PATIENT CARE DELIVERY SYSTEM

BY THE END OF THIS LECTURE THE AUDIENT

WILL BE ABLE TO:
oDefine Assignment
oIdentify purposes of Assignment
oExplain the principles of personnel Assignment
oApply characteristics of effective Assignment in his or her field of
specialty
oHow to apply the process of organizing patient care
oCompare and differentiate between the different methods of
Assignment.
7- Methods Of Patient Care Delivery (Methods Of Assignment)
1-TRADITIONAL
METHODS
a-Case Method b-Functional Method

c-Team Method d-Modular Method

e-Primary nursing Method

2-In Advanced Methods

a-Case Management b- PRACTICE PARTNERSHIPS
c- CRITICAL d- DIFFERNTIATED PRACTICE
PATHWAYS
 MODULAR
NURSING
• A mini-team (2-3 members approach).
• Members are sometimes called “care pairs”.
• A small team requires less communication, allowing
members better use of their time for direct patient
care activities.
 MODULAR NURSING METHOD

Nurse manager
Geographic patient unit Geographic patient unit
Geographic patient unit
Patient care team: Patient care team:
Patient care team:
RNs RNs
RNs
LPNs/LVNs LPNs/LVNs
LPNs/LVNs
Nurse aides Nurse aides
Nurse aides
Meds Meds
Meds
Supplies linens Supplies linens
Supplies linens
 PRIMARY
NURSING
• A cultural revolution occurred in the
united states during the 1960s.the
revolution emphasized individual rights
.this revolution influenced the nursing
profession. for quality
Searching patient of this model
care
method led to
to increase RN as a
accountability for
 PRIMARY
NURSING
• An adaptation of the case method, as a method for
organizing patient care delivery in which one RN
functions autonomously as the patient’s primary
nurse throughout the hospital stay
 PRIMARY
NURSING
• Provide the patient and the with coordinated
family comprehensive, continuous care. ,

• Care is organized, using the nursing process.

• A nursing Staff comprised totally of RNs.
• clear communication among the the physician, the
patient, associate nurses, and other team
 EXAMPLE
•A patient is to a medical unit with
admitted pulmonary

• edema .
His primary nurse admits him and then provides a
written plan of care. When his primary nurse is not
working, an associate nurse implement the plan.
 PRIMARY
NURSING
• Is the only type of patient care delivery that requires a one-
to one relationship between a nurse and a patient with
responsibility for planning and managing care clearly
established.
 II- THE INTEGRATED MODEL OF
CARE:-

1-Practice partnership:-
• Introduced by Marie Manthey in 1989.
• An RN and assistant (UAP,LPN or less experienced RN agree to
be practice partners.
• Work together with same schedule and the same group
of patients.
 1-PRACTICE
PARTNERSHIP:-
 1-PRACTICE PARTNERSHIP:-
• Senior RN direct the work of the junior
partner according to partner’s abilities.
• Two partners work in concern with patients.
• Senior perform selected patient care activities
and delegates less ones to the junior.
 ADVANTAGES
• IMPROVED CONTINUITY OF CARE .

• OFFERED AN EFFICIENT WAY OF NURSING SKILLS OF A MIX OF

DIFFERENT LEVELS OF EXPERIENCES.

• LESS EXPENSIVE FOR THE ORGANIZATION.

• SATISFYING PROFESSIONALLY FOR THE PARTNERS.

 DISADVANTAGES
• Increase number of UAP and ratio of
decrease professional nurses to non-

• professional
Potential for. junior team members to assume

too much responsibility than appropriate.

 II- THE INTEGRATED MODEL OF
CARE:-
2-CASE MANAGEMENT:

• is a process of coordinating healthcare by planning,

facilitating and evaluating interventions across levels of
care to achieve measurable cost and quality outcomes.

• It may be within the wall of hospitals or beyond the walls.

Con
2 CASE MANAGEMENT:-

• It became apopular and effectíve method to manage

shortened lengths of stay for patients while achieving
desired patient outcomes and to prevent expensive
hospital re-admissions.
 CASE MANAGEMENT MODEL

Collaborates With Patient

& Family

Perform care, Evaluates Pt care To

Resolution
Onset Of
Illness Meet Pt Health Of illness

Collaborate with: Physician Coordinates Service :Homecare

,Physical Speech, Dietary Long Term goal

08/04/1439 94
 THE CASE
MANAGER:-
• The case manager may help the family to identify all the
options for care and treatment, ask questions to obtain
greater understanding of the overall problem, and work
with the family in the decision- making process. The private
case manger is paid by the client or family usually based on
the hours of service provided.
 THE CASE
MANAGER’S:-
• The case manager role requires not only advanced nursing
skills but also managerial and communication skills
Professional nurse assigned responsibility for this process.

