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My imagined healthcare scenario is one that I am somewhat familiar with, patient care in an outpatient anemia management clinic.  There are several patient care delivery models in use in these clinics around the world.

 

One model that can be used effectively in this setting is the primary nursing care model. In this model, a specific nurse is assigned to take care of a patient for the entire time the patient is in this outpatient unit. This would work well in this setting, as the patients’ appointments are of a predetermined length and can be set up to align with nursing staff schedules. In an outpatient anemia management clinic, most patients are having infusions of parenteral iron and erythrocytes-stimulating agents, usually under the direction of a hematologist/oncologist and a collaborating advanced practice provider. The primary nursing care model would support person-centered care in a safe environment, because there is a significant risk of anaphylactic reactions with some of these iron products, and it is ideal that a primary nurse observes the patient during the test dose and early part of the iron infusion. As such, the nurse can quickly intervene in any untoward reaction, contributing to increased patient safety. In this model, the nurse would take care of 2-3 patients at a time, coordinating their infusions in a staggered fashion so as to be able to observe them carefully during the initial phases of therapy.

 

Another model that could be used in this setting is the team nursing care model, in which fewer nurses coordinate their activity under the direction of a team leader, combining their skills and abilities to care for the patient during the patient’s time in the outpatient anemia management clinic. This model could be useful in that these programs are often organized under the management of an advanced practice nurse, and nurses can be organized based on the patient’s previous response to this type of treatment. Patients often have multiple visits to the anemia management clinic and if they have had a previous reaction to the therapy, they are very likely to have an increasingly worse reaction on subsequent visits.

 

In this scenario, I would likely apply that rational decision-making model, as there are very predictable elements and challenges to this clinical setting. Most of the issues surround reimbursement and coding, and as such leading with this knowledge, and early identification of the problem contributes to developing potential solutions and then evaluating them. In this case, I would use this systematic approach to make an algorithm to guide decision-making. In this case, payor reimbursement often determines which formulation of iron a patient can receive, and this choice has implications for the nursing care that follows. Finally, I would work with the team to evaluate the implemented decision to drive elements of care through an algorithm and determine the safety and efficacy of the care pathway.

 

A key competency that would be required in this setting is that of balanced processing. In this competency, a nursing leader must be able to assimilate and analyze relevant data to help reach a decision. There are a variety of concerns, including clinical, financial, and logistical ones that must be coordinated to care for patients in this setting. 

SCIENCE
HEALTH SCIENCE
NURSING
NR 529

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