Care models,practice settings.interdisciplinary team

Care models,practice settings.interdisciplinary team

1. College Of Nursing Madras Medical College Chennai-03 CARE MODELS,PRACTICE SETTINGS,INTERDISCIPLINARY TEAM PRESENTED BY EDWIN JOSE.L MSc(nursing) I YEAR College of nursing Madras medical college Chennai-03 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

2. INTRODUCTION “Nursing is a significant ,therapeutic ,interpersonal process. It functions co-operatively with other processes that make health possible for individuals in communities” - Hildegard Peplau The nurse patient relationship is strengthened through countinity of care and collaboration of interdisciplinary teams. Client care is delivered on any nursing unit is through nursing care models . 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

3. Concept of caring and Nursing Caring is about interpersonal relationship Nurse-patient Nurse-patient family Nurse- members of the care team Dr.Jean Watson introduced the human caring theory in 1979 Watson core principles includes Practice of loving and kindness Cultivation of ones own spiritual practice towards wholeness of mind ,body and spirit BEING the caring –healing environment 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

4. Using nursing theory in everyday care Nursing theory strengthens the nursing practice by providing structure and a common language Caring is based on continuous healing relationship Patients are the source and centre of care Care is custamized and reflects values and need of patients Families are the integral part of the care team All team members are caregivers Transperency is the rule in patient care 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

5. How nursing care is provided Nursing theory is the term given to the body of knowledge that is used to support nursing practice Nursing models are used to help nurses to assess , plan,and implements patient care by providing a framework Nursing models help nurses achieve uniformity and seamless care Care models pertaining to organization of nursing care and may be founded in every settings where nurses provide care This includes hospital settings,ambulatory care,home care, and nursing homes. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

6. Nursing care models Providing safe ,quality nursing care requires well educated,competent,professional staff members who are committed to providing safe ,high quality care. Historically four care models have established,namely Total patient care Functional nursing Team nursing Primary nursing 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

7. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING NURSING CARE MODELS ORGANIZATION OF DELIVERY OF CARE STAFFING CARE MODEL NURSING FACTOR ORGANIZATION FACTORS TOTAL PATIENT CARE FUNCTIONAL NURSING TEAM NURSING MODULAR NURSING PRIMARY NURSING VARIATIONS CLIENT SAFETY QUALITY NURSING THEORY EVIDENCED BASED INDIVIDUAL CLIENT NEEDS FINANCES TYPE OF ORGANIZATIONS LEADERSHIP BELIEFS ABILITY TO RECRUIT AND RETAIN STAFF

8. Total patient care It is the oldest method of organizing patient care Each nurse is responsible for planning,organizing and performing all care for assigned patients In the early 1800’s nurse received no training and were expected to clean and do laundary as well as caring for patients Total patient care is the nursing model used in areas where patient require intensive nursing care such as ICU,PACU etc …. The main concern regarding the total care provided by RN’s are cost and availability of qualified nurses 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

9. Functional nursing Functional nursing is a system of care that concentrates on duties. It evolved during World war II as a result of nursing shortage ,as RN were needed to nurse the troops Unskilled workers are trained to perform routine,simple tasks Functional nursing is a task oriented. Instead of one nurse performing many functions,several nurses are given one or two assignments Eg.there is a medication nurse whose sole responsibility is administering medications The principle idea of functional nursing is for nurses to be assigning tasks ,not patients 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

10. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING CHARGE NURSE LPN/LVN ORAL MEDICATIONS RN TREATMENT ADMISSIONS RN INTRAVENOUS MEDICATIONS NA VITAL SIGNS UNIT OF 30 PATIENTS

11. CONT…. Advantages: Care is provided economically Cost effective as minimum number of RN is required Tasks are completed quickly Disadvantages: Fragmented care Communications issues Patients may confused with many care providers Caregivers feel unchallenged Often exeeds the charge nurse’s span of control 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

12. Team nursing Eleanor C.Lambertsen introduced team nursing in 1957 to improve patient care In team nursing the registered nurse works with one or more health care personal to provide care for four or more clients It was considered one approach to using peoples skills more effectively Eg. In team nursing medications might be given by one nurse ,while baths and physical care are given by nursing assistant under the supervision of a nurse. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

13. cont Advantages: Registered nurse is usually head of the team and generally know the clients Team leader can provide guidance to new or inexperience staffs The talents and abilities of each nurse is used Disadvantages: It is fairly expensive Lack of deligation skills by RN’s 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

14. Modular nursing It is a variant of team nursing Modular nursing is a modification of team nursing and focuses on the patient’s geographic location for staff assignments The unit is divided into groups refered to as modules also called districts or pods The same team of caregivers is assigned consistently to the same geographic location. Each location or modules has an RN assigned as the team leader and the other team members may include LVNs/UAP. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

