Patient classification system bjb

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…