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Nurse care delivery system
- 1. NURSE CARE DELIVERYSYSTEM
- 2. DEFINITION • The nursingcare 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”.
- 3. ELEMENTS OF HEALTHCARE DELIVERY SYSTEM Clinical decision making Work allocation Communication Management Coordination
- 4. PRINCIPLES OF NURSINGCARE DELIVERY • Holistic approach is used to identify nursing care needs. • Nursing care is based on a helping relationship. • It is the unique function of nurse to provide nursing care according to client s needs. • 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 polices to be considered.
- 5. Factors influencing nursingcare delivery system • Availability of adequate staff in wards or units. • Patient census. • Extend of staff deficiency. • Organizational policies regarding nurses practice. • Patient preference for care. • Availability of skilled staff.
- 6. Factors influencing nursingcare delivery system cont… • Opportunities for continuing and in-service education for the staff. • Budget of the organization. • Socioeconomic condition of the patient. • Organizations mission. • Patient and community needs.
- 7. Methods of nursingcare delivery TRADITIONAL METHODS • Case method • Functional method • Team method • Modular nursing • Primary nursing method ADVANCED METHODS • Case management • Critical pathway • Practice partner ship • Differentiated practice
- 8. CASE METHOD • Oldestmethod • Total patient care method • Total responsibility of meeting patient need is of nurse on duty • Assignment of one or more clients to a nurse for a specific period of time. • Accountability of care planning • Continuity • Co-ordination • Documentation • Nursing process • Cost effectiveness PRINCIPLES
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- 10. MERITS OF CASEMETHOD • The nurse can see better an attend to the total needs of clients.(physical , emotional, medical regimen, teaching) • Continuity of care can be facilitated with care • Rapport can be build. • Client may feel more secure. • Educational needs can be monitored. • Family and friends become well known by nurse and get more involved in the care of the client. • Workload can be equally divided among staffs. • Nurses are accountable for their function.
- 11. DEMERITS OF CASEMETHOD • The greatest disadvantage is when the nurse is inadequately trained or prepared to provide total care to the patients. • Nurses are not enough to comply the demand of this model: cost effectiveness should be considered. • This method has to be modified is nonprofessional health workers are to be used. • It is difficult for nurses to use this method to become involved in long term planning and evaluation of care
- 12. Functional nursing • Introducedin 1930, USA • 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. • Good for long term care setting with improved coordination, care planning and communication Task method
- 13. Merits of functionalnursing. • The person can be skilled in the assigned task, it can be efficient and economical. • The best use of persons aptitudes and experience and desires. • Saves time • Easy to organise the work • Useful in emergency
- 14. Demerits of functionalnursing. • Clients can become impersonal, accomplished and fragmented • Tremendous risk in diminishing continuity of care. • Staff may have very little motivation to develop self and others, as work becomes monotonous • Clients may feel insecure not knowing who their staff is . • It is difficult to establish clients priorities
- 15. TEAM NURSING • Introducedin the year 1950’s • A nursing team made up of professional nurses, nursing auxillaries and nursing aids. They can work together co- operatively under a well qualified team leader to provide a range of nursing services which may vary from the simple to the most complex nursing functions.
- 16. TEAM NURSING- Functions •Simple nursing functions - nursing aides • Intermediate nursing functions - trained nursing personnel. • Professional functions - a nurse with professional nursing education background. Better coordination, supervision and efficiency. Potential for high quality care.
- 17. CHARACTERISTICS OF TEAMNURSING. • Common agreed goals • Clear division of labour • Adequate resources human and material • Supportive and cooperative interpersonal relationships • Open, honest communications • Provision for evaluation and improvement • Good scope for utilization of nursing process by the team.
- 18. ADVANTAGES OF TEAMNURSING • High-quality, comprehensive care with a high proportion of ancillary staff. • Team members participate in decision making and contribute their own expertise.
- 19. DISADVANTAGES • No directcare may be given by the team member. • Individual members may not have comprehensive knowledge about the patient as a whole due to lack of communication. • Team members may become too much dependent on the leader for the decision making. • Nursing care may become fragmented. • Continuity suffers if daily team assignments vary • Team leader should have good leadership skills. • Insufficient time for planning and communication
- 20. MODULAR NURSING • Thenursing staff includes technical and nurse aides, as wellas professional nurses. • Two or three persons are assigned to each module, the greatest responsibility for the care of assigned patients falls on the professional nurse. The professional nurse is also responsible for guiding and teaching non-professional nurse.
