Assignment systems for staffing (Nursing care delivery systems)

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.Objectives -1 .Introduction -2 .Types of nursing care delivery systems -3 .Restructuring nursing care delivery -4 -:Objectives At the end of this lecture, the student will be -able to Identify the different types of nursing care -1 delivery system Compare and contrast among the different -2 types of nursing care delivery System Identify the restructuring nursing care delivery -3

-:Introduction
One of the significant issues challenging nursing is the Way in which nursing is delivered. This lecture describes how nursing care is organized to ensure quality care in an area of cost .containment The purpose of nursing care delivery system is * to provide a structure that enables nurses to deliver nursing care to as a specified group of .patients

Types of nursing care delivery system -:Case method -1

The original model of nursing care delivery was case method also called total patient care, in which

nurse was responsible for all aspects of the care of one or more patient Each patient is assigned to a nurse for all patient) care while that nurse is on duty). In case method nurses work directly with the patient, family, physician and other health care staff in implementing a plan of care. The patient has different nurse each shift and no guarantee of having the nurses the next day, the goal of these delivery systems is to have one nurse give all care to the same patient for the entire shift. Total patient care delivery systems are typically used in areas requiring a high level of nursing expertise .such as in critical care units

-:Advantages of a case method

.Continuous, holistic, expert nursing care -1 Total accountability for the nursing care of the assigned -2 .patients for that shift ,Continuity of communication with the patient, family -3 Physicians and staff from other department -:Disadvantages of a case method The nurses spend some time doing tasks -1 that could be done more cost-effectively by less .skilled persons

-:Functional nursing -2
Functional nursing, also called task nursing, begin in hospitals in response to nursing shortage. In functional nursing, the needs of a group of patient s are broken down into tasks and hierarchical structure predominates. The medication nurse, treatment nurse, and bedside nurse are all products of this system. The functional method emphasizes efficiency, division
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of labor .few registered and only some practical nurses were available. Registered nurses keep busy with managerial and non-nursing duties and .practical nurses deliver the majority of care

-: Advantages of functional method

All employee become very efficient and -1 effective at performing there regular assigned .tasks

-:Disadvantages of functional method

.Uneven continuity of care -1 .Absence of a holistic view of the patient -2 .Time consuming communications -3 .Problems with follow up -4

:Team nursing -3
Team nursing was introduced during 1950s to improve nursing services by using the knowledge and skills of professional nurses and to supervise the auxiliary nursing staff. The result was an improvement in patient and staff satisfaction. Team nursing is based on philosophy that supports the achievement of goals through group action. The team is led by a professional or technical nurse who plans, interprets, coordinates, supervise and evaluate the nursing care. Team leaders assign team members to patients by matching patient needs with staffs knowledge and skills. One of main features of team nursing is the nursing care conference. Its primary purpose is the development and revision of nursing care plans by providing an opportunity to identify and solve problems. The nursing care plan is another main feature of team nursing. A care plan identifying present and potential

problems and long and short-term objectives .should be developed for each patient

-:Advantages of team method

Team effort -1 Nursing care conference helps problems -2 solving and develop staff Nursing care planning -3 Team method contributes to the -4 satisfaction of patients and staff needs The team acting as a unified whole has a -5 .holistic respective of the need of each patient

-:Disadvantages of team method

Time to coordinate and delegated work -1 A large amount of time is required for the -2 team leader to maintain effective communication for team planning, supervising and coordinating the care provided by all team members Continuity of care may be diminished because -3 of day-to-day changes in team members and leaders Because each members of the team is assigned -4 specific tasks for the patients and no one considers the total patient, team nursing does .not allow for a holistic view of the patients

-:Modular nursing -4
Modular nursing is modification of team primary nursing. It is sometimes used when there are not enough registered nurses to practice primary nursing. Each registered nurse assisted by paraprofessional delivers as much care as .possible to a group of patients

The registered nurse plans the care, delivers as possible and directs the paraprofessionals for the more technical Aspects of care. The registered nurse's role is closer to That of coordinator and information .processor than that of a charge nurse

-: Advantages of modular nursing

.Useful where there are few RNs -1 When nurses are consistently assigned to the -2 same modular, continuity and quality of care can .increase -: Disadvantages of modular nursing Paraprofessional does technical aspects of -1 .care :Primary nursing -5 Primary nursing conceptualized by Marie man they and implemented during late 1960s after two decades of team nursing the RN remains responsible for the care of patients 24 hrs a day Through out the patient's hospitalization the associated nurse cares For the patients by using the care plan developed by primary nurse while the primary nurse is of duty the number of patients assigned to one nurse varies according to length of hospitalization, complexity of care, number of medical and paramedical personal involved with the patient's care availability of support systems. Decentralized decision making by staff nurses is the core principles of primary nursing, with responsibility and authority for nursing care allocated to staff nurses at the bedside. Primary nursing recognized that nursing was a knowledge
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based professional practice, not just a task based activity. A primary nurse designed, implements, and is accountable for the nursing care of patients for the duration of the patient's stay on the unit. Actual is given by the primary nurse and .associate nurses

