaborative team. Historically, physicians have had the role of team leader in healthcare settings due to various cultural, gender, and power factors. Still relevant today remains the issueof legal responsibility for patient care. An emerging pattern in many primary care teams, however,involves equal participation and responsibility on the part of team members with "shifting" leadershipdetermined by the nature of the problem to be solved. Emphasis by the team on "health care" ratherthan the more narrow focus of "medical care" broadens the roles and responsibilities on non-physician providers.

Description Advantages Disadvantages

Ad Hoc/Task Group

1discipline/department/agency

Group selects or agrees on aleader

Focus on one issue

No elaborate rules

Quick and dirty

Solutions lack depth/breadth

Some fearexpressing views

Status may hinder



Rules set by the group

Solves a problem and

disbands

Members captureenthusiasm

openness

Difficulty getting

together

FormalUnidisciplinaryWork

Group

(e.g., MDs from multiple specialties

One discipline/department 1

agency

Members report to group

Individual identities moreimportant than integrated

diagnoses

Don’t work on team

problems

Leadership by election or

rank

Discipline specific care

Members speak same language

Final decisions by formalleader

Ongoing

Rules established to keeporder

Security of one discipline

Solutions may have depth

Some resent

leaders’ decisions

Solutions lack breadth

May missimportantproblems

Little integrativedialogue

Inefficient withcomplexity

Formal Multidisciplinary Work Group

(e.g., MD, RN, SW, OT)

1 discipline/department/ 1

agency

Members report to group

Individual identities more

important than integrateddiagnoses

Don’t work on team

problems

Leadership by election or

rank

Discipline specific care

Final decisions by formalleader

Ongoing

Rules established to keep

order

Information from manyperspectives

Solutions may have breadth

Some resentleaders’ decisions

Speak differentlanguages

Solutions notintegrated

Different culturesof disciplines notusedadvantageously

Little integrativedialogue

Inefficient withcomplexity

InteractiveUnidisciplinaryTeam

(e.g., MDs from multiplespecialties)

One discipline/department/ 1agency

Integrated diagnoses

Team goals for patient andteam

Members interdependent

Members speak samelanguage

Share responsibility forleadership

More openness

More informal collaboration

Initial decisionstake more time

Solutions may lack breadth

May missimportantproblems



Team structures enablecollaboration

Work on team problems

Leadership appropriate toissue/ expertise

Solutions have depth

Members feel empowered

Culture encourages

creativity

Need time andspace to discussvalues;renegotiate roles,leadership, conflict

Interactive Interdisciplinary

Team

(e.g., MD, RN, SW, OT)

1 discipline/department/ 1

agency

Integrated diagnoses

Team goals for patient andteam

Members interdependent

Team structures enablecollaboration

Work on team problems

Leadership appropriate toissue/ expertise

Integrated care

Share responsibility forleadership

Solutions address complex

problems

Solutions have depth & breadth

Members feel empowered

Creative approaches tocomplexity

Understand autonomouspractice

Initial decisionstake more time

Members must

learn differentlanguages/terms

Effort to maintainthe team

Need time and

space to clarifyvalues;renegotiate roles,

leadership, conflict

Autonomous Practice Individual decides based onknowledge

Quick, appropriate solutions

Works only if understandsinterdisciplinarypractice

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Mod Ali Ties of Care Written Output