learning method of patient assignment and

METHOD’S OF
PATIENT
ASSIGNMENT
1/3/2024

Types of patient assignment
• Case method or Total patient care
• Functional nursing
• Team nursing
• Modular or district nursing
• Progressive patient care
• Primary nursing
• Case management
1/3/2024

CASE METHOD
Features:
• It was the first type of nursing care delivery
system.
• In this method, nurses assume total responsibility
for meeting all the needs of assigned patients
during their time on duty.
• It involves assignment of one or more clients to a
nurse for a specific period of time such as shift.
• The patient has a different nurse each shift and
no guarantee of having the same nurses the next
day. Nurse‘s responsibility includes complete care
including treatments, medication and
administration and planning of nursing care.
1/3/2024

• This is the way most nursing students were
taught – take one patient and care for all of their
needs.
• This model is used in critical care areas, labor and
delivery, or any area where one nurse cares for
one patient‘s total needs.
• Here nurses were self-employed when the case
method came into being, because they were
primarily practicing in homes.
• It lost much of that autonomy when healthcare
became institutionalized in hospitals and clinics
and now called as private duty nursing.
1/3/2024

Merits:
 The nurse can attend to the total needs of clients
due to the adequate time and proximity of the
interactions.
 Good client nurse interaction and rapport can be
developed.
 Client may feel more secure.
 RNs were self-employed.
 Work load can be equally divided by the staff.
 Nurse‘s accountability for their function is built-
it.
 It is used in critical care settings where one nurse
provides total care to a small group of critically ill
patients.
1/3/2024

Demerits:
 Cost-effectiveness.
 The greater disadvantage to case nursing
occurs, when the nurse is inadequately
trained or prepared to provide total care to
the patient.
 Nurse may feel overworked if most of her
assigned patients are sick.
 She/he may tend to neglect‘ the needs of
patient when the other patients problem‘ or
need‘ demands more time.
1/3/2024

FUNCTIONAL NURSING
Features:
• This system emerged in 1930s in U.S.A during
WWII when there was a severe shortage of
nurses in US.
• A number of Licensed Practice Nurses (LPNs) and
nurse aides were employed to compensate for
less number of registered nurses (RNs) who
demanded increased salaries. It is task focused,
not patient-focused.
• In this model, the tasks are divided with one
nurse assuming responsibility for specific tasks.
1/3/2024

• For example, one nurse does the hygiene and
dressing changes, whereas another nurse
assumes responsibility for medication
administration.
• Typically a lead nurse responsible for a specific
shift assigns available nursing staff members
according to their qualifications, their
particular abilities, and tasks to be completed.
1/3/2024

FUNCTIONAL NURSING
1/3/2024
Charge Nurse
RN Treatment
Nurse
LPN Vital signs
Nurse
RN Medication
Nurse
Patients assigned to the team
LPN Vital signs
Nurse
UAP Hygiene
Nurse
UAP Hygiene
Nurse
UAP Hygiene
Nurse

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.
1/3/2024

 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.
1/3/2024

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.
1/3/2024

 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.
1/3/2024

TEAM NURSING
Features:
• Developed in 1950s because the functional method
received criticism, a new system of nursing was devised
to improve patient satisfaction.
• Care through others became the hallmark of team
nursing. Team nursing is based on philosophy in which
groups of professional and non-professional 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.
1/3/2024

• 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.
1/3/2024

• The team leader assigns tasks, schedules care,
and instructs team members in details of care.
A conference is held at the beginning and end
of each shift to allow team members to
exchange information and the team leader to
make changes in the nursing care plan for any
patient.
• The team leader also provides care requiring
complex nursing skills and assists the team in
evaluating the effectiveness of their care
1/3/2024

TEAM NURSING
1/3/2024
Charge Nurse RN
Team Leader RN Team Leader RN
RN LPN RN LPN NA
NA
Group of Patients Group of Patients

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.
1/3/2024

• Feeling of participation and belonging are
facilitated with team members.
• Work load can be balanced and shared.
• Division of labor allows members the
opportunity to develop leadership skills.
• There is a variety in the daily assignment.
• Nursing care hours are usually cost effective.
1/3/2024

• 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.
1/3/2024

Disadvantages:
• Establishing a team concept takes time, effort
and constancy of personnel. Merely assigning
people to a group does not make them a ‗group‘
or ‗team‘.
• Unstable staffing pattern make team nursing
difficult.
• All personnel must be client centered.
• There is less individual responsibility and
independence regarding nursing functions.
1/3/2024

• 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.
• Nurses are not always assigned to the same
patients each day, which causes lack of continuity
of care.
• Task orientation of the model leads to
fragmentation of patient care and the lack of
time the team leader spends with patients.
1/3/2024

MODULAR NURSING
Features:
• Modular nursing is a modification of team nursing
and focuses on the patient‘s geographic location
for staff assignments.
• The concept of modular nursing calls for a smaller
group of staff providing care for a smaller group
of patients.
• The goal is to increase the involvement of the RN
in planning and coordinating care.
1/3/2024

