Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Upcoming SlideShare
What to Upload to SlideShare
What to Upload to SlideShare
Loading in …3
×
1 of 52

Methods of Patients assignment

51

Share

Download to read offline

Nursing management,

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Methods of Patients assignment

  1. 1. SEMINAR ON CASE METHOD AND PRIMARY NURSING CARE Presented by: Mr. RAHUL RANJAN M.Sc Nursing 2nd Year
  2. 2. ORGANIZING NURSING SERVICES AND PATIENT CARE • ‘’A hospital may be soundly organized, beautifully situated and well equipped, but if the nursing care is not of high quality the hospital will fail in the responsibility’’.
  3. 3. ORGANIZING NURSING SERVICES Nursing services • Nursing services is the part of the total health organization which aims at satisfying the nursing needs of the patients/community. • In nursing services, the nurse works with the members of allied discipline such as dietetics, medical social service, pharmacy etc. in supplying a comprehensive program of patient care in hospital.
  4. 4. Cont… Nursing service administration • Nursing service administration is a complex of elements in interaction and is organized to achieve the excellence in nursing care service. • It results in output of clients whose health is unavoidably deteriorating, maintained and improved through input of personnel and material resources used in a process of nursing services.
  5. 5. Definition of patient care • The service rendered by members of the health professionals and non-professionals under the supervision for the benefit of the patient. OR • The prevention, treatment and management of illness and the preservation of mental and physical wellbeing through the services offered by the medical and allied health professions.
  6. 6. Patient classification system • Patient classification system (PCS), which quantify the quality of nursing care, is essential to staffing nursing unit of hospitals and nursing homes. • The primary aim of PCS is able to respond to constant variation in the care needs of the patients. • Grouping of patients according to the amount & complexity of their nursing requirements • Patient classification system is the scheme that group patients according to the amount & complexity of their nursing care requirements
  7. 7. ORGANIZING PATIENT CARE/ METHODS OF PATIENT ASSIGNMENT • Overall goal of nursing is to meet the patient nursing needs with the available resources for providing smooth day and night 24 hour of quality care to patient and honor his right. • To ensure that nursing care is provided to patient, the work must be organized. • A Nursing Care Delivery Model organizes the work of caring for patients.
  8. 8. Cont.. • The decision of which nursing care delivery model is used is based on the needs of the patients and the availability of competent staff in the different skill levels. • For organizing function to be productive and facilitated meeting the organizational need, the leader must know the organization and its member well.
  9. 9. Purpose • To delegate to work to be done to the nursing personnel • To gain the cooperation of nursing personnel by knowing and accepting the accepting of the work to be done. • To prepare the work systematically • To prepare and motivate the nurses for delivery of care. • To shoulder accountability
  10. 10. PRINCIPLES OF PATIENT ASSIGNMENT • Made by head nurse for each individual nurse • Planned weekly and revised daily to ensure continuity of care • Must be balanced among nursing staff • Never assign same task to more than one nurse Based on: • Nursing needs of each patient • Skill, experience, capabilities of each staff • Job description
  11. 11. FACTORS AFFECTING PATIENT ASSIGNMENT • Patient characteristics • Nursing resource • Organization support • Type of nursing care delivery system
  12. 12. CHALLENEGES IN PATIENT ASSIGNMENT • Problem of personal management • Shortage of trained manpower • Lack of adequate training • No involvement in planning • No autonomy in nursing activities • Inadequate number of nursing staff
  13. 13. METHODS OF PATIENT ASSIGNMENT • Case method nursing or total patient care. • Functional nursing • Team nursing or modular nursing • Primary nursing • Case management or managed care • Progressive patient care
  14. 14. CASE METHOD • The case method or total patient care method of nursing care delivery is the oldest method of providing care to a patient. • In this method, nurses assume total responsibility for meeting all the needs of assigned patient during their time on duty. • The premise of the case method is that one nurse provides total care to one patient during her entire work period of one shift. • This method was used in the era of Florence nightingale when patient received total care in the home.
  15. 15. Cont… • That time nurses were ‘hired’ and they lived with in the family of the patient provided 24 hours care to patient and even family. • During an 8-12 hour shift the patient receives consistent care from one nurse. The nurse, Patient, family share mutual trust and work together toward specific goals. • Usually the care is patient centered, comprehensive, holistic and continuous.
  16. 16. CHARACTERISTICS • Complete care • Provides nurses with high autonomy and responsibility. • Assigning patients is simple and direct. • Patient theoretically receives holistic and un-fragmented care during the nurse’s time on duty. • It is developed and communicated through written sources, its usage remains in contemporary practice.
  17. 17. ORGANIZATION OF THE CASE METHOD Nurse Manager’ role: • The nurse manager must consider the expense of the system before arranging the staff • Arrange skilled and qualified nurse so that she could manage all the care of the person • The manager also need to identify the level of education and communication skills of all • Arrange for continuing education and in service education for the personnel Staff nurse’s role: • Provide holistic care to assigned patient during a defined work period • Assessment and teaching the patient and family
