Patient classification system bjb

Models of Patient Assignments

1. Models of Patient assignment Bivin JB Dept of Psychiatric Nursing

2. Introduction Grouping of patients according to the amount & complexity of their nursing requirements Patient acuity- Nursing work load that is generated for each patients Patient acuity ≈ Amount of nursing service Patient classification system is the scheme that group patients according to the amount & complexity of their nursing care requirements

3. Class Presentation Ms Anila Mathew

4. Presentation overview Case method nursing or total patient care. Functional nursing Team nursing or modular nursing Primary nursing Case management or managed care

5. Case method Nurses assume total responsibility for meeting all the needs of assigned patients during their time on duty.

6. Characteristics: Complete care. N urses 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.

7. 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.

8. 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.

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

10. Characteristics: A functional 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.  

11. Merits: P erson become specifically skilled in performing certain assigned task. B est utilization of a person’s aptitudes, experiences and desires. Less equipment is needed. S aves time. D evelopment of technical skill Sense of productivity for the task oriented nurse Easy to organize the work of the unit and staff

12. Demerits: Client care become impersonal, compartmentalized and fragmented. D iminishing continuity of care. Staff may become bored and have little motivation. Only the nurse in-charge has accountability for the client.

13. Continues… 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.

14. Team nursing A group of professional and non- professional personnel work together who identify, plan, implement and evaluate comprehensive centered care.

15. 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.

16. Continues… 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

17. 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 labor allows members the opportunity to develop leadership skills Every team members has the opportunity to learn from and teach colleagues.

18. 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.

19. 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.

20. 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

21. 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

22. Demerits : 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. Staffing patterns may necessitate a heavy client load. It may be difficult to recruit and retain enough staff, especially in times of nursing shortage.

23. Case management A collaborative process that assesses, plans, 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. 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 team Monitoring client progress and client outcomes. Advocating for clients Serving as a liaison with third party

26. Merits: Additional work efficiency due to geographical proximity. Establishes solid relationships with nursing and ancillary staff working on the unit. Case management provides a well coordinated care. Provides comprehensive care It seeks the active involvement of the patient, 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. Expensive

28. Modular Nursing   Modular nursing is a modification of team nursing and focuses on the patient‘s geographic location for staff assignments.

29. 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 LPN.

30. Continues.. 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.

31. 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.

32. ♣ 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.  

33. Demerits: ♠ 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.  

34. 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.

35. Principal elements of PPC   Intensive care or critical care Intermediate care Convalescent and Self Care Long-term care Home care Ambulatory care

36. 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. ♣ Persons have greater probability to function towards their fullest capacity.

37. 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 difficulty in meeting administrative need of the organization, staffing evaluation and accreditation.

38.   Differentiated Nursing Practice An attempt to separate nursing practice roles based on education or experience or some combination of both. 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.

39. 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.

40. THANK YOU…