- 21. MODULAR NURSING • Modularnursing is a modification of team nursing and focuses on the patient's geographic location for staff assignments. • The patient unit is divided into modules, 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 LVNs/LPNs and UAP
- 22. MODULAR NURSING • Theconcept 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. • Communication is more efficient among a smaller group of team members (Marquis and Huston, 2000). • To maximize efficiency, each designated module should contain all the supplies needed by the staff to perform patient care.
- 23. ADVANTAGES AND DISADVANTAGESOF MODULAR NURSING ADVANTAGES • Continuity of care is improved • Rn more involved in planning and coordinating care geographic closeness and efficient communication DISADVANTAGES • Increased costs to stock each module • Long corridors not conducive to modular nursing.
- 24. PRIMARY NURSING METHOD •Comprehensive, continuous and coordinated nursing process for meeting the total needs of each patient. • Primary nursing concept was to promote individualized nursing care and to make qualified registered nurses assume responsibilities for nursing care provided to patients . • One registered nurse is responsible for patient care over 24 hours period , 7 days a week from the time the patient admitted.
- 25. CONCEPT OF PRIMARYNURSING • Patient assessment by a primary nurse • Complete communication of care given in the nursing staff daily reporting method. • Discharge planning including teaching, family involvement and appropriate references
- 26. PROCESS OF PRIMARYNURSING CARE METHOD • The head nurse • The professional Staff nurse • Technical nurse Nursing aide Ward clerk. Primary nurse Associate nurse
- 27. PRIMARY NURSING METHOD ADVANTAGES •High-quality, holistic patient care • Establish rapport with patient • RN feels challenged and rewarded • Increased communication with physician and other health care provider • Works with professional staff • Autonomy, Motivation. DISADVANTAGES • RN may be inexperienced and lack of autonomy. • RN must accept 24-hour responsibility • More RNs needed; not cost-effective
- 28. CASE MANAGEMENT METHOD •Case management is a process of monitoring an individual patient’s health care by the case manager, for the purpose of maximizing positive outcomes and containing costs Quality of care plus cost.
- 29. CASE MANAGEMENT METHOD •From the diagnostic phase through hospitalization, rehabilitation and back to home care. • Planning, implementing, coordinating and evaluating care for the patient throughout the period of illness • Plans are made in advance for the next needed step
- 30. Advantages and Disadvantages Advantages •For the patient: - standardized patient care outcomes for each patient. - early patient discharge - Using the fewest possible appropriate health care resources - Facilitating the continuity of patient care • For the nurse: - Enhancing nurse’s professional development and job satisfaction. • - Facilitating the transfer of knowledge of expert clinical staff of novice staff Disadvantages • lack of administrative support. • Expensive • client focused and outcome oriented • Facilitates and promotes co- ordination of cost- effective care • It is a professionally autonomous role that requires expert clinical knowledge and decision-making skills
- 31. Critical pathway • Clinicalpathways/ care pathways /critical pathways/ integrated care pathways/care maps • Manage the quality in healthcare concerning the standardization of care processes • Clinical pathways promote organized and efficient patient care based on evidence based practice. • Clinical pathways optimize outcomes in the acute care and home care settings.
- 32. Progressive patient care •Medical /surgical care is delivered in various areas or units according to the health status of the patient. • Principal Elements
- 33. BENEFITS • Specialized attention •Patient gets assistance in making adjustment to hospital , home and community • Effective use of special skills and abilities of nurses • Quantity of nursing services can be increased by use of semi-skilled staff • Quality nursing can be improved • Efficient use of highly skilled, personnel and expensive high tech equipment • Continuity of care.
- 34. Palliative care concept •The goal of palliative care is achievement of the best quality of life for patients and their families. • Palliative care affirms life and regards dying as a normal process neither hastens nor postpones death provides relief from pain and other distressing symptoms integrates the psychological and spiritual aspects of care. • Offers a support system to help family cope during the patient’s illness and in their own bereavement
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- 36. REFERENCE • Basheer PS,Khan YS. A concise textbook of advanced nursing practice. Bangalore: EMMESS medical Publishers; 2012. • • Soni S .Ttextbook of advanced nursing practice. India: Jaypee Publication; 2013. • • Basvanthappa BT. Nursing Administration. Second edition. India: Jaypee Publication; 2009. • Dickerson J, Latina A. Team Nursing: a collaborative approach improves patient care. Nursing 2017. Volume 47 (issue 10); 16-17.