ASSIGNMENT OF

PATIENTS/PATIENT CARE
DELIVERY MODELS
 ASSIGNMENT

It refers to a written delegation of duties to care for a

group of patients by trained personnel assigned to
the unit.
 Purposes of assignment

To delegate the work to be done to the nursing

personnel.

To gain the co operation of nursing personnel by

knowing and accepting the acceptance of work to be
done.
 Characteristics

Definitive and easily understood

Simple
Clear
Signed
Written
Posted in advance
Process of organizing patient care

Planning

Assigning

Leading

Evaluating

Reporting
Planning:
Developing a course of action
Assigning:
Assignment of patients and nursing activities are
written in a paper
Methods of patient care delivery (methods of patient assignment)

Traditional methods
 Case method
 Functional method

 Team method
 Modular nursing

 Primary nursing

Advanced methods
 Case management
 Collaborative practice

 Differentiated practice
 Case method

One professional nurse assumes total responsibility of

providing complete care for one or more patients.

Nurse is responsible for planning, organizing, and

performing all care.

Provides nurses with high autonomy and responsibility.

Common use areas—intensive care unit (ICU) and

postanesthetic care unit (PACU)
Advantages
 High degree of autonomy
 Lines of responsibility and accountability are clear
 Patient receives holistic, unfragmented care
 Patient, nurse, and family can develop a trusting relationship
 Nurse has more opportunity to observe and monitor patient
progress 
 Educational needs of clients can be closely monitored.
 Work load can be equally divided among the available staff.
Disadvantages
 Each RN may have a different approach to care
 Not cost-effective
 Lack of RN availability
 Non professional health workers are not used effectively
 It will be a great difficulty if the nurse is inadequately trained
or prepared.
Registered Registered Registered
Nurse Nurse Nurse
8-hour shift 8-hour shift 8-hour shift

Patient Care
The registered nurse plans,
organizes, and performs all
care

Total Patient Care (Case Method) Delivery

 Functional method

Staff members assigned to complete specific tasks

for a group of patients
Evolved during World War II as a result of a nursing
shortage
In this model, each care provider is responsible for
specific duties or tasks.
Unskilled workers trained to perform routine, simple
tasks
Common use area—operating room
Advantages
 Care is provided economically and efficiently
 Minimum number of RNs required
 Tasks are completed quickly
 Care can be delivered to a large number of patients

 Uses other types of health care workers when there is a

shortage of RNs 
Disadvantages
 Care may be fragmented
 Patient may be confused with many care providers
 Caregivers feel unchallenged
 Lack of continuity of care

 Neglecting the humanity of patients and the individual need of

the patient will be lost in an effort to get work done.
 Nurse Manager

LPN RN Nurse Aide Nurse Aide

PO Meds Assessments Vital signs Hygiene
Treatments Care Plans Hygiene Stocking

Assigned Patient Group

Functional Nursing Care Delivery Model

 Team nursing

Assignment of a group of clients to a small group of

workers under the direction of a team leader.
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 areas—most inpatient and outpatient
areas
Advantages
 High-quality, comprehensive care with a high proportion of
ancillary staff
 Team members participate in decision making and contribute
their own expertise
 Maximizes the role of the registered nurse
 Every team member has the opportunity to learn from and
teach colleagues.
Disadvantages
 Continuity suffers if daily team assignments vary
 Team leader must have good leadership skills
 Insufficient time for planning and communication
 Nurse Manager

RN Team Leader RN Team Leader

RN RN
LPN LPN
Nursing Assistants Nursing Assistants

Assigned Patient Group Assigned Patient Group

Team Nursing Model

 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
Advantages
 Continuity of care is improved
 RN more involved in planning and coordinating care
 Geographic closeness and efficient communication
 Every team member has the opportunity to learn from and
teach colleagues.
Disadvantages
 All personnel must be client centered.
 Unstable staffing patterns make it difficult
 Team leader must have complex skills.
 Nurse Manager

