Transcript
Models of Patient
assignment
Bivin JB
Dept of Psychiatric Nursing
Introduction
• Grouping of patients according to the
amount & complexity of their nursing
requirements
• Patient acuity- Nursing work load that is
generated for each patients
• Patient acuity ≈ Amount of nursing service
• Patient classification system is the scheme
that group patients according to the
amount & complexity of their nursing care
requirements
Class Presentation
Ms Anila Mathew
Presentation overview
1. Case method nursing or total patient
care.
2. Functional nursing
3. Team nursing or modular nursing
4. Primary nursing
5. Case management or managed care
Case method
• Nurses assume total responsibility for
meeting all the needs of assigned patients
during their time on duty.
Characteristics:
• Complete care.
• Nurses with high autonomy and responsibility.
• It is developed and communicated through
written sources, its usage remains in
contemporary practice.
• The lines of authority and accountability are
clear.
Merits:
• The nurses attend to total needs of clients
• Continuity of care.
• Client/ nurse interaction/rapport can be developed.
• Client may feel more comfortable
• Educational needs of the client can be closely monitored.
• Family and friends became better known by the nurse
• Workload of the patient can be equally divided.
• Nurse’s accountability for their function is built-in.
Demerits:
• Many clients do not require the inherent care
of intensity in this type of service.
• This method need to be modified if
professional workers are to be involved
effectively.
• It is difficult for the nurses to use this method
to become involved in long term planning and
evaluation of care.
• It is not possible if the nurses are not
adequately trained for the total care of the
patient.
Functional method
• In this, persons were assigned to
complete certain tasks rather than care
of specific patients.
• Eg. Checking BP,
administering medications
Characteristics:
• A functional method is a technical approach
of nursing care.
• The available staff in the unit, for a particular
period of time, are assigned selected
functions of nursing practice such as vital
signs, treatments, medications.
• All the responsibilities are assigned in
accordance with the expertise.
• The only person who has responsibility of the
client is the head nurse or nurse acting the
role.
Merits:
• Person become specifically skilled in
performing certain assigned task.
• Best utilization of a person’s aptitudes,
experiences and desires.
• Less equipment is needed.
• Saves time.
• Development of technical skill
• Sense of productivity for the task oriented
nurse
• Easy to organize the work of the unit and
staff
Demerits:
• Client care become impersonal,
compartmentalized and fragmented.
• Diminishing continuity of care.
• Staff may become bored and have little
motivation.
• Only the nurse in-charge has
accountability for the client.
Continues…
• Little avenue for the staff development.
• Client may tend to feel insecure.
• Only parts of the nursing care plan are
known
• Difficult to establish the client priorities.
• Only safe when the head nurse co-
ordinate all the activities of the members.
Team nursing
• A group of professional and non-
professional personnel work together who
identify, plan, implement and evaluate
comprehensive centered care.
Characteristics:
• Ancillary personnel collaborate in
providing care.
• Team nursing involves decentralization of
nursing unit and professional head nurse
authority.
• Each team composed of a team leader,
team members and patients.
• Comprehensive care is the responsibility
of the entire team.
Continues…
• The head nurse has the
responsibility to know the
conditions of all patients assigned
to the team and planning individual
care.
• Democratic leadership.
• Group members are given as
much as autonomy
Merits:
• includes all health care personnel in the
group functioning and goals.
• Feelings of participation and belonging
• Workload can be balanced and shared.
• Division of labor allows members the
opportunity to develop leadership skills
• Every team members has the opportunity
to learn from and teach colleagues.
Demerits:
• Establishing the team concept takes time, effort
and constancy of personnel.
• Unstable staffing patterns make team nursing
skills patterns make team nursing difficult.
• All personnel must be client centered.
• This leads to blurred lines of responsibility,
errors, and fragmented care.
• For the team nursing to be effective the leader
must be excellent practitioner and have good
communication, organizational, management,
and leadership skills.
Primary nursing
• It is also called
relationship based
nursing. It involves
total nursing care,
directed by a nurse on
24 hour basis as long
as the client is under
the care.
Characteristics:
• The Primary nurse assumes 24-hour
responsibility from admission or start of
treatment to discharge or the treatment’s
end.
• During work hours, primary nurse provides
total direct care for that patient.
• When the primary nurse is not on duty,
care is provided by other junior nurses.
• An integral responsibility of the primary
nurse is to establish a good
communication
Merits:
• Opportunity for the nurse to see the client and family as one system.
• Nursing accountability, responsibility and independence are increased.
• The nurse is able to use wide range of skills, knowledge and expertise.