15. Primary nursing Primary nursing evolved in 1969 from unit 32 of acute medical care ward at university of Minnesota medical center,where the nursing staff was extremely frustration with chaotic work environment The goal is for each client care to be comprehensive and coordinated from admission to discharge Each client is assigned a primary nurse who is an RN and that nurse provides care for that client when she is working 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

16. cont Advantages: High quality, holistic patient care Allows for time, opportunity to establish relationship RN autonomy;ability to make nursing care decision Clients psychological needs can be met Disadvantages: RN must accept 24 hrs responsibility More RN is needed, not cost effective Relectance of other RN’s to follow nursing conditions 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

17. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING PATIENT TOTAL PATIENT CARE 24HRS/DAY PRIMARY NURSE COMMUNICATIONS WITH SUPERVISORS CONSULTS WITH OTHER HEALTH CARE PROVIDERS ASSOCIATE (DAYS) WHEN PRIMARY NURES IS NOT AVAILABLE ASSOCIATE (EVENINGS) WHEN PRIMARY NURES IS NOT AVAILABLE ASSOCIATE (NIGHTS) WHEN PRIMARY NURES IS NOT AVAILABLE

18. Variant of primary nursing Partnership model(co-primary nursing) Modification of primary nursing to make more efficient use of the RNs as the primary RN is partnered with another nurse Advantages: Assists communications RN can encourage training and growth of LPN/LVN More cost effective than primary nursing Disadvantages: RN may have difficulty in deligating to partner Consistents partnership difficult to maintain due to varied schedules 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

19. Cont …. 2. Relationship based care: Model designed to transition nursing care from task focused to relationship based Three main relationship Nurse-patient Nurse- collegues Nurse-self This actualizes the role of the nurse in and contributes to job satisfaction 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

20. Case management model This model incorporates concepts of continuity and efficiency in addressing both long and short term physical ,psychological and social needs of the clients. Case managers are nurses who coordinates care of a group of clients ,monitor the implementation of interdisciplinary care plans and maintains communication with third party Primary goal are promoting self care,upgrading the quality of life and using resources efficiently 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

21. Interdisciplinary team Introduction Interdisciplinary teams bring together several disciplines to work together through joint planning,decision making and goal setting. The primary goal of each team is to promote and restore health To work effectively as a team ,each discipline must understand and respect the role and contribution made by the other disciplines The goal of the team is to provide higher quality,better coordinated client care. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

22. Team members Registered nurse Advanced practice nurse Physicians Physician assistant Physical therapist Respiratory therapist Occupational therapist Speech therapist Dietitian Pharmacist Medical social worker Spiritual and religious personal Alternative practitioners 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

23. Registered nurse Focus on health promotion ,disease prevention and provides care for sick and injured clients Registered nurse is a graduate of a state approved school of nursing and licensed by the state to practice nursing Nurses are the largest single group of health care professionals 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

24. Advanced practice nurse With an emphasis on holistic care,health promotion and disease prevention ,advanced practice nurses retain their identity as nurses across multiple care settings The APN is an registered nurse who has advanced educational and clinical practice requirements beyond the basic nursing education required of all RNs The nurse practitioner contributes to the availability of primary health care in large practice and underserved areas 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

25. physicians Physicians are licensed to diagnose and treat disease A physician is a graduate of a college of medicine and licensed ubd the medical practice act Physician are granted the authority to admit patients to a healthcare agency They may choose to be general practitioners or specialize in the treatment of one type of illness or body system 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

26. Physician assistants: A physician assistant has completed a specific course of study and licensing examination in preparation for providing support to the physician They are responsible for conducting physical examination and suturing lacerations Physical therapist: They seek to restore function or to prevent further disability in a patient after an injury or illness They uses various techniques like massage,UV rays,IR lights,exercises,electric stimulations etc ….. 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

27. Respiratory therapist: Respiratory therapist is trained in techniques that improve pulmonary functions and oxygenation They are responsible for administering various tests that measures lung function tests and educating the patient about various devices and machines Occupational therapist: Occupational therapist assists physically challenged patients to adopt to limitations They use variety of adoptative devices and statergies to aid patient in carring out the activities of daily living 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

28. Speech therapist: They are trained to help hearing impaired patients speak more clearly ,to assist patients who have had stroke to relearn how to speak They also diagnose and treat swallowing problems in patients who have had a head injury or a stroke Dietitian: A dietitian manages and plans for the needs of the patient based on knowledge about all aspects of nutrition They can adapt specialized diets for the individual needs patients,and supervises the dietary services Pharmacist: Licenced to formulate and dispense medication Resposible for keeping a file of all patients Excellent resources for information related to medications 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

