UNIT III:PATIENT CARE ASSIGNMENT

1. UNIT III:PATIENT CARE ASSIGNMENT Mrs.Indumathi Lecturer YNC

2. Learning Objectives • Clarify purposes of nursing assignment • Identify principles of nursing assignment. • Determine factors to be considered in distributing duties. • Differentiate between different methods of nursing assignment.

3. Patient Assignment • In the patient method of assignment a nurse is a expected to give complete nursing care to one or more patient including general nursing measures, treatments, medications,taking temperature, pulse, respiration

4. Purposes • To provide patient with best possible nursing care. • To provide a well rounded education experience for student nurses. • Suggest appropriate procedures for nursing care, with maximum efficiency with minimum effort. • Gain the cooperation of workers in the acceptance of work to be done. • Serve as work plan

5. Principles • Use simple clear words in writing assignment. • Fix responsibility for all duties clearly with no overlapping. • Provide for emergency situations and provide for special nursing activities.

6. Contd… • Give each person time and opportunity to plan her work. • Assignment must include information from the nursing orders as well as from the doctor's orders. • Arrange the various parts of the assignment in logical order

7. Contd… • Ensure continuity of patient care. • Assignment should be made in accordance with the administrative policies. • It should be made by the head nurse. • Planning for skills development

8. CASE METHOD • oldest mode of organizing the patient care. • Assignment of one or more clients. • Complete care. • High autonomy and responsibility.

9. The patient has different nurse in each shift. • -Is used frequently in intensive care unit. • -As a method for teaching student nurses. • -Is widely used in home health agencies.

10. MERITS • The nurse can see better and attend to the total needs of clients. • Co-ordination of all aspects of care is the main responsibility of the nurse • Continuity of care can be facilitated with care.

11. Conti… • Client / nurse interaction / rapport can be developed. • Client may feel may secure • Educational needs of the clients can be closely monitored

12. Conti… • Work load for the unit can be equally divided. • Nurse’s accountability

13. DEMERITS • This method must be modified if non- professional health workers are to be used effectively. • Nurses are not enough to comply the demand of this model; cost- effectiveness must be considered.

14. Conti… • It is difficult for nurses to use this method to become involved in long –term planning and evaluation of care. • The greatest disadvantage to case nursing occurs , when the nurse is inadequately trained or prepared to provide total care to the patient.

15. THE FUNCTIONAL METHOD • The work is divided among the personnel, and each person is concerned with a particular task . • E.g: Temperature taking. • Gives injections and medications – chartings.

16. MERITS • The person can become particularly skilled in performing assigned tasks , it can be efficient and economical. • The best utilization can be made of person’s aptitudes , experience and desires. • Less equipment is needed.

17. Conti… • This method saves time • The potential for development of technical skills is amplified. • There is a sense of productivity for the task oriented nurse.

18. DEMERITS • Client care may become impersonal, compartmentalized and fragmented. • There is tremendous risk for diminishing continuity of care. • Staff may become bored and have little motivation to develop self and others , work may become monotonous.

19. Conti… • The staff members are accountable for the task ; only the nurse in charge of the unit has accountability for the individual . • There is little avenue for staff development , except as it relates to tasks. • Clients may tend to feel insecure , not knowing who is their own nurse.

20. TEAM NURSING

21. DEFINITION A team is defined as a group of persons with different levels of knowledge , abilities and personalities who must compliment each other who share a common goal.

22. Conti… • According to Barbara , team nursing is the delivery of individualized nursing care to patients by the nursing team led by a professional nurse.

23. OBJECTIVE • To give the best possible quality of patient care by utilizing the ability of every member of the staff • To the fullest extent and by providing close supervision both of patient care and of the individuals who give it.

24. CHARACTERISTICS OF TEAM NURSING A nursing team is • Always led by a nurse licensed to practice . • Functions wherever there are health needs focusing on the patient’s total needs. • Includes the patient in the development and implementation of care plans whenever possible • It is changeable and adaptable. • Recognizes and appropriately uses each individuals talents , abilities and interests to the fullest.

25. QUALITIES • The individual chosen as team leader should be a nurse who gives individualized comprehensive nursing care. • She should have knowledge of the objectives for patient care on the division and believe in the values of continuity. • Understanding and acceptance of the philosophy of team nursing and knowledge of the responsibilities entailed in team leadership are essential .

26. Conti… • The team leader needs to be familiar with the capabilities and limitations of practical nurses and aides , and with the experience needs of students and staff members.

