Methods of patients assignment-nursing management

Nursing Management

1. WARD MANAGEMENT AND METHODS OF PATIENT ASSIGNMENT

2. INTRODUCTION Management is a process that involves planning, organizing, directing and controlling resources to achieve desired goals. Resources include man, money, material and methods. It is also an activity that involves getting the work done through others by directing their efforts, decision-making and interpersonal relationship .

3. Introduction contd... ward management plays a very important role in a hospital. Wards are the local units of the hospital is headed by the head nurse. she holds the responsibility to manage each word peacefully without any issues, as it reflects the quality of care at the hospital.

4. Definition Of Ward Management 🍓 Ward management can be defined as the optimal utilization of the ward resources to produce maximum output namely care and Comfort of patients. - Net source. 🍓Ward management is managing the work of a ward that involves planning, organizing, directing and controlling the staff material and support services of the unit to achieve the best patient care. - Jogindra vati (2020)

5. CONCEPTS OF WARD MANAGEMENT 💉Ward is the place for patient care unit for the treatment of admitted patients. 💉 It is also a block, which forms a division in hospital that is shared by patients, who needs similar kinds of care. 💉Number and types of words depends upon the type of hospital like District Hospital, General Hospital, referred hospital and specialised hospitals and may be private voluntary, aided or Government hospitals.

6. Concepts of ward management contd... 💉Mostly there are 2 types of warts i.e general and special wards example intensive care units pediatric ward and psychiatric ward. 💉 All the departments of a hospital including all wards are involved in caring for the sick and injured in the aspect of promoting health, preventing diseases, education, teaching and research. 💉As the ward nursing unit is the place for patients to stay it becomes the center for coordinating all efforts

7. ORGANIZATION OF WARD MANAGEMENT: HEAD NURSE OF THE ENTIRE DEPARTMENT MED WARD SUR WARD GERI WARD ORTHO WARD OT OBG WARD PAED WARD MHN WARD WARD INCHARGE STAFF NURSE EACH WARD HAS; SENIOR NURSE – 1, JUNIOR NURSE – 1. STUDENT NURSE, ATTENDANT AND SWEEPER

8. Objectives Of Ward Management : Make sure that the highest possible quality of patient care is provided. Provide a clean, safe, comfortable and free from infection, accident and hazards environment. Help staff in achieving the highest level of work satisfaction. Ensure all the facilities are available to meet the needs of the patient and their attendants.

9. Objectives Of Ward Management contd... Direct and supervise staff working under a hesd nurse. Coordinate and communicate with team members Establish and maintain professional code of ethics in clinical practice and among staff. Provide the sense of highest job satisfaction among the staff members. Ensure maximum utilization of hospital resources.

10. PRINCIPLES OF WARD MANAGEMENT The principles of ward management are as follows; 📌 Identify the staff of the word as their most significant asset. 📌 Recognize the value and importance of each person associated and inspire them for their best thinking and performance. 📌Approach every task in an organised conscious manner to achieve the outcome.

11. Principles of ward management contd... 📌 Established definite short term and long range objectives to ensure most significant accomplishment. 📌 Secure full attainment of goals through general understanding and acceptance of them by others. 📌Utilise resources carefully to achieve the most significant possible benefits. 📌Keep individual faculty of the team well adjusted by ensuring that each one knows what he or she is supported to do, how well with what authority and what type of work relationship he are she has with others.

12. Principles of ward management contd... 📌Concentrate on individual improvement through regular review of performance and potential. 📌 Private an opportunity for assistance and guidance in self development and a fundamental of institution for growth. 📌 Maintain adequate and timely incentive and rewards for an increase in human efforts. 📌 Supply work satisfaction for those who perform their work and those who are served by it.Be flexible to meet the changing conditions and emergencies

13. RESPONSIBILITIES OF NURSING PERSONNEL INVOLVED MANAGEMENT Responsibilities of the head nurse : * To plan the duty roaster * To control and coordinate the activities of the special wards * To plan all the activities done by ward in-charge. * To supervisor nursing care being rendered for all patients To conduct nursing rounds * To conduct rounds to maintain enrolment register of all the staff and ward in charge.

14. Responsibilities of the head nurse contd... * To allocate the alternative staff in case of absentee. * To conduct meeting the subordinate staff and provide guidance and teaching. * To ensure proper functioning of all class iv workers. * To frequently supervise all wards to maintain cleanliness.

