2. ORGANIZING NURSING SERVICES
AND PATIENT CARE
• ‘’A hospital may be soundly organized, beautifully situated and well
equipped, but if the nursing care is not of high quality the hospital will
fail in the responsibility’’.
3. ORGANIZING NURSING SERVICES
Nursing services
• Nursing services 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
discipline such as dietetics, medical social service, pharmacy etc. in
supplying a comprehensive program of patient care in hospital.
4. Cont…
Nursing service administration
• Nursing service administration is a complex of elements in
interaction and is organized to achieve the excellence in nursing
care service.
• It results in output of clients whose health is unavoidably
deteriorating, maintained and improved through input of personnel
and material resources used in a process of nursing services.
5. Definition of patient care
• The service rendered by members of the health professionals and
non-professionals under the supervision for the benefit of the patient.
OR
• The prevention, treatment and management of illness and the
preservation of mental and physical wellbeing through the services
offered by the medical and allied health professions.
6. Patient classification system
• Patient classification system (PCS), which quantify the quality of nursing
care, is essential to staffing nursing unit of hospitals and nursing homes.
• The primary aim of PCS is able to respond to constant variation in the care
needs of the patients.
• Grouping of patients according to the amount & complexity of their nursing
requirements
• Patient classification system is the scheme that group patients according
to the amount & complexity of their nursing care requirements
7. ORGANIZING PATIENT CARE/
METHODS OF PATIENT ASSIGNMENT
• Overall goal of nursing is to meet the patient nursing needs with the
available resources for providing smooth day and night 24 hour of
quality care to patient and honor his right.
• To ensure that nursing care is provided to patient, the work must be
organized.
• A Nursing Care Delivery Model organizes the work of caring for
patients.
8. Cont..
• The decision of which nursing care delivery model is used is based
on the needs of the patients and the availability of competent staff in
the different skill levels.
• For organizing function to be productive and facilitated meeting the
organizational need, the leader must know the organization and its
member well.
9. Purpose
• To delegate to work to be done to the nursing personnel
• To gain the cooperation of nursing personnel by knowing and
accepting the accepting of the work to be done.
• To prepare the work systematically
• To prepare and motivate the nurses for delivery of care.
• To shoulder accountability
10. PRINCIPLES OF PATIENT
ASSIGNMENT
• Made by head nurse for each individual nurse
• Planned weekly and revised daily to ensure continuity of care
• Must be balanced among nursing staff
• Never assign same task to more than one nurse
Based on:
• Nursing needs of each patient
• Skill, experience, capabilities of each staff
• Job description
12. CHALLENEGES IN PATIENT
ASSIGNMENT
• Problem of personal management
• Shortage of trained manpower
• Lack of adequate training
• No involvement in planning
• No autonomy in nursing activities
• Inadequate number of nursing staff
13. METHODS OF PATIENT ASSIGNMENT
• Case method nursing or total patient care.
• Functional nursing
• Team nursing or modular nursing
• Primary nursing
• Case management or managed care
• Progressive patient care
14. CASE METHOD
• The case method or total patient care method of nursing care delivery is
the oldest method of providing care to a patient.
• In this method, nurses assume total responsibility for meeting all the needs
of assigned patient during their time on duty.
• The premise of the case method is that one nurse provides total care to
one patient during her entire work period of one shift.
• This method was used in the era of Florence nightingale when patient
received total care in the home.
15. Cont…
• That time nurses were ‘hired’ and they lived with in the family of the
patient provided 24 hours care to patient and even family.
• During an 8-12 hour shift the patient receives consistent care from
one nurse. The nurse, Patient, family share mutual trust and work
together toward specific goals.
• Usually the care is patient centered, comprehensive, holistic and
continuous.
16. CHARACTERISTICS
• Complete care
• Provides nurses with high autonomy and responsibility.
• Assigning patients is simple and direct.
• Patient theoretically receives holistic and un-fragmented care during the
nurse’s time on duty.
• It is developed and communicated through written sources, its usage
remains in contemporary practice.
