Plan-Managing Self, as the Nurse and Client Care

1. Plan-Managing Self, as the Nurse and Client Care Class 8 November 4, 2009 Judith Anne Shaw, Ph.D., R.N.

2. Plan-Managing • Delegation of Client Care • Standards for Nursing Practice • Communication Games • Models of Care Delivery • Contemporary • Traditional • Monitoring & Evaluating Quality of Care • Quality Improvement • Time Management

3. DELEGATION • Know person’s capabilities • Know job description

4. DELEGATION • Concept • Skill • Process • Art (Hansten & Jackson, 2004)

5. DELEGATION • Direct • Indirect

6. DIRECT DELEGATION Verbal Direction by the Registered Nurse

7. INDIRECT DELEGATION Approved list of activities or tasks established in policies and procedures within an agency

8. What is the Difference? Assignment vs. Delegation

9. Five Rights of Delegation • Right task • Right circumstances • Right person 4. Right direction/communication 5. Right supervision/evaluation

10. DELEGATION NURSING PROCESS CONCEPT

11. DELEGATION and theNURSING PROCESS • Assessment • Plan • Implementation/Intervention • Evaluation

12. Assessment • Know your world -Practice -Organization • Know yourself - Barriers - Benefits • Know your delegate - Competency - Motivation (Hansten & Jackson, 2004)

13. Plan • Know what needs to be done - Professional - Technical - Amenity - Based on outcome (Hansten & Jackson, 2004)

14. Implementation/Intervention • Prioritize &Match the Job to the Delegate • Know how to communicate • Know how to resolve conflict (Hansten & Jackson, 2004)

15. Evaluation • Know how to give feedback • Evaluate and problem solve (Hansten & Jackson, 2004)

16. Delegation Decisions • Level of client acuity • Level of unlicensed assistive personnel (UAP) capability • Level of licensed nurse capability

17. Delegation Decisions • Possible injury • Times skill performed by unlicensed assistive personnel • Level of decision-making needed for activity • Client’s ability for self-care

18. Criteria for Safe Delegation • Potential for harm to the client • Complexity of problem solving and innovation required • Predictability of the outcome • Extent of interaction

19. GAMES …people may play

20. Organizational Game • Karpman Triangle: • 3 roles 1. Victim 2. Persecutor 3. Rescuer

21. Karpman Triangle Persecutor Rescuer Victim *Participants move from one to another

22. Refuse to play any of the roles Give an adult response Call The Game!

23. Karpman Triangle Persecutor Rescuer Victim *Participants move from one to another

24. Models of Care

25. Models …remember that a picture (even a wordpicture) is worth a thousand words

26. Traditional Models of Care Total Care Functional Team Modular Primary

27. Gains 1. Extremely client focused Losses 1. Not most efficient use of staff Total Care

28. Gains 1. Efficient 2. Economical 3. Productive Losses 1. Fragmentation of care Functional Care Delivery

29. Gains 1. Holistic care 2. Increased client & employee satisfaction Losses 1. Time consuming 2. Expensive 3. May increase workload stress Team Approach

30. Contemporary Challenge of the Team Approach AIM • Develop a group of individuals into a cohesive whole • Share goals, expectations, and behavioural norms by team members • Individual differences and contributions acknowledged • Develop and promote best practices

31. TEAMWORK WORKING TOGETHER

32. TYPES OF TEAMS • Multidisciplinary Team • Interdisciplinary Team • Transdisciplinary Team

33. TEAM BUILDING CHALLENGE How to build a well-functioning team?

34. TEAM HIGH PERFORMANCE LEVELS • Participative leadership • Shared responsibility • Aligned on purpose • Strong communication • Future-focused • Focused on task • Rapid Response

35. Modular Approach Gains Losses • Located nearer .Use of the client paraprofessionals • Efficient . Dependent on skill of coordinator

36. Gains 1. Decreases fragmented care 2. Increases accountability & client satisfaction Losses 1. Limits number of clients a nurse can provide care to- 2. Client may be in jeopardy Primary Care

37. Mini-Nurse Manager Quiz Of the traditional models of Care Delivery, which model do you think optimizes the provision of quality client care? Provide explanation for your choice.

38. Contemporary Models of Care Delivery Case Management Client-Focused Product Line Management Differentiated Practice

39. Gains 1.Continuity of care 2. Efficient use of resources 3. Professional development & satisfaction 4. Holistic approach Losses 1. May be in jeopardy 2. Possibly, limited prepared staff Case Management

40. Gains 1. Possible increased client & staff satisfaction Losses 1. Possible staff dissatisfaction & stress 2. Institutional licensure 3. Quality of care giver Client-Focused Care

41. Gains 1. Cost effective 2. Potential for being more efficient 3. Allow nurses to provide direct care Losses 1. Potential of not focusing on client 2.Potential of not being able to adequately access client needs Product Line Management

42. Gains 1. Potential for nurse increased satisfaction 2. Potential for cost benefit for agency 3. Improved client care Losses 1. Potential for limited use of nurse who has higher competency skill level vs. educational preparation Differentiated Practice

43. Quality Client Care Monitoring & Evaluating

44. Structured Care Methodologies • Guidelines • Protocols • Algorithms • Standards of Care • Critical (Clinical) Pathways

45. Critical Pathways • Outgrowth of nursing care plan • Multidisciplinary representatives • Provides a communication & documentation framework

46. Critical PathwaysKey Elements • Discharge planning • Consultations • Activities • Nutrition • Medications • Diagnostic Tests • Treatments

47. Quality Improvement • What to evaluate • Structure, process & outcomes • Continuous quality improvement • Quality Circle at the Unit Level

48. What To Evaluate Three different aspects of health care

49. THREE MUSTS Comprehensive Evaluation Program 1. Structure: setting and resources 2. Process: actual activities “carried out” by the health care provider 3. Outcome: results of the activities

50. Remember Outcome Measures -use measurable indicators (objective measures)