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(3.2 Describe the characteristics of integrated models of care, 3.3…

- - - - Includes clinical experts from appropriate
        disciplines.
    - - All professionals equal team members
      - Members take ownership of patient outcomes
    - - Requires qualified nurse case manager, team
        collaboration, and quality management system
      - Established critical pathways needed
    - - Agree on the final draft of the critical pathways
      - Take ownership of patient outcomes
      - Accept responsibility and accountability for the
        interventions and patient outcomes associated with
        their discipline.
  - - - Accommodate unique characters, conditions of
        patients
      - Reduce costs
    - - May need revision
  - - - Improved continuity of care and accountability for
        care
    - - Decreased ratio of RNs to nonprofessional staff
      - Potential for junior team members to assume too
        much responsibility
    - - Senior RN partner directs work of the junior partner
        within the limits of each partner’s abilities.
- - - - Vulnerability
      - Stability
      - Resiliency
      - Complexity
    - - Participation in care
      - Participation in decision making
      - Resource availability
      - Predictability
    - - Advocacy and moral agency
      - Caring practices
      - Clinical judgment
      - Collaboration
      - Response to diversity
      - Facilitation of learning
      - Systems thinking
      - Clinical inquiry
  - - - Delegation
      - Promotion of efficiency and quality
      - Cost control
    - - Patient care coordinators (RNs
      - Patient care associates or technicians
        
        Perform delegated patient care tasks
      - Unit support assistants
        
        Provide environmental services
        
        Can assist with hygiene and ambulation needs
      - Administrative support personnel
        
        Transcribe orders
        
        Coordinate admission and discharge
        
        Maintain patient records
        
        Assist with general office duties
    - - Requires considerable time for nurse manager
      - Demands a strong leader to manage staff
    - - Promotes efficiency, quality, and cost control
- - - - Used infrequently in acute care facilities, and only
        occasionally in long-term care facilities
      - Advantages
        
        Staff become efficient at performing assigned tasks
      - Disadvantages
        
        Uneven continuity of care
        
        Lack of holistic understanding of patient
        
        Problems with follow-up
      - group of patients separated into tasks
        that are assigned to registered nurses (RNs), licensed practical nurses (LPNs), or unlicensed assistive
        personnel (UAPs).
        
        RNs assess patients.
        
        Other staff give baths, make beds, take vital signs,
        and administer treatments
    - - Skills in delegating, communicating, and problem
        solving are essential
      - Open communication between team leaders and the
        nurse manager is also important
      - RN leads team
        
        Other RNs, LPNs, and UAPs provide patient care to
        all patients under the direction of the team leader
      - Advantages
        
        LPNs and UAPs perform tasks that do not require
        RN expertise
        
        Care is more easily coordinated
        
        Saves steps and time
      - Team of nursing personnel provides total care to a
        group of patients.
      - Disadvantages
        
        Total patient not considered by any one person
        
        Role confusion and resentment, hatred
        
        Affect changes in team leaders, members, and
        assignments on continuity of care
        
        Less control for nurses over assignments
        
        Time needed for communicating, supervising, and
        coordinating team members
        
        Possibility of unequal assignments
    - - Disadvantages
        
        RNs perform tasks that could be done more costeffectively
        by less skilled persons
      - Advantages
        
        Continuity of care is assured
        
        Communication with the patient, family, physician,
        and staff from other departments is look after
      - RN works directly with the patient, family, physician,
        and other healthcare staff
      - Original model of nursing care delivery (1920s)
    - - implemented by identifying one nurse who was
        assigned to coordinate care and with whom the family and physician could communicate, and other nurses or UAPs
        assisted in providing care.
      - Disadvantages
        
        Excellent communication required
        
        Accountability of associate nurses
        
        Patient transfers disrupt continuity of care
        
        Compensation and legal responsibility for SN
        
        Unwillingness of associates to take direction
      - RN maintains a patient load of primary patients.
        
        Actual care given by the primary nurse and/or associate
        nurses (other RNs).
      - Advantages
        
        Decentralization of decisions, authority, and
        responsibility
        
        24-hour accountability
        
        Knowledge-based practice model
        
        Improved continuity and coordination of care
        
        Increased nurse, patient, and physician satisfaction
      - Nursing is a knowledge-based professional practice, not just a task-focused activity.
      - Decentralized decision making by staff nurses is the core
        principle.