Chapter 21

Managing Patient Care

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 Building a Nursing Team

 A strong nursing team works together to achieve

the best outcomes for patients.
 Effective team development requires team
building and training, trust, communication, and
a workplace that facilitates collaboration.

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 Building a Nursing Team (Cont.)

 Building an empowered nursing team begins

with the nurse executive.
 Transformational leadership
 TEEAMS (Time, Empowerment, Enthusiasm,
Appreciation, Management, and Support) approach

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 Magnet Recognition

 Based on five model components

 Transformational leadership
 Structural empowerment
 Exemplary professional practice
 New knowledge, innovation, and improvements
 Empirical quality results

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 Nursing Care Delivery Methods

 Traditional models
 Team nursing
 Primary nursing

 Today’s models
 Patient-centered care
 Total patient care
 Case management

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 Nursing Care
Delivery Methods (Cont.)
 Patient- and family-centered care
 Respect and dignity
 Information sharing
 Participation
 Collaboration

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 Case Study

 Jennifer is a nursing student who is assigned

the following three patients:
 Mrs. Sinclair, who is scheduled for surgery to
repair a fractured right hip
 Mr. Timmons, who has finished lunch and is ready
for pain medication
 Mr. Dodson, who has a postoperative wound
infection and is due for antibiotic medication

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 Nursing Care
Delivery Models (Cont.)
 Total patient care
 Registered nurse works directly with patient, family,
and health care team members.
 RN is responsible for patients during shift of care,
although care can be delegated.
 Approach may not be cost-effective owing to high
number of RNs needed.
 Patient satisfaction is high.

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 Nursing Care
Delivery Models (Cont.)
 Case management
 Collaborative process of assessing, planning,
facilitating, and advocating for options and services to
meet an individual’s health needs.
 Clinicians oversee the management of patients with
specific, complex health problems and are usually
held accountable for some standard of cost
management and quality.
 Often the case manager is an advanced practice
nurse (APN), who helps improve patient outcomes via
specific interventions.

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 Decision Making

 Decentralized management means that decision

making occurs at the level of the staff.
 Encompasses
 Responsibility: duties and activities an individual is
employed to perform
 Autonomy: independent decisions about patient care
 Authority: legitimate power to give commands and
make final decisions specific to a given position
 Accountability: answerable for the actions

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 Quick Quiz!

1. A travel nurse has taken an assignment at a

health care facility where nurses assume
responsibility for a caseload of patients over
a period of time. This type of nursing
exemplifies:
A. team nursing.
B. primary nursing.
C. functional nursing.
D. decentralized management.

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 Decision Making (Cont.)

 Staff involvement
 Transformational
leadership
 All staff benefit from
knowledge and skills
of entire work group
 Requires skilled
communication

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 Decision Making (Cont.)

 Nursing manager supports staff through:

 Establishing nursing practice through problem-solving
committees or professional shared governance
councils
 Interprofessional collaboration among nurses and
health care providers
 Interprofessional rounding
 Staff communication
 Staff education

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Leadership Skills for Nursing Students

Clinical Care
Team Communication
Coordination

Delegation Knowledge Building

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 Clinical Care Coordination

 Clinical Decisions
 Priority Setting
 Organizational Skills
 Use of Resources
 Time Management
 Evaluation

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 Clinical Decisions

 Apply the nursing process

 Know your patient
 Use clinical decision making practices
 Accurate clinical decision-making keeps you
focused on the proper course of action

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 Priority Setting

 Determine which patient’s needs should be

addressed first:
 High priority: immediate threat to patient survival or
safety
 Intermediate priority: nonemergent, non–life
threatening
 Low priority: actual or potential problems may or may
not be directly related to patient’s illness or disease

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 Case Study (Cont.)

 Mrs. Sinclair’s surgery is scheduled for 1 p.m.

She has never had surgery before and is very
nervous and moving restlessly in bed. She is
reluctant to talk, but her preoperative checklist is
not yet completed, and she needs to be escorted
to surgery in 30 minutes.

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 Case Study (Cont.)

 Mr. Timmons had abdominal surgery 2 days ago

for colon tumor removal. He has finished his
lunch and is ready for pain medication. He is
preparing to get out of bed to walk down the hall.

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 Case Study (Cont.)

 Mr. Dodson has a postoperative wound

infection. His wet-to-dry abdominal dressing
needs to be changed, and he needs his next
dose of antibiotic.

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 Case Study (Cont.)

 Jennifer stays with Mrs. Sinclair to assess her

new symptoms and complete her preoperative
checklist. She sends a unit clerk to check on Mr.
Timmons.
 Once Mrs. Sinclair’s checklist is completed, she
stops by Mr. Timmons’ room to assess his pain
and administer his medication.
 She then verifies Mr. Dodson’s identification and
administers the antibiotic, and next completes
the dressing change.
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 Organizational Skills

 Do the right things.

 Do things right.
 Inform and prepare patient.
 Clean and organize work area.
 Keep patient’s needs at the center of attention.

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 Use of Resources

 Appropriate use of resources is an important

aspect of clinical care coordination.
 Administration of patient care occurs more
smoothly when staff members work together.

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 Time Management

 Remain goal oriented.

 Identify priorities.
 Establish personal goals.

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 Evaluate

Evaluate process.

Evaluate patient response.

Evaluate therapy efficacy.

Evaluate patient and expected outcomes.

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 Case Study (Cont.)

 When Jennifer assesses Mr. Timmons’ pain,

she discovers that his pain is still 8 out of 10
following Percodan 20 mg every 6 hours.
Patient-controlled analgesia (PCA) with
morphine was removed 4 hours ago.
 She determines that his current pain
medication is insufficient to control his pain
and requests a change in his medication.

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 Team Communication

Respect others’ ideas.

Share information.
Stay informed.
Strive to improve your communication.
Share expectations of communication.
Use structured communication techniques

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 Delegation

 Transfers responsibility while remaining

accountable for outcomes
 Requires knowing which skills are transferable
 Results in improved quality, safe patient care,
improved efficiency, increased productivity, an
empowered staff, and skill development of
others

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 Delegation (Cont.)

 The Five Rights of Delegation

 Right Task
 Right Circumstance
 Right Person
 Right Direction
 Right Supervision

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 Delegation (Cont.)

 Steps to Effective Delegation

 Assess the knowledge and skills of the delegatee.
 Match tasks to the delegatee’s skills.
 Communicate clearly:
• Task, outcome, time
 Listen attentively.
 Provide feedback.

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 Quick Quiz!

2. A newly graduated nurse is assigned to care for a

team consisting of herself and a certified nursing
assistant. When delegating skills, she needs to:
A. assign only bed-making and feeding skills.
B. assess the knowledge of the certified nursing
assistant.
C. remind the staff member that she is working under
the license of the RN.
D. allow the staff member to perform only skills that the
RN is able to teach certified nursing assistants to
perform.

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 Knowledge Building

 Remain competent.
 Pursue lifelong learning.
 Share the knowledge.
 To become a leader, actively pursue learning
opportunities, both formal and informal, and
learn to share knowledge with the professional
colleagues you encounter.

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