Organizing nursing services and patient care

2. Presented By
Susy Mary Thomas
IIYEAR MSC (N)
BBCON
ORGANIZING
NURSING
SERVICES
AND PATIENT
CARE

3. “A hospital may be soundly organized, beautifully situated and well
equipped, if the nursing care is not of high quality the hospital will fail
in its responsibility”. Nursing service is the part of the total health
organization which aims at satisfying the nursing needs of the patients/
community. In nursing services, the nurse works with the members of
allied disciples such as dietetics, medical social service, pharmacy etc
in supplying comprehensive program of patient care in hospital.

4.  The nursing service as the part of the total health
organization which aims to satisfy major objective of the
nursing services is to provide prevention of disease and
promotion of health.
-WHO expert committee on nursing –

5. PATIENT CARE
ADMINISTRATION AND
ORGANIZATION
EDUCATION
RESEARCH
PERFORMANCE
APPRAISAL

6.  The quality in nursing care and management of nursing services is achieved
through professional nurses who assist in the development of comprehensive
programs of delivering nursing care.
♦ The quality of nursing care services is clearly and directly related to
continuing growth and development of nursing personnel.

7.  High quality of nursing care can be best provided by a mixture of
professional and non professional personnel who are organized
into self directed work teams.
 To ensure continuous improvement of nursing care quality, the
role of professional nurse must include responsibility of nursing
research and nursing education.

8.  Initiate a set of human relationships at all levels of nursing
personnel to accomplish their job and responsibilities through
systematic management process by establishing flexible
organizational design.
 Establish adequate staffing pattern for rendering efficient nursing
service to clients and its management.

9.  Develop or revise proper job description for
nursing personnel at all the levels and all units
for proper delivery of nursing care.
 Share nursing information system with other
discipline functionaries in the hospital.

10.  Develop and implement proper communication
system for communicating policies, procedures and
updating advance knowledge.
 Develop and initiate proper evaluation and
periodic monitoring system for proper utilization of
personnel.

11.  Assist the hospital authorities for preparation of
budget by involvement.
 Participate in interdepartmental programs and
other programs conducted by other disciplinaries
for improvement of hospital services.

12.  To assist the individual patient in performance of those activities
contributing to his health or recovery that he would otherwise perform
unaided has had the strength, will or knowledge.
 To help and encourage the patient to carry out the therapeutic plan
initiated by the physician.

13.  To assist other members of the team to plan and carry out the total
programme of care. The organization of nursing care constitutes a
subsystem for achieving the hospital’s overall objective. Nursing care of
patients generally takes forms:
 Technical
 Educational
 Trusting relationship

15. DIRECTOR (hospital) SERVICE
Chief Nursing Officer
Nursing Superintendent
Assistant Nursing Superintendent
Ward Sister - Clinical Supervisor
Staff nurse- Student nurse

16. DIRECTOR OF HEALTH
Asst. Director of Health Service
Nursing Superintendent Grade-I
Nursing Superintendent Grade-II
Head Nurse
Staff Nurse

19. ♠ Lack of adequate training.
♠ Problem of personnel management.
♠ Inadequate number of nursing staff.
♠ Shortage of trained manpower.
♠ Lack of motivation.
♠ No involvement in planning.
♠ No career mobility.
♠ Poor role model.

20. ♠ No research scope.
♠ Professional risk/hazards.
♠ No autonomy in nursing activities.

21.  Shortage of nurses.
 Lack of motivation.
 Negative attitude.
 Lack of training.
 Lack of team approach.
 Inactive participation of program
 Lack of interpersonal relationship
 Less involvement in patients care by the nursing supervisors.
 Lack of supervision.

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

24.  Patient classification system (PCS), which quantifies the quality of the
nursing care, is essential to staffing nursing units of
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.

25.  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 repot and use.

26.  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.

27.  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.
 Program costing and formulation of the nursing budget.
 Tracking changes in patients care needs. It helps the nurse managers the
ability to moderate and control delivery of nursing service

28.  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.

