Models of Nursing Care Delivery.pptx

EDUCATIVE

1. Nursing CARE DELIVERY MODELS Ms Nelly Nzingo

2. Objectives: differentiate among various types of patient care delivery systems list the essential components of total patient care, team nursing, primary nursing, and case management explain what effect staff mix has on work design and the patient care organization

3. Nursing Care Delivery The practice of nursing has emerged as an aggregate of complicated duties and responsibilities. There is, therefore, a need to develop certain systems, methods or modalities to ensure delivery of quality care. There are five methods of assignment of patient care in a hospital. Total Patient Care Functional Nursing Team Nursing Primary Nursing Case Assignment

4. Total Patient Care This was the first method to be identified in nursing care delivery . It i s the oldest mode of organizing patient care It was popular in the 1920's . Each patient is assigned to a nurse for total patient care while the nurse is on duty . It provides nurses with high autonomy and responsibility. If they go off duty, the work is handed over promptly to another nurse. This means that the patient has a different nurse each shift.  Assignment is made according to the severity of illness and tends to be mostly for acutely ill patients

5. Total Patient Care The lines of responsibility and accountability are clear. The patient theoretically receives holistic and unfragmented care during the nurse’s time on duty. Each nurse caring for the patient can, however, modify the care regimen, meaning that the patient could receive different approaches to care in 24hrs requires highly skilled personnel and thus may cost more than some other forms of patient care .

6. Advantages and disadvantages Advantages Consistency in carrying out the nursing care plan Patient needs are quickly met as high number of RN hours are spent on the patient Relationship based on trust is developed between the RN and the patient’s family Disadvantage: It can be very costly

7. Functional Nursing The second method is known as the functional nursing method.It was the first major deviation from case method. The functional method of delivering nursing care developed due to an increased demand of nurses This method emphasizes the division of labor according to specific tasks. It is ‘task or thing oriented’ and is determined by the technical aspects of the job to be done. Each nurse has a clearly defined set of tasks determined by complexity, including skills, knowledge and experience in certain nursing techniques, for example, drug administration, wound dressing, bed baths and so on

8. Functional nursing It requires relative skill to do simple tasks and proficiency is gained by repetition. Personnel are assigned to complete certain tasks rather than care for specific patients In this model, Registered nurses became managers of care rather than direct care providers, and “care through others’’

9. Functional nursing It is considered, an economical means of providing care. This is true if quality care and holistic care are not regarded as essential. A major advantage of functional nursing is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities. May lead to fragmented care and the possibility of overlooking patient priority needs. Because some workers feel unchallenged and under stimulated in their roles, functional nursing also may result in low job satisfaction

10. Advantages and disadvantages Advantages: A very efficient way to delivery care. Could accomplish a lot of tasks in a small amount of time Staff members do only what they are capable of doing Least costly as fewer RNs are required Disadvantages: Care of patients become fragmented and depersonalized Patients do not have one identifiable nurse Very narrow scope of practice for RNs Leads to patient and nurse dissatisfaction

11. Team Nursing Team nursing was introduced in the late 1950's to improve nursing services by utilizing the knowledge and skills of professional nurses and to supervise the increasing number of auxiliary staff. The philosophy supports achieving goals through group action or team spirit . The team member possessing the skill needed by the individual patient is assigned to that patient, but the Team Leader still has accountability for all of the care. Team conferences occur in which the expertise of every staff member is used to plan the care.

12. Team nursing In team nursing , ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. The team leader is responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care. The team leader’s duties vary depending on the patient’s needs and the workload and may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities. Team nursing is usually associated with democratic leadership. There is much autonomy as possible when performing assigned tasks.

13. Team Nursing Team nursing can be organized in the following manner: A group or team of nurses with different levels of skills are assigned to a group of patients. The size and composition of the team is dependent upon the setting. The team works together to accomplish a goal. They focus on patient centered as opposed to task oriented assignments. These are based on patient needs and the knowledge, skills and experiences of team members. A member of the work group is assigned as a leader. In the original concept, the team was led by a registered nurse .

