patterns of nursing care delivery in india

8/11/2019 Patterns of Nursing Care Delivery in India

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SEMINAR

ONPATTERNS OF NURSING

CARE DELIVERY IN INDIA

SUBMITTED BY: SUBMITTED TO:

MS.JIJI.JOHN

MS.SIMAN.X

1ST YEAR MSC NSG HOD

CHN



GENERAL OBJECTIVES

At the end of the seminar the students are able to

understand the various patterns of nursing are deliver! in

India"

SPECIFIC OBJECTIVES

At the end of the lass the students #ill be able to:

∗ $ist do#n the various patterns of nursing are

∗ Desribe ase method nursing"

∗ E%plain funtional nursing"

∗ Understand about team nursing"

∗ Tell about primar! nursing"

∗ &no# about the ase management"



I'T(ODU)TIO': As nursing has evolved over a period* nursing is still foused

on aring" (apid tehnologi advanes* +no#ledge e%plosion*

emphasis on ,ualit!* ost effetiveness* aessibilit! of health

are and inreased demand b! the patients for advaned

alternative health are modalities present man! hallenges for

nursing profession" -o# are nurses responding to these

hallenges. So ho# an #e best utili/e professional nurses aross

various pratie settings. The ans#er for this ,uestion is that it is

possible b! reshaping organi/ational poliies and developing suh

s!stem of nursing are deliver! as best suited to lient needs"

MEA'I'0 O1 'U(SI'0 )A(E DE$I2E(Y SYSTEM

A s!stem ma! be defined as a #hole made up of integrated

or 3oined and interrelated parts" Although eah omponent of the

s!stem has its speifi funtion* !et all of them #or+

harmoniousl! for ommon out ome"

The nursing are deliver! s!stem means 4the proess of

delivering are to the lient b! ombining various aspets of

nursing servie #hih #ill fit to various patient are settings to

produe a ommon outome of delivering ,ualit! are and

meeting the needs of lients5"



There are various t!pes of nursing are deliver! s!stem inlude

ase method* funtional method* team nursing* primar! nursing*

modular nursing* nursing are management* patient foused are"

'ursing are deliver! has to be based on the individual needs of

eah patient* planned #ith involvement of the patient and the

evaluated for its effetiveness" )onsisten! of are and goodommuniation are also essential" 'ursing developed nursing

proess as a means to develop these goals"

6(I')I6$ES O1 'U(SI'0 )A(E DE$I2E(Y:

7" -olisti approah is used to identif! nursing are needs"

8" 'ursing are is based on a helping relationship

9" It is the uni,ue funtion of the nurse to provide nursing are

aording to lients needs"

" The aspet of patient are has to be initiated and ontrolled b! nurse

;" There should be 3ustifiation for seleting eah deliver!

s!stem

<" Before planning are organi/ational poliies to be

onsidered"



Several methods of assignment are used to plan for patient are in

hospital" These methods are the traditional methods and the in

advaned methods"

I- The traditional methods

7" )ase method"

8" 1untional method"

9" Team method"

" Modular nursing"

;" 6rimar! nursing method"

II- The advanced method

7" )ase management

8" )ritial path#a!



CASE METHOD

Oldest mode of organi/ing patient are" The total responsibilit!of meeting the patient=s needs is of the nurse on dut!" It involves

the assignment of one or more lients to a nurse for a speifi

period of time suh as shifts" )omplete are inluding

treatments* mediation administration and nursing are planning

is the nurses= responsibilit!" The ase method is one of the

earliest methods of nursing are deliver! and is still #idel! used

till toda!" )ase method provides nurses #ith high autonom! and

responsibilit!" Assigning patients is simple and diret and does

not re,uire the planning that the other methods re,uire" The lineof authorit! and aountabilit! are lear" The patient reeives

unfragmented and holisti are during the nurses= time on dut!"

ME(ITS:

a" The nurse an see better an attend to the total needs of

lients">ph!sial * emotional* medial regimen* teahing?

b" )ontinuit! of are an be failitated #ith are

" (apport an be build"

d" )lient ma! feel more seure"

e" Eduational needs an be monitored"

f" 1amil! and friends beome #ell +no# b! nurse and get

more involved in the are of the lient"

g" @or+load an be e,uall! divided among staffs"

h" 'urses are aountable for their funtion"



DEME(ITS:

The greatest disadvantage is #hen the nurse is

inade,uatel! trained or prepared to provide total are to

the patients

'urses are not enough to ompl! the demand of this

model: ost effetiveness should be onsidered"

This method has to be modified is nonprofessional

health #or+ers are to be used"