15. RESPONSIBILITIES OF THE WARD IN-CHARGE SISTERS: * Report to the head nurse about any issues. * Plan control and supervise the activity of the subordinates. * Ensure ward cleanliness safety and security * Oversee the patient conditions regularly. * Conduct ward rounds with staff nurse and plan her daily activities accordingly. * Coordinate the shift schedule day or night. * Meet the healthcare needs of all patients in the ward.

16. RESPONSIBILITIES OF THE SENIOR STAFF NURSES: * They have to report to the ward duty in time and sign in the register. * The allocate duties the juniors and student nurses. * They provide individual care to the patients. * They write and record the patient details. * They report the patient care to ward in-charge regularly. * They maintain the patient care sheets.

17. Responsibilities of the senior staff nurses contd... * They maintain the patient care sheets. * They oversee the work of class iv workers. * They keep in the units neat and clean. * They identify and order and need of the supplies for approval from ward in-charge for patient care.

18. FACTORS AFFECTING WARD MANAGEMENT : 1. Knowledge of the ward means knowledge of the ward duties and activities. 2.Planning the schedule. 3. Starting the work on time. 4. Preventing interruptions. 5. Establishment of word routines. 6.Use of democratic method in establishing ward policy. 7.Orientation of new personnel.

19. Factors affecting ward management contd... 8.Organization of - hospital and - ward / unit 9. Maintenance of suitable environment 10.Providing supplies and equipments in hospital 11.Clear cut, specific orders for medical therapy and nursing 12.Record keeping, maintaining accurate record is essential for good management.

20. Factors affecting ward management contd... 13.Reporting. 14.Maintenance of high morale. 15.Establishment of good relationship 16. Delegating responsibility 17.Assigning duties and responsibilities. 18.Time planning. 19.Good teaching 20.Good supervision

21. COMPONENTS OF WARD MANAGEMENT

22. COMPONENTS OF WARD MANAGEMENT a. MANAGEMENT OF PATIENT CARE 1. Admission and orientation of the patient 2.Assessment of the needs of patients and planning care 3.Prioritizes nursing care 4. Planned and incidental teaching 5. Supervision of patient care 6. Planning a program for the improvement of patient care 7.Preparing patient for discharge.

23. Management of patient care contd... 8.Assignment of personnel for patient care 9. Planning the time schedules and work schedules. 10.Ward rounds 11. Reports and records 12. Management of emergencies 13. Patient education 14. Appraisal of nursing services

24. b. MANAGEMENT OF PERSONNEL

25. A . Components of Managing the Nursing Staff

26. B.Management of class IV staffs: 🧴Prepares the duty schedule and keeps a record of their off days. 🧴Adjust casual leaves, compensatory leaves and earned leaves 🧴Forwards late attendance and absentesim to the sanitary inspector 🧴Request for a substitute against absenties . 🧴Fills the annual confidence report and send to sanitary inspector.

27. C.MANAGEMENT OF SUPPLIES AND EQUIPMENTS : ✂️Apply the principles of material management ✂️The head nurse ensures proper utilization of the supplies and equipment by the stuff. ✂️ Follow the hospital policies regarding indentings and maintaining supplies and equipment.

28. D.MANAGEMENT OF ENVIRONMENT: * Regulation of atmospheric temperature humidity and ventilation. * Adequate lighting. * Prevention of noise * Safe water supply * Elimination of unpleasant odors . * Safe disposal of excreta. * Dust control * Free from insects and pest

29. Management of environment contd... * Protection from all types of injuries * Protection from radiation * Provide adequate privacy * Restriction of visitors * Prevention of infection

30. e. INTEGRATING WARD POLICIES: Patient and patient care Ward management Staff Medical staff Policies related to

31. * Admission policy. *Orientation policy * Visiting hour policy * Diet policy * Policy regarding sample collection, * Preoperative and post - operative policy * Transfer policy * Discharge policy * Leave against medical advice and discharge on request * Last office policy * For absconding policy and * policy for medico legal cases. Policies related to patient and patient care :

32. * Central sterile supply * Indent policy * Records and report policy * Census policy * Drug policy * Linen policy * Sanitation policy * Hand washing policy * Policy for prevention of infection * Waste management policy * Ward rounds policy * Standard operative procedures Policies related to ward management

33. * Policy on orientation for new team. * Policy for time schedule and assignment of staff * Leave policy * Discipline policy * Supervision and appraisal * Policy for staff development Policies related to staff

34.   Policies for the medical staff * The staff this is the mediator between doctors and patients * The ward sister / senior sisters should accompany on medical rounds * All instructions are written by a doctor * The senior staff should inform the senior doctor during an emergency during the day or night.