17. ORGANIZATION OF THE CASE METHOD
Nurse Manager’ role:
• The nurse manager must consider the expense of the system before arranging the staff
• Arrange skilled and qualified nurse so that she could manage all the care of the person
• The manager also need to identify the level of education and communication skills of all
• Arrange for continuing education and in service education for the personnel
Staff nurse’s role:
• Provide holistic care to assigned patient during a defined work period
• Assessment and teaching the patient and family
18. MERITS
• Nurse can see better and attend to the total needs of the patient
• Continuity of care can be facilitated
• Client or nurse interaction and rapport can be developed
• Client may feel more secure
• Nurse’s accountability for their function is built-it.
• Family friends become more known by nurse and get more involved
• Work load can be equally divided by the staff.
19. DEMERITS
• Many clients do not require the inherent care
• Must be modified if non-professional health workers are used
• Great disadvantage when nurse is inadequately trained
• Cost–effectiveness
• Nurse may feel over workload if most of her assigned patient care sick.
• She/he may tend to ‘neglect‘ the needs of patient when the other
patients ‘problem‘ or ‘need‘ demands more time
20. PRIMARY NURSING CARE
• It was developed in the 1960s with the aim of placing RNs at the bedside
and improving the professional relationships among staff members.
• It supports a philosophy regarding nurse and patient relationship.
• This method is based on the concept of ‘my patient-my nurse” In this
nursing care delivery system, each registered nurse is assigned to the
care of group of patient for which she plans complete 24 hours care and
writes the nursing care plan.
• He or she is responsible for coordinating and implementing all the
necessary nursing care that must be given to the patient during the shift.
21. Cont…
• 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.
• This type of nursing care can also be used in hospice nursing, or
home care nursing.
• Provides total direct care for patients.
• Requires a nursing staff made up of only Nurses.
23. CHARACTERISTICS
• 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.
• 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 Primary nurse assumes 24-hour responsibility from admission or start of
treatment to discharge or the treatment’s end.
24. Cont…
• 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
25. ADVANTAGES
• Satisfaction for both patients and nurses
• The relationship between nurses and patient is intimate
• Autonomy for the nurses
• Nurse is the person who is planning and providing complete care
• She communicates with all other health team members involved in
client care
• Other health team members including physician tend to view her
more knowledgeable and responsible
26. Cont..
• Patient receives quality and continuity of care
• Reduces the number of errors than can result from a relay of orders
• Increased satisfaction both to patients and nurses
• Nurse can identify patient outcome as a result of their work
27. DISADVANTAGES
• 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.
• It may be cost-effective especially in specialized units such as the ICU.
• May create conflict between primary and associate nurses.
• Stress of round the clock responsibility.
28. Cont…
• Difficult hiring all RN staff
• Confines nurse‘s talent to his/her own patients.
• Nurse may be isolated from colleagues
• Nurses talent to a limited number of patients
• Nursing care plan can be changed only with the permission of primary
nurse
• Creates separation anxiety in patients when nurse
• Nurses should be well educated and trained in all area of patient care,
most of the time which may lack
29.
30. FUNCTIONAL NURSING
• It is task focused, not patient-focused.
• In this model, the tasks are divided with one nurse assuming
responsibility for specific tasks. For example, one nurse does the
hygiene and dressing changes, whereas another nurse assumes
responsibility for medication administration.
31.
32. 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 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.
• 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.
33. Demerits:
• 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.
• Only parts of the nursing care plan are known to personnel.
• Patients get confused as so many nurses attend to them, e.g. head nurse,
medicine nurse, dressing nurse, temperature nurse, etc.
34. TEAM NURSING
• Team nursing is based on philosophy in which groups of professional and nonprofessional
personnel work together to identify, plan, implement and evaluate comprehensive client-
centered care.
• In team nursing an RN leads a team composed of other RNs, LPNs or LVNs and nurse
assistants or technicians.
• The team members provide direct patient care to group of patients, under the direction of
the RN team leader in coordinated effort.
