PRESENTED To,

DR. MRS. UMA SHENDEY

PROFESSOR
DEPARTMENT OF CHILD HEALTH
NURSING
GOVERNMENT COLLEGE OF NURSING

RAINANDGAON (CG)

PRESENTED BY
ANJU SINHA
M.SC. NURSING 2nd
YEAR
ORGANIZING PATIENT CARE
 ORGANIZING PATIENT CARE
• The overall goal of nursing is to meet the
patients needs with the available resources for
providing smooth day and night 24 hrs quality
care to patients and to honor his rights.
Definition
The prevention, treatment and management of
illness and the preservation of mental and
physical well-being through the services offered
by the medical and allied health professions.
 Patient classification system(PCS)

Patient classification system(PCS) which

quantifies the quality of the nursing care, is
essential to staff the nursing units of hospitals
and nursing homes. In selecting or implementing
a PCS, a representative committee of nurse
manager can include a representative of
hospital administration.
Definition

• It is structured method used in health care to

categorize patients in to different groups
based on factor such as diagnosis, severity of
illness, requires level of care.
 CHARACTERISTICS

 Differentiate intensity of care among definite classes.

 Measure and quantify care to develop a management engineering
standard.
 Match nursing resources to patient care requirement.
 Relate to time and effort spent on the associated activity.
 Be economical and convenient to repot and use.
 Be mutually exclusive, continuing new item under more than one unit.
 Be open to audit
 Be understood by those who plan, schedule and control the work.
 Be individually standardized as to the procedure needed for
accomplishment.
 Separate requirement for registered nurse from those of other staff.
 Purpose
The system will establish a unit of measure for
nursing, that is, time, which will be used to
determine numbers and kinds of staff needed.
Program costing and formulation of the nursing
budget.
Tracking changes in patients care needs.
Determining the values of the productivity
equations
Determine the quality
 COMPONENTS OF PCS

Method for grouping patient‘s categories.

Set of guidelines for patients classification.

Amount of the time required for care of a

patient in each category.
 CONCEPT

Administrative tool that aims to provide

quality patient care and the degree of nursing
care requirements. The PCS is referred as
patient acuity system. Thus PCS is used to
assist nurse administrators to determine
workload of nurses and staffing needs.
 MODES OR METHOD OF ORGANIZING PATIENT CARE

 Traditional methods
 Case method or Total patient care

 Functional nursing
 Team nursing
 Modular or district nursing
 Progressive patient care
 Primary nursing

 advance method
 Case management
 TRADITIONAL METHOD

1) CASE METHOD/TOTAL PATIENT CARE

• In this method, nurses assume total responsibility
for meeting all the needs of assigned patients during
their time on duty. It involves assignment of one or
more clients to a nurse for a specific period of time
such as shift.
• Nurse's responsibility includes complete care
including treatments, medication and administration
and planning of nursing care.
 Merits

• The nurse can attend to the total needs of clients due to

the adequate time and proximity of the interactions.
• Client may feel more secure
• Good client nurse interaction and rapport can be develop
• Nurse's accountability for their function is built-it.
• It is used in critical care settings where one nurse
provides total care to a small group of critically ill
patients.
Demerits
• Nurse may feel overworked if most of her assigned
patients are sick.
 2) FUNCTIONAL NURSING METHOD

• This system emerged in 1930s in U.S.A during World

War II when there was a severe shortage of nurses in
US.
• In this model, the tasks are divided with one nurse
assuming responsibility for specific tasks.
For example, one nurse does the hygiene and
dressing changes, whereas another nurse assumes
responsibility for medication administration.
Functional nursing
Charge nurse

Treatment nurse Nursing Assistants/

Hygienic Care

Medication nurse
Clerical /nurse
patients
 Merits:
 Each person become very efficient at specific tasks and a great
amount of work can be done in the short time (time saving)
 It is easy to organize the work of the unit and staff.
 Nurses become highly competent.

Demerits:
• Client care may become impersonal, compartmentalized and
fragmented.
• Continuity of care may not be possible.
• Staff may become bored and have little motivation to develop self
and others.
• Client may feel insecure.
• Patients get confused as so many nurses attend to them, e.g. head
nurse, medicine nurse, dressing nurse, temperature nurse, etc.
 TEAM NURSING METHOD

• Developed in 1950s because the functional method

received criticism, a new system of nursing was devised
to improve patient satisfaction.
• Team nursing is based on philosophy in which groups of
professional and nonprofessional personnel work
together to identify, plan, implement and evaluate
comprehensive client-centered care.
 Charged Nurse

Team
Team
Team Leader
Leader
Leader

Nursing Nursing
Nursing Staff Staff
Staff

patients patients
patients
Advantages:

• High quality comprehensive care can be provided

to the patient
• Each member of the team is able to participate in
decision making and problem solving.
• Each team member is able to contribute his or her
own special expertise or skills in caring for the
patient.
• Improved patient satisfaction.
• Work load can be balanced and shared.
• There is a variety in the daily assignment
 Disadvantages:

• Establishing a team concept takes time, effort and constancy of

personnel.

• All personnel must be client centered.

• There is less individual responsibility and independence regarding
nursing functions.
• The team leader may not have the leadership skills required to
effectively direct the team and create a ―”team spirit”.
• It is expensive because of the increased number of personnel
needed.
• Nurses are not always assigned to the same patients each day,
which causes lack of continuity of care.
 MODULAR NURSING

• Modular nursing is a modification of team nursing

and focuses on the patient‘s geographic location for
staff assignments.
• The concept of modular nursing calls for a smaller
group of staff providing care for a smaller group of
patients.
• A mini team (2-3 members).
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 when staff members are consistently
assigned to the same module
• The RN as team leader is able to be more involved in planning &
coordinating care.
• Geographic closeness and more efficient communication save staff time.

