PATIENT CARE ASSINGMENT

RAKESH PATIDAR

NURSING CARE ASSIGNMENT (sometimes called.. )

Modalities of Nursing Care, Systems of Nursing Care, Patterns of Nursing Care

Nursing modalities are ways care is organized and delivered to patients. They have to do with arranging staff members and assigning patients. Care delivery methods take into account the total number of patients and tasks needed to be accomplished as well as how many nurses are needed. Most importantly, they are concerned with meeting patient's needs and continuity of care. "The purpose of any delivery system is to provide high quality care, efficiently and effectively," according to Kaiser Permanente Institute for Health Policy.

Definition: Refers to the manner in which the total work of the nursing unit is divided up among personnel.

Purposes:
-To delegate the work to be done by nursing personnel. -Suggest appropriate procedures for nursing care, with maximum efficiency with minimum effort. -Gain the cooperation of workers in the acceptance of work to be done. -Serve as work plan.

Principles:
Formulate assignment of activities based on the following principles: -Use simple clear words in writing assignment. -Fix responsibility for all duties clearly with no overlapping. -Provide for emergency situations and provide for special nursing activities. - Give each person time and opportunity to plan her work.

-Assignment must include information from the nursing orders as well as from the doctor's orders. -Arrange the various parts of the assignment in logical order. -Ensure continuity of patient care. -Assignment should be made in accordance with the administrative policies.

-Should be made by the head nurse. -Planning for skills development -Should be in written form. -Based on accurate assessment. -Two workers should never be assigned to do the same work. -It should be related to previous assignment.

Factors to be considered in distributing duties:

- The number, qualifications, experience, and abilities of nurses. -The number, condition of patients (i.e. patient's acuity) -The availability of supplies and equipment. -Architectural features of the unit.

Methods of assigning personnel:

There are five methods of assignment in general use: 1-Case method. 2-Functional method. 3-Team nursing method. 4-Primary care method. 5-Modular method.

 1-The

case method:

-Is the oldest patient care delivery system. -In this system one must assume total responsibility for the complete care of the patient while she is on duty. -The patient has different nurse in each shift. -Is used frequently in intensive care unit. -As a method for teaching student nurses. -Is widely used in home health agencies.

Registered Nurse
8-hour shift

Registered Nurse
8-hour shift

Registered Nurse
8-hour shift

Patient Care
The registered nurse plans, organizes, and performs all care

Total Patient Care (Case Method) Delivery

Total Patient Carecontd

Advantages

High degree of autonomy Lines of responsibility and accountability are clear Patient receives holistic, unfragmented care Each RN may have a different approach to care Not cost-effective Lack of RN availability

Disadvantages

 2-Functional

nursing method:

It is a task-oriented method wherein a particular nursing function is assigned to each staff member. The medication nurse, treatment nurse and bedside nurse are all products of this system. For efficiency, nursing was essentially divided into tasks, a model that proved very beneficial when staffing was poor. The key idea was for nurses to be assigned to tasks, not to patients.

Nurse Manager

LPN
PO Meds Treatments

RN
Assessments Care Plans

Nurse Aide
Vital signs Hygiene

Nurse Aide
Hygiene Stocking

Assigned Patient Group

Functional Nursing Care Delivery Model

Advantages:
Merits:

Each person become very efficient at specific tasks and a great amount of work can be done in a short time (time saving). 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. Nurses become highly competent with tasks that are repeatedly assigned to them. Less equipment is needed and what is available is usually better cared for when used only by a few personnel.

Disadvantages:
-Fragmented care. -No one nurse is familiar with patient total needs. -It is difficult to fix responsibility for errors. -Depersonalized patient care. -Less satisfaction for nurses and patients .

3-Team nursing method: -Team nursing uses a group of health care workers with varied skills, and training. They are directed by a leader to provide total services for a defined patient population. -Team nursing usually refers to large group of patients.

-The team leader plans, coordinates and supervises, evaluates and participates in the delivery of care to patients. -The main features of team nursing are the nursing care plan and team conference.

Nurse Manager

RN Team Leader RN LPNs/LVNs Nursing Assistants

RN Team Leader RN LPNs/LVNs Nursing Assistants

Assigned Patient Group

Assigned Patient Group

Team Nursing Model

Advantages:
- High quality of care. - Nurses satisfaction is high. - Patients and physician satisfaction is high. - Development of leadership skills.

Disadvantages: -Very high cost. -More time needed by the team to meet and share ideas and coordinate efforts. -Need more equipment and supplies.

4-Primary nursing method:

-Primary nursing features a registered nurse who gives total patient care from four to six patients, while she is on duty; and remains responsible for the care of these patients twenty four hours a day throughout the patient's hospitalization.

Primary Nurse
Physician and other members of the health care team

24-hour responsibility for planning, directing & evaluating patient care

Associate Nurses Provide care when primary nurse is off duty

Patient

Primary Nursing Model

Primary Nursingcontd
Advantages

High-quality, holistic patient care Establish rapport with patient RN feels challenged and rewarded

Disadvantages

Primary nurse must be able to practice with a high degree of responsibility and autonomy RN must accept 24-hour responsibility More RNs needed; not cost-effective

5-Modular method: It is a combination of primary method and team method. -Varied from primary nursing that, it can be used when nursing staff includes practical nurses and professional nurses.

-It is similar to primary assignment in that each pair of nursing personnel is responsible for care of patient from admission to discharge. -It is similar to team nursing that professional and non professional workers work together.

Nurse Manager

Geographic Patient Unit

Patient Care Team: RNs LPNs/LVNs Nurse Aides Meds Supplies Linens

Geographic Patient Unit

Patient Care Team: RNs LPNs/LVNs Nurse Aides Meds Supplies Linens

Geographic Patient Unit

Patient Care Team: RNs LPNs/LVNs Nurse Aides Meds Supplies Linens

Modular Nursing Model

Modular Nursingcontd
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