![Page 1: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/1.jpg)
Introductory Medical-Surgical Nursing
Introductory Medical-Surgical Nursing
Settings and Models for Nursing Care
![Page 2: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/2.jpg)
Nursing CareNursing Care• Introduction
– Caring for: Individual; Family; Groups
– Nurse’s role
• Health education; Prevention; Promotion
• Attend client needs: Hygiene; Activity; Diet; Medical treatment; Physical, emotional, spiritual comfort
![Page 3: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/3.jpg)
QuestionQuestion
Is the following statement True or False?
If a LPN/LVN has a question regarding client care, they should phone the physician.
![Page 4: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/4.jpg)
AnswerAnswer
False.
If a LPN/LVN has a question regarding client care, they should initially discuss the issue with their supervisory RN.
![Page 5: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/5.jpg)
Nursing CareNursing Care
• Nursing Roles
– Different educational levels provide care:
• Licensed Practical/Vocational nurse: Under RN or physician; Determines need to seek out RN
• RN’s role: Management and coordination of care provided to clients
![Page 6: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/6.jpg)
Nursing CareNursing Care• Definitions of Nursing
– Clear and comprehensive definition-difficult
– Florence Nightingale: “the patient in the best condition for nature to act upon him”
– Virginia Henderson: Definition; Regaining independence
– Definition of nursing: The American Nurses Association (ANA)
• Six essential features of contemporary nursing practice
![Page 7: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/7.jpg)
Nursing CareNursing Care
• Nursing care: Provided in various settings
• Levels of nurses: Outpatient and inpatient care areas
• Decreased reliance on hospitals
– Client needs determine setting for care
– Much interest in determining most cost-effective methods of care
![Page 8: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/8.jpg)
QuestionQuestion
Is the following statement True or False?
Budgetary constraints are the primary determining factor in client care.
![Page 9: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/9.jpg)
AnswerAnswer
False.
While budgetary constraints can be a factor in determining, the primary determining factor in client care is the need of the client. Frequently nurses advocate for best care for the client.
![Page 10: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/10.jpg)
Models for Nursing Care DeliveryModels for Nursing Care Delivery
• Case method
– One nurse provided all services-particular client required
– Provided care in the home; Performed household duties
– Evolution: Modern version is private duty nursing
![Page 11: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/11.jpg)
Models for Nursing Care DeliveryModels for Nursing Care Delivery• Hospital-Based Nursing: Functional nursing
– Task-oriented; Distinct duties - specific personnel; Divided tasks; Several people during shift
– Fragments care; Confusing for client
• Hospital-Based Nursing: Team nursing
– Response to fragmented care of functional nursing
– Varying education levels and skill; RN - team leader; LP/LVNs; Nursing assistants
![Page 12: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/12.jpg)
Models for Nursing Care DeliveryModels for Nursing Care Delivery
• Hospital-Based Nursing: Total care
– Nurse: Assumes all the care for a small group of clients
– Focuses: More on client as a whole rather than the collection of nursing tasks to be accomplished
– Often practiced in intensive care units where nurses are assigned one or two clients
![Page 13: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/13.jpg)
QuestionQuestion
Is the following statement True or False?
Team nursing was a model developed in response to functional nursing.
![Page 14: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/14.jpg)
AnswerAnswer
True.
Team nursing was a model developed in response to functional nursing which resulted in fragmented care which was highly confusing to clients.
