PATTERNS OF NURSING CARE DELIVERY SYSTEM IN INDIA : PATTERNS OF NURSING CARE DELIVERY SYSTEM IN INDIA SUBMITTED TO, SUBMITTED BY,
Mrs. Devakirubai M.Sc(N) Rajeswari. G
Reader I year M.Sc(N)
SHNC SHNC. MEANS OF ORGANIZING NURSING CARE : MEANS OF ORGANIZING NURSING CARE CASE METHOD OF NURSING
CASE MANAGEMENT CASE METHOD : CASE METHOD Slide 4: Oldest mode of organizing patient care.
It involves the assignment of 1 or more patients to a nurse for a specific period of time. Complete care including treatment, medication administration etc
Nurses assume total responsibility for meeting all the needs of assigned patients.
Widely used in hospitals & in nursing homes.
Students, private duty nurses, & specialty units such as ICU, ICCU etc. MERITS : MERITS Nurse can see better & attend to the total needs.
Continuity of care can be facilitated
Client/nurse interaction & Rapport can be developed
Client may feel more secure
Family & friends become better known by nurse & get more involved
Equal Workload DEMEIRTS : DEMEIRTS Many clients do not require the inherent care.
Must be modified if non-professional health workers are used.
Great disadvantage, when nurse is inadequately trained
Cost-effectiveness Slide 7: FUNCTIONAL METHOD Slide 8: In 1950s, when few registered & only some practical nurses were available, much patient care was given by nurse’s aides.
RNs were keep busy with managerial & non-nursing duties & nurse’s aides deliver the majority of patient care.
The functional method of delivering nursing care evolved as a result of World War II.
Ancillary personnel were used to assist in patient care
Unskilled workers were trained & assigning persons to complete certain tasks. Eg checking BP, changing linen, bathing patients etc MERITS : MERITS Person can become particularly skilled in performing assigned tasks,
The best utilization can be made
Less equipment is needed
Potential for development of technical skills is amplified
There is a sense of productivity for the task oriented nurse
It is easy to organize the work of the unit & staff. DEMERITS : DEMERITS Client care become impersonal
Tremendous risk for diminishing continuity of care
Staff may become bored & have little motivation to develop self & others,
Work may become monotonous
The staff nurse are accountable for the task,
Client may tend to feel insecure.
Only parts of the nursing care plan are known to personnel. Slide 11: TEAM NURSING Slide 12: After II World War, RNs were still scarce, although the number of auxiliary personnel had increased.
It was introduced during the 1950s
To improve nursing services by using the knowledge and skills of professional nurses & supervise the work of auxiliary staff. The result was an improvement in patient and self satisfaction.
Auxiliary personnel collaborate in providing care to a group of patients under the direction of a professional nurse.
Based on philosophy that supports the achievement of goals through group action. Slide 13: …cont
Team is led by a professional or technical nurse who plans, interprets, coordinates, supervise, and evaluates the nursing care.
Team leader assign team members to patients by matching patient needs with staffs knowledge and skills.
Main features of team nursing is,
- nursing care conference
- team conference
- nursing care plan Slide 14: ..cont
RESPONSIBILITIES OF TEAM LEADER:
Responsible for knowing the condition and needs of all assigned patients
Duty vary depending on the workload. i.e assisting the members and giving direct personal care to the patient.
Planning and conducting the conference
Continuity of care is not given
Changing team membership makes it difficult for the team leader to assign the patient. Slide 15: MODULAR OR DISTRICT NURSING Slide 16: Modification of team & primary nursing.
It is used when there are not enough registered nurses to practice.
RN plans the care & directs the paraprofessionals
Paraprofessionals care MERITS : MERITS Includes all health care personnel.
Balanced & shared workload
Develop leadership skills
Opportunity to learn & to teach
Client is able to identify personnel who are responsible
All care is directed by a RN
Barriers between professional & non-professional can be minimized
Every one has the opportunity to contribute to the care plan. DEMERITS : DEMERITS Unstable staffing patterns make team nursing difficult
All personnel must have complex skills and knowledge i.e., communication, leadership.
There is less individual responsibility and independence regarding nursing practice. Slide 19: PRIMARY NURSING Slide 20: Developed in the early 1970s in some hospitals by professional nurses.
Based on the philosophy that patients, instead tasks.
It involves total nursing care, directed by a nurse on a 24 hrs basis as long as the client is under the care.
Here one nurse is the client’s nurse, at all times directing, planning, evaluating & teaching.
Here one professional nurse who gives total patient care to 4-6 patients & she is responsible for the care of those patients 24 hrs a day throughout the patients hospitalization. Slide 21: …cont
The primary nurse does the admission interview & develops the nursing care plan and shared with the associate nurse.
The associate nurse cares for the patient by using the care plan developed by primary nurse
The number patients assigned to one nurse varies according to length of hospital stay, complexity of care.
Research suggest that patients have fewer complications and a shorter hospitalization when cared by a primary nurse. MERITS : MERITS Reduces the number of errors that can result from a relay of orders.
Increased satisfaction by both nurse and satisfaction.
Nurses can identify patient outcomes as a result of their work.
The nurse may be isolated from colleagues.
It may be cost-effectiveness
Nurse’s talents to a limited number of patients.
Nursing care plan can be changed only with the permission of primary nurse. Slide 23: CASE MANAGEMENT Slide 24: Case management focuses an entire episode of illness, including all settings in which the receives care. Is a method in which client care areas or units provide various levels of care.
e.g. – ICU for the critically ill
- Post intensive care unit
- Regular care unit
- Convalescent unit
- Self care unit
Clients are evaluated in all level
It emphasizes achievement of outcomes in designated time frames with limited resources. Slide 25: ….cont
Case consultation may be indicated when the client’s condition differs.
Case consultation is conducted about once a week for a few minutes immediately after intershift to deal with variation.
It may be conducted informally whenever a staff identifies a variation.
The problem solvers focus on the variation and desired outcomes, brainstorm ideas to achieve desired outcomes MERITS : MERITS Efficient use is made of personnel & equipment
Clients are in the best place to receive the care they require.
Use of nursing skills & expertise are maximized.
Clients are moved towards self care, independence is fostered where indicated. DEMERITS : DEMERITS Discomfort to clients
Continuity care is difficult
Long term nurse /client relationship are difficult to arrange. Slide 28: THANK YOU