patient classification system bjb
TRANSCRIPT
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Models of Patient
assignment
Bivin JB
Dept of Psychiatric Nursing
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Introduction
• Grouping of patients according to the
amount & complexity of their nursing
requirements
• Patient acuity- Nursing work load that is
generated for each patients
• Patient acuity ≈ Amount of nursing service
• Patient classification system is the scheme
that group patients according to the
amount & complexity of their nursing care
requirements
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Class Presentation
Ms Anila Mathew
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Presentation overview
1. Case method nursing or total patient
care.
2. Functional nursing
3. Team nursing or modular nursing
4. Primary nursing
5. Case management or managed care
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Case method
• Nurses assume total responsibility for
meeting all the needs of assigned patients
during their time on duty.
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Characteristics:
• Complete care.
• Nurses with high autonomy and responsibility.
• It is developed and communicated through
written sources, its usage remains in
contemporary practice.
• The lines of authority and accountability are
clear.
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Merits:
• The nurses attend to total needs of clients
• Continuity of care.
• Client/ nurse interaction/rapport can be developed.
• Client may feel more comfortable
• Educational needs of the client can be closely monitored.
• Family and friends became better known by the nurse
• Workload of the patient can be equally divided.
• Nurse’s accountability for their function is built-in.
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Demerits:
• Many clients do not require the inherent care
of intensity in this type of service.
• This method need to be modified if
professional workers are to be involved
effectively.
• It is difficult for the nurses to use this method
to become involved in long term planning and
evaluation of care.
• It is not possible if the nurses are not
adequately trained for the total care of the
patient.
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Functional method
• In this, persons were assigned to
complete certain tasks rather than care
of specific patients.
• Eg. Checking BP,
administering medications
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Characteristics:
• A functional method is a technical approach
of nursing care.
• The available staff in the unit, for a particular
period of time, are assigned selected
functions of nursing practice such as vital
signs, treatments, medications.
• All the responsibilities are assigned in
accordance with the expertise.
• The only person who has responsibility of the
client is the head nurse or nurse acting the
role.
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Merits:
• Person become specifically skilled in
performing certain assigned task.
• Best utilization of a person’s aptitudes,
experiences and desires.
• Less equipment is needed.
• Saves time.
• Development of technical skill
• Sense of productivity for the task oriented
nurse
• Easy to organize the work of the unit and
staff
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Demerits:
• Client care become impersonal,
compartmentalized and fragmented.
• Diminishing continuity of care.
• Staff may become bored and have little
motivation.
• Only the nurse in-charge has
accountability for the client.
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Continues…
• Little avenue for the staff development.
• Client may tend to feel insecure.
• Only parts of the nursing care plan are
known
• Difficult to establish the client priorities.
• Only safe when the head nurse co-
ordinate all the activities of the members.
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Team nursing
• A group of professional and non-
professional personnel work together who
identify, plan, implement and evaluate
comprehensive centered care.
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Characteristics:
• Ancillary personnel collaborate in
providing care.
• Team nursing involves decentralization of
nursing unit and professional head nurse
authority.
• Each team composed of a team leader,
team members and patients.
• Comprehensive care is the responsibility
of the entire team.
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Continues…
• The head nurse has the
responsibility to know the
conditions of all patients assigned
to the team and planning individual
care.
• Democratic leadership.
• Group members are given as
much as autonomy
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Merits:
• includes all health care personnel in the
group functioning and goals.
• Feelings of participation and belonging
• Workload can be balanced and shared.
• Division of labor allows members the
opportunity to develop leadership skills
• Every team members has the opportunity
to learn from and teach colleagues.
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Demerits:
• Establishing the team concept takes time, effort
and constancy of personnel.
• Unstable staffing patterns make team nursing
skills patterns make team nursing difficult.
• All personnel must be client centered.
• This leads to blurred lines of responsibility,
errors, and fragmented care.
• For the team nursing to be effective the leader
must be excellent practitioner and have good
communication, organizational, management,
and leadership skills.
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Primary nursing
• It is also called
relationship based
nursing. It involves
total nursing care,
directed by a nurse on
24 hour basis as long
as the client is under
the care.
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Characteristics:
• The Primary nurse assumes 24-hour
responsibility from admission or start of
treatment to discharge or the treatment’s
end.
• During work hours, primary nurse provides
total direct care for that patient.
• When the primary nurse is not on duty,
care is provided by other junior nurses.
• An integral responsibility of the primary
nurse is to establish a good
communication
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Merits:
• 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 wide range of skills, knowledge and expertise.
