mod ali ties of care written output
TRANSCRIPT
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 1/8
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.
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 2/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 3/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 4/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 5/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 6/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 7/8
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
8/4/2019 Mod Ali Ties of Care Written Output
http://slidepdf.com/reader/full/mod-ali-ties-of-care-written-output 8/8
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