Zagazig University

Faculty of Nursing
Master Degree
Second Term

Patient Care Delivery

System
Under Supervision
Assistant prof. Maha Abdeen Abdeen
Dr. Azza Abdeldayem Ata
Dr. Aisha El-Sayed El-Araby
Prepared by:

Raghda Salah Mohamed

2020

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Out Lines
 Introduction
 Definition of assignment
 Purpose of assignment
 Characteristic of effective assignment
 Principles of personnel assignment
 The types of patient care delivery (advantage – disadvantage )
 Nurse manager role in assignment
 Principles that guide personnel to refuse an assignment
 Reference

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Objectives
By the end of lecture, the student will be able to:

 Define the assignment

 Identify the purpose of assessment
 List the principles of developing assessment.
 Factors considered in distributing duties
 Identify the factors considered in distributing duties
 State the characteristics of effective assignment.
 Discuss the various models of delivering patient care, advantage
and dis advantage each model.
 Determine the nurse manager's role in assignment


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 Patient care delivery system
Introduction:
The goals of successful patient care delivery include high-quality and low-
cost care and the achievement of patient outcomes and satisfaction level. The
ability to reach these objectives depends on the organization's approach to the
matching of human and material resources with patient characteristics and health
care needs. The identification of patient care processes that are necessary to
achieve care goals must be done in order to determine health care provider roles
most appropriate to the specific process

Definitions
 Assignment it refers to a written delegation of duties to care for a group of
patients by trained personnel assigned to the unit
 Assignment the allocation of client care functions among nurses in order to
meet client care needs.
Purpose of assignment
1. Serves as work plan for the provision of nursing care
2. Provides forgiving comprehensive nursing care to all patient in the word at all
times.
3. Increase the skills of nursing personnel.
4. Define responsibility of each staff nurse
5. Provide for teaching of staff nurses and nursing students.
6. Prevent overlapping of nursing functions.
7. To distribute the work to be done to the nursing personnel.
8. To gian the cooperation of the nursing personnel by knowing and accepting the
acceptance of the work to be done

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Principles of personnel assignment:
1. Made by the head nurse or nurse in charge for each individual nurse
2. Based on:
- Nursing needs of each patient and approximate time required to care for him
- The capabilities, skills level, pervious experience and interest of the staff
member.
- Job description
3. Planned weakly and revised daily if necessary to assure continuity of care.
4. Nurses act in a manner that is consistent with their standers practice, codes of
ethics and scopes of practice .
5. Effective communication among nurses and within organization
6. Supervise those to whom nursing activities have been delegated .
7. Determine the model of care delivery .
8. Use simple clear words in writing assignment.
9. Fix responsibility for all duties clearly with no overlapping.
10.Provide for emergency situations and provide for special nursing activities.
11.Give each person time and opportunity to plan her work.
12.Assignment must rely on the preliminary planning.
13.Arrange the various parts of the assignment in logical order.
14.Ensure the continuity of patient care.
15.Assignment should be made in accordance with the administrative policies.
16.Should be in a written form.
17.Based on accurate assessment.
18.Two workers should never be assigned to do the same work.
Factors to be considered in distributing duties:
 The number, qualifications, experience and abilities of nurses.

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  The number, condition and location of patients.
 Nursing needs of each patient and appropriate time required for care
 Consider each nurse as individual.
 The availability of supplies and equipment.
 Architectural feature of unit.
Characteristic of effective assignment
 Definite and easily understood.
 Signed.
 Should be done according to personnel abilities and patient needs.
 Should be posted in advance in place easily accessible to ward nurses.
 Should be related to previous assignments in order to provide for progressive
learning experience.
 Should be written clearly, concisely, and simple words
 Done on weekly basis and adjusted to meet changing patient needs or
changes in nursing personnel
Major types of care delivery systems
A patient care delivery model is the method used to deliver care to patients .
There are multiple care delivery models, and the choice of a model within an
organization is dependent on many factors : financial , staffing capabilities , patient
population , and organizational mission and philosophy .the fundamental element
of any patient care delivery system ( Manthey. 1990) is a combination of following
 Clinical decision making
 Work allocation
 Communication
 Management

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  Coordination
 Accountability
The following are models associated with hospital practice :
 Total patient care
 Functional Nursing
 Modular Nursing
 Team Nursing
 Primary Nursing
 Case management
 The case /function method
Total patient care
In which nurse assumes full accountability for a group of patient .

