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Methods of Patient Assignment & Primary Care Nursing

Definition
A nursing care delivery model is a method used to provide care to patients.
The nursing care delivery models describe which healthcare worker is going to perform what tasks, who
is responsible and who has the authority to make decisions.
Match number and type of caregivers to patient care needs
A nursing care model or the system of nursing care delivery is often called a care modality.

A care modality is defined as a method of organizing and delivering nursing care in order to achieve
desired patient outcomes.
Nursing care delivery models must address both direct patient care functions and indirect patient care
functions
The direct patient care functions are facilitated by and dependent on the management.
Direct Patient Care Functions:
Assessment
Monitoring
Prioritizing goals
Care coordination
Therapeutic interventions
Evaluation
Communication
Patient education
Indirect Patient Care Functions:
Clinical practice
Education/research
Leadership
Operations
Personnel management
Quality improvement
System coordination
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Classic Nursing Care Models
Total patient care / Case Method
Functional nursing
Team nursing
Primary nursing
Case Management
Total Patient Care
Nurse is responsible for planning, organizing, and performing all care
Oldest method of organizing patient care
Typically performed by nursing students
Common use areasintensive care unit (ICU) and postanesthetic care unit (PACU)
Total Patient Carecontd
Nurse Managers role
Expense of the system
Level of education and communication skills of the staff
Staffs Role
To provide holistic care
Must know their job descriptions
Functional Nursing
Functional Nursing
Staff members assigned to complete specific tasks for a group of patients
Evolved during World War II as a result of a nursing shortage
Unskilled workers trained to perform routine, simple tasks
Common use areaoperating room
Functional Nursingcontd
Advantages
Care is provided economically and efficiently
Minimum number of RNs required
Tasks are completed quickly
Disadvantages
Care may be fragmented
Patient may be confused with many care providers
Caregivers feel unchallenged

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Team Nursing
RN as team leader coordinates care for a group of patients
Evolved in the 1950s to improve patient satisfaction
Goal was to reduce fragmented care
Common use areasmost inpatient and outpatient areas
Team Nursingcontd
Advantages
High-quality, comprehensive care with a high proportion of ancillary staff
Team members participate in decision making and contribute their own expertise
Disadvantages
Continuity suffers if daily team assignments vary
Team leader must have good leadership skills
Insufficient time for planning and communication
Case Management
First introduced in the 1970s by insurance companies
Hospitals adopted the model in the 1980s
Value demonstrated through research
Components include:
Assessment, planning, implementation, evaluation, and interaction
Variations are found in most health care organizations
Reserved for chronically ill patients, seriously ill patients, or long-term, expensive cases
RN assumes a planning and evaluative role; usually not responsible for direct-care duties
Supplemental form of care delivery; does not replace direct-care model
RN Case Manager
Coordinates the patients care throughout the course of an illness from a payer or facility
perspective
Employee of the payer (external case management)
Employee of the health care facility (internal case management)


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Primary Nursing
Definition
The RN assumes a 24 hour responsibility for planning and evaluating the patients care from admission
through discharge.
ORIGIN: 1960s Cultural revolution in the US
need for autonomy in the nursing profession was a felt need.
Founded Marie Manthey (1970)

Features of Primary Nursing
Coordinated, comprehensive and continuous care.
Collaborates, communicates and coordinates all aspects of patient care with the health care
team.
Is held responsible for meeting patient outcome criteria
Primary Nursing Contd..
Holistic & autonomous care for the patient
Prepares plan for 24 hours informs patient and family
Communicates care to various level of people
provide total care to patients from bath to patient education.

Advantages
High-quality, holistic patient care
Establish rapport with patient
RN feels challenged and rewarded
Autonomy
Motivation


Disadvantages
Primary nurse must be able to practice with a high degree of responsibility and autonomy
RN must accept 24-hour responsibility
More RNs needed; not cost-effective
Inexperienced
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Nurse Managers Role
Determine the desire of staff to become primary nurse & educate them accordingly
Clear and defined roles
Clinical competency, teaching ability serve as role model
Budget
Unit quality control
Staff Nurses Role
Professional care Care giver
Advocate
Decision- maker
Teacher
Collaborator & manager.
Provide care using care plan prepared by primary nurse.
The model provides consistency between nurses & shifts.

HYBRID MODELS
Modular Nursing
Modification of team nursing
Patient unit is divided into modules or units with an RN as team leader
The same team of caregivers is assigned consistently to the same geographic area
Concept evolved to increase RN involvement in care

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Advantages
Continuity of care is improved
RN more involved in planning and coordinating care
Geographic closeness and efficient communication
Disadvantages
Increased costs to stock each module
Long corridors not conducive to modular nursing