Demerits:
• Establishing the team concepts takes time, effort, and constancy of
personnel.
• Unstable staffing pattern make team difficult.
• There is less individual responsibility and autonomy regarding nursing
function.
 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.
• Here the clients are evaluated with respect to all
level (intensity) of care needed.
 Principal elements of PPC are:

1.Intensive care or critical care

 Patients who require close monitoring and intensive care round the
clock, e.g. patients with acute MI, fatal dysarythmias.
 . These units have 9-15 numbers of beds, life-saving equipment and
skilled personnel for assessment, revival, restoration and
maintenance of vital functions of acutely ill patients.
 Nursing approach in these units is patient-centered.

2) Intermediate care:
Critically ill patients are shifted to intermediate care units when their vital
signs and general condition stabilizes, e.g. cardiac care ward, chest ward,
renal ward.
3) Convalescent and Self Care:
Although rehabilitation programme begins from
acute care setting, yet patients in these areas
participate actively to achieve complete or partial
self-care status.
4) Long-term care:
Chronically ill, disabled and helpless patients are cared for
in these units. Nurses and other therapists help the
patients and family members in coping, ambulation,
physical therapy, occupational therapy along with
activities of daily living. Patients and family who need
long-term care are, cancer patients, paralyzed and
patients with ostomies.
v) Home care:
Some hospital/centers have home care services. A
hospital based home care package provides staff,
equipment and supplies for care of patient at home,
e.g. paralyzed patients, post-operative, mentally
retarded/spastic patient and patient on long
chemotherapy
vi) Ambulatory care:
Ambulatory patients visit hospital for follow up,
diagnostic, curative rehabilitative and preventive
services. These areas are outpatient departments,
clinics, diagnostic centers, day care centers etc
Merits:

♣ Efficient use is made of personnel

and equipment. Demerits:
♣ Clients are in the best place to  There may be discomfort to clients
receive the care they require. who are moved often.
♣ Use of nursing skills and expertise  Continuity care is difficult.
are maximized.  Long term nurse/client
♣ Clients are moved towards self care, relationships are difficult to
independence is fostered where arrange.
indicated.  Great emphasis is placed on
♣ Efficient use and placement of comprehensive, written care plan.
equipment is possible.  There is often times difficulty in
♣ Personnel have greater probability to meeting administrative need of the
function towards their fullest organization, staffing evaluation
capacity and accreditation
 PRIMARY CARE NURSING

• It is a system in which one nurse is caring for all the needs of a

patient or more within a 24 hour from admission to discharge.
• If the nurse is not available, the associate nurse responsible for
filling in for the nurse‘s absence will provide hospital care to
the patient based on the original plan of care made by the
nurse.
• In acute care the primary care nurse may be responsible for
only one patient; in intermediate care the primary care nurse
may be responsible for three or more patients
• This type of nursing care can also be used in hospice nursing,
or home care nursing.
Advantages

• Primary nurses are in a

position to care for the entire
person-physically,
emotionally, socially and
spiritually.
• High patient and family
satisfaction
• Increases coordination and
continuity of care
Disadvantages:
• It may be cost-effective
especially in specialized units
such as the ICU.
• May create conflict between
primary and associate nurses
• Stress of round the clock
responsibility.
• Difficult hiring all RN staff
 Advance method

1) CASE MANAGEMENT

• The case manager (RN or social worker with managerial qualification) is

assigned responsibility of following a patient‘s care and progress from the
diagnostic phase through hospitalization, rehabilitation and back to home
care.
For example: - case manager for cardiac surgery patients assists them go
through diagnostic procedures, pre-operative preparations, surgical
interventions, family counseling, post-operative care and rehabilitation.
 Case management involves

• critical paths,
• variation analysis; inter shift reports,
• case consultation
• health care team meetings
• quality assurance.
 Responsibility of case manager
• Assessing clients and their homes and
communities.
• Coordinating and planning client care.
• Collaborating with other health professionals
in the provision of care.
• Monitoring client progress and client
outcomes.
 Advantages
• Case management provides
a well-coordinated care
experience that can improve
the care outcome, decrease
the length of stay, and use
multiple disciplines and
services efficiently.
• Provides comprehensive Disadvantages
• use multiple disciplines and
services efficiently. • Financial barriers and lack of
administrative support.
• Provides comprehensive
• Expensive care for those with
care for those with complex
complex health problems.
health problems.
 FACTORS INFLUENCING THE QUALITY PATIENT CARE

• Many variable factors influence the number of nurses needed on

a ward in order to render a high quality of patient care.
• The total number of patient to be nursed
• The degree of illness of patients (physical dependency)
• Type of service: medical, surgical, maternity, pediatrics and
psychiatric
• The total needs of the patients
• Methods of nursing care
• Number of nursing aids and other non professional available, the
amount and quality of supervision available
• The amount, type and location of equipment and supplies
• The acuteness of the service and the rate of turnover in
patients according to the degree or period of illness.
• The experience of the nurses who are to give the patient
care.
• The number of non-nurses who involve in the patient care,
the quality of their work, their stability in service.
• The physical facilities
• The number of hours in the working week of nurses and other
ward personnel and the flexibility in hours
• Methods of performing nursing procedures