The systems approach integrates the analytic and the synthetic method, encompassing both holism and reductionism. It was first proposed under the name of " General System Theory " by the biologist Ludwig von Bertalanffy
It consists of information concerning the time lapsed between duty shifts of employyes ,patient assignment and so on.
Patient Classification System “ The greatest asset of a man’s business is his pride in work ."
Rapid and dynamic changes in healthcare delivery have placed the issues of patient safety and quality of care at the center of healthcare. The American Nursing Association’s Nursing Safety and Quality Initiative, highlighted the strong linkage between nursing actions and patient outcomes. Developing a fair, objective, and reliable way to predict the required number and skill level of staff to meet patient needs and staffing assignments is a continuous challenge to healthcare leaders.
The PCS is a scheme that group patients according to the amount and complexity of their nursing care requirements. It serves as a tool to measure patient needs, caregiver interventions, and the skill levels required to meet those needs.
suppose that for an adult medical-surgical ward it has been established that an average of 5 hours of nursing care per day is to be provided each patient; that there will be an average of 20 patients per day on the unit; and that an all-registered nurse staff is to be assigned to the unit, Suppose further that in the same agency, nursing contract calls for each nurse to work a 40-hour, five-day week, to have 20 day of vacation each year, to be given 10 paid holidays each year, and to be allowed 12 paid sick days per year. If a review of personnel attendance records shows nurse uses an average of six paid sick leaves with 140 off leaves
In the factor system, a number of critical care descriptors are identified, against each of which the patient’s need for care is measured to yield a subscore.this subscore,when combined with other subscores,yields a total score that designates the patient’s dependency category.
Most patient classification systems are of the factor type, in which a number of care elements or descriptors are identified, each of these elements is broken down into component sub elements, and a standard time is set for accomplishment of each sub element (each of which represents a different level of patient dependency).
In one s ys t e m th e d esc ri p t or s us e d t o ass i g n p a ti e n t s t o car e c at eg or i es ar e the ac t iv i t i es of da il y l i v i n g - f eedi n g, g r oo m in g, to il e ti n g , comfo r t m e a s ur es , an d mo b i lit y. T he amo u n t o f ti m e r e q uir e d t o ass i s t th e pa t i e n t w ith ea c h of t h ese i s th e n q u an tif i e d from l eas t possib l e t i me r e quir e d (a s " f ee d s s e l f o r n ee ds l i tt l e h e l p " ) to mos t po ss ib l e tim e r equ i r e d ( as " c a nn o t f e ed se l f a t a ll an d m ay hav e diffi c ul t y c h ewing and s wa ll ow i ng foo d ") .
C a t eg or y I : Pati e nt s w i th ac ut e , non c h r o ni c , epi s odi c di s ea se or di sa bilit y w h o w ill r e tu rn t o t h e ir p r e- il l n es s l e v e l of fun c tion in g and f or w h om t h e care goa l i s comp l e t e e li mi n a t ion of t h e ex i s ting h ea lt h prob l em s.
C a t e go r y I I : P a ti e nt s w ith c h r o n i c di sease o n w hi c h i s s up e rimpo se d a n a c u t e epi s od e of i l ln ess, w h o h a ve th e pot e nti a l to r e t ur n t o t h e pre -e pi s od i c l eve l of f u n c t ion i ng , and f or w h om th e c ar e go a l i s man a g e m e nt of t h e c h ron i c h ea l t h prob l e m b y th e pa ti e nt and fam i ly w ith o ut o n go in g s u p p o rt fr o m th e age n cy .
Cat ego r y I II : P a ti e nt s wi th c h r o n i c di seas e or di sa b il i t y , w h e re r e t urn t o pr e- ill ne ss l e v e l o f fun c t ioning i s not p o s s ib l e bu t t h e r e i s pot e n ti al t o in c r e a se t he l e ve l o f fu n ct i o n in g, and f o r w h o m t he ca r e g o a l i s r e h a b ili ta ti on to a ma x imum l e v e l of fun c t ion in g th rou g h c o nt inu i n g age n cy s u p p o rt .
C a t e gor y I V: P a ti e nt s w ith a c hr o n i c di se a se or di sa bilit y who ca n ' t be maint a in e d a t h o m e without on go in g a ge n cy su p port, for w h om t h e ca r e g oal i s ma i nt e n anc e a t h o m e at a m ax imum l ev e l of f u n c t i on i n g t h r o u g h on g oin g a ge n cy s u p p o rt .
Ca t e go r y V: P a ti e nt s w ith e n d s t ag e il l n es s for w h om th e ca r e go al i s a s s ur a n c e o f c om f o rt and d i g nit y thr o u g h o ut th e t e rmin a l s t age of illne s s .
MODES OF ORGANISING PATIENT CARE / NURSING CARE DELIVERY SYSTEM
There are five primary means of organizing nursing care for patients namely
It involves the assignment of one or more clients to a nurse for a specific period of time, such as shift. Complete care, including treatments, medication administration and nursing planning, is the assigned nurse's responsibility.
Case method nursing provides nurses with high autonomy and responsibility.