Total patient care is the oldest method of providing care to patient. It is

sometimes called case method (not to be confused with case management). it was the
primary care delivery model until the 1930s, and it had a resurgence in the 1990s in
this model one nurse assumes accountability for the complete care of a group of
patients. it has been describe as a type of primary nursing (Reverby 1987), but in total
patient care the accountability for coordination of care doe s not extend beyond the
assigned shift. This is the type of care seen private duty nursing and some intensive
care units and was the model of care used by Florence Nightingale
Advantage of total patient care:
 High quality of care – all care is delivered by a registered nurse
 Continuity of care for a given shift
 High patient satisfaction
 Decreases communication time between staff

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  Reduces the need for supervision
 Allows one person to perform more than one task
Disadvantage of total patient care
 May not be cost effective because of the number of registered nurses needed
to provide care
 Some nurses dislike this model because they believe that some of patient care
activities could be done by others with less skill
Functional nursing
Functional nursing is a model in which work is allocated according to
specific tasks and technical skills. This model was popular from the late 1800s to
end of World War II. In this model, the charge nurse identifies the task /work that
need to be completed during the shift. These tasks /work are then divided and
assigned to personal. In this model, there would be a “medication nurse, “a”
dressing nurse, etc. this model of care delivery is oriented to the accomplishment
of tasks. It is efficient in times of staff shortages, and you will see patient care units
reverting to this delivery mode in times of staff shortage, such as “snow
emergencies” when the number of staff is limited. Some institutions with a large
variation in the classification of staff (registered nurses, licensed practical nurses,
nurse aides, and technicians) to care for patients may also use functional nursing.
Advantages of functional nursing are:
 A large number of tasks can be completed in a shift
 Ability to mix staff classifications
 Efficient financially
 Staff members can be trained to master one task
Disadvantages of functional nursing are:
 Charge nurse may be only one with total view of patient

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  Decreased patient satisfaction
 Decreased nurse satisfaction
 Fragmented communication
 Unit coordination becomes responsibility of charge nurse
 Fragmented accountability
This assignment, everyone is accountable for a portion of care. A challenge
is that all aspects of patient care need to be communicated to the next shift, and the
charge nurse must make sure that all pertinent information is known by her and
that she is then able to communicate it to the next shift. This can lead to
fragmented patient knowledge and a lack of holistic care
Team nursing
Team nursing model of care in which a group of staff members led by a
nurse provides care.
Team nursing is a delivery approach that uses a group of staff members led
by a nurse to provide care. The team is composed of health care workers with a
diversity of skills, education, licensure, and ability who work collaboratively to
provide care to a group of patients. The registered nurse is the team leader, and she
supervises and evaluates team members delivering care. The team leader can
provide care to a patient with complex care needs but usually does not provide
hands-on care. Strong communication skills are essential. This model supports
group work and productivity.
Advantages of team nursing are:
 Facilitation and oversight of novice nurses
 Smaller group of patients allows for higher quality of care than with
functional nursing

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  Team leader has knowledge of patient needs and can provide coordination of
care
 Fixed teams relate to higher-quality patient care
Disadvantages of team nursing are:
 Increased time to communicate within the team
 Expensive due to the increased number of staff needed
 Increased time needed to supervise, coordinate, and delegate
 Can lead to omissions in care
 Most educated staff relegated to role of supervision, not direct delivery of
care. In this assignment, care is delivered by a group of staff, all of whom
report back to the team leader. It is the team leader who has the decision-
making responsibility for the care delivered to the group of patients.
Modular nursing
Modification of team nursing Patient unit is divided into modules or units or
district, with an RN as team leader. Evolved to increase RN involvement in care.
Recent attempts to refine and improve team nursing have resulted in the concept of
“modular nursing,” which is a mini –team (two or three members) approach.
Modular nursing assignment is used when the nursing staff includes
technical and nurse aides, as well as professional nurses. Although two or three
persons are assigned to each module, the greatest responsibility for the care of
assigned patients falls on the professional nurse.
Advantages:
 Continuity of care is improved
 Useful when there are few RNs
 RN more involved in planning and coordinating care
 Geographic closeness and efficient communication.