29.  Enhance staff satisfaction through stress free work
environment.
 Ensure that quality of nursing care is provided in safe
environment

30.  The first component of a PCS is a method for grouping patient’s categories.
Johnson indicates two methods of categorizing patients. Using
categorizing method each patient is rated on independent elements of care,
each element is scored, scores are summarized and the patient is placed in a
category based on the total numerical value obtained.

31.  Johnson describes prototype evaluation with four basic categories for a
typical patient requiring one –on- one care. Each category addresses
activities of daily living, general health, teaching and emotional
support, treatment and medications. Data are collected on average
time spent on direct and indirect care.

32.  The second component of a PCS is a set of guidelines describing the way
in which patient will be classified, the frequency of the classification,
and the methods in each category
 The third components of a PCS is the average amount of the time
required for care of a patient in each category

33.  Administrative tool that aims to provide quality patient care
and the degree of nursing care requirements. The PCS is
referred as patient acuity system. Thus PCS is used to assist
nurse administrators to determine workload of nurses and
staffing needs.

34. DISCRIPTIVE SYSTEM
CHECKLIST SYSTEM
TIME STANDARD SYSTEM
SELF- CARE / MINIMAL
CARE
MODERATE CARE
MAXIMUM CARE
INTENSIVE CARE

35.  Descriptive System
This is purely subjective system wherein the nurse selects
which category the patient is best suited.
 Checklist System
Another subjective system, wherin the patient is assigned to a numerical
value based on the level of activity in specific categories. The numerical values
are added up to give the nurse an overall rating.

36.  Time Standards System
This is the another method where the nurse assigns a time
value based on the various activities needed to be completed
for the patient. This time value is sum up and converted to an
acuity level. Among these three, the most commonly used is
the descriptive kind of PCS.

37.  DEFINITION OF ASSIGNMENT
Assignment is defined as a written document of assigning of tasks to
render patient care for a group of patients by trained nursing personnel
working in that ward.

38.  To distribute the work to be done for patient care to nursing staff.
 To ensure the cooperation of nursing personnel by knowing and
accepting of the work to be done.

39.  Patient assignment should be done by the head nurse or nurse in charge for
each individual nurse assigned in that unit.

41. Planning
Assigning
Leading
Evaluating
Reporting

42. METHODS OF
ASSIGNMENT
TRADITIONAL
ADVANCE

43.  It is one of the oldest methods of organizing patient care.
 It means the assignment of one or more patients to a particular
nurse for a specific period of time
 She is responsible for the complete care including assessing
vital signs, general nursing measures, treatment, medication
administration nourishments and imparting health education etc
 Mostly used in hospital and in nursing homes, private duty
nurses and specialty units etc.

44.  Ensure comprehensive care by meeting total
needs of patients
 More individualized nursing care is facilitated.
 Continuity of care can be facilitated
 Patient nurse interaction can be developed
 Patient and family feel more safe and develop
trust in nurse

45.  Equal workload for nurses is possible.
 Better patient education
 Patient receives totality of care
 Enhance patient satisfaction
 Enhance nurses satisfaction

46.  Many patient do not require the inherent care.
 Qualified nurses are always not available.
 cost-effective

47.  Emerged in 1930s in USA during world war II when there was a severe
shortage of nurses in US
 It is task focused, not patient focused.
 In this model, the tasks are divided with one nurse assuming
responsibility for specific tasks.
 For e.g.: one nurse dose the hygiene and dressing changes, where as
another nurse assumes responsibility for medication administration.

48.  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 person’s 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.

49.  Client care may become impersonal, compartmentalized 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.

50.  Developed in 1950s because the functional method received criticism, a
new system of nursing was devised to improve patient satisfaction.
 It is a method of nursing assignment that comprises of all personnel
involvement in care of patient.
 This method utilizes all professional, technical and nursing aids into small
teams efficiently and effectively for patient care.

51.  Team nursing is based on philosophy in which groups of professional and
non-professional personnel work together to identify, plan, implement and evaluate
comprehensive client-centered care.
 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.
 A conference is held at the beginning and end of each shift to allow team members to
exchange information and the team leader to make changes in the nursing care plan
for any patient.

