Chapter 21: Managing Patient Care 1. Nursing care delivery models; clinical scenarios, advantages/disadvantages a. Team Nursing: RN leads team of other RNs, team members provide direct care under supervision of RN. Team leader develops care plans, coordinates care among team members and provides care requiring complex nursing skills. Advantages: care is provided through a collaborative style that encourages each member of team to work with and help the other members. Model has a high level of autonomy for the team leader. Decision-making occurs at clinical level. Nursing care conferences help to solve patient problems. Disadvantages: RN team leader does not spend time with patients b. Total Patient Care: RN is responsible for all aspects of care for one or more patents during shift. Care can be delegated. RN works directly with patient, family, and health care team members. Advantages: patient satisfaction is high. RNs plan care. High degree of collaboration. Disadvantages: continuity of care is often a problem if RNs don’t communicate patient needs to one another. Not cost effective. c. Primary Nursing: one primary RN assumes responsibility for a caseload of patients. When an RN is working, he or she provides care for the same patients during their stay in a facility. RN assesses patient, develops plan of care, and delivers appropriate nursing interventions. Advantages: model is flexible and uses a variety of staffing levels and mixes. Model has a high level of autonomy and authority. Model promotes collaboration with physician. Disadvantages: associate nurse cannot change care plan without discussing with primary nurse. Model does not necessarily decrease cost of care, even with staff mix. d. Case Management: a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes. A case manager coordinates a patient’s acute care in the hospital and follows us with the patient after discharge. They don’t usually provide direct care but they work with and supervise the care delivered by other staff and actively coordinate discharge. 2. Decentralized management: responsibility, autonomy, authority, accountability a. Decentralized management: decision-making is moved down to the level of staff, is very common within health care organizations. This type of management structure has the advantage of creating an environment in which managers and staff becomes more actively