SEMINAR

ON
PATTERNS OF NURSING
CARE DELIVERY IN INDIA
SUBMITTED BY: SUBMITTED TO:
MS.JIJI.JOHN
MS.SIMAN.X
1
ST
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 good
ommuniation 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 line
of 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 7A;Bs* 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!
7A;Bs" 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 andDor
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 professional
nurses"
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"
E
DISAD2A'TA0E
Inreased osts to sto+ eah module
$ong orridors not onduive to modular nursing
P RIMARY NURSING METHOD :
This method is the best in an agen! #ith an allCprofessional
nurse staff" It is: A omprehensive* ontinuous and
oordinated nursing proess for meeting the total needs of
eah patient"
Basic concepts in primary nursing:
Patient assessment b! a primar! nurse* #ho plans the
are to be given b! seondar! or assoiate nurse #hen
the primar! nurse is off dut!" The 8: hours responsibilit!
for are is put into pratie through the primar! nurse=s
#ritten diretive on a preplanned ommuniation
assignment"
Com!ete "omm#ni"ation of are given in the nursing
staff dail! reporting method"
Dis"$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 8:Chour 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"