  18. 18. MERITS • Nurse can see better and attend to the total needs of the patient • Continuity of care can be facilitated • Client or nurse interaction and rapport can be developed • Client may feel more secure • Nurse’s accountability for their function is built-it. • Family friends become more known by nurse and get more involved • Work load can be equally divided by the staff.
  19. 19. DEMERITS • Many clients do not require the inherent care • Must be modified if non-professional health workers are used • Great disadvantage when nurse is inadequately trained • Cost–effectiveness • Nurse may feel over workload if most of her assigned patient care sick. • She/he may tend to ‘neglect‘ the needs of patient when the other patients ‘problem‘ or ‘need‘ demands more time
  20. 20. PRIMARY NURSING CARE • It was developed in the 1960s with the aim of placing RNs at the bedside and improving the professional relationships among staff members. • It supports a philosophy regarding nurse and patient relationship. • This method is based on the concept of ‘my patient-my nurse” In this nursing care delivery system, each registered nurse is assigned to the care of group of patient for which she plans complete 24 hours care and writes the nursing care plan. • He or she is responsible for coordinating and implementing all the necessary nursing care that must be given to the patient during the shift.
  21. 21. Cont… • If the nurse is not available, the associate nurse responsible for filling in for the nurse‘s absence will provide hospital care to the patient based on the original plan of care made by the nurse. • This type of nursing care can also be used in hospice nursing, or home care nursing. • Provides total direct care for patients. • Requires a nursing staff made up of only Nurses.
  22. 22. MODEL OF PRIMARY NURSING CARE
  23. 23. 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 • The Primary nurse assumes 24-hour responsibility from admission or start of treatment to discharge or the treatment’s end.
  24. 24. Cont… • 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
  25. 25. ADVANTAGES • Satisfaction for both patients and nurses • The relationship between nurses and patient is intimate • Autonomy for the nurses • Nurse is the person who is planning and providing complete care • She communicates with all other health team members involved in client care • Other health team members including physician tend to view her more knowledgeable and responsible
  26. 26. Cont.. • Patient receives quality and continuity of care • Reduces the number of errors than can result from a relay of orders • Increased satisfaction both to patients and nurses • Nurse can identify patient outcome as a result of their work
  27. 27. DISADVANTAGES • More nurses are required for this method of care delivery and it is more expensive than other methods. • Level of expertise and commitment may vary from nurse to nurse which may affect quality of patient care. • Associate nurse may find it difficult to follow the plans made by another if there is disagreement or when patient‘s condition changes. • It may be cost-effective especially in specialized units such as the ICU. • May create conflict between primary and associate nurses. • Stress of round the clock responsibility.
  28. 28. Cont… • Difficult hiring all RN staff • Confines nurse‘s talent to his/her own patients. • Nurse may be isolated from colleagues • Nurses talent to a limited number of patients • Nursing care plan can be changed only with the permission of primary nurse • Creates separation anxiety in patients when nurse • Nurses should be well educated and trained in all area of patient care, most of the time which may lack
  29. 29. FUNCTIONAL NURSING • It is task focused, not patient-focused. • In this model, the tasks are divided with one nurse assuming responsibility for specific tasks. For example, one nurse does the hygiene and dressing changes, whereas another nurse assumes responsibility for medication administration.
  30. 30. Merits • Each person become very efficient at specific tasks and a great amount of work can be done in a short time (time saving). • It is easy to organize the work of the unit and staff. • The best utilization can be made of a person‘s aptitudes, experience and desires. • The organization benefits financially from this strategy because patient care can be delivered to a large number of patients by mixing staff with a large number of unlicensed assistive personnel. • Nurses become highly competent with tasks that are repeatedly assigned to them. • Less equipment is needed and what is available is usually better cared for when used only by a few personnel.
  31. 31. Demerits: • Client care may become impersonal, compartmentalized and fragmented. • Continuity of care may not be possible. • Staff may become bored and have little motivation to develop self and others. • The staff members are accountable for the task. • Client may feel insecure. • Only parts of the nursing care plan are known to personnel. • Patients get confused as so many nurses attend to them, e.g. head nurse, medicine nurse, dressing nurse, temperature nurse, etc.
  32. 32. TEAM NURSING • Team nursing is based on philosophy in which groups of professional and nonprofessional personnel work together to identify, plan, implement and evaluate comprehensive client- centered care. • In team nursing an RN leads a team composed of other RNs, LPNs or LVNs and nurse assistants or technicians. • The team members provide direct patient care to group of patients, under the direction of the RN team leader in coordinated effort. • The charge nurse delegates authority to a team leader who must be a professional nurse. This nurse leads the team usually of 4 to 6 members in the care of between 15 and 25 patients. • The team leader assigns tasks, schedules care, and instructs team members in details of care.