• 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 LVN/LPN or UAP.
• 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.
1/3/2024

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 when staff
members are consistently assigned to the
same module
• The RN as team leader is able to be more
involved in planning & coordinating care.
1/3/2024

• Geographic closeness and more efficient
communication save staff time.
• Feelings of participation and belonging are
facilitated with team members.
• Work load can be balanced and shared.
• Division of labor allows members the
opportunity to develop leadership skills
• Continuity care is facilitated especially if
teams are constant.
• Everyone has the opportunity to contribute to
the care plan.
1/3/2024

Demerits:
• Costs may be increased to stock each module
with the necessary patient care supplies
(medication cart, linens and dressings).
• Establishing the team concepts takes time,
effort, and constancy of personnel.
• Unstable staffing pattern make team difficult.
1/3/2024

• 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
1/3/2024

PROGRESSIVE PATIENT CARE:
• Features:
• 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.
1/3/2024

Principal elements of PPC are:
• Intensive care or critical care:
Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute MI, fatal
dysrhythmias, those who need artificial ventilation, major
burns, premature neonates, immediate post or
cardiothoracic, renal transplant, neurosurgery patients.
These units have 9-15 numbers of beds, life-saving
equipment and skilled personnel for assessment, revival,
restoration and maintenance of vital functions of acutely
ill patients. Nursing approach in these units is patient-
centered.
1/3/2024

• Intermediate care: Critically ill patients are
shifted to intermediate care units when their
vital signs and general condition stabilizes, e.g.
cardiac care ward, chest ward, renal ward.
1/3/2024

• Convalescent and Self Care: Although
rehabilitation programme begins from acute
care setting, yet patients in these areas
participate actively to achieve complete or
partial self-care status. Patients are taught
administration of drugs, life style modification,
exercises, ambulation, self-administration of
insulin, checking pulse, blood glucose and
dietary management
1/3/2024

• . 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. Patients and
family who need long-term care are, cancer
patients, paralyzed and patients with
ostomies.
1/3/2024

• 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.
1/3/2024

• 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.
1/3/2024

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
1/3/2024

• It is a system in which one nurse is caring for
all the needs of a patient or more within a 24
hour from admission to discharge. He or she is
responsible for coordinating and
implementing all the necessary nursing care
that must be given to the patient during the
shift.
1/3/2024

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.
1/3/2024

PRIMARY CARE NURSING
• Features:
• It was developed in the 1960s with the aim of
placing RNs at the bedside and improving the
professional relationships among staff
members.
• The model became more popular in the 1970s
and early 1980s as hospitals began to employ
more RNs. It supports a philosophy regarding
nurse and patient relationship.
1/3/2024

• 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.
• In acute care the primary care nurse may be
responsible for only one patient; in intermediate
care the primary care nurse may be responsible
for three or more patients This type of nursing
care can also be used in hospice nursing, or home
care nursing.
1/3/2024

PRIMARY CARE NURSING
1/3/2024
Patients
Total patient care 24 hrs./day
PRIMARY
NURSE
Communicates
with supervisors
Consults with
physician or
other healthcare
Associate (days)
when primary nurse
is not available
Associate (afternoon)
When primary nurse
is not available
Associate
(evenings) when
primary nurse is
not available

Advantages:
• Primary Nursing Care System is good for long-
term care, rehabilitation units, nursing clinics,
geriatric, psychiatric, burn care settings where
patients and family members can establish good
rapport with the primary nurse.
• Primary nurses are in a position to care for the
entire person-physically, emotionally, socially and
spiritually.
• High patient and family satisfaction
1/3/2024

• Promotes RN responsibility, authority,
autonomy, accountability and courage.
• Patient-centered care that is comprehensive,
individualized, and coordinated; and the
professional satisfaction of the nurse.
• Increases coordination and continuity of care
1/3/2024

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.
1/3/2024

• 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.
• Difficult hiring all RN staff
• Confines nurse‘s talent to his/her own
patients.
1/3/2024

CASE MANAGEMENT
• Features:
• The case manager (RN or social worker with managerial
qualification) 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. Case management
involves critical paths, variation analysis; inter shift reports,
case consultation, health care team meetings, and quality
assurance. Critical paths visualize outcomes within a time
frame.
1/3/2024

• Variation analysis notes positive or negative changes
from the critical paths, the cause, and the corrective
action taken. Case consultation may be indicated when
the client‘s condition differs from the critical path as
noted in the inter shift report. Case consultation is
conducted about once a week for a few minutes
immediately after inter shift report to deal with
variations. Health care team meetings provide an
interdisciplinary approach to problem solving.
• The case manager needs to identify no more than
three priority goals and decide what team members
should be present after considering the patient, family
physician, social service, various therapists, and others
involved.
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• The case manager should set the time and
place for the meeting, make the
arrangements, and post the date, time, place,
and people to attend. The case manager calls
the meeting to order, states the goals, initiates
discussion, documents the plans, and sets
time limits for follow through. The variance
between
1/3/2024

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.
1/3/2024

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
1/3/2024

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.
1/3/2024

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