SEMINAR ON METHODS OF PATIENT ASSIGNMENT

PRESENTED BY:
P.V. GREESHMA
2ND M.Sc. NURSING

INTRODUCTION
Nursing service is the part of the
total health organization which
aims at satisfying the nursing needs
of the patients/community.

The overall goal of nursing is to meet the
patient nursing needs with the available
resources for providing smooth day and
night 24 hrs quality care to patients and to
honour his rights. To ensure that nursing
care is provided to patients, the work must
be organized

• Grouping of patients according to the amount
& complexity of their nursing requirements
• Patient acuity- Nursing work load that is
generated for each patients
• Patient acuity ≈ Amount of nursing service
• Patient classification system is the scheme that
group patients according to the amount &
complexity of their nursing care requirements

Patient assignment
A specialty capitation method in which patients ch
oose a provider in each specialty represented.
Capitation payments are then distributed
accordingly to the providers selected.

Meaning
The term assignment is used in educational
procedures is generally taken to refer to that
of the teaching activity where the teacher
gives (assigns) a project, a problem, a reading
test, etc.

Definition
The assignment applies to the part of instructional
activity devoted to the clear recognition and
acceptance by the pupil of the next unit of learning
to take place and of the processes by which learning
may be achieved most effectively.
- Basavanthappa

Assignment refers to” a written
delegation of duties to care for a group of
patients by trained personnel assigned to
the unit.”

Definition of patient care:
The services rendered by members of the health
profession and non professionals under their
supervision for the benefit of the patient
(Medical dictionary & Encyclopaedia)
The prevention, treatment and management of
illness and the preservation of mental and
physical well being through the services offered
by the medical and allied health professions.

Significance:
It improves nurse
employee morale
It helps in reducing
nurse employee
turnover
absenteeism

accident rates.
It avoids the misfit
between nurse and the
job.
It helps the nurse to
work for the pre-
determined objectives
of the organization.

Purpose:
To delegate the work
to be done to the
nursing personnel.
To gain the cooperation
of the nursing
personnel by knowing
and accepting the
acceptance of the work
to be done.
To organize the work
systematically.

Contd….
To prepare and motivate the
nurses for delivery of care.
To shoulder accountability.

Principles of patient assignment
Made by
the head
nurse or
nurse
incharge
for each
individual
nurse.
Based on:
Nursing needs of each
patient and
approximate time
required to care &
The capabilities,
Job description.
Planned
weekly,
and
revised
daily if
necessary

Take into
account
all the
direct,
indirect
and unit
activities
Conside
r the
geograp
hical
location
of the
unit
Must be
balance
d
among
nursing
staff
Never
to
assign
the
same
task to
more
than
one
nurse

Factors affecting assignment pattern
Patient
characteristics
Nursing resources
Organization
The type of
nursing care
delivery system

A nursing care delivery model used to provide
care to patients. The nursing care delivery
models describe which healthcare worker is
going to perform what tasks, who is responsible
and who has the authority to make decisions.
A nursing care model or the system of nursing
care delivery is often called a care modality

Nursing care delivery models
Direct patient
care
Indirect patient
care

Direct
patient
care
functions
Assessme
nt
Monitori
ng
Prioritizi
ng goals
Patient
education
Commun
ication
Evaluatio
n
Therapeu
tic
interventi
ons
Care
coordinat
ion

Indirect
patient care
functions
Clinical
practice
Educati
onal/res
earch
Leaders
hip
Operati
ons
Persona
l m/m
Quality
improve
ment
System
coordin
ation

ORGANIZING PATIENT CARE
DEFINITION OF PATIENT CARE
The services rendered by members of the
health profession and non-professionals
under their supervision for the benefit of
the patient.

Process of organizing patient care

DETERMINING THE NURSING STAFF
REQUIREMENT
Calculating staff needs based on the number
of beds in the hospitals.
Estimating the number of staff according to
the degree of dependency of the patients as
determined on a scale.
This method relies on observations of
nursing activity.

ORGANISATION OF NURSING
SERVICES

The traditional system
• The number of beds per unit (one
nurse per 4-6 beds) or
• The average census of patients per
unit(one nurse per 4 patients)

Patient classification system:
Patient classification system (PCS), which quantifies
the quality of the nursing care, is essential to staffing
nursing units to hospitals and nursing homes. In
selecting or implementing a PCS, a representative
committee of nurse manager can include a
representative of hospital administration. The primary
aim of PCS is to be able to respond to constant
variation in the care needs of patients

• Differentiate intensity of care among
definite classes.
• Measure and quantify care to develop
a management engineering standard.
• Match nursing resources to patient
care requirement.
• Relate to time and effort spent on the
associated activity

• Be economical and convenient to
report and use.
• Be mutually exclusive, continuing new
item under more than one unit.
• Be open to audit.

• Be understood by those who plan,
schedule and control the work.
• Be individually standardized as to the
procedure needed for accomplishment.
• Separate requirement for registered
nurse from those of other staff.

Purposes
• The system will establish a unit of
measure for nursing, that is, time,
which will be used to determine
numbers and kinds of staff needed.