Geographic Geographic Geographic

Patient Unit Patient Unit Patient Unit
Patient Care Patient Care Patient Care
Team: Team: Team:
RNs RNs RNs
LPN LPN LPN
Nurse Aides Nurse Aides Nurse Aides
Meds Meds Meds
Supplies Supplies Supplies
Linens Linens Linens

Modular Nursing Model

 Primary Nursing

RN “primary nurse” assumes 24-hour responsibility

for planning, directing, and evaluating care
Evolved in the 1970s to improve RN autonomy
Common use areas—hospice, home health, and long-
term care settings
Basic concepts in primary nursing are:
 Patient assessment and care
 Complete communication
 Discharge planning
 Functions of primary nurse

Conducting admission assessment

Developing, planning, implementing and revising
nursing care plans
Directing care in her absence
Collaborating with physicians and families
Making referrals
Teaching health concepts
Making discharge plans
Associate nurse:

 Carries out nursing care planned by the primary nurses when she
is not on duty
Advantages
 High-quality, holistic patient care
 Establish rapport with patient and family
 RN feels challenged and rewarded
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
 Primary Nurse
24-hour responsibility for
planning, directing & Associate Nurses
Physician and
other members evaluating patient care Provide care
of the health care when primary
team nurse is off duty

Patient

Primary Nursing Model

PROGRESSIVE PATIENT CARE
PPC has been defined as "the right
patient, in the right bed, with the
right services, at the right time"
(Haldeman JC, 1964)
 Progressive patient care

Here client care areas or units provide various levels

of care; eg 1) intensive care unit for critically ill 2)
post intensive care unit 3) regular care units 4)
convalescent unit 5) self care unit

Clients are evaluated with respect to all level of care

needed. As they progress towards increased self care,
they are mared to units staffed to best provide the
type of care needed.
 PURPOSES OF PROGRESSIVE PATIENT
CARE

PPC is to provide optimum level of care to the

patient as per need in minimum cost.

To raise the level of patient care of those critically

ill patients with effective use of nursing personnel
and facilities by grouping the patients as per their
nursing care need.

PPC is also seen as an important method of

controlling cost with provision of nursing care as
per the need of various patients.
ELEMENTS OF PROGRESSIVE
PATIENT CARE

Intensive Care

Intermediate Care

Self Care

Long Term or Extended Care

Home Care

Ambulatory or Outpatient Care

Merits:
 Clients are in the best place to receive the care they require.
 Use of nursing skills and expertise are maximized due to
different staffing patterns of each unit.
Demerits
 There may be discomfort to clients who are moved often
 Continuity care is difficult even though possible
 Long term nurse client relationship are difficult to arrange
 Case management

First introduced in the 1970s by insurance

companies
Hospitals adopted the model in the 1980s
Value demonstrated through research
Case management include:
 Critical paths, variation analysis, intershift reports, case
consultation, health care team meeting and quality assurance.
RN assumes a planning and evaluative role; usually
not responsible for direct-care duties
Coordinates the patient’s care throughout the course
of an illness
 Responsibilities of case managers

Assessing clients and their homes and communities.

Co ordinating and planning client care
Monitoring client progress
Evaluating client outcomes
Advocating for clients moving through the services
needed
Seeking appropriate resources to fit a client’s need
Serving as a liaison with third party payers in
planning the client’s care.
 Collaborates With
Patient and Family

NURSE CASE MANAGER

Onset of Resolution of
Assesses, plans, implements, coordinates,
Illness Illness
monitors, and evaluates patient care
options and services to meet health needs

Collaborates with Nursing, Coordinates Services:

Physicians, Physical/Speech/ Home Care, Hospice,
Occupational Therapists, Dietary, Extended /Long-term Care
and Ancillary Services Ambulatory Care Services

Nursing Case Management Model

 Collaborative practice

It includes interdisciplinary teams, nurse physician

interaction, or nurse physician collaboration in care
giving.
 Differentiated practice

It refers to the difference between professional and

technical nursing.
Professional nurses give direct care to the patients
with complex interactions of nursing diagnosis.
Technical nurse give care to patients with common
conditions in a structured settings.
THANK U ..!!!