Its is diffiult for nurses to use this method to beome

involved in long term planning and evaluation of are



FUNCTIONAL NURSING:

Emerged during 7;s* due to shortage of nurses" This

method fouses on getting the greatest amount of tas+s in the

least time" In this method* the nursing are is divided into

tas+s and eah staff member is assigning to perform one or

t#o tas+s for all patients in the unit aording to the level of

s+ill re,uired for performane as follo#s:

Registered professional nurses: (esponsible for administering

mediation to all unit patients* another for hanging dressings

and administering ordered treatments >suh as postural

drainage or #arm ompresses? for all patients"

Technical nurses: (esponsible for ta+ing vital signs and

reording inta+e and output for all patients in the unit* #hile

another might be giving baths to all bedridden patients"

Nurse aides: (esponsible for ma+ing beds for all ambulator!

patients and assisting mobilit!Cimpaired patients to move in

bed or #al+ in the hall"

Unit clerk : (esponsible for ans#ering telephone* delivering

messages* reording admissions and disharges* et"



1untional method is a tehnial approah to nursing are that

emphasises the dependent funtions of nursing pratise" In

funtional nursing the hierarhial nursing predominates"

although effiient *the funtional assignment method does not

enourage patient and staff satisfation"regimentation of tas+s

ma! bore the nurse beause the! no longer have the

satisfation of seeing the effets of their total patient are"on

the other hand is benefiial during ritiaal staff shortage

times"persons #ere assigned to omplete ertain tas+ rather

than are of speifi patients"eg he+ing of blood

pressure"the responsibilit! depends in aordane #ith their

e%pertise"

ME(ITS:

• The person an be s+illed in the assigned tas+*it an be

effiient and eonomial"

• The best use of persons aptitudes and e%periene and

desires"

• This method saves time beause it lends itself to strit

organisational protool"

• It is eas! to organise the #or+ of the unit and staff

• Useful in emergen!



DEME(ITS:

• )lients an beome impersonal*aomplished*and

fragmented

• Tremendious ris+ in diminishing ontinuit! of are"

• Staff ma! have ver! little motivation to develop self and

others*as #or+ beomes monotonous

• )lients ma! feel inseure not +no#ing #ho their staff is "

• It is diffiult to establish lients priorities"



TEAM NURSING

The onept of team nursing #as introdued in the earl!

7;s" It is a method of nursing assignment that binds

professional* tehnial and nurse aides into small teams" This

method allo#s for effiient utili/ation of tehnial andor

nurses aide through the diret supervision* guidane* and

teahing of professional nurses"

Process of implementing the team method:



One registered nurse in the team is appointed b! the head

nurse to serve as a team leader" The team members ommonl!

onsist of at least one professional nurse* one tehnial nurse*

nursing students and nursing aides" All team members ma!

reeive reports about their patients= are needs from the team

leader or team member on previous shift"

The team leader usuall! assigns:

7" 6rofessional nurse to are for the most seriousl! ill

patients* to ensure informed observation and s+illed

interventions"

8" Often* the team leader assigns the tehnial nurse to bath*

feed* and move and hange dressings for patients"

9" Aides are assigned to ma+e beds* assist ambulator!

patients #ith bathing and grooming* testing urine and

performing simple nursing are proedures"

" Team leader usuall! administers mediations and

monitors parenteral fluid therap! for all patients assigned

to the team" @ithout team planning and ommuniation

through the team onferenes* team nursing ma! beome

in realit! 3ust a variation of the funtional method"



AD2A'TA0ES

• -ighC,ualit!* omprehensive are #ith a high proportion

of anillar! staff

• Team members partiipate in deision ma+ing and

ontribute their o#n e%pertise

DISAD2A'TA0ES

• )ontinuit! suffers if dail! team assignments var!

• Team leader should have good leadership s+ills"

• Insuffiient time for planning and ommuniation"



M ODULAR NURSING :Modular nursing assignment is used #hen the nursing staff

inludes tehnial and nurse aides* as #ell as professionalnurses"

Although t#o or three persons are assigned to eah module*

the greatest responsibilit! for the are of assigned patients

falls on the professional nurse" The professional nurse is also

responsible for guiding and teahing nonCprofessional nurse"

AD2A'TA0ES

• )ontinuit! of are is improved

• (' more involved in planning and oordinating are

• 0eographi loseness and effiient ommuniation"



oordinated nursing proess for meeting the total needs of

eah patient"

Basic concepts in primary nursing:

• Patient assessment b! a primar! nurse* #ho plans the

are to be given b! seondar! or assoiate nurse #hen

the primar! nurse is off dut!" The 8 hours responsibilit!

for are is put into pratie through the primar! nurse=s

#ritten diretive on a preplanned ommuniation

assignment"