• Tracking changes in patients care
needs. It helps the nurse managers the
ability to moderate and control
delivery of nursing service.
• Determining the values of the
productivity equations

Determine the quality: once a standards
time element has been established,
staffing is adjusted to meet the aggregate
times. A nurse manager can elect to staff
below the standard time to reduce costs.

Task quantification
• The patients grouped according to
their nursing needs into 3 or more
groups:
• Group 1: Self care
• Group 2: Partial or intermediate care
• Group 3: Intensive or total care

MODES OF ORGANIZINGPATIENT CARE
Case method
or total
patient care
Functional
nursing
Team nursing
Modular
nursing
Progressive
patient care
Primary
nursing
Case
management

Characteristics Merits Demerits
1.Nurses
assume total
responsibility
for meeting all
the needs of
assignment
patients during
their time on
duty.
1.The nurses
attend to total
needs of clients
Continuity of
care.
2.Client/nurse
interaction/rap
port can be
developed.
1.It is difficult
for the nurses to
use this method
to become
involved in long
term planning.

2.It involves
assignment of one
or more clients to
a nurse for a
specific period of
time such as shift.
3.Nurse’s
responsibility
includes complete
care including
treatments,
medications and
administration
and planning of
nursing care.
3.Client may feel
more comfortable
4.Educational
needs of the client
can be closely
monitored.
5.Family and
friends became
better known by
the nurse
2.It is not possible
if the nurses are
not adequately
trained for the
total care of the
patient
3.Nurse may feel
overworked if
most of her
assigned patients
are sick.
4.She/he may tend
to ‘neglect’ the
needs of patient
when the other
patients ‘problem’

Functional nursing
CHARG
E
NURSE
RN
Medication
Nurse
RN
Treatment
Nurse
LPN
Vital signs
NUrse
UAP
Hygiene Nurse
Patient assigned to
the team

The tasks are divided with
one nurse assuming
responsibility for specific
tasks. For eg. One nurse does
the hygiene and dressing
changes, whereas another
nurse assumes responsibility
for medication
administration.
1. Person become specifically
skilled in performing certain
assigned task.
2.Best utilization of a
person’s aptitudes,
experiences and desires.
3. Less equipment is needed.
Saves time.
4. Development of technical
skill
5. Sense of productivity for
the task oriented nurse
Easy to organize the work of
the unit and staff
1. Diminishing continuity of
care.
2. Staff may become bored
and have little motivation.
Only the nurse in-charge has
accountability for the client.
Client may feel insecure.
3. Patients get confused as so
many nurse attend to
them,e.g. head nurse,
medicine nurse, dressing
nurse, temperature nurse.

Characteristics. Merits Demerits
1. Each team
composed of a
team leader, team
members and
patients.
2. Comprehensive
care is the
responsibility of
the entire team
1. Includes all
health care
personnel in the
group functioning
and goals.
2. Feelings of
participation and
belonging
Workload can be
balanced and
shared.
1. Takes time,
effort and
constancy of
personnel.
2. For the team
nursing to be
effective the leader
must be excellent
practitioner and
have good
communication,
organizational,
management, and
leadership skills.

• The patient unit is
divided into
modules or
districts, and the
same team of
caregivers is
assigned
consistently to the
same geographic
location.
 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
• Save staff time.
• Feelings of
participation and
belonging
• Takes time, effort,
and constancy of
personnel.
• Unstable staffing
pattern make team
difficult.
• There is less
individual
• All personnel must
be client centered.
• The team leader
must have complex
skills and
knowledge

Progressive patient care
The central theme is better
utilization of facilities, services and
personnel for the better patient care.

PPC
Intens
ive
care
Inter
media
te care
Convale
scent
and Self
Care
Long
term
care
Ambu
latory
care
Home
care

MERITS DEMERITS
 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.
 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 difficulty in
meeting administrative need of
the organization, staffing
evaluation and accreditation.

 The 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.
 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.
 The nurse may be
isolated from the
colleagues.
 Little avenue for group
planning of care.

 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
 Potentiates
creativity by the
nurse and thereby
work satisfaction
increases
 Increased trust
and satisfaction
for both
 Nurse must be
mature and
independently
competent.
 It must be cost
effective
 Staffing patterns
may necessitate a
heavy client load.

 Handle each
case
individually
 Use critical
pathways and
multidisciplina
ry action plans
to plan patient
care
 Additional
work efficiency
due to
geographical
proximity.
 Establishes
solid
relationships
with nursing
and ancillary
staff working
on the unit.
• Expensive
• Nurse is client
focused and
outcome
oriented
• Facilitates and
promotes co-
ordination of
cost effective
care

Characteristics Merits demerits
Case management
provides a well
coordinated care.
Provides
comprehensive care
It seeks the active
involvement of the
patient, family and
diverse health care
professionals
Nursing case
management is a
professionally
autonomous role that
requires expert
clinical
Knowledge and
decision making
skills.

