organizingnursingservices in administration II.pptx

Organizing nursing services

1. ORGANIZING NURSING SERVICES AND PATIENT CARE

2. MODES OF ORGANIZING PATIENT CARE  Case method nursing or total patient care.  Functional nursing  Team nursing or modular nursing  Primary nursing  Case management or managed care

3. Case method  In this method, nurses assume total responsibility for meeting all the needs of assigned patients during their time on duty.

4. Characteristics:  Complete care.  nurses with high autonomy and responsibility.  It is developed and communicated through written sources, its usage remains in contemporary practice.  The lines of authority and accountability are clear.

5. Merits:  The nurses attend to total needs of clients  Continuity of care.  Client/ nurse interaction/rapport can be developed.  Client may feel more comfortable  Educational needs of the client can be closely monitored.  Family and friends became better known by the nurse  Workload of the patient can be equally divided.  Nurse’s accountability for their function is built-in.

6. Demerits:  Many clients do not require the inherent care of intensity in this type of service.  This method need to be modified if professional workers are to be involved effectively.  It is difficult for the nurses to use this method to become involved in long term planning and evaluation of care.  It is not possible if the nurses are not adequately trained for the total care of the patient.

7. Functional method:  In this, persons were assigned to complete certain tasks rather than care of specific patients. Eg. Checking BP, administering medications

8. Characteristics :  Afunctional method is a technical approach of nursing care.  The available staff in the unit, for a particular period of time, are assigned selected functions of nursing practice such as vital signs, treatments, medications.  All the responsibilities are assigned in accordance with the expertise.  The only person who has responsibility of the client is the head nurse or nurse acting the role.

9. Merits :  person become specifically skilled in performing certain assigned task.  best utilization of a person’s aptitudes, experiences and desires.  Less equipment is needed.  saves time.  development of technical skill  sense of productivity for the task oriented nurse  easy to organize the work of the unit and staff

10. Demerits:  Client care become impersonal, compartmentalized and fragmented.  diminishing continuity of care.  Staff may become bored and have little motivation.  only the nurse in-charge has accountability for the client.

11.  little avenue for the staff development.  Client may tend to feel insecure.  Only parts of the nursing care plan are known  difficult to establish the client priorities.  only safe when the head nurse co-ordinate all the activities of the members.

12. Team nursing:  Team nursing is based in the philosophy in which a group of professional and non- professional personnel work together who identify, plan, implement and evaluate comprehensive centered care.

13. Characteristics:  ancillary personnel collaborate in providing care.  Team nursing involves decentralization of nursing unit and professional head nurse authority.  Each team composed of a team leader, team members and patients.  Comprehensive care is the responsibility of the entire team.

14.  The head nurse has the responsibility to know the conditions of all patients assigned to the team and planning individual care.  democratic leadership.  Group members are given as much as autonomy

15. Merits:  includes all health care personnel in the group functioning and goals.  Feelings of participation and belonging  Workload can be balanced and shared.  Division of labour allows members the opportunity to develop leadership skills  Every team members has the opportunity to learn from and teach collegues.

16. Demerits:  Establishing the team concept takes time, effort and constancy of personnel.  Unstable staffing patterns make team nursing skills patterns make team nursing difficult.  All personnel must be client centered.  This leads to blurred lines of responsibility, errors, and fragmented care.  For the team nursing to be effective the leader must be excellent practitioner and have good communication, organizational, management, and leadership skills.

17. Primary nursing:  It is also called relationship based nursing. It involves total nursing care, directed by a nurse on 24 hour basis as long as the client is under the care.

18. Characteristics :  The RN 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.

19.  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 combination of clear interdisciplinary group communication and consistent, direct patient care by relatively few nursing staff allows for holistic, high quality patient care.

20. Merits :  opportunity for the nurse to see the client and family as one system.  Nursing accountability, responsibility and independence are increased.  The nurse is able to use wide range of skills, knowledge and expertise.  potentiates creativity by the nurse and thereby work satisfaction increases  increased trust and satisfaction for both

21. De m e r it s :  The nurse may be isolated from the colleagues.  Little avenue for group planning of care.  Nurse must be mature and independently competent.  It must be cost effective.