• Com!ete "omm#ni"ation of are given in the nursing

staff dail! reporting method"

• Dis"$a%&e !annin& inluding teahing* famil!

involvement and appropriate referenes"

Process for implementing primary nursing method:

T$e $ea' n#%se:

a" Assigns primar! nurse to patients b! mathing the s+ills of the nurse to the needs of the patients"

b" Ensures proper sheduling for all shifts so that if primar!

nurse is off the unit an assoiate nurse is available for are"

" 0uides* ounsels and evaluates are given"



d" Ma! also assign herself to patients either as a primar! nurse

or assoiate nurse"

P%o(essiona! sta(( n#%se:

I -Primary nurse:

1untions of primar! nurse inlude performing the follo#ing:

o )onduting an admission >initial? assessment"

o Developing* planning* implementing* and revising the

nursing are plan"

o Direting are in her absene"

o

)ollaborating #ith ph!siians and families"

o Ma+ing referrals"

o Teahing health onepts"

o Ma+ing disharge plans"

II -Associate nurse:



Assoiate nurse ma! be professional or tehnial nurse" She

arries out the nursing are planned b! the primar! nurse

#hen she is not on dut!"

• Tehnial nurse: )arr! out the nursing tas+s assigned b!

the primar! or assoiate nurses in giving the are"

• 'urse aides: Their ativities are fousing a#a! from

diret ontat #ith the patient and an be utili/ed as

messengers and transporters" F

• @ard ler+: (esponsible for the nonCnursing funtions of

administrative duties"

AD2A'TA0ES

• -ighC,ualit!* holisti patient are

• Establish rapport #ith patient

• (' feels hallenged and re#arded"

DISAD2A'TA0ES

• 6rimar! nurse must be able to pratie #ith a high degree

of responsibilit! and autonom!

•

(' must aept 8Chour responsibilit!



• More ('s neededG not ostCeffetive

CASE MANAGEMENT:

)ase management is a proess of monitoring an individual

patient=s health are b! the ase manger* for the purpose of

ma%imi/ing positive outomes and ontaining osts"

The ase manger has graduateClevel preparation or is at an

advaned level of nursing pratie" The ase manager role

re,uires not onl! advaned nursing s+ills but also advaned

managerial and ommuniation s+ills"

The ase manager is an individual Hprofessional nurse5

assigned responsibilit! for this proess"



• The ase manager ma! follo# the patient from the

diagnosti phase through hospitali/ation* rehabilitation

and ba+ to home are"

• )ase manager has responsibilit! and authorit! for

planning* implementing* oordinating and evaluating

are for the patient throughout the period of illness*

regardless of the patient=s movement among various

units and servies >suh as emergen! room* surgial

unit* reover! unit* et"?"

• The ase manager ensures that plans are made in advane

for the ne%t needed step" Through this* the manager

assists #ith deisionCma+ing and helps to ensure that the

patient reeives are that #ill ahieve the most positive

outomes in the most effiient manner" This proess

helps to eliminate ostl! dela!s in progress"

AD2A'TA0ES

a? 1or the patient:

C Establishing and ahieving a set of 4e%peted5 or

standardi/ed patient are outomes for eah patient"



C 1ailitating earl! patient disharge or disharge #ithin an

appropriate length of sta!"

C Using the fe#est possible appropriate health are resoures

to meet e%peted patient are outomes"

C 1ailitating the ontinuit! of patient are through

ollaborative pratie of diverse health professionals"

b? 1or the nurse:

C Enhaning nurse=s professional development and 3ob

satisfation"

C 1ailitating the transfer of +no#ledge of e%pert linial staff

of novie staff



CRITICAL PATH)AY

)linial path#a!s* also +no#n as are path#a!s* ritial

path#a!s* integrated are path#a!s* or are maps* are one of

the main tools used to manage the ,ualit! in healthare

onerning the standardi/ation of are proesses" It has been

sho#n that their implementation redues the variabilit! in

linial pratie and improves outomes" )linial path#a!s

promote organi/ed and effiient patient are based on

evidene based pratie" )linial path#a!s optimi/e outomes

in the aute are and home are settings"

http://en.wikipedia.org/wiki/Care_maps

http://en.wikipedia.org/wiki/Healthcare

http://en.wikipedia.org/wiki/Clinical_medicine

http://en.wikipedia.org/wiki/Patient

http://en.wikipedia.org/wiki/Healthcare

http://en.wikipedia.org/wiki/Clinical_medicine

http://en.wikipedia.org/wiki/Patient

http://en.wikipedia.org/wiki/Care_maps

patterns of nursing care delivery in india

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