Unit-II

Patient Care Management

J.Kanaganayagam

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 Introduction
This lesson will help you to,
 Identify different care delivery models
 Understand the nurse managers role in
delivering patient care

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 Definition

“The process of delivering care to the client by

combining various aspects of nursing service
which will fit to various patient care settings to
produce a common outcome of delivering
quality care and meeting the needs of clients”.

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 Nursing Care Delivery Models
• A nursing care delivery model defines,
o How client’s care is organized,
o How nursing staff are deployed( move into
action), and
o Who does what in providing nursing care.
• These models identify who has the
accountability for nursing care and clinical
outcomes.

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 Cont/d …
• Selection of a model of nursing care delivery
depends on the size of the institution, staff
availability, physical layout of the unit, and
organizational goals.
• It also acts as a guide in decision-making and
so reduce conflict within the team of nurses as a
whole.

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 Nursing Care Delivery Models
1. Functional Nursing Model
2. Team Nursing Model
3. Case Method/Total Patient Care Model
4. Primary Nursing Model
5. Modular Nursing Model

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 1. Functional Nursing
• A care delivery model in which every nursing
personal is assigned specific task related to the
care in a unit.
• The assigned nurse has to carry out a specific
task to all patients.
E.g. - Administering medication
- Dressing wounds

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 Advantages
• Efficiency and cost effectiveness.
• The best use of person’s aptitudes and
experience and desires.
• Saves time.
• Easy to organize the work.
• Useful in emergency.

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 Disadvantages
• Low levels of job satisfaction because they have
little opportunity in decision making.
• Very little motivation to develop self and others,
as work becomes monotonous.
• Diminishing continuity of care.
• Clients may feel insecure not knowing who their
staff is.
• It is difficulty to establish clients priority.
• Fragmented care; task oriented.
• Frustrating to professional nurse.
• Lapses in communication. 10
 2. Team Nursing
• Care is given by a team of registered nurses
and nursing assistants.
• Nurses in the unit are divided as number of
teams and each team has to provide care to a
fixed group of patients.
• Each team has a team leader who is
responsible for the performance of the team.
• However, nurse manager is responsible for
whole nursing care provided in the ward.
• Nurses use this method have a close relation
with the patients they have to take care for. 11
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 Advantages
• High quality, comprehensive care with a high
proportion of ancillary staff.
• Team members participate in decision making
and contribute their own expertise.

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 Disadvantages
• Individual members may not have comprehensive
knowledge about the patient as whole due to lack
of communication.
• Team members may become too much dependent
on the leader for the decision making.
• Nursing care may become fragmented.
• Continuity suffers if daily team assignments vary.
• Team leader should have good leadership skills.
• Insufficient time for planning and communication.

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 3. Case Method
• Considered oldest of care delivery model.
• Also called “Total Nursing Care”.
• One nurse is assigned to and responsible for
the “comprehensive care” of a client or a group
of client during a shift.
• A client has consistent contact with one nurse
during a shift but may have different nurses on
other shifts.

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 3. Case Method Cont/d …
• Case method provides a high degree of
autonomy, clear lines of responsibility and
accountability, holistic patient care, and
unfragmented care.
• This is not cost effective as it requires
abundant availability of nurses.

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 Advantages
For the Patient:
• Standardized patient care outcomes for each
patient.
• Early patient discharge.
• Using the fewest possible appropriate health
care resources.
• Facilitating the continuity of patient care.
• Patient receives holistic care.

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 Advantages
For the Nurse:
• Enhancing nurse’s professional development
and job satisfaction.
• Facilitating the transfer of knowledge of
expert clinical staff of novice staff.
• High degree of autonomy.
• Lines of responsibility and accountability are
clear.

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 Disadvantages
• Lack of administrative support.
• Expensive.
• Client focused and outcome oriented.
• It is a professionally autonomous role that
requires expert clinical knowledge and
decision-making skills.

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 4. Primary Nursing
• Primary nursing care is one type of patient care
delivery that requires a one-to-one relationship
between the RN and the patient, with
responsibility for planning and managing care
clearly established.
• A method of providing comprehensive,
individualized and consistent care.
• The primary nurse
o Assesses and prioritizes each client’s needs,
o Makes nursing diagnoses,
o Develops a plan of care with the client, and
o Evaluates the effectiveness of care. 21
 4. Primary Nursing cont/d ...
• When the primary nurse is not on duty,
associate nurses have to follow the care plan
which was established by the primary care
nurse.
• Can provide better, continuity and more
expertise nursing care than the Team Nursing
model.

