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SRI GURU RAM DAS NURSING INTITUTE PANDHER

AMRITSAR

ASSIGNMENT
ON
METHODS OF PATIENT
ASSIGNMENT AND PRIMARY CARE
NURSING

Submitted To: Miss Arpandeep Kaur

Associate professor
Dept. of Community Health Nurse

Submitted By: Pawandeep Kaur

MSc Nursing 1st year
Medical Surgical Nursing

Submitted On:
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Methods of Patient Assignment & Primary Care

Nursing

Definition

A nursing care delivery model is a method used to provide care to patients.

The nursing care delivery models describe which healthcare worker is going to perform what tasks, who
is responsible and who has the authority to make decisions.

Match number and type of caregivers to patient care needs

A nursing care model or the system of nursing care delivery is often called a care modality.

A care modality is defined as “a method of organizing and delivering nursing care in order to achieve
desired patient outcomes”.

Nursing care delivery models must address both direct patient care functions and indirect patient care
functions

The direct patient care functions are facilitated by and dependent on the management.

Direct Patient Care Functions:

• Assessment
• Monitoring
• Prioritizing goals
• Care coordination
• Therapeutic interventions
• Evaluation
• Communication
• Patient education

Indirect Patient Care Functions:

• Clinical practice
• Education/research
• Leadership
• Operations
• Personnel management
• Quality improvement
• System coordination
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Classic Nursing Care Models

• Total patient care / Case Method

• Functional nursing
• Team nursing
• Primary nursing
• Case Management

Total Patient Care

• Nurse is responsible for planning, organizing, and performing all care

• Oldest method of organizing patient care
• Typically performed by nursing students
• Common use areas—intensive care unit (ICU) and postanesthetic care unit (PACU)
• Total Patient Care—cont’d

Nurse Manager’s role

• Expense of the system

• Level of education and communication skills of the staff

Staff’s Role

• To provide holistic care

• Must know their job descriptions
• Functional Nursing
• Functional Nursing
• Staff members assigned to complete specific tasks for a group of patients
• Evolved during World War II as a result of a nursing shortage
• Unskilled workers trained to perform routine, simple tasks
• Common use area—operating room
• Functional Nursing—cont’d

Advantages

• Care is provided economically and efficiently

• Minimum number of RNs required
• Tasks are completed quickly
• Disadvantages
• Care may be fragmented
• Patient may be confused with many care providers
• Caregivers feel unchallenged
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Team Nursing

RN as team leader coordinates care for a group of patients

Evolved in the 1950s to improve patient satisfaction

Goal was to reduce fragmented care

Common use areas—most inpatient and outpatient areas

Team Nursing—cont’d

Advantages

• High-quality, comprehensive care with a high proportion of ancillary staff

• Team members participate in decision making and contribute their own expertise
• Disadvantages
• Continuity suffers if daily team assignments vary
• Team leader must have good leadership skills
• Insufficient time for planning and communication

Case Management

First introduced in the 1970s by insurance companies

Hospitals adopted the model in the 1980s

Value demonstrated through research

Components include:

• Assessment, planning, implementation, evaluation, and interaction

• Variations are found in most health care organizations
• Reserved for chronically ill patients, seriously ill patients, or long-term, expensive cases
• RN assumes a planning and evaluative role; usually not responsible for direct-care duties
• Supplemental form of care delivery; does not replace direct-care model

RN Case Manager

• Coordinates the patient’s care throughout the course of an illness from a payer or facility
perspective
• Employee of the payer (external case management)
• Employee of the health care facility (internal case management)
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Primary Nursing

Definition

The RN assumes a 24 hour responsibility for planning and evaluating the patient’s care from admission
through discharge.

ORIGIN: 1960’s Cultural revolution in the US

need for autonomy in the nursing profession was a felt need.

Founded – Marie Manthey (1970)

Features of Primary Nursing

• Coordinated, comprehensive and continuous care.

• Collaborates, communicates and coordinates all aspects of patient care with the health care team.
• Is held responsible for meeting patient outcome criteria
• Primary Nursing Contd…..
• Holistic & autonomous care for the patient
• Prepares plan for 24 hours informs patient and family
• Communicates care to various level of people
• provide total care to patients from bath to patient education.

Advantages

• High-quality, holistic patient care

• Establish rapport with patient
• RN feels challenged and rewarded
• Autonomy
• Motivation

Disadvantages

• Primary nurse must be able to practice with a high degree of responsibility and autonomy
• RN must accept 24-hour responsibility
• More RNs needed; not cost-effective
• Inexperienced
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Nurse Manager’s Role

• Determine the desire of staff to become primary nurse & educate them accordingly
• Clear and defined roles
• Clinical competency, teaching ability serve as role model
• Budget
• Unit quality control

Staff Nurse’s Role

Professional care – Care giver

Advocate

Decision- maker

Teacher

Collaborator & manager.

Provide care using care plan prepared by primary nurse.

The model provides consistency between nurses & shifts.

HYBRID MODELS

• Modular Nursing
• Modification of team nursing
• Patient unit is divided into modules or units with an RN as team leader
• The same team of caregivers is assigned consistently to the same geographic area
• Concept evolved to increase RN involvement in care
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Advantages

• Continuity of care is improved

• RN more involved in planning and coordinating care
• Geographic closeness and efficient communication

Disadvantages

• Increased costs to stock each module

• Long corridors not conducive to modular nursing