msc nsg anp topic

1. PATTERNS
OF
NURSINGCAREDELIVERYSYSTEM
ININDIA
Presented by- Kiran Bisht
MSc. Nsg I’st year

2. INRODUCTION:
•As nursing has evolved over a period, nursing
is still focused on caring.
• Rapid technologic Advances, knowledge
explosion, emphasis on quality –cost
effectiveness-accessibility of health care

3. • Increased demand by the patients for
advanced alternative health care
modalities present many challenges
for nursing profession.

4. How are nurses responding to these
challenges ?.
So how can we best utilize professional
nurses across various practice settings?

5. The answer for this question is that it is
possible by reshaping organizational
(administrative) policies and developing
such system of nursing care delivery as
best suited to client needs.

6. DEFINITION
•A system may be defined as a whole made up of
integrated or joined and interrelated parts.
Although each component of the system has its
specific function, yet all of them work
harmoniously for common outcome.

7. Contd..
•The nursing care delivery system means ‘the
process of delivering care to the client by
combining various aspects of nursing service
which will fit to various patient care settings to
produce a common outcome of delivering
quality care and meeting the needs of client

8. PRINCIPLES

9. Holistic
approach
Physical
needs
Mental and
social needs
Spiritual
needs

10. Nursing care is based on a helping
relationship.
It is the unique function of the nurse to
provide nursing care according to
client’s needs

11. The aspect of patient care has to be
initiated and controlled by nurse.
There should be justification for
selecting each delivery system.
Before planning care organizational
policies to be considered.

12. FACTORS INFLUENCING NURSING
CARE DELIVERY SYSTEM

13. Availability of adequate staff in wards or units
Patient census
Extend of staff deficiency
Organizational policies regarding its practice
Patient’s preferences for care
Availability of skilled staff

14. Other factors
• Opportunities for continuing and in-service
education to the staffs.
• Budget of the organization.
• Socio economic condition of the patient.
•The organization’s mission.
• Patient and community needs.

15. TYPES OF PATIENT CARE
DELIVERY SYSTEM

16. Functional
nursing
Team nursing
Primary
nursing
Case
management
nursing

17. FUNCTIONAL NURSING:
•Functional nursing is a method of
providing patient care by which each
licensed and unlicensed staff members
perform specific tasks for a large group of
patients.

18. For example RN may administer all
intravenous medications one LPN /LVN may
give treatments another LPN/LVN may give
all oral medication, one assistant may do all
hygienic tasks, and another assistant may
take all vital signs. The nurse become expert
in the particular task she is performing.

19. A charge nurse co-ordinates care and
assignments and may ultimately be the
only person familiar with all the needs
of any individual patient.

20. ‘The key idea was nurses to be assigned
for tasks not to the patient’

21. Goal
Of
Functional
Nursing
Time
Task
Efficient
management
Energy

22. Advantages
•E- EFFICIENT
•W- WORKERS DO ONLY TASKS THEY ARE
EDUCATED TO DO
•R-REMOTES ORGANIZATIONAL SKILLS
•O- ORGANISE HIS OWN WORK
•P – PROMOTES WORKER AUTONOMY

23. Disadvantages
•L- Lack Of Holistic View Of Patient-
Emphasis On Task Not Person
•L-Lacks Continuity- Patient Often Do Not
Know Who Is Their Nurse
•R- Registered Nurse Have Little Time To Talk
With Patients Or Render Personal Care.

24. Team nursing
•HISTORY : Team nursing was created at the end of
World War II to make the best use of the limited
nursing staff available and alleviate the problems
created by the functional method. As more workers
with minimum on –the- job training were hired in
the healthcare field, it became necessary to
reorganize the delivery of care.

25. It was also hoped that the use of team
nursing would increase both staff and
patient satisfaction and improve the
quality of care

26. DEFINITION
•In team nursing, a team leader is
responsible for coordinating the group of
licensed and unlicensed personnel to
provide patient care to a small group of
patients.

27. The team leader is a highly skilled
leader, manager, and practitioner who
assigns each member specific
responsibilities according to role,
licensure, education, ability, and the
complexity of the care required.

28. The members of the team report directly
to the team leader, who then reports to
the charge nurse or unit manager.

29. There are several teams per unit, and
patient assignments are made by each
team leader.

30. Communication is enhanced through
the use of written patient assignments,
the development of nursing care plans,
and the use of regularly scheduled team
conferences to discuss patient status and
formulate revision to the plan of care.

31. PATIENT CENTERD CARE
•Employs effective supervision and
recognizes that personnel are the media by
which the objectives are met in a
cooperative effort between team leaders
and team members.

32. NURSING CARE GOALS:
Identifies team members needs
Focuses on fulfilling goals and needs
Motivating team members to grow as workers and citizens.
Guide team members to help, set and meet high standards of patient care and job performance.

33. Responsibilities Of Team Leader:
Team leader assign team members to patients by matching
patient’s needs and staff knowledge and skill.
Knowing condition and needs of all assigned patients
Duty vary according to work load, i.e. assisting the members
and giving direct care to patients.
Planning and conducting the conference.