27. Conti… • The team leader must have • excellent communication skills, • leadership skills, • delegation abilities , • conflict resolution techniques , • strong clinical skills , • effective decision –making abilities to provide a working “team” environment to the members.

28. RESPONSIBILITIES • Team members are expected to work cooperatively with each other and with the team leader. • Each team member should be willing to contribute to nursing care and provide nursing care and nursing care plan. • Team members should be capable of providing excellent patient care.

29. MERITS • It includes all health care personnel in the groups functioning and calls. • Feelings of participation and belonging are facilitated with team members. • Workload can be balanced and shared. • Division of labour allows members the opportunity to develop leadership skills. • Every team member has the opportunity to learn from and teach colleagues.

30. Conti… • Continuity care is facilitated , especially if teams are constant. • Barriers between professional and non-professional workers can be minimized; • There is a variety in the daily assignment.

31. Conti.. • The client is able to identify personnel who are responsible for his care. • All care is directed by a registered nurse.

32. DEMERITS • Establishing the team concept takes time, effort and constancy of personnel . • Unstable staffing patterns make team nursing difficult. • All personnel must be educated in client centered nursing care. • There is less individual responsibility and independence regarding nursing functions.

33. Conti… • The team leader must have complex skills and knowledge • The client may still perceive care as fragmented , if the team leader does not establish a satisfactory relationship with the patient . • Too much of disturbances to the patient may occur if each team member tries to collect data from him.

34. PRIMARY NURSING

35. DEFINITION According to Ganong and Ganong , primary nursing is a method of managing patient care in which one nurse , the primary nurse , assumes 24 hour accountability for a caseload of patients by implementing the nursing process from admission to discharge or transfer.

36. CHRACTERISTICS • Professional nurses are identified as primary or associate nurses. • Each professional nurse is assigned to a relatively small case load (4-8 patients) • The nursing process is used. • The focus is on the one- to-one relationship of my patient

37. Conti… • Care is based on patient needs and patient problems , and not based on routine. • The primary nurse is accountable for the assigned patients 24hours a day, 7days a week. In the absence of primary nurse , the written nursing care plan prepared by the primary nurse is used by the associate nurse on every shift.

38. Conti… • There is a problem solving , nursing – by- objectives approach to patient care management based on sound clinical knowledge and skills.

39. FUNCTIONS OF PRIMARY NURSING SERVICES • Actual provision of nursing care services and treatment. • The organization of nursing services. • Quality control or to improvement in the quality care. • Supervision activity. • The establishment of a communication system for the collection of information to the nursing personnel , other workers ,patients , health authorities and public

40. CLINICAL RESPONSIBILITIES • Assess the condition of the patient and family on admission. • Outline the patient’s problems on admission. • Develop the plan for 24 hours a day nursing care of the patient on admission. • Maintain current problems list and care plans based on continuing assessment of the patient’s status.

41. Conti… • Implement the plans of care to the extent possible . • Collaborate with the nursing staff, physicians and other health workers in the care of the patient. • Evaluate the effectiveness of nursing interventions. • Collaborate with the unit leader and other primary nurses in the assignment of primary nurses to newly admitted patients.

42. ADVANTAGES • There is 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 a wide range of skills , knowledge and expertise . • This method potentiates creativity by the nurse; work satisfaction may increase significantly.

43. Conti… • Direct patient care provided by few nurses allows for high quality , holistic patient care. • Job satisfaction is high.

44. DISADVANTAGES • The nurse may be isolated from colleagues . • There is a little avenue for group planning of client care. • Nurses must be mature and independently competent. • It may be cost- effective .

45. Conti… • Staffing patterns may necessitate a heavy client load. • An inadequately prepared or educated primary nurse may be incapable of coordinating a multidisciplinary team or identifying complex patient needs and condition changes

46. PROGRESSIVE PATIENT CARE

47. DEFINITION • Progressive patient care is defined as “better patient care through the organization of facilities , services and staff around the medical and nursing needs of patient.” Loretta C.Ford

48. PRINCIPLES • Study the concept. • Develop team work • Evaluate needs. • Orient staff • Estimate costs • Establish policies

49. Conti.. • Provide flexibility • Staff adequacy • Instruct patients • Inform public

50. MERITS Efficient use is made of personnel and equipment. • Clients are in the best place to receive the care they require. • Use of nursing skills and expertise are maximized due to different staffing patterns of each unit.