35. FACTORS INVOLVED IN GOOD WARD MANAGEMENT : The factors involving in good ward management are as follows: 1.A planned program/ work schedule for each day’s work 2.Beginning the day on time 3.Preventing interruptions 4.Establishment of ward routines and policies 5. Use of democratic method in establishing ward policies 6. Orientation to newly joined staffs.

36. FACTORS INVOLVED IN GOOD WARD MANAGEMENT : 7.Maintaining a safe and healthy work environment 8.Provision of adequate supplies and equipment for efficient work 9. Clear cut doctors and nurses instructions 10. Accurate reports and records 11.Keeping high morale and interpersonal relationship among staffs 12.Delegation of responsibility 13.Proper schedule plans 14. Good teaching and supervision 15.Periodically evaluation of the team.

37. CRITERIA TO BE FULFILLED FOR GOOD NURSING MANAGEMENT : 1.All the staff should work with team spirit. 2. Organization should ensure positive reinforcement by rewarding staff talent. 3.Good economic and improve working conditions for all the staff should be established. 4. Following unity in direction and unity in command. 5.Strict observation of rules and regulations.

38. Criteria to be fulfilled for good nursing management contd... 6.Organization should ensure conducting regular medical and nursing audit. 7.Organization should provide orientation, training for the newly appointed staff and encourage their talents. 8. Provision in service education and continuing education 9.Guidance and the counselling 10.Trained talented administration to control and oversee the entire environment process of patient care.

39. ROLE OF HEAD NURSE IN PATIENT CARE 1. Admissions and discharges 2.Management of patient discharges 3.Doctors rounds activities to be performed - before activities - during the doctors rounds - after rounds 4. Drug administration 5. Operation Theatre administration 6.Inter departmental coordination and Reporting.

40. METHODS OF PATIENT ASSIGNMENT INTRODUCTION One important function of the professional nurse at the first line management position of nursing service department organising the activities of the staff into a workable pattern to meet patient needs

41. Methods of patient assignment contd... Planning of patient assignment is not a mere matter of dividing up the patients among the available members of the staff but it is an assigning an individual patient or group of patients to nurses according to the patients nursing care needs and nurses ability to give care to those assigned patients.

42. MEANING OF PATIENT ASSIGNMENT : The patient assignment is delegating or assigning duties to the trained nurses for the care of a group of patients admitted in the unit The terms nursing assignment patterns, nursing assignment systems and organization mode of nursing care synonymously refer to the methods of patient assignment.

43. DEFINITION OF PATIENT ASSIGNMENT Patient assignment refers to “ a written delegation of duties to care for a group of patients by trained persons assigned to the unit - Nisha Clement (2018). The method of patient assignment is a process or system by which nurses deliver the care to the assigned patients.The nurses are responsible and accountable for the care of patients. - J.Vati (2020).

44. OBJECTIVES OF PATIENT ASSIGNMENT : * To promote good health in the patient with the best possible nursing care. * To plan assignments that are interesting and stimulating to professional growth. * To provide a broad education and experience for each student nurse. * To achieve good ward management.

45. PURPOSES OF ASSIGNMENT IN HOSPITAL SERVICES : * Explain what is to be done and describe to how to do it. * Provide the instructions and tasks to subordinates to carry out their work as scheduled. * Control and supervise their activities assigned. * Motivate to meet the firm goals * Provide a proper leadership to control the hospital services.

46. PRINCIPLES OF PATIENT ASSIGNMENT : The principles of assignments are as follows, 1. Assigning the task of patient care by that head nurse 2.Following the departmental policies and guidelines 3. Considering patients needs, unit activities and geographical location of the unit. 4. Assigning equal and balanced workload among staff and duty and rotation

47. Principles of patient assignment contd... 5.Considering capabilities experiences and interest of nursing staff 6. Patient assignment planned for nurses to grow in professional competencies and necessarily involve the fulfillment of student education requirements 7. Assuring continuity of care and selecting the method well in advance . 8.Documenting and making everyone familiar.

48. FACTORS INFLUENCING PATIENT ASSIGNMENT * Availability of nursing workforce * Organizational complexity * Severity of illness * Patient characteristics * Physical design of the unit * Nursing resources * Organization support * The financial health of the institution * Recommendation of the accrediting body

49. METHODS OF PATIENT ASSIGNMENT :

50. FUNCTIONAL NURSING : The functional method of patient assignment is efficient method,it aims to get the task at that least cost of time and staff. This method developed in the late of 1800’s due to the acute sort of nurses, increased demand for hospital nursing and tasks.