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 Advantages
• High quality, holistic patient care.
• Establish rapport with patient.
• RN feels challenged and rewarded.
• Increased communication with physician and
other health care provider.
• Have autonomy and motivation.

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 Disadvantages
• Primary nurse must be able to practice with a
high degree of responsibility and
accountability.
• RN must accept 24 hours responsibility.
• More RNs needed; not cost effective.

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 5. Modular Nursing
• A group of nursing staff is assigned with caring
for a group of clients located in close proximity
to each other.
• This is considered to be cost-effective since this
model needs few care givers to a group of
clients and limits the physical areas in which
care givers function.
• It combines elements of functional nursing
and team nursing.

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 Advantages
• Continuity of care is improved.
• RN more involved in planning and
coordinating care.
• Geographic closeness and efficient
communication.

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 Disadvantages
• Increased cost to stock each module.
• Long corridors not conducive to modular
nursing.

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 Selecting a Nursing Care Delivery Model
• The manager, when selecting a nursing care
delivery model for her unit, must be able to
answer the following questions:
o Is the model congruent with the philosophy of
the institution and nursing department?
o Is it cost effective?
o Is there patient satisfaction and staff
satisfaction?
o Does it support independent and
interdependent nursing?
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 Nurse manager’s responsibilities in
providing nursing care
• Ensure that organizational philosophy supports
the patient care delivery method practiced in
the unit.
• Select a care delivery method that is most
appropriate to the needs of the patients being
served.
• Use a care delivery method that maximizes
human and physical resources as well as time.

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 Nurse manager’s responsibilities in
providing nursing care cont...
• Group patient care activities in a manner that
facilitates communication and coordination
within and between units.
• Organize work in a cost effective manner.

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Problem solving and Nursing process
Problem solving is,
- The systematic identification of a problem,
- Determination of goals relating to the problem,
- Identification of possible approaches to achieve
these goals,
- Implementation of selected approaches and
- Evaluation of goal achievement.

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 Problem solving and Nursing process
Nursing Process
• Most recognize tool for clinical problem
solving.
• Has five steps including Assessment, Nursing
Diagnosis, Planning, Implementation and
Evaluation.

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 Problem solving and Nursing process
cont/d ...
Nurse Manager’s Role in Nursing Process
• Assess each patient’s particular needs
• Set client-specific goals and match the skills of
the person assigned responsibilities with the
tasks that need to be accomplished in the
assessment phase.
• Identify the person best suited for the tasks in
planning.

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 Problem solving and Nursing Process
cont/d ...
Nurse manager’s role in Nursing process
• Assigning the task to the appropriate person in
the implementation phase.
• Once these are done, nurse manager oversees
care to determine whether patient’s care needs
have been met.

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 Nursing Process
Assessment
• Collect data by interviewing, physical
examination and observation.
• Collect both objective and subjective data.
• Data may be physiological, psychological, socio-
cultural, spiritual, economic and life style
factors.

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 Nursing Process Cont/d ...
Nursing Diagnosis
• This is the nurse’s clinical judgment about the
client’s response to actual or potential health
conditions or needs.
• The diagnosis is the basis for selection of
nursing interventions to achieve outcomes for
which the nurse is accountable.

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 Nursing Process Cont/d ...
Planning
• In this phase nurse sets the measurable and
achievable short and long term goals for the
patient and put a care plan.

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 Nursing Process Cont/d ...
Implementation
• Nursing care is implemented according to the
care plan.
• Therefore, continuity of care for the patient
during hospitalization and in preparation for
discharge needs to be assured.
• Care implemented is documented in the
patient’s record.

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 Nursing Process Cont/d ...
Evaluation
• Both the patient’s status and the effectiveness
of the nursing care are continuously evaluated.
• The care plan is modified as needed.

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 Nursing Process Cont/d ...
• Nursing process is cyclic.
• If the process is not effective, all steps should
be reviewed and revised and the process
implemented.

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 Responsibility and Accountability of Nurse
Manager
Responsibility:
The obligation to do a certain activity to the best
of one’s ability.

Accountability:
Being answerable to someone for one’s actions.

First level nurse manager holds 24 hour

responsibility and accountability for the
performance of his or her unit.
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 Responsibility and Accountability of
Nurse Manager
• Nurse manager is accountable for
o Providing sufficient material resources to ensure patient
safety and appropriate utilization of staff
o Supervision of staff.
o His or her own actions and actions of subordinates.
• Nurse manager is answerable to the questions of
persons within the ward (the patient, physicians,
nurses or other staff) and of those who visit the
patient and many others involved in patient care.

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