methods of nursing assignment
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RAKESH PATIDAR
PATIENT CARE ASSINGMENT
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NURSING CARE ASSIGNMENT(sometimes called.. )
Modalities of Nursing Care,
Systems of Nursing Care,
Patterns of Nursing Care
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Nursing modalities are ways care is organizedand delivered to patients. They have to do
with arranging staff members and assigningpatients. Care delivery methods take intoaccount the total number of patients andtasks needed to be accomplished as well as
how many nurses are needed. Mostimportantly, they are concerned with meetingpatient's needs and continuity of care. "Thepurpose of any delivery system is to provide
high quality care, efficiently and effectively,"according to Kaiser Permanente Institute forHealth Policy.
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Definition:
Refers to the manner in which the
total work of the nursing unit isdivided up among personnel.
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Purposes:
-To delegate the work to be done by nursingpersonnel.
-Suggest appropriate procedures for nursing
care, with maximum efficiency with
minimum effort.
-Gain the cooperation of workers in theacceptance of work to be done.
-Serve as work plan.
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Principles:
Formulate assignment of activities based on thefollowing principles:
-Use simple clear words in writing assignment.
-Fix responsibility for all duties clearly with nooverlapping.
-Provide for emergency situations and provide
for special nursing activities.- Give each person time and opportunity to plan
her work.
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-Assignment must include information from
the nursing orders as well as from thedoctor's orders.
-Arrange the various parts of the
assignment in logical order.-Ensure continuity of patient care.
-Assignment should be made in accordancewith the administrative policies.
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-Should be made by the head nurse.
-Planning for skills development-Should be in written form.
-Based on accurate assessment.-Two workers should never be assigned
to do the same work.
-It should be related to previousassignment.
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Factors to be considered in distributing
duties:
- The number, qualifications, experience, and
abilities of nurses.-The number, condition of patients (i.e. patient'sacuity)
-The availability of supplies and equipment.-Architectural features of the unit.
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Methods of assigning personnel:
There are five methods of assignment ingeneral use:
1-Case method.
2-Functional method.
3-Team nursing method.
4-Primary care method.5-Modular method.
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1-The case method:
-Is the oldest patient care delivery system.-In this system one must assume total
responsibility for the complete care of the
patient while she is on duty.-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.
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Patient Care
The registered nurse plans,organizes, and performs all care
Registered
Nurse8-hour shift
Registered
Nurse8-hour shift
Registered
Nurse8-hour shift
Total Patient Care (Case Method) Delivery
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Total Patient Carecontd
Advantages
High degree of autonomy
Lines of responsibility and accountability are
clear
Patient receives holistic, unfragmented care
Disadvantages
Each RN may have a different approach to care Not cost-effective
Lack of RN availability
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2-Functional nursing method:It is a task-oriented method wherein a
particular nursing function is assigned toeach staff member. The medication nurse,treatment nurse and bedside nurse are all
products of this system. For efficiency,nursing was essentially divided into tasks, amodel that proved very beneficial when
staffing was poor. The key idea was fornurses to be assigned to tasks, not topatients.
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Nurse Manager
LPNPO Meds
Treatments
RNAssessments
Care Plans
Nurse AideVital signs
Hygiene
Nurse AideHygiene
Stocking
Assigned Patient Group
Functional Nursing Care Delivery Model
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Advantages:Merits:
Each person become very efficient at specific tasks and a
great amount of work can be done in a short time (time saving).
It is easy to organize the work of the unit and staff.
The best utilization can be made of a persons aptitudes,experience and desires.
The organization benefits financially from this strategybecause patient care can be delivered to a large number ofpatients by mixing staff with a large number of unlicensedassistive personnel.
Nurses become highly competent with tasks that are
repeatedly assigned to them.Less equipment is needed and what is available is usually
better cared for when used only by a few personnel.
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Disadvantages:
-Fragmented care.-No one nurse is familiar with
patient total needs.-It is difficult to fix responsibility
for errors.
-Depersonalized patient care.-Less satisfaction for nurses and
patients .
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3-Team nursing method:
-Team nursing uses a group of healthcare workers with varied skills, andtraining. They are directed by a leaderto provide total services for a definedpatient population.
-Team nursing usually refers to largegroup of patients.
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-The team leader plans, coordinatesand supervises, evaluates andparticipates in the delivery of care topatients.
-The main features of team nursing are
the nursing care plan and teamconference.
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Nurse Manager
RN Team Leader
RN
LPNs/LVNs
Nursing Assistants
RN Team Leader
RN
LPNs/LVNs
NursingAssistants
Assigned Patient Group Assigned Patient Group
Team Nursing Model
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Advantages:
- High quality of care.- Nurses satisfaction is high.
- Patients and physician satisfactionis high.
- Development of leadership skills.
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Disadvantages:-Very high cost.
-More time needed by the team tomeet and share ideas andcoordinate efforts.
-Need more equipment and supplies.
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4-Primary nursing method:-Primary nursing features a registered nurse who
gives total patient care from four to six
patients, while she is on duty; and remainsresponsible for the care of these patientstwenty four hours a day throughout the
patient's hospitalization.
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Primary Nurse24-hour responsibility forplanning, directing &
evaluating patient care
Patient
Associate Nurses
Provide care
when primarynurse is off duty
Physician andother members
of the health care
team
Primary Nursing Model
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Primary Nursingcontd
AdvantagesHigh-quality, holistic patient care
Establish rapport with patient
RN feels challenged and rewardedDisadvantages
Primary nurse must be able to practice
with a high degree of responsibility andautonomy
RN must accept 24-hour responsibility
More RNs needed; not cost-effective
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5-Modular method:
It is a combination of primary method
and team method.-Varied from primary nursing that, it can be
used when nursing staff includes practical
nurses and professional nurses.
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-It is similar to primary assignment in thateach pair of nursing personnel isresponsible for care of patient from
admission to discharge.
-It is similar to team nursing that
professional and non professional workerswork together.
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Geographic
Patient UnitPatient Care
Team:
RNsLPNs/LVNs
Nurse Aides
Meds
Supplies
Linens
Geographic
Patient UnitPatient Care
Team:
RNsLPNs/LVNs
Nurse Aides
Meds
Supplies
Linens
Geographic
Patient UnitPatient Care
Team:
RNsLPNs/LVNs
Nurse Aides
Meds
Supplies
Linens
Nurse Manager
Modular Nursing Model
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Modular Nursingcontd
AdvantagesContinuity of care is improved
RN more involved in planning and
coordinating careGeographic closeness and efficient
communication
DisadvantagesIncreased costs to stock each module
Long corridors not conducive to modularnursing
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