ORGANIZING PATIENT CARE

Raharjo Apriyatmoko
2005
Overview
First and middle managers have their greatest
influence on the organizing phase of the
management process at the unit or departement
level
At the unit level, managers have a good deal of
control on the organizational climate and in
determining how patient care delivery is organized
(Marquis & Huston, 2000)
A nursing care model, or the method or system of
nursing care delivery, is defined as a method of
organizing and delivering nursing care (Huber, 2000)

Elements of nursing care delivery
(Manthey, 1990)

Clinical decision making
Work allocation
Communication
Management
Choosing the most appropriate
organizational mode depends on :
Skill and expertise of the staff
The availability of registered
proffesional nurses
The economic resources of the
organization
The acuity of the patients
The complexity of the tasks to be
completed
Modes of organizing patient care
Marquis & Huston,
2000

Total patient care
Functional nursing
Team and modular
nursing
Primary nursing
Case management
Huber (2000), nursing care
models in the history of American
Nursing

Private duty
Functional
Team
Primary
Case management
Current evolving types
Nursing care delivery system
(Tappen, 1995)
MODEL Nurses are
Called
Description
Case
Nurse
Each nurses is assigned to the total care of one or
more patient
Functional
Medication nurses
Treatment nurses
Nurses are assigned to specific tasks rather than
to specific patient
Team
Team leader
Team member
Nursing staff members are devided into small
groups responsible for the total care of a given
number of patients
Primary
Primary nurse
Nurses are assigned either as primary nurse
responsible for the overall plan of care of several
patients or as associate nurse who assist in
implementation of the plan
Care
management
Care manager
Nurse provide coordination of services as well as
direct care for their assigned patients
Patient-focused
care
Care pair
Nurses paired with other caregivers are cross-
trained to provide as many nursing and non
nursing services themselves as possible to each
patient assigned
Total patients care nursing
The oldest mode of organizing patient care
Sometimes called case nursing or private duty
nursing
Is defined as one nurse caring for one client
There were two main variations to the basic
pattern of private duty nursing that
developed : group nursing (private duty
nurses in group practice) and total patient
care (one-shift responsibility for a client)

Case method or total patient care structure

Charge Nurse
Nursing Staff
Nursing Staff
Nursing staff
Patients/clients
Patients/clients
Patients/clients
Functional nursing
Is a care model that use the division of labor
according to specific tasks and technical aspects of
the job
Such as passing medicine, doing dressing change,
giving boths or taking vital sign (Mc Closkey, Blegen
& Gardner, 1991)
Does allow care to be provided with a minimal
number of registered nurses
There has been an increase in the use of unlicensed
assitive personel (UAP) in healthcare organization
Functional nursing organization structure

Charge Nurses
RN medication
nurses
RN treatment
nurses
Nursing
Assistances/hyg
ienic care
Clerical/hous
ekeeping
Patients/clients
Team Nursing
Was developed to decrease the problem associated
with the functional organization of patient care
That uses a group of people led by a knowledgeable
nurse. Delivery approach that provide care to a group
clients by coordinating a team of RNs, licensed
Practical Nurses (LPNs), and aides under the
supervision of one nurse, called the team leader
(Glandon, Colbert, & Thomasma, 1989; Hegyvary,
1977)
Communication is vital
Team nursing contd
One variation of team nursing that developed
is modular nursing
The essential features of modular nursing
(Anderson & Hughes, 1993):
A module consists of a group of nurses and a
group clients
Clients are grouped by geography
Nurse/client assignment is standardized
Moduler care planning rounds occur regularly
A unit-based moduler committee is established
Team nursing organization structure

Charge Nurse
Nursing staff
Nursing staff
Nursing staff
Nursing staff
Nursing staff
Nursing staff
Patients/clients
Patients/clients
Patients/clients
Primary Nursing
Developed in the early 1970s, uses some of the concepts of
total patient care.
As originally designed, primary nursing requires a nursing staff
comprised totally of RNs. The RNs primary nurse assumses 24-
hour responsibility for planning the care of one or more patients
from admittance or the start of treatment to discharge or
treatment end.
During work hours, the primary nurse provides total direct care
for that patient, when not on duty, care is provides by
associated nurses, who follow the care plan by the primary
nurse.
Thus primary nurses provides for the total nursing process for
the client during a period of hospitalization (Glandon, colbert &
Thomasma, 1989; Hegyvary, 1977)
Autonomy, authority and accountability are basic to primary
nurse
Primary nursing structure

Physician Charge Nurse Hospital resources
Primary nurse


Patients/clients
Associate nurses
(Evenings)
Associate nurses
(nights)
Associate nurses
(days)
Case Management
The ANA (1991), define case management as .a
healthcare delivery process whose goals are to
provide healthcare, decrease fragmentation, enhance
the clients quality of life and contain costs
Case management define it in rel;ationship to
healthcare delivery rather than nursing care delivery
system (Powell, 1996)
The term case management to define a client-
centered model of care that uses critical pathways
and care multidisciplinary action plans (MAPs) to help
plan oatient care (Bower, 1992)
Case Management contd
Zander (1988) lists four essential components
of case management :

1. Achievement of clinical outcomes within a
prescribe time frame
2. The caregiver acting as the case manager
3. Episodic nurse-physician group practice that
transcends unit or departements
4. Active participation of the clients and the
familiy in setting goals and evaluation
Selecting the optimum mode of
organizing patient care
A history of selecting methods of organizing patients care based
on the most current popular mode rather than objectively
determining the best method for a particular unit or
departement (Mc Closkey et.all, 1996)
The leader should consider the following when evaluation the
current system :
Does the method facilitated organizational goals?
Is the delivery in a cost-effective manner?
Does satisfy patients and their families?
Does provide of fullfillment and role satisfaction to nursing
personel?
Does allow implementation of the nursing process?
Does promote and support the profession of nursing as both
independent and inderdependent?
Does facilitated adequate communication among all members of
the healthcare team?