NR 226- Exam 1 Study Guide
NR 226: Patient Care
Topics
Managing Patient Care
1. Nursing care delivery models; clinical application, Case Management; discharge planning, referrals
delivery models:
team nursing – work and help each other; starts w/ same level then going higher in level if help is still needed; RN leads
team of other RN’s, LPN & UAP; team lead creates care plan, coordination of team & provides care for required difficult
skills (team for quality care of one pt)
total patient care – RN responsible for full care of one or more pt during shift; care can be delegated; works w/ pt,
family & team members (charge nurse gives assignment)
primary nursing – one RN accountable/responsible for individual; to put more RN’s at bedside; assess pt, creates care
plan & gives appropriate nursing interventions; communication is lateral(Rn gives the antibiotic, not transferring to
another person)
Case management – works with continued care outside of acute care; coordinates outpatient care; helps keep cost
down but still maintain quality (setting up pt for rehab)
2. Decentralized management; responsibility, autonomy, authority, accountability
Decentralized management: decision making is moved down to the level of staff; managers & staff actively involved;
potentially greater collaborative effort, increased success, increased motivation, great sense of satisfaction.
Responsibility – performing the job you were assigned
Autonomy – including pt’s in decisions; allowing them to make a choice in their healthcare; self-governing
Authority – having power to give commands & make final decisions according to position
Accountability – answering to your actions
3. Staff involvement; effective communication with staff, collaboration, professional development, In-services
Effective communication w/ staff – manager using a variety of communicating styles; quickly & accurately (biweekly or
monthly newsletters, staff meetings, info from meeting available for staff to read)
Collaboration – RN & doctor working together; two different views combined to solve problems; improves pt safety,
outcomes & reduces errors
Professional development – continuing education to better yourself & keep up w/ current medical & nursing practice
In-services -
4. Establishing priorities; high, intermediate and low; nursing implications
High – immediate threat to pts safety & survival (pain, airway, circulation, loss of consciousness, blood loss)
Intermediate – non-emergent, non-life threatening (teaching pt, avoiding post-op problems, infection, rash, bp of 150,
lab values rising)
Low – actual or potential problems may or may not be directly related to disease or illness; developmental needs or
long-term care needs (edema, slipped IV w/ low meds, skin breakdown, uti from foley, pt being admitted w/ need
teaching at discharge)
Nursing implication – make careful judgements; when pt has more than one issue focus on worst one first
5. Delegation; rights of delegation, interventions that may/may not be delegated to LPN or UAP, interventions only the RN
can perform
Delegation – giving responsibility to someone else but you are still accountable for it; person needs to know what you
are asking them to do; give it to the right person
The 5 Rights of delegation
• Right task
• Right circumstance
• Right person
• Right direction
*** Please note that this is meant to serve as an augmentation tool. Students ARE subject to be tested on any
material related to readings, simulations, labs, assignments and activities within the course. ***
NR 226: Patient Care
Topics
Managing Patient Care
1. Nursing care delivery models; clinical application, Case Management; discharge planning, referrals
delivery models:
team nursing – work and help each other; starts w/ same level then going higher in level if help is still needed; RN leads
team of other RN’s, LPN & UAP; team lead creates care plan, coordination of team & provides care for required difficult
skills (team for quality care of one pt)
total patient care – RN responsible for full care of one or more pt during shift; care can be delegated; works w/ pt,
family & team members (charge nurse gives assignment)
primary nursing – one RN accountable/responsible for individual; to put more RN’s at bedside; assess pt, creates care
plan & gives appropriate nursing interventions; communication is lateral(Rn gives the antibiotic, not transferring to
another person)
Case management – works with continued care outside of acute care; coordinates outpatient care; helps keep cost
down but still maintain quality (setting up pt for rehab)
2. Decentralized management; responsibility, autonomy, authority, accountability
Decentralized management: decision making is moved down to the level of staff; managers & staff actively involved;
potentially greater collaborative effort, increased success, increased motivation, great sense of satisfaction.
Responsibility – performing the job you were assigned
Autonomy – including pt’s in decisions; allowing them to make a choice in their healthcare; self-governing
Authority – having power to give commands & make final decisions according to position
Accountability – answering to your actions
3. Staff involvement; effective communication with staff, collaboration, professional development, In-services
Effective communication w/ staff – manager using a variety of communicating styles; quickly & accurately (biweekly or
monthly newsletters, staff meetings, info from meeting available for staff to read)
Collaboration – RN & doctor working together; two different views combined to solve problems; improves pt safety,
outcomes & reduces errors
Professional development – continuing education to better yourself & keep up w/ current medical & nursing practice
In-services -
4. Establishing priorities; high, intermediate and low; nursing implications
High – immediate threat to pts safety & survival (pain, airway, circulation, loss of consciousness, blood loss)
Intermediate – non-emergent, non-life threatening (teaching pt, avoiding post-op problems, infection, rash, bp of 150,
lab values rising)
Low – actual or potential problems may or may not be directly related to disease or illness; developmental needs or
long-term care needs (edema, slipped IV w/ low meds, skin breakdown, uti from foley, pt being admitted w/ need
teaching at discharge)
Nursing implication – make careful judgements; when pt has more than one issue focus on worst one first
5. Delegation; rights of delegation, interventions that may/may not be delegated to LPN or UAP, interventions only the RN
can perform
Delegation – giving responsibility to someone else but you are still accountable for it; person needs to know what you
are asking them to do; give it to the right person
The 5 Rights of delegation
• Right task
• Right circumstance
• Right person
• Right direction
*** Please note that this is meant to serve as an augmentation tool. Students ARE subject to be tested on any
material related to readings, simulations, labs, assignments and activities within the course. ***