51. Head nurse Nurse 1 Treatment Nurse 3 planing care Nurse 2 Checking vital signs Nurse 4 Hygeine and care Of All Unit Patient Care FUNCTIONAL NURSING :

52. ADVANTAGES OF THE FUNCTIONAL NURSING : * Emphasize the concept of specialization and division of labor . * Requires less number of nurses * It is a quite economical and efficient way of doing work. * Carries out some activities within the limited period of time Makes the nurses competent to carried out the assigned task repeatedly.

53. Advantages of functional nursing contd... * Helps establish managerial control over the planning job. * Is a ppropriate for handling emergencies * Ensure the less confusion of the nurse over the assignment. * Requires minimum articles and equipment of care.

54. DISADVANTAGES OF FUNCTIONAL NURSING : * Is task focused and not patient focused. * More mechanical than the humanistic. * Requires some nurses to look after one patient through different activities. * Causes communication barriers and among various persons. * No nurse is responsible for overall responsibility of the patient. * Neglects the holistic approach * Make the nurse task oriented rather than the patient oriented.

55. TEAM NURSING The concept of team nursing was introduced in the early 1950’s response to the dissatisfaction of the nurses with the functional method.

56. Head nurse TEAM LEADER RN TEAM LEADER RN Assigned Patients TEAM NURSING : ASSOCIATE RN ASSOCIATE RN NURSE AID NURSE AID Assigned Patients

57. ADVANTAGES OF TEAM NURSING : * Offer comprehensive care from all expertise * Ensures the integration of nursing personnel with varying skills into a team. * Focuses on patient needs than on staff member needs. * Enhances communication and coordination. * Offers cohesive participation by the team members in decision making * Fosters a sense of contribution via the team * Improves patient care by using diverse skills * Economizes time and efforts.

58. DISADVANTAGES OF TEAM NURSING : There is a possibility of in-continuity of care due to change in the leaders, team members and patient assignment. None is accountable for total patient care There is role confusion and resentment against team leaders It requires knowledgeable and skilled leader with leadership qualities. It needs more staff.

59. MODULAR (OR) DISTRICT NURSING: The modular nursing method has a combination of functional and team nursing methods with some modifications.

60. Head nurse Geographic patient unit I Geographic patient unit II Patient care team MODULAR (or) DISTRICT NURSING : ASSOCIATE RN NURSE AID Patient care team ASSOCIATE RN NURSE AID

61. MERITS OF MODULAR NURSING : * Nursing care hours are usually cost –effective * The client is he able to identify personnel who are responsible for his care. * All care is directed by a registered nurse * Continuity of care is improved when staff members are constantly assigned to the same schedule. * The RN team leader is able to be more involved in planning and coordinating care.

62. Merits of modular nursing contd... * Geographic closeness and more efficient communication save staff time. * Feelings of participation and belonging are facilitated with team members. * Workload can be balanced and shared. * Division of labour allows/members the opportunity to develop leadership. * Continuity of care is facilitated especially if teams are constant. Everyone has the opportunity to contribute to the care plan.

63. Demerits of Modular nursing : * Cost may be increased to stock each module * Establishing the team concepts takes more resources * Unstable staffing pattern * Less individual responsibility * All personal must be client centered . * The team leader must have complex skills and knowledge.

64. PROGRESSIVE PATIENT CARE ( PPC ) It is a method in which the client care provide various levels of care. The clients are evaluated with respect all the level of care. PRINCIPLE ELEMENTS OF PPC :

65. MERITS OF PPC : * Efficient use in 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.

66. DEMERITS OF PPC : * There may be discomfort to clients who are moved often. * Continuity of 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.

67. PRIMARY CARE NURSING It was developed in 1960s with the aim of placing RN at the bedside and improving the professional relationship among the staff members. * In acute care - 1 patient * In intermediate care - 3 patients are under the Care of primary care nursing

68. PRIMARY CARE NURSING PRIMARY NURSE COMMUNICATE WITH SUPERVISORS CONSULTS WITH PHYSICIAN OR OTHER HEALTH CARE ASSOCIATES [DAY OR AFTERNOON OR EVENING] WHEN PRIMARY NURSE IS NOT AVAILABLE TOTAL PATIENT CARE 24 HRS / DAY PATIENTS