22.  Staffing patterns may necessitate a heavy client load .  It may be difficult to recruit and retain enough staff, especially in times of nursing shortage.  An inadequately prepared or incompetent primary nurse may be incapable of coordinating a multidisciplinary team or identifying complex patient needs and condition changes.

23. Case management: Case m anage m ent collaborative process is defined that assesses, as a p lans, implements, coordinates, monitors and evaluates opinions and services to meet an individual health needs through communication and available resources to promote quality, cost-effective outcomes. Case management society of America

24. Characteristics:  Case mangers handle each case individually.  In general case manger can handle a load of 25 patients [smith, 2003].  Case mangers use critical pathways and multidisciplinary action plans to plan patient care.

25. Responsibilities of case managers:  Assessing clients and their homes and communities .  Coordinating and planning client care.  Collaborating with other health  Monitoring client progress and client outcomes.  Advocating for clients  Serving as a liaison with third party

26. Mer i t:  addi t ional work e f fic i ency due t o geograp h ic a l proximity.  Est a b lishes sol id re l a t i o nshi ps w i th nursing a n d ancillary staff working on the unit.  Case m anage m ent provides a w e ll co o rd i n a ted care.  Provides comprehensive care  It s eeks t h e a cti v e i n volve m ent of the p a t i ent, family and diverse health care professionals

27. Demerits:  Some experts are argued that this role should be reserved for the advance practitioner nurse or an RN with advanced training or need 3 to 5 year experience.  The case manger should also be extremely bright, have well developed interpersonal skills, be able to multitask, have a strong foundation in utilization review, and understand payer-patient specifics and hospital reimbursement mechanisms.

28.  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.

29. Modular nursing Modular nursing is a modification of team nursing and focuses on the patient‘s geographic location for staff assignments. The concept of modular nursing calls for a smaller group of staff providing care for a smaller group of patients.

30. Characteristics :  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 may include LVN/LPN or UAP.

31.  The team leader is accountable for all patient care and is responsible for providing leadership for team members and creating a cooperative work environment.  The success of the modular nursing depends greatly on the leadership abilities of the team leader.

32. Merits: ♣ Nursing care hours are usually cost-effective. ♣ The client is able to identify personnel who are responsible for his care. ♣ All care is directed by a registered nurse. ♣ Continuity of care is improved ♣ The RN as team leader is able to be more involved in planning & coordinating care.

33. ♣ save staff time. ♣ Feelings of participation and belonging ♣ Work load can be balanced and shared. ♣ develop leadership skills ♣ Continuity care is facilitated ♣ Everyone has the opportunity to contribute to the care plan.

34. Demer i ts : ♠ Costs may be increased to stock each ♠ takes time, effort, and constancy of personnel. ♠ Unstable staffing pattern make team difficult. ♠ There is less individual responsibility and autonomy regarding nursing function. ♠ All personnel must be client centered. ♠ The team leader must have complex skills and knowledge .

35. 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 .

36. Principal elements of PPC are:  Intensive care or critical care  Intermediate care  Convalescent and Self Care  Long-term care  Home care  Ambulatory care

37. Merits : ♣ Efficient use is made of personnel and equipment. ♣ Clients are in the best place to receive the care . ♣ 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.

38. Demerits : ♣ discomfort to clients who are moved often. ♣ Continuity care is difficult. ♣ 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.

39. DIFFERNTIATED NURSING PRACTICE  Differentiated nursing practice refers to an attempt to separate nursing practice roles based on education or experience or some combination of both.

40.  Education model: Role differentiation based upon type of educational preparation [BSN, MSN etc]  Competency model: Role differentiation based on individual nursing skills, expertise, experience etc.

41. Merits:  match patients needs with nursing competencies .  efficient use of nursing resources.  Provide equitable compensation  It increase nurse satisfaction, built loyalty and increase the prestige of the nursing profession.

42. THANK YOU…