Assigning patient is simple and direct and does not require the planning that other methods of patient care delivery do.
The lines of authority and accountability are clear.
The patient theoretically receives holistic and unfragmented care during the nurses time on duty. Each nurse caring for the patient can, however modify the care regimen. The merits and demerits of this method are as follows.
The nurse can see better attend to the total needs of clients due to the time and proximity of interactors. Co-ordination of all aspects of care is the main responsibility of the nurse; which includes physical, emotional, medical regimen, teaching and all other aspects related to it.
Continuity of care can be facilitated with care.
Client /nurse interaction / rapport can be developed by virtue of intensity of time and proximity of those involved.
The functional method is a technical approach to nursing care that emphasizes the dependent functions of nursing practice.
It consists of separating nursing tasks and assigning each nursing staff member available on a unit to perform selected functions such as vital signs, treatments, medications for all the patients in a unit or for a large number of patients in the unit.
The responsibilities of the unit are assigned to selected people in accordance with their expertise. The only person who has complete responsibility of the client is the head nurse or nurse acting in that role. The following are merits and demerits of functional nursing.
It is only safe when the head nurse can co-ordinate the activities of all members of the
staff and make certain that nothing essential in client care is overlooked or forgotten. This is a tremendous responsibility on one person who probably has to think of approximately thirty or more clients, plus the staff.
Majority of them viewed this functional nursing as an executed economical means of providing care . Major advantage of this method is its efficiency, tasks are completed quickly, with little confusion regarding responsibility, e.g. in many areas such as operating room, labour room; etc the functional nursing works well end is still very much in evidence. But may lead to fragmented care and the responsibility of overlooking priority needs and may lead to low job satisfaction.
Team nursing is based on a philosophy (Kron ,1978) in which a group of professional and non- professional personnel work together who identify, plan, implement and evaluate comprehensive client centered care. The key concept is a group that works together towards a common goal, providing qualitative comprehensive nursing care.
In team nursing ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. Actually the team nursing involves decentralization of a nursing unit and professional head nurses authority, in which the unit is divided into teams.
Each team composed of team leader, team members and patients. In comprehensive care, the client is the responsibility of the entire team, but is led by the team leader who should be a registered nurse.
Assignments are made according to the capability of the members and respond to the needs of the group of clients.
In team nursing, team leader or the head nurse is responsible for knowing the conditions and needs of all the patients assigned to the team and planning individual care. The team leader duties vary depending on the patient needs and workload. These duties may include assisting team members, giving direct personal care to patients, teaching and coordinating patient care activities.
Here the clients are evaluated with respect to all level (intensity) of care needed. As they progress towards increased self care (as they become less ethically ill or in need of intensive care or monitoring) they are mared to units/wards staffed to best provide the type of care needed. The merits and demerits of progressive patient care are as follows
Primary nursing involves total nursing care, directed by a nurse on a 24 hours basis as long as the client is under care. As originally designed, this method requires a nursing staff comprising totally of registered staff nurses. Here one specific nurse is the client's nurse, at all times directing, planning, evaluating and teaching. The primary nurse is essentially, on call all the time and arranged coverage when away.
During working hours the primary nurse provides total direct care for that patient, when the primary nurse is not on duty, care is provided by other junior nurses who follow the care plan established by the primary nurse, that means, even though the primary nurse is the director of care for clients, segments of care are often delegated.
The function of any system is to convert or process information, energy, or materials into a planned outcome or product for use within the system, outside the system, or both.
Thus, nursing process is system the function of which I to convert the knowledge and skills of the nurse, the patient, and the patient’s family into supportive and therapeutic interventions against illness, debility and loss.
Selection is the process of choosing the most suitable persons out of all the applicants. In this process relevant information about applicants is collected through a series of steps so as to evaluate their suitability for the job requirements.
All employees are appointed to confined position shall serve 12 months on the probation .if satisfactory reports received at the end of this time ,such staff may be considered for the confirmation . If the reports are not satisfactory ,either the probationary period ,may be terminated as provided by rules and regualtion of hospital.
A term appointment is an employment offered for fixed duration and the termination date is stated on the appointment agreement .It ends automatically on due date and no notice on either side is necessary.
Manager must assign on and off duty time for workers for a span of days so as to group the total staff into desired congratulations.
She must check the completed schedule for errors such as names omitted, promised holidays or vacations not provided, inadequate numbers of personnel during certain periods, and improper mix of personnel on certain days or shifts.
She must secure approval of the proposed schedule from appropriate nursing mangers or directors.
She must post schedules to notify staff members of assigned duty hours for several weeks in advance
She must review and analyze schedules and policies on a regular basis to identify staffing problems that necessitate scheduling changes.
The supervisor or head nurse has been responsible for scheduling on duty time for unit nursing personnel.
Scheduling must be prepared several weeks in advanced, and then modified to accommodate changes in patient census, worker illness and emergency time-off requests, much valuable supervisory time spent in preparing and adjusting time schedules
It consists of assigning work days and shifts for unit staff members according to a predictable and repeating pattern, makes available desired numbers and mix of personnel and facilitates continuity of patient care and constancy of primary work groups