69. ADVANTAGES PRIMARY CARE SYSTEM: * Is good for long term care rehabilitation units and nursing clinics. * Primary nurses are in a position care of entire needs of person holistically. * High patient and family satisfaction. * Promotes registered nurses responsibility or a utonomy accountability and coverage. * Focusing Patients centred care * Increases coordination and continuity of care

70. DISADVANTAGES OF PCN : * More nurses are required for this method * Level of expertise and commitment may differ from nurse to nurse * Associate nurses find the difficulties * It may be cost effective * May create conflict between primary and associate nurses * Stress of round the clock responsibility * Difficulty hiring all registered nurse. * Confines talent to his/her own patient

71. CASE MANAGEMENT The case manager (RN or social worker with managerial qualification) is assigned responsibility following a patient’s care and progress from the diagnostic phase through hospitalization rehabilitation and back to home care.

72. Responsibilities of the case manager : * Accessing 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 outcomes * A dvocating for clients moving through the services needed * Serving as liasion with the 3 rd party payers in planning the client care.

73. MERITS OF CASE MANAGEMENT : * Case management provides a well coordinated care experience that can improve the care outcome. * Provides comprehensive care for those with complex health problems * It seeks the active involvement of the patient f amily and diverse healthcare professionals

74. DEMERITS OF CASE MANAGEMENT : * Nurses identify more obstacles in the implementation of this service, financial barriers and lack of administrative support. * Expensive * Nurse is client focused and outcome oriented. * Facilitated and promotes coordination of cost effective care * It requires professionally autonomous role of the nurses.

75. PRIVATE NURSING This nursing care delivery system was a popular as care nursing, private duty nursing is one nurse carrying for one client. According to this system the private duty nurse responsible for one patient who is responsible for adding total care. ADVANTAGES * Is based on the need of the patient. * Focuses on the therapeutic nurse client relationship * Increases nurse and client satisfaction with care delivery

76. DISADVANTAGES OF PRIVATE NURSING : *Is a costly model *Offers slow efficiency *Lacks of job security and job motility.

77. Collaborative practice Collaborative practice can include interdisciplinary team nurse physician interaction in joint practice nurse physician collaboration in care giving. The American Nurses Association and the American nurses Medical Association established the National joint practice committee in 1972 is suppoerts the collaborative nursing care.

78. DIFFERENTIATED PRACTICE It refers to the difference between professional and technical nursing. Completion of decision making, timeline of care and structure of setting are its main distinctive features. Professional nurses received a baccalaureate or graduate degree. They give direct care to the clients with complex interactions of nursing diagnosis and related to their families from pre admission to post discharge in a variety of more or less structured settings.

79. Factors influencing the quality of patient care : The total number of patient to be nursed. The degree of illness of patients Types of services(medical or surgical) The total needs of the patient Method of nursing care Number of nursing aids and other non professisonal available. The amount type and location of equipment and supplies The acuteness of the service and rate of turnover of patients according to the degree or period of illness The experience of the analysis who are give patient care. The physical facilities The number of non nurses who giving care to the patients The number of working hours in the working week of the nurses Method of performing nursing procedures Affliation of the hospital with the medical school Methods of assignment individual or functional method The standards of nursing services

80. Summary so far we discussed about the ward management by the head nurse in the various aspects, objectives functions , principles and the good qualities, factors affecting in ward management and components of word management, factors improved to the ward management and criteria to be fulfilled for effective word management and the methods of patient assignment, we in detail discussed about the patient assignment objectives purposes and principles under the various methods advantages and disadvantages.

81.   Conclusion : Ward is a place nursing and patient care unit for the treatment of admitting patients. Hospitals are the institutions where the patients are treated and provided shelter during their illness. The coordinated effort of all healthcare workers helps the patient to recover quickly from the illness. A nurse is an important part of the healthcare team the overall goal of nursing is to meet the patients nursing needs with the available resources effectively by the method of patient assignment

82. THEORY APPLICATION FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY NURSING ACTIONS methods of patient assignment Team Nursing HEALTH PATIENT ENVIRONMENT Patients treatment room arrangement according to his comfort

83. Journal application Title of the study Nursing management of general ward under the COVID-19 outbreak Author : Fanglian yi.et.al., Findings of the study COVID-19 is complicated and is of high possibility of management of cross infection management of patients should be isolated during treatment with relatively long recovering period. Therefore effective nursing management with following of cleaning and disinfection of the medical ward takes important place in the prevention and control of the pandemic.

84. Assignment write an assignment about the methods of patient assignment followed in Government Medical College hospital, Cuddalore in their respective department intensive care units.