ORGANISING NURSING SERVICES AND PATIENT

CARE: METHODS OF PATIENT ASSIGNMENT-

ADVANTAGES & DISADVANTAGES,
PRIMARY NURSING CARE.

BY
D . SATHYA
2ND YEAR M.SC(N)
SNCON
 INTRODUCTION

• 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 of period of
one shift.
• A hospital may be soundly organised beautifully situated and well equipped
but if the nursing care is not of high quality the hospital will fail in the
responsibility.
 NURSING SERVICES

Nursing services is the part of the total health organization which aims at satisfying

the nursing needs of the patient / community.

In nursing services the nurse works with the members of ailed discipline such as

dietetics medical social service, pharmacy etc. in supplying a comprehensive program

of patient care in hospital.

 NURSING SERVICE ADMINISTRATION

• Nursing service administration is a complex of elements in

interaction and is organized to achieve the excellence in nursing care
services.
• 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.
 DEFINITION OF PATIENT CARE

• 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 professionals.

 PATIENT CLASSIFICATION SYSTEM

• Patient classification system which quality of nursing care is essential to staffing

nursing unit of hospitals and nursing homes.
• The primary aim of patient classification system is able to respond to constant
variation in the care needs of the patients.
• Grouping of patients according to the amount and complexity of their nursing
requirements.
• Patient classification system is the scheme that group patients according to the
amount and complexity of their nursing care requirements.
 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.

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.
 PURPOSES

To delegate to work to be done to the nursing personnel

To gain the cooperation of nursing personnel by knowing and 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.
 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
FACTORS AFFECTING PATIENT ASSIGNMENT

Patient
characteristi Nursing
cs resources

Type of
Organization nursing care
support delivery
system
 Problem of
personal
management

Inadequate Shortage of
number of trained
nursing staff manpower

Challenges in
patient
assignment
No
Lack of
autonomy in
adequate
nursing
training
activities

No involvement
in planning
 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.

 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 receive total care in the
home.
 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 centred, comprehensive holistic and continuous

 CHARACTERISTICS
• Complete care

• Provides nurses with autonomy and responsibility.

• Assigning patients is simple and direct.

• Patient theoretically receives holistic and un fragmented care during the nurses time on
duty.

• It is developed and communicated through written sources its usage remain in

contemporary practice.
 ORGANIZATION OF THE CASE METHOD

• Nurse manager role :-

• The nurse manager must consider the expense of the system before
arraigning 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.
 CONT.…

• STAFF NURSE ROLE:-

• Provide holistic care to assigned patient during a defined work

period.
• Assessment and teaching the patient and family.
 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.
• Nurses 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.
 DEMERITS

• Many clients do not require the inherent care

• Must be modified if non professional health workers are used
• Great disadvantages when nurse is inadequately trained
• Cost effective
• 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.
 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
coordinate 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.
 Charge nurse RN

Team Leader Team Leader RN

RN

RN LPN NA
RN LPN NA

Group of Group of
Patients 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.
• Feeling of participation and belonging are facilitated with team members.
• Work load can be balanced and shared.
 CONT.….

• 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.
 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 sprit.
• It is expensive because of the increased number of personnel needed.
 FUNCTIONAL NURSING

• It is 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.
 Charge nurse

RN
Lpn Uap
Medical RN
Nurse Treatment Nurse
Vital signs Hygiene
nurse nurse

Patient Assigned To The Team

 MERITS

• Each person become very efficient at specific tasks and a great amount of work
can be done in a short time.

• It is easy to organize the work of the unit and staff.

• The best utilization can be made of a persons 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.
 DEMERITS

• Client care may become impersonal, compartment 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.

 PROGRESSIVE PATIENT CARE

• It is a method in which client care area 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 of care needed.
• As they progress towards increased self care they are marred to units/ ward
staffed to best provide the type of care needed.
 PRINCIPLES

INTENSIVE CARE OR CRITICAL CARE:-

• Patients who require close monitoring and intensive care round the clock.

INTERMEDIATE CARE :-

• Critically ill patients are shifted to intermediate care units when their vital

signs and general condition stabilizes.

 CONT.….

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.
LONG TERM CARE :-

Chronically ill, disabled and helpless patients are carer 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.

 CONT.….
HOME CARE:-

Some hospital / centres have home care services. A hospital based home care package provides
staff, equipment and supplies for care of patient at home.
AMBULATORY CARE:-

Ambulatory patients visit hospital for follow up, diagnostic, curative, rehabilitative and
preventive services. These areas are outpatient departments, clinics, diagnostic centres, day
care centres etc,.
 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 functional towards their fullest capacity.

 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.
 CASE MANAGEMENT

• The case manager is assigned responsibility of following a patients care and

progress from the diagnostic phase through hospitalization, rehabilitation and

back to home care.

 RESPONSIBILITIES

• 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 clients care.
 MERITS

• Case management provides a well coordinated care experience that can improve
the care outcome decreases the length of stay and use multiple disciplines and
service efficiently.

• Provides comprehensive care for those with complex health problems.

• It seeks the active involvement of the patient family and diverse health care
professionals.
 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.
• Facilities and promotes coordination of cost effective care.
• Nursing case management is a professionally autonomous role that requires
expert clinical knowledge and decision making skills.
 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.
 CONT

• If the nurse is not available the associate nurse responsible for filling in for the
nurses 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.
 CHARACTERISTICS

• The primary nurse assumes 24 hour responsibility from admission or start of treatment

to discharge or the treatment 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.

 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.
 CONT.….

• Patient receives quality and continuity of care.

• Reduces the number of errors that can result from a relay of orders.

• Increased satisfaction both to patients and nurses.

• Nurse can identify patient outcomes as a result of their work.

 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 patients 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.
 CONT….

• Difficult hiring all RN staff.

• Confines nurses 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.

• Nurse should be well educated and trained in all area of patient care, most of the
time which may lack.
 CONCLUSION

• No single nursing care model works in all settings, or even necessarily across a

single multiservice setting. Before selecting a module nurse manager must

consider all the influencing factors. For the 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.