SOCIOLOGY

2. 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 and increased demand by
the patients for advanced alternative health care modalities present many
challenges for nursing profession.
How are nurses responding to these challenges? So how can we best
utilize professional nurses across various practice settings? 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.

3. 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.
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
clients.’
There are various types of nursing care delivery system include
case nursing, nursing care management, patient focused care.

4. Holistic approach is used to identify nursing care needs:
oPhysical needs
oMental and social needs
oSpiritual needs
oNursing care is based on a helping relationship
oIt is the unique function of the nurse to provide nursing care
according to client’s needs
oThe aspect of patient care has to be initiated and controlled by
nurse
oThere should be justification for selecting each delivery system
oBefore planning care, organizational policies to be considered

5. Availability of adequate staff in wards or units
Patient census
Organizational policies regarding it’s practice
Patient’s preferences for care

6. Availability of skilled staff
Opportunities for continuing and in-service education to
the staffs
Budget of the organization
Socio economical condition of the patient
Patient and community needs

8. The case method or total patient care method of nursing care
delivery is the oldest method of providing care to a patient.
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. That time nurses were
‘hired’ and they lived with in the family of the patient provided 24
hrs care to patient and even family.
But the case method developed over the years to the specialty of
private duty nursing especially in critical care nursing where one
nurse cared one or two clients.

9. 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.
Organization of the case method:
REGISTERED
NURSE
PATIENT

10. 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.
Arrange for continuing education and in service education for
the personnel.

11. Staff nurse’s role:-
Provide holistic care to assigned patient during a
defined work period
Assessment and teaching the patient and family

12. Nurse can better attend 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
Family friends become more known by nurse and get more
involved
Equal work load

13. Many clients do not require the inherent care
Great disadvantage when nurse is inadequately
trained
Cost –effectiveness

14. This system emerged in 1930’s in USA
Meaning:-
Individual care givers are assigned to specific tasks rather
than being assigned to certain patients or clients.
This model is also referred to as task method.
Functional nursing evolved during the depression when
RNs went from being private practitioners to becoming
employees for the job security

15. Origin:-
• Once world war II was broke out resulted in severe
shortage of nurses in US.
• Many nurses entered the military to care for the soldiers.
To accommodate this shortage, hospitals increased their
usage of auxiliary personnel.

16. 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. For example
RN may administer all intravenous medications, One
assistant may do all hygienic tasks, and another assistant
may take all vital signs.
A charge nurse co-ordinates care and assignments and may
ultimately be the only person familiar with all the needs of
any individual patient.
‘The key idea was nurses to be assigned for tasks not to the
patient’

18. The nurse manager must be sensitive to the quality of patient care
delivered and the institution’s budgetary constraints
Achieving patient outcome is her responsibility
Rotate assignments among staff, to alleviate boredom with
repetition
Conduct staff meeting frequently to encourage staff to
communicate about care and unit functions.
Staff nurse’s role:-
They are skilled at the task which is assigned
Complete the task in an efficient and economical manner

19. Person can become particularly skilled in performing assigned tasks
The best utilization of personnel can be done
Less equipment is needed
Saves time
Potential for development of technical skills is amplified
There is a sense of productivity for the task oriented nurse
It is easy to organize the work of the unit and staff
Task oriented and time saving
Reduced work load to the registered nurses.

20. Client care become impersonal
Diminishing continuity of care
Staff may become bored and have little motivation to develop self and
others.
Work may become monotonous
Less accountability for the nurse
Lack of professional development
Client may tend to feel insecure and inconvenient
Only parts of the nursing care plan are known to personal

21. Team nursing is the delivery of nursing care by a designated group of
staff members including both professional nurses and non-
professional staff .
This method of nursing care was introduced in early 1950’s.
Several elements are considered necessary:
Team leader is the delegated authority to make assignments for team
members and guide the work of the team. The leader of the team
should be a registered nurse, not a practice nurse
The leader is expected to use a democratic or participative style in
interactions with team members.
The team is responsible for the total care given to an assigned group
of patients or clients.

22. Communication among team members is essential to its success,
and includes written patient care assignments, nursing care plans,
reports to and from the team leader, team conferences in which
patient care problems and team concerns are discussed, and
frequent informal feedback among team members.
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.
It was hoped that the use of team nursing would increase both staff
and patient satisfaction and improve the quality of care.

23. 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.
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.
The members of the team report directly to the team leader, who then
reports to the charge nurse or unit manager.
There are several teams per unit, and patient assignments are made by each
team leader.
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.

25. 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.

26. Improved patient satisfaction
Cost effectiveness for the agency
Care is less fragmented because of the increased
communication and extensive ordination efforts of team
leader
Allows comprehensive, holistic nursing care when the
team function best.
Good interpersonal relationships among staffs and with the
patients
Satisfaction to the patient and the nurses

27. Continuity of care is not given
Changing team membership makes it difficult for the
team leader to assign the patient.
Team nursing requires a great deal of co-operation,
communication from all staff members
The large number of people attending the same is
causing some discomfort to the patient.

28. 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.

29. The total unit is divided in to modules or districts and the same
team of staff is assigned consistently to the module.
Each module has a modular, or team leader RN, who assigns the
patient to module staff.
Each module ideally consists of at least one RN, one LPN/LVN
and one nursing assistant.
A charge nurse will co-ordinate the work of all the modules in a
unit. She expects the module leaders to be accountable for
patient care but assist in problem solving when necessary. Staff
nurses work independently or together, depending on the size of
a modular districts.
Modules may have same or different number of patients.

31. Assign patients to different modules
Co-ordinate the work schedule and supervises all care.
Make patient care assignments, and there by maintain continuity of care.
Assist in problem solving when necessary
RESPONSIBILITIES OF MODULAR OR TEAM LEADER:
Assigns patient to module staff
Co-ordinate the module activity
Accountable for the care and to the charge nurse
Communicate with other modules

32.  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
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.

33. 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”
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.

34. 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.
The primary nurse is intensively involved with the patients.
Licensed practical nurses function as associate nurse sand are supervised
by the head nurse.
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.

36. 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
Patient receives quality and continuity of care
Increased satisfaction both to patients and nurses

37. 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 changed
Nurses should be well educated and trained in all area of
patient care, most of the time which may lack.

38. Case management is considered as the newest type of nursing care delivery
system developed in 1985 as an outgrowth of primary care, nursing case
management is a model used to co-ordinate the care, maintain quality, and
contain cost while focusing on the outcomes of care
“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 insurance companies and in community.

39. 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
More patient and nurse satisfaction is achieved through
intensive care
They attend to a specific high risk population

40. 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

41. 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 patient

42. THANK YOU