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Disadvantages:
 Increased costs to stock each module

Primary nursing
RN “primary nurse” assumes 24-hour responsibility for planning, directing,
and evaluating care. Evolved in the 1970s to improve RN autonomy. She/he is
responsible for those patients from the moment of admission until discharge and
even throughout next admissions.
Primary nursing is a one-to-one approach to patient care. Each patient is
assigned a specific nurse, who assumes 24-hour responsibility for the delivery,
implementation, evaluation, and coordination of care for the duration of the
hospital stay. The primary nurse works in conjunction with nurses (associate
nurses) on the other shifts to coordinate all care for the patient and family. The
primary nurse is responsible for the development and evaluation of the plan of care
for the patient. Decision making is decentralized and takes place at the patient’s
bedside. This is a flexible model and can include a variety of skill mixes. It does
not mean that only registered nurses care for patients. The primary nurse plans,
coordinates, and evaluates the plan of care, but the care can be delegated to
appropriate staff members depending on the severity of the patient condition.
Common use areas—hospice care, home health, and long-term care settings
Advantages of primary nursing are:
 High-quality, holistic patient care
 Establish relationship with patient
 RN feels challenged and rewarded
 Increase nurse patient, and physician satisfaction

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Disadvantages of primary nursing are:
 Primary nurse must be able to practice with a high degree of responsibility
and autonomy
 RN must accept 24-hour responsibility
 More RN needed; not cost-effective because many tasks should be done by
less skilled persons.
 Time consuming
Case management
Case management is a process of monitoring an individual patient's health
care by the case manager, for the purpose of maximizing positive outcomes and
containing costs. The case manager has graduate-level preparation or is at an
advanced level of nursing practice. The case manager role requires not only
advanced nursing skills but also advanced managerial and communication skills.
The case manager is an individual "professional nurse” assigned
responsibility for this process:
1. The case manager may follow the patient from the diagnostic phase through
hospitalization, rehabilitation and back to home care.
2. Case manager has responsibility and authority for planning, implementing,
coordinating and evaluating care for the patient throughout the period of
illness, regardless of the patient’s movement among various units and
services (such as emergency room, surgical unit, recovery unit, etc.).
3. The case manager ensures that plans are made in advance for the next
needed step. Through this, the manager assists with decision-making and
helps to ensure that the patient receives care that will achieve the most
positive outcomes in the most efficient manner. This process helps to
eliminate costly delays in progress.

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Advantages of case management are that it:
For the patient:
 Establishing and achieving a set of “expected” or standardized patient care
outcomes for each patient.
 Facilitating early patient discharge or discharge within an appropriate length of
stay.
 Using the fewest possible appropriate health care resources to meet expected
patient care outcomes.
 Facilitating the continuity of patient care through collaborative practice of
diverse health professionals.
For the nurse:
 Enhancing nurse’s professional development and job satisfaction.
 Facilitating the transfer of knowledge of expert clinical staff to novice staff
Disadvantages of case management are that it:
 May lead to fragmented communication
 Needs to be integrated into the care delivery model
 May lead to nurses caring for patients to become more skill focused if the case
manager makes all the decisions.
Case /function method
It is a combination of both the case and functional method of assignment.
The nurse manger’s role:
1. Ensure competent nursing care is provided to the patient.
2. Evaluate nurse’s ability to deliver specialized patient care.
3. Organize resources to insure that patients receive appropriate nursing care.
4. Collaborate with the staff nurse to clarify assignment, assess personal
capabilities.

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 5. Communicate to staff through written policies the process of making
assignment and reassignment decisions.
6. Provide education to the staff and supervisory personnel in the decision
making process regarding patient care assignment and reassignment and
patient placement and allocation of resources.
7. Plan and budget of staffing patterns based upon patient’s acuity and
priorities for care.
8. Provide a clearly defined written policy for immediate internal review of
proposed assignments which includes the participation of staff involved.
Refusing an assignment
The following principles guide the nurse’s decisions and actions when faced with
situations in which she/he is considering refusing an assignment or discontinuing
service:
The safety and well –being of the client is of primary concern
 Nurses have the right to refuse assignment that they believe will subject
them or their clients to an un acceptable level of risk
 Nurses are not required to work extra shifts or over time for which they are
not contacted
 Individual nurses and groups of nurses safeguard clients when planning and
implementing any job action

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