Coordination of Care, Delegation, Clinical Reasoning, and Priority Setting

Flashcards covering key vocabulary terms related to coordination of care, delegation, clinical reasoning, and priority setting in nursing.

Care Coordination

A set of activities purposefully organized by a team of personnel, including the patient, to facilitate the appropriate delivery of necessary services and information to support optimal health and care across settings and over time.

Care Coordination Models

Developed to improve care, promote health and independence, and reduce unnecessary service utilization; includes Social Models, Medically Oriented Models, and Integrated Models.

Social Model (Care Coordination)

Manages home and community-based services, does not address medical care, and is aimed at supporting Activities of Daily Living (ADLs).

Medically Oriented Model (Care Coordination)

Traditionally diagnosis-specific, evolved into coordination of care for multiple treatments and conditions, coordinating care across settings and over time.

Integrated Model (Care Coordination)

Involves the integration of healthcare, social support, and community clinical and nonclinical services.

PACE (Program for All Inclusive Care for the Elderly)

An example of a fully integrated care coordination model that integrates acute and long-term care services for eligible elderly patients who choose home health.

Interrelated Concepts (Care Coordination)

Concepts influencing care coordination such as Culture, Family dynamics, Functional ability, Self-management, Quality, Evidence-based practice, Collaboration, Informatics, Communication, Safety, Patient education, and Health promotion.

Delegation

The transference of responsibility and authority for an activity to a competent individual.

Delegator

The individual who transfers an activity or assignment to another.

Delegate

The individual who accepts responsibility for completing a task.

Role Differentiation

Distinguishing the specific responsibilities and scopes of practice among different healthcare professionals (e.g., RNs, LPNs, CNAs, Providers, Therapists, Pharmacists, Social Workers, Dieticians).

Nurse Practice Acts

State laws that define the scope of practice for nurses based on professional licensure.

Five Rights of Delegation

Guidelines for successful delegation: Right task, Right circumstances, Right person, Right direction and communication, and Right supervision.

Tasks Delegated to UAP

Activities that may be delegated to Unlicensed Assistive Personnel, such as vital signs, I&O, patient transfers, bathing, feeding, and attending to safety.

Tasks Not Delegated to UAP

Activities that may not be delegated to Unlicensed Assistive Personnel, such as assessment, interpreting data, making nursing diagnoses, creating care plans, evaluating care, IV line care, medication administration, or patient education.

Benefits of Delegation

Advantages for the nurse (more time for complex care, job satisfaction), delegate (promotes confidence, builds communication skills, forms a cohesive team), manager (focus on additional responsibilities, efficient unit), and organization (increased efficiency, goals met, decreased turnover, increased productivity, improved financial position).

Delegation Process

Involves Assessment and planning, Communication, Surveillance and supervision, and Evaluation and feedback.

Environmental Barriers to Delegation

Factors that hinder effective delegation, including a nonsupportive environment, lack of resources, limited training, and insufficient time.

Underdelegation

Occurs when the delegator fails to transfer full authority to the delegate, takes back responsibility for aspects of the task, or fails to appropriately equip or direct the delegate.

Reverse Delegation

When someone with a lower rank delegates a task to someone with more authority.

Overdelegation

When a delegator gives a delegate too much authority or responsibility, increasing the delegator's risk of liability.

Referral

When a healthcare provider requests evaluation or services from another healthcare professional or specialist to ensure comprehensive, specialized, or supportive care.

Clinical Reasoning

The use of careful reasoning in the clinical setting to improve patient care; a learned skill involving reflection on previous situations and decisions.

Clinical Judgment

A highly complex cognitive process combining critical thinking abilities, evaluative decision-making, and nursing experience to determine appropriate responses to a patient's complex situation.

Prioritizing Care

A process that enables a nurse to manage time and establish interventions for a single patient or for a group of patients.

Priority Assessments

Key areas to prioritize in patient assessment: Airway, Breathing, Circulation, Pain, and Safety.

Maslow's Hierarchy of Needs (Prioritizing Care)

A framework for prioritizing care where fundamental needs (physiological, safety) must be satisfied before higher-level needs (love/belonging, self-esteem, self-actualization) can be addressed.

High Priority (Care)

Life-threatening problems (ABCs) or those with the potential to become life-threatening within a short amount of time.

Medium Priority (Care)

Problems that may result in unhealthy physical or emotional consequences but are not immediately life-threatening.

Low Priority (Care)

Problems that can be resolved easily with minimal interventions and do not cause significant dysfunction.

Priority 1 or Must Do

Interventions that take priority over others, are essential, and must be completed.

Priority 2 or Should Do

Interventions that should be done but are not essential, completed after 'must do' activities.

Priority 3 or Nice to Do

Interventions that can be completed when there is available time, after 'must do' and 'should do' activities.

Factors to Consider When Setting Priorities

Include safety, availability of resources, situational variables, ethics, time constraints, patient's preferences, nurse's preferences, patient's health values/beliefs, stability/changes in patient's condition, the unexpected, nurse self-care, and delegation.

Triage

The process of identifying priorities for implementing care, especially in emergency or multi-patient situations.

Emergent (Triage)

Life-threatening issues that require immediate intervention.

Nonurgent (Triage)

Minor issues that do not require prompt care and would not result in life-threatening situations, often with stable patients who can ambulate.

Emergency Severity Index (ESI)

A triage algorithm system used in emergency departments to categorize patient urgency from ESI 1 (requires immediate life-saving intervention) to ESI 5 (no resources needed).

The Nursing Process

A systematic approach to patient care involving five dynamic phases: Assessment, Diagnosis, Planning, Implementation, and Evaluation.

Assessment (Nursing Process)

The phase of the nursing process where data is collected, organized, and validated about the patient's health status.

Diagnosis (Nursing Process)

The phase of the nursing process where data is analyzed, health problems, risks, and strengths are identified, and diagnostic statements are formulated.

Planning (Nursing Process)

The phase of the nursing process where patient problems/diagnoses are prioritized, goals/desired outcomes are formulated, and nursing interventions are selected and written.

Implementation (Nursing Process)

The phase of the nursing process where the patient is reassessed, assistance needs are determined, nursing interventions are implemented, delegated care is supervised, and activities are documented.

Evaluation (Nursing Process)

The phase of the nursing process where data related to outcomes is collected and compared, nursing actions are related to goals, conclusions are drawn about problem status, and the care plan is continued, modified, or terminated.