organizingnursingservices in administration II.pptx

ORGANIZING NURSING
SERVICES AND PATIENT CARE

MODES OF ORGANIZING
PATIENT CARE
Case method nursing or total patient care.
Functionalnursing
Team nursing or modularnursing
Primarynursing
Case management or managedcare

Case method
In this method, nurses assume total
responsibility for meeting all the needs of
assigned patients during their time on duty.

Characteristics:
Complete care.
nurses with high autonomy and responsibility.
It is developed and communicated through written
sources, its usage remains in contemporary practice.
The lines of authority and accountability are clear.

Merits:
The nurses attend to totalneeds of clients
Continuity ofcare.
Client/ nurse interaction/rapport can bedeveloped.
Client may feel morecomfortable
Educational needs of the client can be closely
monitored.
Family and friends became better known bythe nurse
Workload of the patient can be equally divided.
Nurse’s accountability for their function isbuilt-in.

Demerits:
Many clients do not require the inherent care of intensity in this
type of service.
This method need to be modified ifprofessional workers are to be
involved effectively.
It is difficult for the nurses to use this methodto become involved in
long term planning and evaluation of care.
It is not possible if the nurses arenot adequately trained for the total
care of the patient.

Functional method:
In this, persons were assigned to complete
certain tasks rather than care of specific
patients. Eg. Checking BP, administering
medications

Characteristics:
Afunctional method is a technicalapproach of nursing care.
The available staff in the unit, for a particular period of time,
are assigned selected functions of nursing practice such as
vital signs, treatments, medications.
All the responsibilities are assigned in accordance with the
expertise.
The only person who has responsibility of the client is the head
nurse or nurse acting the role.

Merits:
person become specifically skilled in performing certain assigned
task.
best utilization of a person’s aptitudes, experiences and
desires.
Less equipment isneeded.
savestime.
development of technicalskill
sense of productivity for the task oriented nurse
easy to organize the work of the unit and staff

Demerits:
Client care become impersonal, compartmentalized and
fragmented.
diminishing continuity ofcare.
Staff may become bored and have littlemotivation.
only the nurse in-charge has accountability forthe client.

little avenue for the staffdevelopment.
Client may tend to feel insecure.
Only parts of the nursing care plan are known
difficult to establish the clientpriorities.
only safe when the head nurse co-ordinate all the activities of the
members.

Team nursing:
Team nursing is based in the philosophy in which a
group of professional and non- professional personnel
work together who identify, plan, implement and
evaluate comprehensive centered care.

Characteristics:
ancillary personnel collaborate in providing care.
Team nursing involves decentralization ofnursing unit and
professional head nurse authority.
Each team composed of a team leader, team members and
patients.
Comprehensive care is the responsibility ofthe entire team.

The head nurse has the responsibility to know the conditions of
all patients assigned to the teamand planning individual care.
democraticleadership.
Group members are given as much asautonomy

Merits:
includes all health care personnel in the group
functioning and goals.
Feelings of participation andbelonging
Workload can be balanced andshared.
Division of labour allows members the opportunity to develop
leadership skills
Every team members has the opportunity to learn from and
teach collegues.

Demerits:
Establishing the team concept takes time, effort and constancy of
personnel.
Unstable staffing patterns make team nursing skills patterns
make team nursing difficult.
All personnel must be clientcentered.
This leads to blurred lines of responsibility, errors, and
fragmented care.
For the team nursing to be effective the leader must be excellent
practitioner and have good communication, organizational,
management, and leadership skills.

Primary nursing:
It is also called relationship based nursing. It involves total
nursing care, directed by a nurse on 24 hour basis as long as
the client is under the care.

Characteristics:
The RN primary nurse assumes 24-hour responsibility from
admission or start of treatment to discharge or the treatment’s
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
The combination of clear interdisciplinary group
communication and consistent, direct patient care by
relatively few nursing staff allows for holistic, high
quality patient care.

Merits:
opportunity for the nurse to see the client and
family as one system.
Nursing accountability, responsibility and independence are
increased.
The nurse is able to use wide range of skills,
knowledge and expertise.
potentiates creativity by the nurse and thereby work satisfaction
increases
increased trust and satisfaction for both

Demerits:
The nurse may be isolated from thecolleagues.
Littleavenue for group planning of care.
Nurse must be mature andindependently competent.
It must be costeffective.

