PATIENT CARE

DELIVERY SYSTEM
What is ASSIIGNMENT ???
Definition:
Assignment 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 giant the cooperation of the nursing
personnel by knowing and accepting the
acceptance of the work to be done.
Principles of personnel assignment
*Made by the head nurse or nurse in charge
for each individual nurse.
Based on :
*-Nursing needs of each patient and
approximate time required to care for him.
The capabilities, skill level, previous
experience and the interest of the staff
members.
Job description,
*Planned weekly, and revised daily if
necessary to assure continuity of care.
Characteristics of effective assignment
1. Definite and easily understood.
2. Simple.
3. Clear.
4. Signed.
5. Written.
6. Posted in advance
Patient Care Delivery Models:
Total patient care method.
Functional method.
Team method.
Modular method.
Primary care method.
Case management.
Total Patient Care(case method )
Nurse is responsible for planning,
organizing, and performing all care of one or
more pts.

Oldest method of organizing patient care

Typically performed by nursing students

Common use areas—intensive care

unit (ICU) and post-anesthetic care
unit (PACU)
Total Patient Care—cont’d
Advantages
High degree of autonomy
Lines of responsibility and accountability are
clear
Patient receives holistic, unfragimented care
Disadvantages
Each RN may have a different approach to care
Not cost-effective the nurse spend some times
doing tasks that could be done by less skilled
persons
Lack of RN availability
Functional Nursing ( task nursing )
Staff members assigned to complete specific tasks for a
group of patients. Medication nurse ,bedsides nurse,
admission nurse.
Evolved during World War II as a result of a nursing
shortage.
Unskilled workers trained to perform routine, simple
tasks ,Common use area—operating room
Functional Nursing—cont’d
Advantages
Care is provided economically and efficiently
Minimum number of RNs required
Tasks are completed quickly

Disadvantages
RN busy with managerial and non nursing duties and
practical nurses deliver the majority of care
Care may be fragmented
Patient may be confused with many care providers
Caregivers feel unchallenged
Team Nursing
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
Team Nursing—cont’d
Advantages
High-quality, comprehensive care with a high proportion
of ancillary staff.
Team members participate in decision
making and contribute their own expertise
Nursing conferences help problem solving and staff
development .
Disadvantages
Continuity suffers if daily team assignments vary
Team leader must have good leadership skills
Insufficient time for planning and communication
Day to day change in team member may reduce the care .
Modular Nursing
Modification of team nursing Patient unit is divided into
modules or units or district ,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

Modular Nursing—cont’d
Advantages
useful when there are few Rns
Continuity of care is improved
RN more involved in planning and coordinating care
Geographic closeness and efficient communication
Disadvantages
Increased costs to stock each module
Long corridors not conducive to modular
Nursing.
Paraprofessional does technical aspects of care
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
Primary Nursing—cont’d
Advantages
High-quality, holistic patient care
Establish rapport with patient
RN feels challenged and rewarded
Increase nurse patient, and physician satisfaction
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
Because many tasks should be done by less skilled
persons .
Case Management
First introduced in the 1970s by insurance
companies
Hospitals adopted the model in the 1980s
Value demonstrated through research
Components include:
Assessment, planning, implementation,
evaluation, and interaction
Case Management—cont’d
Variations are found in most health care organizations
Reserved for chronically ill patients, seriously ill
patients, or long-term, expensive cases
RN assumes a planning and evaluative
role; usually not responsible for direct care duties
Supplemental form of care delivery;
does not replace direct-care model
Coordinates the patient’s care throughout
the course of an illness.
The case manager has a case load of 10 to 15 patients
observed from the admission to discharged ,the case
manger does not provide direct pt care but supervises
the care provided by other team
Choosing a Nursing Care Delivery
Model
What staffs mix is required?
Who should make work assignments?
Work assigned by task? By patient?
How will communication be handled?
Who will make decisions?
Who will be responsible and accountable?
Fit with unit//facility//organization
management?
You can delegate responsibility, but you
can't delegate accountability to anyone.
If someone gives you a job to do, you
can get someone else to do it, but you
are still accountable to produce the
results. If the job isn't done right the
only person to blame is you, because
even though you've delegated the
responsibility, you are still accountable
\\"Accountability\\\" focuses more upon what
others including God expect from the person
who is accountable. \\\"Accountability\\\"
includes judgment and the extent of judgment
for the success or failure to \\\"do,\\\"
\\\"complete\\\" or \\\"protect\\\" that for
which a person is held accountable.
Responsibility is the 'ability to respond'. Simple really. For you to do
the job, you are assigned, you simply need an ability to do it. Whether
you do it well, or not, is another matter.

Accountability is the 'ability to be brought to a count'. In other words,

your work is checked and verified that it has been completed well,
accurately and in accordance to the goal that was set.

An example is when you have to count some money. Responsibility

says, "Yes, I have the ability to count the money and have done so."
Accountability is when the boss says, "Ok, so let's do a count and
check that we get the same balance." An audit if you will. At that
point, you became accountable.