-:Advantages of primary nursing

.A knowledge- based practice model -1 Decentralization of nursing care decisions, -2 authority, and responsibility to the staff nurse hrs accountability for nursing care activities 24 -3 .by one nurse .Improved continuity and coordination of care -4 Increased nurse patient, and physician -5 .satisfaction -:Disadvantages of primary nursing Primary nursing requires excellent-1 communication between the primary nurse and associate nurse This practice was viewed as not only expensive-2 but also ineffective because many tasks could be done by less skilled persons. As a result, many .hospitals discontinued the use of primary nursing Unwillingness of associates to take direction -3 .from primary nursing Although the concept of 24hrs accountability is -4 .worthwhile, it is a fallacy -':CASE Management * Nursing case management is a model for identifying, coordinating and monitoring the implementation of services needed to achieve desired patient care out comes within a specified period of time
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nursing case management organizes patient care by major diagnosis or related to groups (DRGs) and focuses on attaining predetermined patient out comes within specific time frames and recourses. The essential elements of nursing case :management are A- Collaboration of all health care members B- Identification of expected patient out comes .with time frames C- Use of principles of continuous quality improvement D- Promotion of professional practice On a patient care unit there may be one or * more nurse case managers who coordinates, communicates, collaborates, problem solves, and facilitate patient care for a group of patients. Nursing care managers are nurses with a advanced degrees and considerable experience. The case manager has a case load of 10 to 15 patients and follows patients progress through the system from admission to discharge, the case manger usually does not provide direct patient care but rather supervises the care provided by licensed and un licensed nursing personnel . The system has contribute to a reduction in complication, reduced cost, increased .collaboration and improved quality of care After a specific patient population is selected to * be case managed a collaborative practice established. A collaborative practice team mad up of clinical experts (e.g. nursing, medicine, physical therapy) needed for the selected patients. Each member of the team determines appropriate interventions within a specified time frame. To initiate case management, specific patients are selected (e.g. high-risk patients) and base line

data must be collected and analyzed before case .management is initiated These data provide bases for comparison of the * effects of case management. Essential base line data include length of stay, cost of care and .complication information Five elements are essential to successful ** implementation of case management. These -elements are A- Support by key members of the organization ( (administrator, physicians, nurses .B- Selection of a qualified nurse case manager .C- Collaborative practice teams .D- A quality management system .E- Established critical pathways Critical pathways are tools or guidelines that *** provide direction for care also refer to the care plan developed by the collaborative practice .team

-:Collaborative practice
Collaborative practice can include inter disciplinary teams, nurse, physician interaction in joint practice, or nurse physician collaboration in care giving. The interaction between nurses and physicians or other health team members in collaborative practice should enable the knowledge and skills of professional to influence the quality of patient care provided. Primary nursing nurse decision making, integrated patient record and a joint practice committee were found .to enhance nurse- physician collaboration

-: Differentiated Practice*
Differentiated practice is a method that maximizes nursing resources by focusing on the structure or roles and functions of nurses
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according to their education, experience and .competence Some organization differentiate roles, * responsibilities and tasks for professional nurses,,, Licensed practical nurses (LPNS ) and .(unlicensed assistative personnel ( UAPs The original integrated competencies of ** nurses' model. Addressed roles by developing a differentiated practice model. The baccalaureate nurses assessed planned, and evaluated. The associate degree-prepared nurses implemented care. One professional and two or three associated nurses cared for 10 to 15 patient during the day. Differentiated practice improves patient care and safety and increased satisfaction .for nurses

-: Restructuring Nursing care delivery

Do more with less) is a goal for most health care) organizations today. As health care organization confront the problem of the shrinking bottom line by reducing salary and reduce the cost of delivering health care. In the search for costeffectiveness, productivity and efficiency, the focus must always be to provide safe, high .quality patient care Nursing service executives are required to * review the nursing care delivery system of the organization critically and systematically for effectiveness, efficiency, and identifying the best mix of (Rns, LPN and UAPs) for each patient .care That will both maintain quality care and be cost * .effective

:Exercise Drew figure to demonstrate the organizational structure of the team method of nursing care delivery system Exam Multiple-choice question Mrs Eman is staff nurse in surgical unit who is -1 responsible for all aspects of the care of one or more patients, her nursing assignment is a- Team method b- Functional method c- Case method d- Case management

Which on of the following statements is -2 incompatible to disadvantages of functional ?method

.a- continuity of care .b- Absence of a holistic view of the patient .c- Time consuming communications .d- Problems with follow up Answer C 2- a -1

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