• 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.
• The team leader assigns tasks, schedules care, and instructs team members in details of
care.
35.
36. Advantages
• High quality comprehensive care can be provided to the patient
• Each member of the team is able to participate in decision making and problem
solving.
• Each team member is able to contribute his or her own special expertise or skills
in caring for the patient.
• Improved patient satisfaction.
• Feeling of participation and belonging are facilitated with team members.
• Work load can be balanced and shared.
37. • Division of labour allows members the opportunity to develop leadership
skills.
• There is a variety in the daily assignment.
• Nursing care hours are usually cost effective.
• The client is able to identify personnel who are responsible for his care.
• Barriers between professional and non-professional workers can be
minimized, the group efforts prevail.
38. Disadvantages
• Establishing a team concept takes time, effort and constancy of personnel.
• Unstable staffing pattern make team nursing difficult.
• All personnel must be client centered.
• There is less individual responsibility and independence regarding nursing
functions.
• The team leader may not have the leadership skills required to effectively
direct the team and create a ―team spirit‖.
• It is expensive because of the increased number of personnel needed.
39. 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.
• Here the clients are evaluated with respect to all level (intensity) of care
needed.
• As they progress towards increased self care (as they become less
ethically ill or in need of intensive care or monitoring) they are marred to
units/ wards staffed to best provide the type of care needed.
40. Principal elements of PPC are
• i) Intensive care or critical care: Patients who require close
monitoring and intensive care round the clock, e.g. patients with
acute MI, fatal dysarythmias.
• ii) Intermediate care: Critically ill patients are shifted to intermediate
care units when their vital signs and general condition stabilizes, e.g.
cardiac care ward
41. • iii) Convalescent and Self Care: Patients are taught administration
of drugs, life style modification, exercises, ambulation, self-
administration of insulin, checking pulse, blood glucose and dietary
management.
• iv) 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.
42. • v) 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.
• vi) 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.
43. Merits
• 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.
• 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.
44. Demerits
• 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.
45. CASE MANAGEMENT
• The case manager is assigned responsibility of following a patient‘s
care and progress from the diagnostic phase through hospitalization,
rehabilitation and back to home care. For eg; case manager for
cardiac surgery patients assists them go through diagnostic
procedures, pre-operative preparations, surgical interventions, family
counseling, post-operative care and rehabilitation.
46. Responsibilities of case managers
• Assessing clients and their homes and communities.
• Coordinating and planning client care.
• Collaborating with other health professionals in the provision of care.
• Monitoring client progress and client outcomes.
• Advocating for clients moving through the services needed.
• Serving as a liaison with third party payers in planning the client‘s
care.
47. Merits
• Case management provides a well coordinated care experience that
can improve the care outcome, decrease the length of stay, and use
multiple disciplines and services efficiently.
• Provides comprehensive care for those with complex health
problems.
• It seeks the active involvement of the patient, family and diverse
health care professionals
48. Demerits
• Nurses identify major obstacles in the implementation of this service,
financial barriers and lack of administrative support.
• Expensive
• Nurse is client focused and outcome oriented
• 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.
50. CONCLUSION
• No single nursing care model works in all settings, or even
necessarily across a single multiservice setting.
• Before selecting a model nurse manager must consider all the
influencing factors.
• For a better care effective selection and mixing of these methods are
essential.
• All the models should be evaluated periodically for its
appropriateness to ensure safe and effective nursing care.
51. REFERENCES
• Whitehead, D. K., Weiss, S. A. & Tappen, R. M. (2010), Essentials of
Nursing Leadership and Management, 5th edition, Philadelphia,
F.A.Davis Company.
• Deepak, K., Chandran, S. C. & Kumar, M. B. P (2017), A comprehensive
textbook of Nursing management, 2nd edition, New Delhi, EMMESS
Medical Publisher.
• Vati, J. (2013), Principles & Practice Of Nursing Management &
Administration, 1st edition, New Delhi, JAYPEE Medical Publisher.