![Page 15: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/15.jpg)
Models for Nursing Care DeliveryModels for Nursing Care Delivery
• Hospital-Based Nursing: Primary Nursing
– RN: 24-hour accountability for client’s care; Total nursing responsibility of clients assigned
– Secondary nurses: Carry out care in primary nurse’s absence
– Expensive; Relies on RNs
– Advantage: Client assured of comprehensive, holistic care
– Home care settings: Effective use
![Page 16: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/16.jpg)
Models for Nursing Care DeliveryModels for Nursing Care Delivery• Hospital-Based Nursing: Patient-focused care
– Updated version of primary care and team nursing
– RN with one or more assistive personnel care for group of clients
– Licensed and unlicensed assistants are cross-trained
– RN Role: Resource management and nursing care outcome responsibility
![Page 17: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/17.jpg)
• Community-Based nursing
– Various locations: Nurses practice
– Skilled nursing facilities: Acute illness; Invasive procedures
– Intermediate care facilities: Nursing homes provide custodial care for people with mental or physical disabilities; No reimbursement from Medicare
– Rehabilitation centers: Provide physical and occupational therapy for ADLs
Settings and Types of Nursing CareSettings and Types of Nursing Care
![Page 18: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/18.jpg)
• Community-Based Nursing (Cont’d)
– Hospices: Terminal illness; Staff trained to help clients with grieving process; Medicare coverage
– Community health centers; Community mental health centers - funding
– Other facilities: Seniors; Adult; Physical or mental disabilities
– Goal-alternative care facilities: Least restrictive, safe, quality living arrangements
Settings and Types of Nursing CareSettings and Types of Nursing Care
![Page 19: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/19.jpg)
Settings and Types of Nursing CareSettings and Types of Nursing Care
• Community-Based Nursing: Congregate housing
– Independent to minimal assistance: Seniors and disabled adults; Free-standing apartments; Private rooms
– Residents: Certain qualifications; Subsidized rent; Meals; Recreational activities; Affordable housing
• Assured of appropriate housing
• May lack resources, ability, opportunity to participate in outside activities
![Page 20: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/20.jpg)
Settings and Types of Nursing CareSettings and Types of Nursing Care• Community-Based Nursing: Boarding Homes
– Small home: Individual rooms
– Residents: Pay for room, board, and minimal nursing services; Have supervision, may relinquish independence and privacy
– Share rooms; Common dining area
– Oversee employment: Disabled adults
– Stable environment: For those who cannot live independently
![Page 21: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/21.jpg)
Settings and Types of Nursing CareSettings and Types of Nursing Care• Community-Based Nursing: Assisted Living
– Care: Require assistance with three ADLs; Maximizes independence while maintaining privacy, dignity
– Joint Commission on Accreditation of Healthcare Organizations: Developing voluntary accrediting process
– Very expensive; May not provide housekeeping, laundry, transportation, and meals
![Page 22: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/22.jpg)
Settings and Types of Nursing CareSettings and Types of Nursing Care
• Home health nurses provide specialized care in the client’s home.
Figure 2-2. Home health nurses
![Page 23: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/23.jpg)
Settings and Types of Nursing CareSettings and Types of Nursing Care
• Home Health Nursing: Cost containment measures
– Expansion of home healthcare
– Covers health needs: Long-term and short-term; Specialized care; Medications, and chemotherapy
– Hospice care
– Postcardiac surgery care
– Vent-dependent clients
![Page 24: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/24.jpg)
• Home Health Nursing: Cost containment measures (Cont’d)
– RN manages and coordinates care
– High level of competency: Assessment, skills, communication, teaching, management, and documentation
– Encourages self-care skills with support from community resources
Settings and Types of Nursing CareSettings and Types of Nursing Care
![Page 25: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/25.jpg)
• Case ManagementModels for Nursing Care DeliveryModels for Nursing Care Delivery
Figure 2-3. Functions of the nurse case manager.
![Page 26: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/26.jpg)
• Case Management
– Maximizes fiscal outcomes without sacrificing quality
– Careful oversight of client’s healthcare
– RN: Bachelor’s or master’s degree
– Case manager
– Employed: Insurance companies and hospitals
– Tools to plan and coordinate care: Clinical pathways; Practice guidelines; Standards of care
Models for Nursing Care DeliveryModels for Nursing Care Delivery
![Page 27: Introductory Medical-Surgical Nursing Settings and Models for Nursing Care](https://reader036.vdocuments.mx/reader036/viewer/2022081511/56649e435503460f94b3651a/html5/thumbnails/27.jpg)
• Case Management (Cont’d)
– Plan and coordinate client’s progress through phases of care
• Avoid delays, unnecessary diagnostics, overuse of expensive resources
• Early, thorough discharge planning
Models for Nursing Care DeliveryModels for Nursing Care Delivery