1001463_pt Care Dilevery System

8/6/2019 1001463_pt Care Dilevery System

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PATIENT CARE

DELIVERY SYSTEM





Purposes of assignmentTo delegate the work to be done to the

nursing personnel.

To giant the cooperation of the nursing personnel by knowing and accepting the

acceptance of the work to be done.



Principles of personnel assignment

*Made by the head nurse or nurse in chargefor each individual nurse.

Based on :

*-Nursing needs of each patient and

approximate time required to care for him.The capabilities, skill level, previous

experience and the interest of the staff

members.

Job description,*Planned weekly, and revised daily if

necessary to assure continuity of care.



Characteristics of effective assignment

1. Definite and easily understood.2. Simple.

3. Clear.

4. Signed.

5. Written.

6. Posted in advance



Patient Care Delivery Models:

Total patient care method.Functional method.

Team method.

Modular method.Primary care method.

Case management.



Total Patient Care(case method )

Nurse is responsible for planning,organizing, and performing all care of one or

more pts.

Oldest method of organizing patient care

Typically performed by nursing students

Common use areas—intensive care

unit (ICU) and post-anesthetic care

unit (PACU)



Total Patient Care—cont’d

Advantages

High degree of autonomy

Lines of responsibility and accountability are

clear

Patient receives holistic, unfragimented careDisadvantages

Each RN may have a different approach to care

the nurse spend some timeseffective-Not costdoing tasks that could be done by less skilled

persons

Lack of RN availability



Functional Nursing ( task nursing )Staff members assigned to complete specific tasks for a

group of patients. Medication nurse ,bedsides nurse,

admission nurse.

Evolved during World War II as a result of a nursingshortage.

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

RN busy with managerial and non nursing duties and

practical nurses deliver the majority of care

Care may be fragmentedPatient may be confused with many care providers

Caregivers feel unchallenged





Team Nursing—cont’d

AdvantagesHigh-quality, comprehensive care with a high proportion

of ancillary staff.

Team members participate in decision

making and contribute their own expertise

Nursing conferences help problem solving and staff

development .

DisadvantagesContinuity suffers if daily team assignments vary

Team leader must have good leadership skills

Insufficient time for planning and communication

Day to day change in team member may reduce the care .



Modular NursingModification of team nursing Patient unit is divided intomodules or units or district ,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



Modular Nursing—cont’d

Advantagesuseful when there are few Rns

Continuity of care is improved

RN more involved in planning and coordinating care

Geographic closeness and efficient communicationDisadvantages

Increased costs to stock each module

Long corridors not conducive to modular

Nursing.

Paraprofessional does technical aspects of care



Primary NursingRN “primary nurse” assumes 24-hour

responsibility for planning, directing, and evaluating care

Evolved in the 1970s to improve RN autonomy

Common use areas—hospice, homehealth, and long-term care settings



Primary Nursing—cont’d

Advantages

High-quality, holistic patient careEstablish rapport with patient

RN feels challenged and rewarded

Increase nurse patient, and physician satisfaction

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

Because many tasks should be done by less skilledpersons .



Case ManagementFirst introduced in the 1970s by insurance

companies

Hospitals adopted the model in the 1980s

Value demonstrated through researchComponents include:

Assessment, planning, implementation,

evaluation, and interaction



Case Management—cont’d

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



Coordinates the patient’s care throughout

the course of an illness.The case manager has a case load of 10 to 15 patients

observed from the admission to discharged ,the case

manger does not provide direct pt care but supervises

the care provided by other team



Choosing a Nursing Care Delivery

Model

What staffs mix is required? Who should make work assignments?

Work assigned by task? By patient?

How will communication be handled?

Who will make decisions? Who will be responsible and accountable?

Fit with unit// facility //organization

management?



You can delegate responsibility, but you

can't delegate accountability to anyone.If someone gives you a job to do, you

can get someone else to do it, but you

are still accountable to produce theresults. If the job isn't done right the

only person to blame is you, because

even though you've delegated the

responsibility, you are still accountable



\\"Accountability\\\" focuses more upon what

others including God expect from the person

who is accountable. \\\"Accountability\\\"

includes judgment and the extent of judgment

for the success or failure to \\\"do,\\\"\\\"complete\\\" or \\\"protect\\\" that for

which a person is held accountable.



Responsibility is the 'ability to respond'. Simple really. For you to do

the job, you are assigned, you simply need an ability to do it. Whether

you do it well, or not, is another matter.

Accountability is the 'ability to be brought to a count'. In other words,

your work is checked and verified that it has been completed well,

accurately and in accordance to the goal that was set.

An example is when you have to count some money. Responsibility

says, "Yes, I have the ability to count the money and have done so."

Accountability is when the boss says, "Ok, so let's do a count and

check that we get the same balance." An audit if you will. At that

point, you became accountable.

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1001463_pt Care Dilevery System