NURSING CARE DELIVERY

1. GROUP 11
MEMBERS
1. MARTIN OTIENO BSN-1-8718-2/2017
2 MATINI ABWOTO BSN-1- 8249-3/2017
3 SOLOMON MUTURA BSN-1-8192-2/2017
4. BENJAMIN KIPROP BSN-1-9795-2/2016

2. OBJECTIVES
By the end of the lesson the students should be able to
i) Define Nursing Care System
ii) Explain methods of assignment of patient care in hospital
a) Case management
b) Team nursing
c) Functional nursing
d) Primary nursing

3. NURSING CARE DELIVERY SYSTEMS
• The practice of Nursing has emerged as an aggregate of complicated duties
and responsibilities. There is therefore need to develop certain systems,
methods or modalities to ensure that we deliver quality care. Basically
there are four methods of assignment of patient care in a hospital. These
are:-Case assignment, Team Nursing, Functional Nursing and Primary
Nursing
• The changes in these modalities (systems) are as a response to ever
changing needs. These methods may be used singly or complement one
another.

4. Case Assignment (method)
• This is the first and oldest method which became popular in 1920's.
Each patient is assigned to a nurse for total patient care while nurse is
on duty (private duty). If she/he goes off duty, the work is handed
over promptly to another nurse. The patient has a different nurse
each shift.
• The mode of assignments is made according to severity of illness -
mostly used for acutely ill patients eg. In Intensive care unit.

5. Functional Nursing
• The second method is functional nursing which became the first
major deviation from case method. It came in early 1950's when
there were few Registered Nurses and more practical nurses
available. At the time much of patient care was given by nurse aides.
• In this modality each nurse has clearly defined set of tasks according
to complexity. Consideration is given to individual skills, knowledge
and experience

6. • Method emphasizes division of labour according to specific tasks. The
basis for assignment is "task-oriented" or "thing oriented" where
each nurse is assigned a task for example, drug administration, wound
dressing, bed baths etc.
• The assignment is determined by technical aspects of the job to be
done.

7. • Implications for Nursing
• The Nurse in charge must have experience and exceptional
knowledge of nursing. He/She must know skill levels of her workers in
order to make assignments.
• The Nurse in charge also establishes rigid routines, structures and
time scheduling for all the activities and procedures.

8. • Strengths
• The modality emphasis on efficient delivery of care.
• There is little likelihood of confusion over who will do what.
• Minimal time spent coordinating activities.
• Economical - allows use of less skilled personnel.
• Each member can become highly skilled if he or she does the same tasks
repetitively.

9. However the modality proves useful when:
 Workers have limited knowledge and experience.
 Facilities and equipment are poor and inadequate.
 There is shortage of staff.

10. Weaknesses
• Nurse tends to lose intimate contact with patients.
• Fragmentation of care rather than total care. Patient's needs can be
overlooked if the need fail to fit in compartments or task categories
eg. 'Medication nurse' but no 'anxiety nurse'.
• Continuity of care is difficult if not possible - since no single staff
member has a complete picture of the client's needs and responses
to nursing or medical interventions.
• Little avenue for professional development.

11. Team Nursing
• The other method is Team Nursing which was introduced in later
1950's to improve nursing services by utilizing the knowledge and
skills of professional nurses and to supervise the increasing number of
auxiliary staff. The philosophy supports achieving goal through group
action or team spirit

12. Basis for Assignment
• A group or team of nurses with different levels of skills are assigned to a group of
patients - the size and composition are dependent upon the setting. The nurses work
together to accomplish a goal.
• The Focus is on patient-centred assignments as opposed to task-oriented.
Assignments are based on client needs and the knowledge, skills and experiences of
team members.
•
• A member of the work group is assigned as a leader. In the original concept, the
team was led by a Registered Nurse. Leadership role may be permanent or rotated

13. • The Team works together with each member performing tasks for
which she is best prepared.
• Team members report to team leader who reports to head nurse. The
success is dependent upon effective communication.

14. Strengths
- Individual members make personal and useful suggestions. It combines best
thinking of all team members about patients' problems which improves quality of
decision making.
- There is a team spirit which affects climate and continuity of care. There is
no fragmentation of care.
- Better utilization of personnel in the performance of quality care.
- Potential for leadership development.

15. - Individualized care approach - more satisfying to patients.
Patient cared for by a limited number of nurses who know him better.
- Opportunity for more therapeutic, closer nurse - patient
relationships.
- Greater staff satisfaction due to increased guidance and better
matching of assignments to skills.

16. Weaknesses
- Finding time needed for team planning and conferences which makes
care plans not comprehensive.
- Increased time spent in coordinating delegated work and checking on
workers. This can prove expensive.
- Logistics may hamper Team Nursing eg. 4 or 5 team leaders crowding a
medicine cupboard designed to support functional nursing with one

17. Primary Nursing
• This is a newer approach to the delivery of nursing services. The
concept was developed in early 1970's. it is used by many institutions
in the developed world. People are becoming more aware of it in this
country and some institutions are using the method.

18. Basis for Assignment
• A professional nurse (usually RN) is assigned to a patient or to a small
group of patients (usually not more than 4 or 5) for their total hospital
stay
• The nurse assumes responsibility for 24 hours a day for duration of
stay in hospital.
• The primary nurse assesses, plans and executes the plan or may
delegate a secondary nurse - (Associate Nurse) to execute the plan
during her absence.

19. • Every nurse serves as the Primary Nurse for a few patients and as
Associate Nurse for the other patients on other shifts.
• The Primary Nurse communicates with the Physician and co-ordinates
care with other health workers.
• The Charge Nurse functions as a coordinator of the unit and is a
resource person for the primary nurses.

20. • Strengths
- One to one relationship.
- Reduction of fragmentation of care promotes total patient care by virtue of
quality of interactions.
Nurse coordinates all aspects of care - physical, social and psychological.
- The Nursing process is facilitated and continuity of care facilitated.
- Promotes increased autonomy and responsibility for the nurse leading to job
satisfaction because of involvement.

21. Weaknesses
- Limits professional mobility.
- Associate nurse may find it difficult to follow plans made by
another if there is disagreement.
- Level of expertise and commitment required of all nurses -
patient care may suffer it the nurse is not quite competent to perform
all tasks.

22. REFERENCE:
• Leadership and Nursing care management
• Huber D (2000) Philadelphia W.B Saunders
• Effective Leadership and management in nursing
• New Jersey Prentice -hall inc
• Strategic Management of Health care organizations
• Swayne Duncan and Ginter PM (2005)