29. Medical social worker: A social worker counsels patients and family members and also informs them of and refers them to various community resources Involved in many activities such as counselling,reporting suspected drug abuse,placing patient in long term care facilities,support to dying patients and their families Spiritual and religious personal: Pastoral careworkers provide spiritual care which is an integral part of holistic health care Clients and their families came from different religious background Lorger hospital may have a department of fulltime pastoral care employees to minister to their dependents and families 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

30. Alternative practitioners: Complementory and alternative medicine practitioners use many healing method from ancient arts such as chinese medicine, acupuncture, Ayurveda, siddha, homeopathy, yoga and naturopathy Some thinks that these methods could reduce the need for physicians and therefore reduce the cost of health care In india there are many controvercies in using alternative medicine The lack of scientific research does not seem to determine the marketing of these therapies 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

31. Practice settings-health care settings Introduction: Health care delivery occurs within a continuum of health care settings and services from outpatient to inpatient and from acute care to long term care Inpatient denotes care given in the context on an overnight stay in a hospital or other facility Outpatient services do not require an overnight inpatient stay in a hospital also called as ambulatory care Services in the community are provided through voluantary ,public or proprietary organisations and include adult day care,respite care,etc …… 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

32. Hospitals An hospital is an institution for the medical treatment of ill and injured person needing a combination of complex services with high risk of complicatios and nursing care Hospital services are appropriate when intensive monitoring is required for the early detection of prevention prevention of complications The need for hospitalization is based on the needs and risk associated with medical-surgical treatment There are three levels of hospitals First tier- hospital system which includes the general hospital,the community hospital and rural hospitals Second tier – larger, usually urban,general hospital with a full range of services Third tier – are large medical centers that provide the most sophisticated ,advanced care and maintain extensive research activities 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

33. Cont …. Hospitals are also classified as Public hospital – public hospitals are owned by agencies of state or local government Private hospital- private hospitals are owned and operated by individuals or charitable organisations Emergency and rescue care: Ambulance service and first aid treatment to victims of acute illness , accidents,and disasters by trained personal Rural areas access medical centers through ambulance services and helicopter medical transport units The hospitals provides service around the clock 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

34. Psychiatric care: In both public and private psychiatric facilities ,the number of beds devoted to psychiatric service has decreased New treatment techniques, consumer protection laws and issues of cost are responsible for the shift from inpatient care to community care Rehabilitative care: rehabilitation services specialize in providing restorative services to optimize the levels of function in chronically ill and disabled clients Clients who are discharged from a short term inpatient stay may transfer to a freestanding rehabilitation hospitals Most rehabilitation hospital offer nursing ,physical therapy, occupational therapy, psychological services, social services and vocational services 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

35. Long term care: Long term care describes a range of health and housing services provided to people unable to care for themselves independently In addition to traditional nursing home care,options include assisted living facilities ,residential care facilities and retirement centers Assisted living provides services associated with a residents activities of daily living Hospice care: Hospice care is a concept that includes a cluster of special services to address the special needs of dying people and their families It blends medical,spiritual,legal,finance,and family support services 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

36. Ambulatory care centers: The ambulatory care center provides health services on an outpatients basis This category covers managed care programs and hospital based ambulatory services Mobile diagnostic services includes mammography,MRI,cardiac assessment and health screening Adult day care centers: Adult day care is a day time programe for frail adults who require supervision and care while members of the family or other informed caregivers are away at work It complements informal care given in the home by family members and helps delay or prevent institutionalization 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

37. Respite care services: It is defined as a service that provides temporary relief to informed caregivers such as family members Respite care is the most frequently suggested intervention to address family caregivers feeling of stress and burden School health clinics: Almost all educational institutional provide some form of ambulatory health services to students These services are provided by local health department The work of most school based health programs is supervised by registered nurse 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

38. Occupational health services: Industrial or occupational health services are provided in most large business and factories The health services are comprehensive ,with complete care for all health disorder,whether or not the disorder of work load related Home health care services: Home health care services such as nursing therapy and health related home maker or social services are brought to clients in their own homes,because these clients are unable to leave their homes It is mainly provided to older clients 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

39. Community health centers: Community health centers concentrates on the delivery of primary health care services to the community as a whole and to individual They serve as a primary care safety for poor and underserved in bi= oth rural and urban areas Long standing out reach programme ,case management, transportation,alcohol and drug abuse screening ,mental health services etc are provided 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING

40. THANKYOU 26.02.2021 EDWIN JOSE .L MEDICAL SURGICAL NURSING