Introductory Medical-Surgical
Nursing
Settings and Models for Nursing Care
Nursing Care
• Introduction
– Caring for: Individual; Family; Groups
– Nurse’s role
• Health education; Prevention; Promotion
• Attend client needs: Hygiene; Activity; Diet;
Medical treatment; Physical, emotional,
spiritual comfort
Question
Is the following statement True or False?
If a LPN/LVN has a question regarding client care, they
should phone the physician.
Answer
False.
If a LPN/LVN has a question regarding client care, they
should initially discuss the issue with their
supervisory RN.
Nursing Care
• Nursing Roles
– Different educational levels provide care:
• Licensed Practical/Vocational nurse: Under RN
or physician; Determines need to seek out RN
• RN’s role: Management and coordination of
care provided to clients
Nursing Care
• Definitions of Nursing
– Clear and comprehensive definition-difficult
– Florence Nightingale: “the patient in the best
condition for nature to act upon him”
– Virginia Henderson: Definition; Regaining
independence
– Definition of nursing: The American Nurses
Association (ANA)
• Six essential features of contemporary
nursing practice
Nursing Care
• Nursing care: Provided in various settings
• Levels of nurses: Outpatient and inpatient care areas
• Decreased reliance on hospitals
– Client needs determine setting for care
– Much interest in determining most cost-effective
methods of care
Question
Is the following statement True or False?
Budgetary constraints are the primary determining factor in
client care.
Answer
False.
While budgetary constraints can be a factor in determining,
the primary determining factor in client care is the need
of the client. Frequently nurses advocate for best care
for the client.
Models for Nursing Care Delivery
• Case method
– One nurse provided all services-particular client
required
– Provided care in the home; Performed
household duties
– Evolution: Modern version is private duty
nursing
Models for Nursing Care Delivery
• Hospital-Based Nursing: Functional nursing
– Task-oriented; Distinct duties - specific
personnel; Divided tasks; Several people during
shift
– Fragments care; Confusing for client
• Hospital-Based Nursing: Team nursing
– Response to fragmented care of functional
nursing
– Varying education levels and skill; RN - team
leader; LP/LVNs; Nursing assistants
Models for Nursing Care Delivery
• Hospital-Based Nursing: Total care
– Nurse: Assumes all the care for a small group of
clients
– Focuses: More on client as a whole rather than
the collection of nursing tasks to be
accomplished
– Often practiced in intensive care units where
nurses are assigned one or two clients
Question
Is the following statement True or False?
Team nursing was a model developed in response to
functional nursing.
Answer
True.
Team nursing was a model developed in response to
functional nursing which resulted in fragmented care
which was highly confusing to clients.
Models for Nursing Care Delivery
• Hospital-Based Nursing: Primary Nursing
– RN: 24-hour accountability for client’s care;
Total nursing responsibility of clients assigned
– Secondary nurses: Carry out care in primary
nurse’s absence
– Expensive; Relies on RNs
– Advantage: Client assured of comprehensive,
holistic care
– Home care settings: Effective use
Models for Nursing Care Delivery
• Hospital-Based Nursing: Patient-focused care
– Updated version of primary care and team
nursing
– RN with one or more assistive personnel care
for group of clients
– Licensed and unlicensed assistants are crosstrained
– RN Role: Resource management and nursing
care outcome responsibility
Settings and Types of Nursing Care
• Community-Based nursing
– Various locations: Nurses practice
– Skilled nursing facilities: Acute illness; Invasive
procedures
– Intermediate care facilities: Nursing homes
provide custodial care for people with mental or
physical disabilities; No reimbursement from
Medicare
– Rehabilitation centers: Provide physical and
occupational therapy for ADLs
Settings and Types of Nursing Care
• Community-Based Nursing (Cont’d)
– Hospices: Terminal illness; Staff trained to help
clients with grieving process; Medicare coverage
– Community health centers; Community mental
health centers - funding
– Other facilities: Seniors; Adult; Physical or
mental disabilities
– Goal-alternative care facilities: Least restrictive,
safe, quality living arrangements
Settings and Types of Nursing Care
• Community-Based Nursing: Congregate housing
– Independent to minimal assistance: Seniors and
disabled adults; Free-standing apartments;
Private rooms
– Residents: Certain qualifications; Subsidized
rent; Meals; Recreational activities; Affordable
housing
• Assured of appropriate housing
• May lack resources, ability, opportunity to
participate in outside activities
Settings and Types of Nursing Care
• Community-Based Nursing: Boarding Homes
– Small home: Individual rooms
– Residents: Pay for room, board, and minimal
nursing services; Have supervision, may
relinquish independence and privacy
– Share rooms; Common dining area
– Oversee employment: Disabled adults
– Stable environment: For those who cannot live
independently
Settings and Types of Nursing Care
• Community-Based Nursing: Assisted Living
– Care: Require assistance with three ADLs;
Maximizes independence while maintaining
privacy, dignity
– Joint Commission on Accreditation of Healthcare
Organizations: Developing voluntary accrediting
process
– Very expensive; May not provide housekeeping,
laundry, transportation, and meals
Settings and Types of Nursing Care
• Home health nurses provide specialized care in the
client’s home.
Figure 2-2. Home health nurses
Settings and Types of Nursing Care
• Home Health Nursing: Cost containment
measures
– Expansion of home healthcare
– Covers health needs: Long-term and shortterm; Specialized care; Medications, and
chemotherapy
– Hospice care
– Postcardiac surgery care
– Vent-dependent clients
Settings and Types of Nursing Care
• Home Health Nursing: Cost containment measures
(Cont’d)
– RN manages and coordinates care
– High level of competency: Assessment, skills,
communication, teaching, management, and
documentation
– Encourages self-care skills with support from
community resources
Models
for
Nursing Care Delivery
• Case
Management
Figure 2-3. Functions of the nurse case manager.
Models for Nursing Care Delivery
• Case Management
– Maximizes fiscal outcomes without sacrificing
quality
– Careful oversight of client’s healthcare
– RN: Bachelor’s or master’s degree
– Case manager
– Employed: Insurance companies and hospitals
– Tools to plan and coordinate care: Clinical
pathways; Practice guidelines; Standards of
care
Models for Nursing Care Delivery
• Case Management (Cont’d)
– Plan and coordinate client’s progress through
phases of care
• Avoid delays, unnecessary diagnostics,
overuse of expensive resources
• Early, thorough discharge planning