52.  High quality comprehensive care is possible by team nursing by utilizing
all members in the team.
 Team members actively participate in decision- making for care and
imparts their own expertise in improving patient care

53.  When the team assignment changes every day, it affects the continuity of
care.
 Team nursing fails when the team leader have inadequate leadership skills.
 It becomes difficult for the team leader to assign the patient during
changing team membership.

54.  Modular nursing is a modification of team nursing and focuses on the
patient’s geographic location for staff assignments.
 In modular nursing assignment, technical and nurse aides, as well as
professional nurses are involved.
 The concept of modular nursing calls for a smaller group of staff providing
care for a smaller group of patients.

55.  The goal is to increase the involvement of the RN in planning and coordinating
care.
 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.
 The team leader is accountable for all patient care and is responsible for
providing leadership for team members and creating a cooperative work
environment.

56.  Continuity of care is improved
 Professional nurse become more responsible and engaged in planning,
coordinating and collaborating care.
 Develop leadership skill among professional nurse.
 Nurses identify more opportunity to learn and to teach
 Patients feels secure as they are well aware of the nurses under whom they are
cared.
 Work load can be balanced and shared.


57.  Costs may be increased to stock each module with the necessary
patient care supplies (medication cart, linens and dressings).
 Establishing the team concepts takes time, effort, and constancy
of personnel.
 Unstable staffing pattern make team difficult.
 The team leader must have complex skills and knowledge.

58.  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.
 Here the clients are evaluated with respect to all level
(intensity) of care needed.

59. PRINCIPLE ELEMENTS OF PPC

60.  Intensive Care Or Critical Care:
 Patients who require close monitoring and intensive care round the
clock.
 These units have 9-15 numbers of beds, life-saving
equipment and skilled personnel for assessment, revival,
restoration and maintenance of vital functions of acutely ill
patients

61.  Nursing approach in these units is patient-centered.
 E.g. Patients with acute MI, fatal dysarythmias, those who
need artificial ventilation, major burns, premature
neonates, immediate post or cardiothoracic, renal
transplant, neurosurgery patients.

62.  Intermediate care:
 Critically ill patients are shifted to intermediate care units
when their vital signs and general condition stabilizes
 e.g. cardiac care ward, chest ward, renal ward.

63.  Convalescent and Self Care:
 Although rehabilitation programme begins from acute care setting, yet
patients in these areas participate actively to achieve complete or partial
self-care status.
 Patients are taught administration of drugs, life style
modification, exercises, ambulation, self-administration of insulin,
checking pulse, blood glucose and dietary management.

64.  Long-term care:
 Chronically ill, disabled and helpless patients are cared 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.
 Patients and family who need long-term care are, cancer patients,
paralyzed and patients with ostomies.

65.  Home care:
 Some hospital/centers have home care services.
 A hospital based home care package provides staff,
equipment and supplies for care of patient at home.
 E.g. Paralyzed patients, post-operative, mentally
retarded/spastic patient and patient on long chemotherapy.

66.  Ambulatory care:
 Ambulatory patients visit hospital for follow up, diagnostic,
curative rehabilitative and preventive services.
 These areas are outpatient departments, clinics,
diagnostic centers, day care centers etc.

67.  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.

68.  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.

69.  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.

70.  It was developed in the 1960s with the aim of placing RNs at
the bedside and improving the professional relationships
among staff members.
 The model became more popular in the 1970s and early
1980s as hospitals began to employ more RNs.
 It supports a philosophy regarding nurse and patient
relationship

71.  It is a system in which one nurse is caring for all the needs of a patient or more within a 24
hour from admission to discharge.
 He or she is responsible for coordinating and implementing all the necessary nursing care
that must be given to the patient during the shift.
 If the nurse is not available, the associate nurse responsible for filling in for the nurse’s
absence will provide hospital care to the patient based on the original plan of care made by
the nurse.
 In acute care the primary care nurse may be responsible for only one patient; in intermediate
care the primary care nurse may be responsible for three or more patients This type of
nursing care can also be used in hospice nursing, or home care nursing.


