Nursing Together
This is a podcast about nursing trends, new technology, innovation, and evidence-based practice models
Nursing Together
Delivery of Care
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This is the 1st part to Nursing Care Delivery Model. Information comes from Davis Advantage for Fundamental Nursing Care by Marti Burton and David Smith
good afternoon, everyone, and welcome to Nursing Together where we talk about educational topics. Today, we are gonna be talking about something that sounds pretty straightforward, delivery of care nursing. But there's actually a lot more than simply taking care of your assigned patients
RyanAbsolutely. And if you're an LPN student, this is especially important because you are going to quickly discover that nursing is not something you do alone.
ChoehnsThat's right. That's probably one of the biggest things nursing students need to understand. You may be the nurse at the bedside, but you are a part of a team that is much larger called the healthcare team.
RyanExactly. And today we are going to talk about who is on that team How everyone works together, different places where the patient receives the care, and what that means for you as a licensed practice nurse
ChoehnsLet's start with the big picture. When the patient enters the healthcare facility, they may interact with an incredible number of different patients And every one of these people have a role
RyanRight. The common goal is to provide quality, cost-efficient care that helps the patient return to their normal level of function and wellness. And I want to emphasize the word team.
ChoehnsYes, because one of the most dangerous things can happen in healthcare when people work in isolation. The textbook describes this as working in a silo. When healthcare professionals don't communicate and instead work independently, the result can be poor quality of care and a higher rate of preventable errors.
RyanThis is so true. So as an LPN, communication isn't just about being polite or friendly with your coworkers. It is about making sure that everyone understands what everyone else is doing in regards to patient care
ChoehnsYep. It's a patient safety intervention.
RyanExactly.
ChoehnsLet's now talk about some of the people that you're going to encounter. First, we have the healthcare provider. That includes physicians, physician's assistants, and nurse practitioners These providers have different educational backgrounds and roles, but they are responsible for diagnosing and treating illnesses and injuries and ordering things such as medication, tests, diets, treatments, therapies, and procedures.
RyanThen we have to talk about our nursing staff, and that's where you come in.
ChoehnsAs an LPN, you practice with defined scope and provide direct patient care. The material also identifies the LPN as working under the supervision of either a physician, a dentist, or an RN, or a supervising assistant professional
RyanNow, that's important distinction for students.
ChoehnsAbsolutely, being a part of a nursing team doesn't mean that every nurse has the same scope of responsibilities. Your responsibility is knowing your scope of practice, understanding your facility's policies, and know when you need to involve another team member
RyanAnd the nursing team is only one piece of the puzzle.
ChoehnsYou having a nursing assistant or other assistive personnel who can help with that patient care.
RyanThen you've got therapy.
ChoehnsYes, there are several different types of therapy, including physical therapy, occupational therapy, speech and language therapy, and the list goes on and on. And then of course, these professionals aren't just people who come into patient's room and perform tasks and leave.
RyanExactly.
ChoehnsTheir observations can be extremely important to nursing care. For example, a physical therapist may notice that the patient is having difficulty walking safely. An occupational therapist may identify problems with activities of daily living. And a speech therapist may evaluate that the patient is either able or unable to swallow safely. The last one is especially important because swallowing problems can place a patient at risk for complications. And then you've got your laboratory staff, radiology, pharmacy, dietary services, social work, and chaplain services. And of course, there are many others. The point is every member brings a different area of expertise for the patient's care
RyanSo let's make this practical. Imagine you are caring for a patient who has suddenly become weak. Maybe yesterday they were walking to the bathroom with minimal assistance, but today they are struggling.
ChoehnsYou don't need to just say, "Well, that's unfortunate," and continue with your day.
RyanExactly.
ChoehnsYou assess the patient, document your findings, and communicate the change to the appropriate members of the healthcare team. Maybe physical therapy needs to know. Maybe the RN needs to know. Maybe the provider even needs to be notified, and perhaps other members of the team need to be involved depending on what is happening, such as case management, because this might change where the patient ends up going after discharge.
RyanThis is what collaboration looks like in real nursing practice.
ChoehnsAnd remember, the goal isn't to prove that you can manage everything yourself. The goal is to make sure the patient receives safe and effective care.
RyanOne way healthcare professionals communicate is through multidisciplinary conferences.
ChoehnsThink about a patient who has experienced a stroke. This patient may be paralyzed, difficult swallowing, or have problems eating. That's not just a patient who needs only one person.