• Follow the patient from the diagnostic phase through

hospitalization, rehabilitation and back to home care.
 ADVANTAGES
a) For the patient:
• Establishing and achieving a set of “expected” or standardized patient care outcomes for
each patient.
• Facilitating early patient discharge or discharge within an appropriate length of stay.
• Using the fewest possible appropriate health care resources to meet expected
patient care outcomes.
• Facilitating the continuity of patient care through collaborative practice of diverse health
professionals.
 ADVANTAGES

b) For the nurse:

• Enhancing nurse’s professional development and job satisfaction.

• Facilitating the transfer of knowledge of expert clinical staff of novice staff.

• Assists with decision-making by ensuring that plans are made in advance for
the next needed step. and helps to ensure that the patient receives care that
will achieve the most positive outcomes in the most efficient manner. This
process helps to eliminate costly delays in progress.
 CASE MANAGER’S
APPROACHES:-
1- Case mangers employed by the hospitals:-

follow a patient from the time admission is planned through

the time of discharge. This case manager might plan the admitting
process to ensure that all preadmission work-ups are completed
and that the patient is being admitted at the appropriate time to
facilitate follow-up through on problems.
 II- THE INTEGRATED MODEL OF
CARE:-
3-Critical pathway:-
• Successful case management relies on critical pathways to
guide care. The term critical path, also called a care map,
refers to the expected outcomes and care strategies
developed by the collaborative practice team.
• It provide direction for managing the care of a specific
patient during a specified time period.
3-Critical pathway:-
• Comprehensive pre- printed standard plan reflecting ideal
course of treatment for diagnosis or procedure
especially with relatively predictable outcomes.

• The critical pathway may need to be revised or additional

data may be needed before changes are made .
ADVANTAG
ES :-
• Accommodate unique characters and conditions
of patients.

• Reduce costs and length of stay.

• Use appropriate sources

 DISADVANTA
GES :-
• The critical pathway may need to be revised or additional
data may be needed before changes are made.
• The critical path must include a means to identify
variances easily and to determine whether the outcome
has been met.
 II- THE INTEGRATED MODEL OF
CARE:-
4-Differentiated practice:-.
• is a method that sorting nursing practice roles, function and work based on
education, experience, and competence or some combination of them.

• Nursing competencies are generally measured in three areas:

technical skills, communication and management of care or leader
ship skills.
ADVANTAG
ES :-
• Nurses are allowed to work in specialized roles for
which they were educated, leading to greater career
satisfaction.
DISADVANTA
GES :-
• Nurses who have experience, knowledge and capability to
function beyond their original education may not
recognized.
• Organizations that have determined minimal educational
requirements for RN positions may have difficulty in
recruiting staff with the requisite credentials.
 2.ASSIGNMENT

• ASSIGNMENT OF PATIENT AND NURSING

ACTIVITIES ARE WRITTEN IN THE ASSIGNMENT
SHEET BY THE HEAD NURSE/NURSE IN CHARGE,
BASED ON THE PRINCIPLES OF ASSIGNMENT.
 3 LEADING

• INCLUDES ISSUING INSTRUCTIONS,

MOTIVATION, AND COORDINATION OF
ACTIVITIES, BY MAKING ROUNDS, CHECKING
PERFORMANCE AND CONDUCTING
CONFERENCES
 4 EVALUATING

• BY REVIEWING NURSING PERFORMANCE AND

PATIENT PROGRESS TO BE COMPARED BY THE
ASSIGNMENT AND NURSING CARE PLAN.
 5.REPORTING

• THE HEAD NURSE PREPARES A NURSING UNIT REPORT “ E.G.

SHIFT REPORT ” WHICH INCLUDES PATIENT’S NEEDS, SPECIAL
OBSERVATIONS, CENSUS, BED NUMBER, ALL CRITICALLY ILL
AND POST OPERATIVE PATIENTS, PATIENTS NEEDS SPECIAL
PREPARATION ON THE ON-COMING SHIFT, ABNORMAL
CHANGE IN PATIENT’S CONDITION, DATA CONCERNING,
ADMISSION, DISCHARGE, TRANSFER AND DEATH.