72.  Primary Nursing Care System is good for long-term care,
rehabilitation units, nursing clinics, geriatric, psychiatric, burn
care settings where patients and family members can
establish good rapport with the primary nurse.
 Primary nurses are in a position to care for the entire person-
physically, emotionally, socially and spiritually.

73.  High patient and family satisfaction
 Promotes RN responsibility, authority, autonomy,
accountability and courage.
 Patient-centered care that is comprehensive, individualized,
and coordinated; and the professional satisfaction of the
nurse.
 Increases coordination and continuity of care.

74.  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 patient’s condition changes.

75.  May create conflict between primary and associate nurses.
 Stress of round the clock responsibility.
 Difficult hiring all RN staff
 Confines nurse’s talent to his/her own patients

76.  It is a patient assignment method described as a process of monitoring an
individual patients health care by the case manger, with the objective of
optimizing positive patient care outcomes and cost effectiveness.
 To become a case manager she or he should be graduate professional nurse
or advance level prepared nurse practitioner.

77.  The case manager role warrants not only advanced nursing skills but also
advanced managerial and communication skills
 Case management is the coordination and collaboration of services
rendered on behalf on an individual patient who is considered a case in
different settings such as health care

78.  For the patient
 A standards or expected nursing care is achieved for the patient.
 The hospital length of stay of the patient is reduced.
 Using the minimal resources, maximal healthy care outcome is achieved.
 Enhance continuity of patient care through collaborative practice of
diverse health professionals.
 Patient are moved towards self-care, independence is fostered where
indicated.

79.  For the nurse
 Professional development and job satisfaction.
 Facilitates the transfer of knowledge of expert clinical staff to
novice staff.

80.  Continuity of care is difficult as case managers are not always
available
 Long term nurse patient relationship are difficult to arrange.

81.  Many variable factors influence the number of nurses needed
on a ward in order to render a high quality of patient care.
 The total number of patient to be nursed
 The degree of illness of patients (physical dependency)
 Type of service: medical, surgical, maternity, pediatrics and
psychiatric

82.  The total needs of the patients
 Methods of nursing care
 Number of nursing aids and other non professional available,
the amount and quality of supervision available
 The amount, type and location of equipment and supplies
 The acuteness of the service and the rate of turnover in
patients according to the degree or period of illness.

83.  The physical facilities
 The number of hours in the working week of nurses and other
ward personnel and the flexibility in hours
 Methods of performing nursing procedures
 Affiliation of the hospital with the medical school
 Methods of assignment-individual, team or functional
method.
 The standards of nursing care

84.  The experience of the nurses who are to give the patient care.
 The number of non-nurses who involve in the patient care,
the quality of their work, their stability in service.
 The physical facilities
 The number of hours in the working week of nurses and other
ward personnel and the flexibility in hours

85.  Nursing is vital aspect of health care and needs to be properly organized. A nurse
is in frequent contact with of the patients hence his/her role in educational aspect
and service aspect in restoring health and confidence of the patient is of utmost
importance. The quality of nursing care and the management of the nursing staff,
reflects an image of the hospital/ nursing home. Many changes have taken place
in the health care delivery system as it struggles with cost and providing care
corresponding to changes in the education of health professionals and their
function within the system.

86.  Basavanthappa B T;. Nursing administration. Ist edn. New Delhi: Jaypee brothers;2000.
 Alamellu; Newer trends in management of nursing services and education. health
science publishers first edition 2017; 92-104
 Deepak. k et al; A comprehensive textbook on nursing management emmess
publications;2013;125-144
 Jogindra vati; principles and practice of nursing management and administration jaypee
publications;256

87.  http://doi.org/10.1016/j.bi.2015.04.005
 http://doi.org/10.1016/j.bi.2015.04.005
 http://www.ncbi.nib.gov/pmc/articles/pmc1435388/