RyanExactly. The team could include the healthcare provider, physical therapist, occupational therapist, speech therapist, dieticians, and nursing staff.
ChoehnsEach person looks at a patient from a different perspective, and that is the beauty of interdisciplinary collaboration. The nurse may know how the patient is doing throughout the day. The physical therapist may know how the patient is progressing with mobility. The speech therapist can provide information about swallowing, and the dietician can help address the nutritional needs. And when everybody shares that information, the team can develop a much more complete and comprehensive picture of the patient's condition
RyanWe also cannot talk about modern healthcare without talking about technology.
ChoehnsElectronic health records or the EHR Help members of the healthcare team access information about the patient and the outcomes. That means that the information you document isn't just for you.
RyanExactly. It's for other members that may rely on that information.
ChoehnsSo when you're documenting, think beyond, "I have to chart this because my instructor said so." Think of it as someone else may need to make a clinical decision based on what I document, and that is a completely different mindset After all that, we need to be talking about something students don't always connect with, and that is the cost of healthcare.
RyanRight. As a nurse, we are focused on our patients. We think about medicines, assessments, safety, comfort, and treatment.
ChoehnsBut somebody is paying for that care, and nurses have to be responsible for making sure that they look at what that cost is when caring for the patient. That doesn't mean we're supposed to withhold necessary care.
RyanNo, absolutely not. That means we should avoid unnecessary waste and conserve supplies when appropriate.
ChoehnsThink about sometimes as simple as opening a supply that we aren't really gonna need. Once you've opened them, you have to discard them. So multiply that by thousands of patients and thousands of days of care, and that can financially impact the hospital that you're working at or even the patient you are caring for
RyanAnother important concept is medically necessary.
ChoehnsIn simple terms, medically necessary means that the service or the item is reasonable and necessary for diagnosing or treating an illness or injury, or improving the function of a body part.
RyanSo healthcare services aren't simply provided because someone wants them.
ChoehnsThere has to be a clinical reason. The material gives the example of cosmetic surgery. A facelift generally isn't considered medically necessary because it doesn't diagnose or treat any illness or injury. But reconstructive surgery following an accident could be medically necessary because it is addressing the injury caused by an accident. For you as the LPN, the takeaway is nursing care occurs within a larger system of clinical and financial decisions.
RyanAnother major concept is the appropriate level of care.
ChoehnsBasically, where should this patient receive care? Does the patient need to be in acute care hospital? Could they safely receive care in a skilled nursing facility? Would rehab be appropriate? Could the patient receive care as an outpatient? Or could they receive care at home? The goal Is to provide care at the most cost-effective level that remains safe and effective.
RyanThat's the key.
ChoehnsCost should never mean sacrificing patient safety. Let's break down the different settings.
RyanFirst, you have inpatient care.
ChoehnsInpatient is where a patient stays overnight or longer in a healthcare facility and is receiving nursing care. That could be an acute care hospital, a long-term care hospital, skilled nursing facilities, rehabilitation facilities, or certain long-term care settings. Acute care hospitals provide things like emergency services, surgeries, inpatient care, diagnostic testing, and some outpatient services. And these hospitals have huge variety of professionals working together.
RyanThen there is the long-term acute care hospital, or an LTAC.
ChoehnsThis is for a patient who still requires a higher level of medical care but need it for a longer period. The material gives an example of a patient who is stable on a ventilator but needs to continue treatment for an infection. Instead of remaining in a traditional acute care hospital for an extended period, the patient may be transferred to an LTAC. So think, acute care equals very sick and requires hospital-level care. LTAC equals still medically complex and requires intense treatment, but over a longer period of time.
RyanNow let's start talking about the skilled nursing facility, or a SNF.
ChoehnsSNF care is generally less intensive than traditional acute care hospital. It can be transitional settings. A patient may receive skilled nursing care along with physical, occupational, or speech therapy. Here's a great example. A patient has surgery for a hip fracture. The surgeon is successful, but the patient isn't strong enough to safely go home. They may transition into a SNF for continued nursing care and therapy. The goal is progress.
RyanExactly.
ChoehnsThe patient is working toward becoming independent enough to move to the next level of care
RyanNow let's compare that with rehabilitation.
