Methods of Organising Care

1. Methods of Organising Care Return to Practice Susie Pease

2. Methods of Organising Care Aims and Objectives • To discuss the methods of care organisation • To list the advantages and disadvantages of these methods. • To discuss the differences in team nursing, primary nursing and case management.

3. Effective, Individualised Care! • How can nurses achieve this? • List the methods of care organisation you know. • Choose two of these methods and identify their advantages and disadvantages to patient care.

4. Organisation or Chaos

5. Task Allocation • Functional nursing • Patient becomes a passive object • Tasks listed on daily or shift basis • Complex tasks to most senior nurse • Follows medical model

6. Advantages of Task Allocation • Efficient – tasks can usually be completed during a span of duty • Nurses are responsible for a block of tasks and the completion of these can be easily checked • Day to day work planning is simple due to rigid organisation

7. Disadvantages of task allocation • Fragmented - patient does not receive holistic care • Tasks may assume priority over patient • Hierarchical • Emotional and psychological needs may remain unmet • Lack of continuity in care delivery

8. Patient allocation • Nurse allocated the care of a number of patients • Advantage • Emphasis on total client care • Disadvantage • Lack of continuity of care

9. Team Nursing • Group of Nurses • Nurse patient during hospital stay • Provide continuity • Provide holistic care? • Can be hierarchical

10. Advantages of team nursing • Promotes patient contact (Chavigny & Lewis 1984) • May increase patient satisfaction • May increase nursing job satisfaction • Should provide continuity of patient care • May provide holistic patient care • Ref: Chavigny K & Lewis A (1984) Team or primary nursing care? Nursing Outlook. 32(6) 322-7

11. Disadvantages of team nursing • May resemble task allocation • Discontinuity of care or fragmentation as different teams on duty • May become hierarchical

12. Primary Nursing • Each patient has one nurse responsible for their care • Primary nurse should assess and plan care • Responsibility delegated to associate nurse when off duty

13. Primary Nursing Advantages • Primary nurses have increased accountability. • Nurses should develop a partnership with patient leading to patient choice. • Consistency of care and development of therapeutic nursing should be increased.

14. Primary Nursing Disadvantages • Dependence on one nurse • Intense relationship • Lack of continuity when primary nurse not available

15. Case Management • Linked to critical care pathways. • All professional groups involved. • Arrive at consensus about standards of care and patient outcomes. • One member of MDT is case manager. • Routine care standardised but individual needs must be assessed and met.

16. Caseload Management • Community settings • Health Visitor or District Nurse acts as caseload manager • Caseloads organised geographically or by GP attachment.

17. Caseload Management continued • Each caseload manager leads a team of qualified nurses and healthcare support workers • Continuity of care should be maintained as teams organised to ensure a team member is available every day • Each registered nurse accountable for his or her actions • Case manager organises skill mix and resources

18. Action Plan • Reflect on your past experiences of care organisation • Find out the method of organising care in your placement areas • List the advantages and disadvantages of this method of organisation

19. Summary • 80% of patient care delivered by nurses • Whether care is organised by • Team nursing • Primary nursing • Case or caseload management • Patients should receive individualised, effective care • Patients are often experts in managing their own care and nurse/patient partnerships should develop

20. References & Book List • Ersser S. & Tutton E. (1991) Primary Nursing in Perspective. Scutari Press • Hale C. et al (1996) Organisation of Nursing Care. Distance Learning Centre • Hogston R. & Simpson P. M. (2002) Foundations of Nursing Practice (2nd Edition) Palgrave MacMillan • Manthey M. (1992) The Practice of Primary Nursing. Kings fund Centre • NMC (2002) Code of Professional Conduct.

21. To contact Susie Pease: • Telephone: 0113 343 1304 • Email: s.pease@leeds.ac.uk