14. Team Nursing The leadership role may be permanent or rotated. The team works together with each member performing the tasks for which they are  best prepared.  Team members report to the team leader who reports to the head nurse. Success is dependent upon effective communication.

15. Advantages and disadvantages Advantages: Each member’s capabilities are maximized so job satisfaction should be high Patients have one nurse (the Team Leader) with  immediate access to other health providers Disadvantages: Requires a team spirit and commitment to succeed RN may be the Team Leader one day and a team member the next, thus continuity of patient care may suffer Care is still fragmented with only 8 or 12 hour accountability

16. Primary Nursing This is a newer approach to the delivery of nursing services.   The concept was developed in the early 1970s and is used by many institutions in the developed world. People are becoming more aware of it in this country and some institutions have begun to incorporate it. Primary nursing , also known as relationship-based nursing , uses some of the concepts of total patient care and brings the registered nurse back to the bedside to provide clinical care

17. Primary nursing Primary nursing requires a nursing staff comprised totally of RNs. The RN primary nurse assumes 24-hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge or the treatment’s end. During work hours, the primary nurse provides total direct care for that patient. When the primary nurse is not on duty, another will follow the care plan established by the primary nurse . job satisfaction is high in primary nursing, this method is difficult to implement because of the degree of responsibility and autonomy required of the primary nurse.

18. Primary Nursing A professional nurse, usually a registered nurse, is assigned to a patient for their total hospital stay or to a small group of patients, not more than four or five This nurse assumes responsibility for twenty four hours a day for the duration of the patient’s stay in hospital. The primary nurse assesses plans and executes the plan or may delegate to a secondary or associate nurse to execute the plan during her absence. Every nurse serves as the primary nurse for a few patients and as an associate nurse for other patients on other shifts. The primary nurse communicates with the physician and coordinates care with other health workers.  The chief nurse functions as a coordinator of the unit and is a resource person for the primary nurses .

19. Advantages and disadvantages Advantages: Increased satisfaction for patients and nurses More professional system: RN plans and communicates with all healthcare members. RNs are seen as more knowledgeable and responsible. RNs more satisfied because they continue to learn as as part of the in-depth care they are required to deliver to their patient Disadvantage: Only confines a nurse’s talents to a limited number of patients, so other patients cannot benefit if the RN is competitive Can be intimidating for RNs who are less skilled and knowledgeable

20. Case management Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes (Powell, 2000). Case managers handle each case individually, identifying the most cost-effective providers, treatments, and care settings for insured individuals ( Finkleman , 2001). length of stay and profit margin per confinement used as measures of efficiency,

21. Case management case management may be unit based, assigned by patient, disease based, or primary nurse case managed (Powell, 2000). Assignment by unit is most common, particularly in mid- to large-sized hospitals because patient units typically care for patients with like diagnoses The premise of inpatient case management is that hospitals are better off “managing the demand for care’’ than attempting to try to increase the “supply of resources’’ such as beds or personnel (Smith, 2003).

22. Advantages and disadvantages Advantages – can be very cost effective and satisfying for patients who are high risk/problem prone. Disadvantages – Case Management is not a true inpatient delivery system but rather the management of patient care.

23. The Future Nursing shortages and health care reform have had a strong impact on the creation of new and evolving types of patient care delivery models. We’re seeing pt focus teams. By that she means the teams have nurses, Dietary, any body else that you can possibly thing of. Everyone gets an input, and you have all the teams working together.

24. The challenges Cost containment Demand for quality outcomes Information age Patient population Multigenerational workforce Fall 2010

25. Integrating Leadership Roles No one best mode Accomplishment of unit goals Seeking solutions not finding fault Working together Facilitates innovative thinking Ensures adequate resources Reduce resistance Remember, change is inevitable Fall 2010

26. The Optimum Mode of Care Carefully constructed Not based solely on economics Fall 2010

27. The End