ChoehnsRehabilitation or rehab can provide intensive physical, occupational, and speech therapy. A patient who has experienced a stroke might go into rehab to regain strength and function. The patient is expected to actively participate in this therapy. So here's an important concept. Rehabilitation isn't simply a place where a patient rests. It is a place where a patient works towards recovery and increased independence.
RyanLet's move outside of the hospital.
ChoehnsOutpatient care is designed to meet the patient's needs without requiring an overnight stay. And outpatient care is generally less expensive than inpatient care. An example include outpatient surgery, diagnostic testing, rehabilitation, ambulatory clinics, medical offices, and some observation services. And students often get confused about observation.
RyanYes, a patient may remain in a hospital for monitoring and diagnostic testing without being formally admitted as an inpatient.
ChoehnsThe material describes an observation stay as generally lasting twenty-four to seventy-two hours and being consistent with outpatient services.
RyanHome healthcare, on the other hand Is how health care can come to a patient rather than the patient coming to a healthcare facility.
ChoehnsHome health can include skilled nursing, physical therapy, occupational therapy, speech therapy, social work, infusion therapy, durable medical equipment, and hospice care. For skilled home, for skilled home health services, the patient must meet criterias, and the material emphasizes that a patient must be homebound and receive these services. Skilled nursing visits may include nursing assessments, evaluations, complex dressing changes, and administration of IV medications. Home healthcare aides, on the other hand, may assist with bathing, grooming, housekeeping, transportation, and food prep. So once again, we're seeing different team members working together.
RyanAnd finally, let's talk about hospice.
ChoehnsThis is especially important in the area of nursing care. Hospice is an interdisciplinary approach focused on palliative care and support for a terminally ill patient and their families. The focus isn't on curing the disease. The focus is comfort, symptom management, and supporting the patient and the family. Hospice can address physical, spiritual, social, and economic needs. The team may include nursing, physicians, social workers, chaplains, home health aides, volunteers, and others. Again, the word that keeps coming back is team.
RyanSo let's go ahead and put this all together with a patient scenario.
ChoehnsImagine your patient is an older adult who had a stroke. The patient is weak on one side and difficult swallowing. Where might the patient go? Initially, we may require an acute hospital stay. Then once medically stable, they can move to rehab. There, physical therapy can work on mobilization. Occupational therapy can work on activities of daily living. Speech therapy may address swallowing. The dietician can help with nutritional needs, and nursing continues to monitor the patient, providing care, education, and communication, and communicating any changes. Eventually, the patient may transition home with home health services or another appropriate level of care.
RyanThat is continuum of care.
ChoehnsAnd the patient needs, and the patient's needs determines where they go next.
RyanThe takeaways that I want you to get from this podcast is if you're sitting there thinking, "Okay, this is a lot of information. What do I actually need to remember for nursing school and practice?"
ChoehnsHere are a few things. One, you're a part of a team. Two, know your scope of practice and responsibilities as an LPN. Three, communication is key Four, use the experts of other healthcare professionals to help understand the patient as a whole. Remember, you don't know everything, and you don't need to know everything. That is why we have a team. Five, document accurately because other members of the team may depend on your documentation. And six, understand where your patient is in the continuum of care because the patient may move from acute to rehab, skilled nursing, home health, outpatient care, or another setting
RyanSo let's go ahead and do a rapid review. What is the main goal of a healthcare team?
ChoehnsTo provide quality, cost-efficient care and help the patients reach their optimal level of functioning and wellness
RyanWhat happens when the healthcare professionals work in silos?
ChoehnsCommunication suffers and the risk of poor quality care and preventable errors increase.
RyanWhat does an LPN do?
ChoehnsProvides direct patient care within the defined scope and supervises patient care assistants according to the rules and regulations within the facility and the state that you work in.
RyanWhat is medically necessary?
ChoehnsServices and items that are reasonable and necessary for diagnosing and treating an illness or injury, or improving function.
RyanWhat is an appropriate level of care?
ChoehnsThe safest, most effective level of care that meets the patient's needs while being cost-efficient.
RyanWhat is the difference between inpatient and outpatient?
ChoehnsInpatient care involves an overnight stay. Outpatient care is generally provided without an overnight admission.
RyanAnd what is the biggest lesson?
ChoehnsNo nurse practices alone. Thank you again for joining us from Nursing Together, we hope that you will go to our next one and understand exactly what the role is, how to document, and making sure that you are walking the walk and talking the talk.