34. ADVANTAGES
OF
TEAM NURSING
Involves all
team members
Provides best
care at the
lowest cost
Each workers
ability is used
to the fullest
Promotes job
satisfaction
Provides
comprehensive
care

35. DISADVANTAGES
Constant need to communicate among team
members is time consuming
Difficult to find time for team conferences and care plans
Team composition varies from day to day which can be
confusing and disruptive and decreases continuity of care
Allows RN who is team leader to have the only significant
responsibility and autonomy.

36. TEAM NURSING ORGANIZATION

37. hospital administration
nursing superitendent
deputy nursing superitendent
assistant nursing superitendent
ward sister
staff nurses, clerks, dietician, attendant, class IV
workers,students

38. MODULAR NURSING

39. DEFINITION
•It is a modification of team nursing In modular
nursing, staff are geographically assigned to patients
for whom they co-ordinate and provide
comprehensive care. It focuses on geographic
location of patient rooms and assignment of staff
members.
• It was developed by Magargal in 1987

40. Responsibilities of charge nurse / head
nurse:
 Assign patients to different modules
 Co-ordinate the work schedule and supervises
all care on the
 Make patient care assignments, and there by
maintain continuity of care.
 Assist in problem solving when necessary

41. Advantages: -
Increased continuity of care Geographic closeness of the modular system saved nursing time
Better communication and co-operation among staff
Easier for less experienced nurses because they have other nurses directly available to them for support
Patients are more secured

42. DISADVANTAGES
Less accountability
Less direct nurse-to-nurse communication and accountability
If patient changes room, he will also change nurses, so patient satisfaction may be less
It’s a costly method as it should have a redesign of the work environment to allow medication
•cart, supplies and charts to be located in each module.

43. PRIMARY NURSING

44. DEFINITION
•Primary nursing developed by Manthey Et al in
1970 as a method for organizing patient care
delivery in which one RN functions
autonomously as the patient’s primary nurse
throughout the hospital stay. This method is
based on the concept of ‘my patient-my nurse”

45. The characteristics of primary nursing
modality are:
• In this nursing care delivery system, each
registered nurse is assigned to the care of
group of patient for which she plans
complete 24 hrs. care and writes the
nursing care plan.

46. The primary nurse cares for her patients
every time she works for as long as the
patient stay on her unit. (ideally from
admission to discharge). When she is not
there, an associate nurse who will follow
the primary nurse’s care plan is assigned to
the care of primary nurse’s patient.

47. The primary nurse is intensively
involved with the patients. Licensed
practical nurses function as
associate nurse sand are supervised
by the head nurse.

48. When nursing assistants are used in
primary nursing system, they are
generally assigned to assist primary
and associate nurses by doing specific
tasks for each nurse they assist.

49. 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

50. DISADVANTAGES
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

51. CASE MANAGEMENT

52. DEFINITION
•Nursing case management is a collaborative
activity that focuses on comprehensive assessment
and intervention and holistic care planning with
appropriate referrals to meet the health care needs
of the patient and family”. The success of nursing
case management models has been demonstrated in
all health care settings including acute, sub-acute or
ambulatory settings long term care facilities, in
health

53. functions of the case manager role
include:

54. Assessor
Gather all relevant data and obtain information
by interviewing patient/family and performing
careful evaluation of the entire situation.
Evaluate all information related to the current
treatment plan objectively and critically to
identify barriers, clarify or determine realistic
goals and objectives and seek potential
alternatives.

55. Planner
Works with patient / family to develop a
treatment plan that enhances the outcomes and
reduces the payees liability.
Includes the patient /family as a primary
decisions maker and goal settings.

56. Facilitator
Actively promotes communications
among team members,
patient,family,health care providers
and all parties involved.

57. Collaborates between the patient and
health care team to maximize outcomes.
Coordinates the health delivery process by
eliminating unnecessary steps and by
promoting timely provision of care.

58. ADVOCATE
Incorporates contingency plans for each step in
the process to anticipate treatment and service
complications.
Initiate and implements plan modifications as
necessary through monitoring and reevaluation
to accommodate changes in treatment and
progress.

59. Obtains consesnsus of all partsies to
achieve optimal outcomes.
Promotes early referral to provide
optimum care and cost outcomes.

60. Represents the patients best interest through
advocacy for necessary funding, treatment
alternatives, coordination of health services and
frequent revaluation of programmes and goals.
Key skills for nurses in these roles include
critical thinking, communication, advocacy,
negotiation, holistic planning and evaluation and
the ability to set both long term and short term
goals.

61. Role of nurse case manager:-

62.  Delivers client focused and outcome
oriented care.
Cost effective care through integration
of clinical services in combination with
financial services.
Serves as an advocate for patient and
family

63. More patient and nurse satisfaction is
achieved through intensive care
They attend to a specific high risk
population

64. Advantages

65. • Patient receives high standard care.
Nurse is highly qualified and skilled in
the particular area.
More satisfaction to the patient
Increased professional standards can
be developed by the nurses

66. Disadvantages

67. Sometimes discomfort to clients
Continuity care is difficult,long time nurse
patient relationships are difficult to
arrange.
Costly, time consuming
No proper attachment between nurses
and patients

68. The nurse’s role on the health care
team

69. nurse
provider or
care
educator
counselor
manager
researcher
collaborator,en
terpreneur
change
agent,patient
advocate

70. THANK YOU