  33. 33. Advantages • High quality comprehensive care can be provided to the patient • Each member of the team is able to participate in decision making and problem solving. • Each team member is able to contribute his or her own special expertise or skills in caring for the patient. • Improved patient satisfaction. • Feeling of participation and belonging are facilitated with team members. • Work load can be balanced and shared.
  34. 34. • Division of labour allows members the opportunity to develop leadership skills. • There is a variety in the daily assignment. • Nursing care hours are usually cost effective. • The client is able to identify personnel who are responsible for his care. • Barriers between professional and non-professional workers can be minimized, the group efforts prevail.
  35. 35. Disadvantages • Establishing a team concept takes time, effort and constancy of personnel. • Unstable staffing pattern make team nursing difficult. • All personnel must be client centered. • There is less individual responsibility and independence regarding nursing functions. • The team leader may not have the leadership skills required to effectively direct the team and create a ―team spirit‖. • It is expensive because of the increased number of personnel needed.
  36. 36. 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. • 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 marred to units/ wards staffed to best provide the type of care needed.
  37. 37. Principal elements of PPC are • i) Intensive care or critical care: Patients who require close monitoring and intensive care round the clock, e.g. patients with acute MI, fatal dysarythmias. • ii) Intermediate care: Critically ill patients are shifted to intermediate care units when their vital signs and general condition stabilizes, e.g. cardiac care ward
  38. 38. • iii) Convalescent and Self Care: Patients are taught administration of drugs, life style modification, exercises, ambulation, self- administration of insulin, checking pulse, blood glucose and dietary management. • iv) Long-term care: Chronically ill, disabled and helpless patients are cared for in these units. Nurses and other therapists help the patients and family members in coping, ambulation, physical therapy, occupational therapy along with activities of daily living.
  39. 39. • v) Home care: Some hospital/centers have home care services. A hospital based home care package provides staff, equipment and supplies for care of patient at home, e.g. paralyzed patients, post- operative, mentally retarded/spastic patient and patient on long chemotherapy. • vi) Ambulatory care: Ambulatory patients visit hospital for follow up, diagnostic, curative rehabilitative and preventive services. These areas are outpatient departments, clinics, diagnostic centers, day care centers etc.
  40. 40. Merits • Efficient use is made of personnel and equipment. • Clients are in the best place to receive the care they require. • 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. • Personnel have greater probability to function towards their fullest capacity.
  41. 41. Demerits • There may be discomfort to clients who are moved often. • Continuity care is difficult. • Long term nurse/client relationships are difficult to arrange. • Great emphasis is placed on comprehensive, written care plan. • There is often times difficulty in meeting administrative need of the organization, staffing evaluation and accreditation.
  42. 42. CASE MANAGEMENT • The case manager is assigned responsibility of following a patient‘s care and progress from the diagnostic phase through hospitalization, rehabilitation and back to home care. For eg; case manager for cardiac surgery patients assists them go through diagnostic procedures, pre-operative preparations, surgical interventions, family counseling, post-operative care and rehabilitation.
  43. 43. Responsibilities of case managers • Assessing clients and their homes and communities. • Coordinating and planning client care. • Collaborating with other health professionals in the provision of care. • Monitoring client progress and client outcomes. • Advocating for clients moving through the services needed. • Serving as a liaison with third party payers in planning the client‘s care.
  44. 44. Merits • Case management provides a well coordinated care experience that can improve the care outcome, decrease the length of stay, and use multiple disciplines and services efficiently. • Provides comprehensive care for those with complex health problems. • It seeks the active involvement of the patient, family and diverse health care professionals
  45. 45. Demerits • Nurses identify major obstacles in the implementation of this service, financial barriers and lack of administrative support. • Expensive • Nurse is client focused and outcome oriented • Facilitates and promotes co-ordination of cost effective care • Nursing case management is a professionally autonomous role that requires expert clinical knowledge and decision making skills.
  46. 46. SUMMARY
  47. 47. CONCLUSION • No single nursing care model works in all settings, or even necessarily across a single multiservice setting. • Before selecting a model nurse manager must consider all the influencing factors. • For a better care effective selection and mixing of these methods are essential. • All the models should be evaluated periodically for its appropriateness to ensure safe and effective nursing care.
  48. 48. REFERENCES • Whitehead, D. K., Weiss, S. A. & Tappen, R. M. (2010), Essentials of Nursing Leadership and Management, 5th edition, Philadelphia, F.A.Davis Company. • Deepak, K., Chandran, S. C. & Kumar, M. B. P (2017), A comprehensive textbook of Nursing management, 2nd edition, New Delhi, EMMESS Medical Publisher. • Vati, J. (2013), Principles & Practice Of Nursing Management & Administration, 1st edition, New Delhi, JAYPEE Medical Publisher.
  49. 49. Thank You!

×