Level I-
Self care
or
Minimal
care
• NCH
1.5/pt/day -
Ratio 55:45
Level II-
Moderate
care or
intermedi
ate care
• NCH 3/pt -
Ratio 60:40
Level III
Total,Com
plete or
Intensive
care
• NCH
6hrs/pt/day
-Ratio 65:35
Level IV
Highly
Specialize
d Critical
Care
NCH 6-9 or more
/pt/day Ratio
70:30 or 80:20

Percentage of patients at
various levels of care per type
of hospital

Type of
hospital
Minimal
care
Interme
diate
care
Intensiv
e care
Highly sp
Primary
Hospital
70 25 5 -
Secondar
y
Hospital
65 30 5 -

Tertiary
Hospital
30 45 15 10
Special
Tertiary
Hospital
10 25 45 20

NURSING CARE NEEDED IN EACHSHIFT FOR
EACH LEVEL
NCH/
SHIF
T
LEVEL I LEVEL II LEVEL III LEVEL IV
DAY 2.3 2.9 3.4 4.6
EVE
NING
2.0 2.3 2.8 3.4
NIGH
T
0.5 1.0 2.0 2.8

ROLE AND FUNCTION
OF NURSE
ADMINISTRATOR IN
PATIENT CARE SYSTEM

Organizes, directs and
supervises
Ensures appropriate
allocation of duties and
responsibilities
Responsible for efficient
functioning
Formulates standing
orders
Evaluates the personal
performance of the
nursing staff.

Ensure that a
standard of
discipline
Maintain good
order and
discipline
Makes daily
rounds

Maintain
cordial
relationships
with the
patients and
their families.
Promotes and
maintains
harmonious
and effective
relationship

OFFICE DUTIES
• Scrutinizes the reports and returns and
submits in accordance with existing
orders.

Carries out
in-service
training
Conduct
various
update
courses
Encourages
the
personnel to
participate
in the CNE

WELFARE
Responsible for health and
welfare
Ensures annual and periodical
health examination and
maintenance of health records

• Responsible for
organizing and
conducting staff
meeting
• Holds conference in
nursing care
problems and
discuss policies

Supervises nursing
care given to the
patients and all
nursing activities
Supervises the work of
all paramedical staff

RECORDS AND REPORTS
• Maintains various records such as duty
roster nursing staff, day off book,
personal bio-data, leave plan, staff
conference book, courses file etc.

ROLE OF STAFF NURSE IN
NURSING SERVICE
ADMINISTRATION

PLANNING
DIRECTIN
G
CONTROL
LING
COORDINA
TING
EVALUATI
NG

PROBLEMS AND CHALLENGES
FACED BY THE NURSE
ADMINISTRATOR

• Lack of adequate training.
• Inadequate number of nursing
staff.
• Shortage of trained manpower.
• Lack of motivation
• Problem of personnel management

• No involvement in planning.
• Poor role model.
• No research scope.
• Professional risk/hazards.
• No autonomy in nursing activities

DAY TO DAY PROBLEM IN
NURSING SERVICES
• Shortage of nurses.
• Lack of motivation.
• Negative attitude.
• Lack of training.

CONTD….
• Lack of team approach.
• Inactive participation of program
• Lack of interpersonal relationship
• Less involvement in patients care
by nursing supervisors.
• Lack of supervision

• Yu-Chih Chen et al (2013) did a quasi
experimental study on Effectiveness of nurse
case management compared with usual care in
cancer patients at a single medical center in
Taiwan: This study was conducted with a
quasi-experimental design in a national
medical center in Northern Taiwan. A total
number of 600 subjects randomly selected
from the cancer case management system
enrolled in the case managed group, and 600
patients who received usual care were
randomly selected from cancer registry and
enrolled in the control group.

• The study instrument was developed to
measure care effectiveness, including the
rates of patient continuing treatment, non-
adherence to treatment, prolonged
hospitalization, unplanned readmission,
and planned admission for active
treatment. Researcher concluded that
cancer case management could improve the
effectiveness of cancer care services and
concretely illustrated a comprehensive
model for oncology patients in Taiwan and
suggested for further investigation

• Changing model of nursing care from individual patient
allocation to team nursing in the acute inpatient
environment.
• Abstract
• Agreement was reached with 12 acute medical and
surgical wards/units at Sydney's Prince of Wales Hospital
to participate in a trial of team nursing (TN). Six units
employed action research principles to undertake a change
to a team nursing model and six remained with the pre-
existing individual patient allocation (IPA) model. Task-
based teaming was widely discarded by the team nursing
units in favour of allocating patients within the team and
introducing more supportive and communicative processes
aimed at fostering responsibility sharing. Localised team-
based models of care arose in the change wards and were
outlined, implemented and refined using social action
research principles

• . A 12-month prospective experimental
comparison of job satisfaction and staff retention
between the TN and IPA groups indicated
statistically significant job satisfaction benefits
and practically important staff retention benefits
associated with moving away from an IPA model
of nursing care delivery towards a team-based
model of care delivery. Perhaps not surprisingly,
job satisfaction gains were most marked among
new graduate nurses, who reported real benefits
from a teaming inspired shift in model of care in
the acute inpatient evironment

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