• Potentiates creativity by the nurse and thereby work satisfaction increases
• Increased trust and satisfaction for both
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Demerits:
• The nurse may be isolated from the
colleagues.
• Little avenue for group planning of care.
• Nurse must be mature and independently
competent.
• It must be cost effective.
• Staffing patterns may necessitate a heavy
client load.
• It may be difficult to recruit and retain
enough staff, especially in times of nursing
shortage.
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Case management
A collaborative process that assesses,
plans, implements, coordinates, monitors
and evaluates opinions and services to
meet an individual health needs through
communication and available resources to
promote quality, cost-effective outcomes.Case management society of America
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Characteristics:
• Case mangers handle each case
individually.
• In general, case manger can
handle a load of 25 patients.
• Case mangers use critical
pathways and multidisciplinary
action plans to plan patient care.
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Responsibilities of case managers:
• Assessing clients and their homes and
communities.
• Coordinating and planning client care.
• Collaborating with other health team
• Monitoring client progress and client
outcomes.
• Advocating for clients
• Serving as a liaison with third party
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Merits:
• Additional work efficiency due to
geographical proximity.
• Establishes solid relationships with nursing
and ancillary staff working on the unit.
• Case management provides a well
coordinated care.
• Provides comprehensive care
• It seeks the active involvement of the
patient, family and diverse health care
professionals
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Demerits:
• Some experts are argued that this role should
be reserved for the advance practitioner
nurse or an RN with advanced training or
need 3 to 5 year experience.
• The case manger should also be extremely
bright, have well developed interpersonal
skills, be able to multitask, have a strong
foundation in utilization review, and
understand payer-patient specifics and
hospital reimbursement mechanisms.
• Expensive
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Modular Nursing
Modular nursing is a modification of team
nursing and focuses on the patient‘s
geographic location for staff assignments.
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Characteristics:
• The patient unit is divided into modules or
districts, and the same team of caregivers
is assigned consistently to the same
geographic location.
• Each location, or module, has an RN
assigned as the team leader, and the other
team members may include LPN.
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Continues..
• The team leader is accountable for all
patient care and is responsible for
providing leadership for team members
and creating a cooperative work
environment.
• The success of the modular nursing
depends greatly on the leadership abilities
of the team leader.
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Merits:
♣ Nursing care hours are usually cost-
effective.
♣ The client is able to identify personnel who
are responsible for his care.
♣ All care is directed by a registered nurse.
♣ Continuity of care is improved
♣ The RN as team leader is able to be more
involved in planning & coordinating care.
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♣ Save staff time.
♣ Feelings of participation and belonging
♣ Work load can be balanced and shared.
♣ Develop leadership skills
♣ Continuity care is facilitated
♣ Everyone has the opportunity to contribute
to the care plan.
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Demerits:
♠ Costs may be increased to stock each
♠ Takes time, effort, and constancy of personnel.
♠ Unstable staffing pattern make team difficult.
♠ There is less individual responsibility and autonomy regarding nursing function.
♠ All personnel must be client centered.
♠ The team leader must have complex skills and knowledge.
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Progressive patient care
It is a method in which client care areas
provide various levels of care.
The central theme is better utilization of
facilities, services and personnel for the
better patient care.
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Principal elements of PPC
• Intensive care or critical care
• Intermediate care
• Convalescent and Self Care
• Long-term care
• Home care
• Ambulatory care
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Merits:
♣ Efficient use is made of personnel and
equipment.
♣ Clients are in the best place to receive the
care .
♣ Use of nursing skills and expertise are
maximized.
♣ Clients are moved towards self care,
independence is fostered where indicated.
♣ Efficient use and placement of equipment is
possible.
♣ Persons have greater probability to function
towards their fullest capacity.
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Demerits:
♣ Discomfort to clients who are moved often.
♣ Continuity care is difficult.
♣ Nurse/Client relationships are difficult to
arrange.
♣ Great emphasis is placed on
comprehensive, written care plan.
♣ There is often difficulty in meeting
administrative need of the organization,
staffing evaluation and accreditation.
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Differentiated Nursing Practice
• An attempt to separate nursing practice roles based on education or experience or some combination of both.
• Education model:
Role differentiation based upon type of educational preparation [BSN, MSN etc]
• Competency model:
Role differentiation based on individual nursing skills, expertise, experience etc.
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Merits:
• Match patients needs with nursing
competencies.
• Efficient use of nursing resources.
• Provide equitable compensation
• It increase nurse satisfaction, built loyalty and
increase the prestige of the nursing profession.
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THANK YOU…