Staffing patterns may necessitatea heavy client load.
It may be difficult to recruit and retain enough staff,
especially in times of nursing shortage.
An inadequately prepared or incompetent primary nurse may be
incapable of coordinating a multidisciplinary team or
identifying complex patient needs and condition changes.

Case management:
Case management
collaborative process
is defined
that assesses,
as a
plans,
implements, coordinates, monitors and evaluates
opinions and services to meet an individual health
needs through communication and available
resources to promote quality, cost-effective
outcomes.
Case management society ofAmerica

Characteristics:
Case mangers handle each caseindividually.
In general case manger can handle a load of25patients [smith,
2003].
Case mangers use critical pathways and multidisciplinary
action plans to plan patient care.

Responsibilities of case managers:
Assessing clients and theirhomes and communities.
Coordinating and planning client care.
Collaborating with otherhealth
Monitoring client progress and client outcomes.
Advocating forclients
Serving as a liaison with thirdparty

Merit:
additional work efficiency due to geographical proximity.
Establishes solid relationships with nursing and ancillary
staff working on the unit.
Case management provides a well coordinated care.
Provides comprehensive care
It seeks the active involvement of the patient, family and
diverse health care professionals

Demerits:
Some experts are argued that this role should be reserved for
the advance practitioner nurse or an RN with advanced
training or need 3 to 5 year experience.
The case manger should also be extremely bright, have well
developed interpersonal skills, be able to multitask, have a
strong foundation in utilization review, and understand payer-
patient specifics and hospital reimbursement mechanisms.

Nurses identify major obstacles in the implementation of this
service, financial barriers and lack of administrative support.
Expensive
Nurse is client focused and outcomeoriented
Facilitates and promotes co-ordination of cost effective care
Nursing case management is a professionally autonomous role
that requires expert clinical knowledge and decision making
skills.

Modular nursing
 Modular nursing is a modification of team nursing
and focuses on the patient‘s geographic location for staff
assignments. The concept of modular nursing calls for a
smaller group of staff providing care for a smaller group
of patients.

Characteristics:
The patient unit is divided into modules or districts, 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 LVN/LPN or
UAP.

The team leader is accountable for all patient care and is
responsible for providing leadership for team members and
creating a cooperative work environment.
The success of the modular nursing depends greatly on the
leadership abilities of the team leader.

Merits:
♣ Nursing care hours are usually cost-effective.
♣ The client is able to identify personnel who are responsible
for his care.
♣ All care is directed by a registered nurse.
♣ Continuity of care is improved
♣ The RN as team leader is able to be more involved in planning
& coordinating care.

♣ save staff time.
♣ Feelings of participation and belonging
♣ Work load can be balanced and shared.
♣ develop leadership skills
♣ Continuity care is facilitated
♣ Everyone has the opportunity to contribute to the care plan.

Demerits:
♠ Costs may be increased to stock each
♠ takes time, effort, and constancy of personnel.
♠ Unstable staffing pattern make team difficult.
♠ There is less individual responsibility and autonomy
regarding nursing function.
♠ All personnel must be client centered.
♠ The team leader must have complex skills and knowledge.

Progressive patient care:
 It is a method in which client care areas provide
various levels of care. The central theme is better
utilization of facilities, services and personnel for the
better patient care.

Principal elements of PPC are:
Intensive care or critical care
Intermediatecare
Convalescent and SelfCare
Long-termcare
Homecare
Ambulatorycare

Merits:
♣ Efficient use is made of personnel and equipment.
♣ Clients are in the best place to receive the care .
♣ 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 function towards their
fullest capacity.

Demerits:
♣ discomfort to clients who are moved often.
♣ Continuity care is difficult.
♣ 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.

DIFFERNTIATED NURSING
PRACTICE
Differentiated nursing practice refers to an
attempt to separate nursing practice roles based
on education or experience or some
combination of both.

Educationmodel:
Role differentiation based upon type of educational preparation
[BSN, MSN etc]
Competencymodel:
Role differentiation based on individual nursing skills,
expertise, experience etc.

Merits:
match patients needs with nursing competencies.
efficient use of nursing resources.
Provide equitable compensation
It increase nurse satisfaction, built loyalty and increase
the prestige of the nursing profession.

organizingnursingservices in administration II.pptx

More Related Content

Similar to organizingnursingservices in administration II.pptx

Recently uploaded

organizingnursingservices in administration II.pptx