88.  Estimating Nursing Intensity and Direct Cost Using the
Nurse-Patient Assignment
 Welton, John M. PhD, RN; Zone-Smith, Laurie PhD, RN;
Bandyopadhyay, Dipankar PhD
 JONA: The Journal of Nursing Administration: June 2009 -
Volume 39

89.  Background: This study examines the feasibility of using the nurse-patient assignment
(NPA) to calculate direct nursing hours and costs for each inpatient-day. The NPA data
are collected at every hospital and therefore represent a readily available information
source that can establish the intensity and economic value of nursing care at US
hospitals.
 Method: Direct nursing care hours for each patient were collected twice a day using an
existing nursing intensity database at a single university hospital between January 2004
and June 2005 for a total of 11,582 patient-days. Nursing intensity was also calculated
for each shift using the NPA. Mean unit and hospital nursing hours were calculated and
compared with the direct nursing care hours using ordinary least squares regression.

90.  Results: For the day shift, the NPA estimate explained 77.2% (r2 = 0.772) of the variance
of patient-level nursing intensity. Unit and hospital mean estimates of nursing intensity
had lower r2 of 0.574 and 0.456, respectively. The night-shift NPA, unit, and
hospital r2 estimates were 0.824, 0.633, and 0.579, respectively.
 Conclusion: The use of the NPA can provide a robust and easy method to calculate
nursing intensity for individual patients using assignment data available in nearly all
care settings. The NPA estimate can be used to allocate direct nursing time and costs for
each patient within the hospital billing system and can also be used in pay-for-
performance or for benchmarking nursing intensity within and across hospitals.

91.  Hospital staffing, organization, and quality of
care: cross-national findings
 LINDA H. AIKEN, SEAN P. CLARKE, DOUGLAS
M. SLOANE

92.  Abstract
 Objective. To examine the effects of nurse staffing and organizational support
for nursing care on nurses’ dissatisfaction with their jobs, nurse burnout, and
nurse reports of quality of patient care in an international sample of hospitals.
 Design. Multisite cross-sectional survey.
 Setting. Adult acute-care hospitals in the United States (Pennsylvania), Canada
(Ontario and British Columbia), England, and Scotland.
 Study participants. 10 319 nurses working on medical and surgical units in 303
hospitals across the five jurisdictions.

93.  Main outcome measures. Nurse job dissatisfaction, burnout, and nurse-rated quality of
care.
 Results. Dissatisfaction, burnout, and concerns about quality of care were common
among hospital nurses in all five sites. Organizational/managerial support for nursing
had a pronounced effect on nurse dissatisfaction and burnout, and both organizational
support for nursing and nurse staffing were directly, and independently, related to
nurse-assessed quality of care. Multivariate results imply that nurse reports of low
quality care were three times as likely in hospitals with low staffing and support for
nurses as in hospitals with high staffing and support.

94.  Conclusion. Adequate nurse staffing and
organizational/managerial support for nursing are key to
improving the quality of patient care, to diminishing nurse job
dissatisfaction and burnout and, ultimately, to improving the
nurse retention problem in hospital settings.
 burnout, health care surve

95.  Knowledge Management: Organizing Nursing Care Knowledge
 Anderson, Jane A. MSN, RN, FNP-BC; Willson, Pamela PhD, RN,
FNP-BC
 Critical Care Nursing Quarterly: January-March 2009 - Volume
32

96.  Almost everything we do in nursing is based on our knowledge. In
1984, Benner (From Novice to Expert: Excellence and Power in
Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984)
described nursing knowledge as the culmination of practical
experience and evidence from research, which over time becomes
the “know-how” of clinical experience. This “know-how”
knowledge asset is dynamic and initially develops in the novice
critical care nurse, expands within competent and proficient
nurses, and is actualized in the expert intensive care nurse.

97.  Collectively, practical “know-how” and investigational
(evidence-based) knowledge culminate into the “knowledge of
caring” that defines the profession of nursing. The purpose of
this article is to examine the concept of knowledge
management as a framework for identifying, organizing,
analyzing, and translating nursing knowledge into daily
practice. Knowledge management is described in a model
case and implemented in a nursing research project.