• Potentiates creativity by the nurse and thereby work satisfaction increases
• Increased trust and satisfaction for both
Demerits:
• The nurse may be isolated from the
colleagues.
• Little avenue for group planning of care.
• Nurse must be mature and independently
competent.
• It must be cost effective.
• Staffing patterns may necessitate a heavy
client load.
• It may be difficult to recruit and retain
enough staff, especially in times of nursing
shortage.
Case management
A collaborative process that assesses,
plans, implements, coordinates, monitors
and evaluates opinions and services to
meet an individual health needs through
communication and available resources to
promote quality, cost-effective outcomes.Case management society of America
Characteristics:
• Case mangers handle each case
individually.
• In general, case manger can
handle a load of 25 patients.
• Case mangers use critical
pathways and multidisciplinary
action plans to plan patient care.
Responsibilities of case managers:
• Assessing clients and their homes and
communities.
• Coordinating and planning client care.
• Collaborating with other health team
• Monitoring client progress and client
outcomes.
• Advocating for clients
• Serving as a liaison with third party
Merits:
• Additional work efficiency due to
geographical proximity.
• Establishes solid relationships with nursing
and ancillary staff working on the unit.
• Case management provides a well
coordinated care.
• Provides comprehensive care
• It seeks the active involvement of the
patient, family and diverse health care
professionals
Demerits:
• Some experts are argued that this role should
be reserved for the advance practitioner
nurse or an RN with advanced training or
need 3 to 5 year experience.
• The case manger should also be extremely
bright, have well developed interpersonal
skills, be able to multitask, have a strong
foundation in utilization review, and
understand payer-patient specifics and
hospital reimbursement mechanisms.
• Expensive
Modular Nursing
Modular nursing is a modification of team
nursing and focuses on the patient‘s
geographic location for staff assignments.
Characteristics:
• The patient unit is divided into modules or
districts, and the same team of caregivers
is assigned consistently to the same
geographic location.
• Each location, or module, has an RN
assigned as the team leader, and the other
team members may include LPN.
Continues..
• The team leader is accountable for all
patient care and is responsible for
providing leadership for team members
and creating a cooperative work
environment.
• The success of the modular nursing
depends greatly on the leadership abilities
of the team leader.
Merits:
♣ Nursing care hours are usually cost-
effective.
♣ The client is able to identify personnel who
are responsible for his care.
♣ All care is directed by a registered nurse.
♣ Continuity of care is improved
♣ The RN as team leader is able to be more
involved in planning & coordinating care.
♣ Save staff time.
♣ Feelings of participation and belonging
♣ Work load can be balanced and shared.
♣ Develop leadership skills
♣ Continuity care is facilitated
♣ Everyone has the opportunity to contribute
to the care plan.
Demerits:
♠ Costs may be increased to stock each
♠ Takes time, effort, and constancy of personnel.
♠ Unstable staffing pattern make team difficult.
♠ There is less individual responsibility and autonomy regarding nursing function.
♠ All personnel must be client centered.
♠ The team leader must have complex skills and knowledge.
Progressive patient care
It is a method in which client care areas
provide various levels of care.
The central theme is better utilization of
facilities, services and personnel for the
better patient care.
Principal elements of PPC
• Intensive care or critical care
• Intermediate care
• Convalescent and Self Care
• Long-term care
• Home care
• Ambulatory care
Merits:
♣ Efficient use is made of personnel and
equipment.
♣ Clients are in the best place to receive the
care .
♣ Use of nursing skills and expertise are
maximized.
♣ Clients are moved towards self care,
independence is fostered where indicated.
♣ Efficient use and placement of equipment is
possible.
♣ Persons have greater probability to function
towards their fullest capacity.
Demerits:
♣ Discomfort to clients who are moved often.
♣ Continuity care is difficult.
♣ Nurse/Client relationships are difficult to
arrange.
♣ Great emphasis is placed on
comprehensive, written care plan.
♣ There is often difficulty in meeting
administrative need of the organization,
staffing evaluation and accreditation.
Differentiated Nursing Practice
• An attempt to separate nursing practice roles based on education or experience or some combination of both.
• Education model:
Role differentiation based upon type of educational preparation [BSN, MSN etc]
• Competency model:
Role differentiation based on individual nursing skills, expertise, experience etc.
Merits:
• Match patients needs with nursing
competencies.
• Efficient use of nursing resources.
• Provide equitable compensation
• It increase nurse satisfaction, built loyalty and
increase the prestige of the nursing profession.
THANK YOU…
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