Nursing Care Delivery System to describe a structure for the organization of nursing work, to define the boundaries for the delegation of authority and to identify the types of health care workers providing the nursing care.
Generally, managers have their greatest influence on the organizing phase of the management process at the unit/ department. Multidisciplinary process is the delivery of health care to the patient. It must take into account the availability of resources, the educational preparation of the nurse, the competencies of staff, the needs of the patient, and the cost implications for the institution or health system.
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There are four well-defined and widely used traditional nursing care delivery system and each of these systems, functional nursing, team nursing, primary nursing and patient-centered care takes advantage of a variety of caregivers with licenses or certifications and different education levels. Choosing the most appropriate organizational mode to deliver patient care for each unit or organization depends on the skill and expertise of the staff, the availability of registered professional nurses, the economic resources of the organization, the acuity of the patients, and the complexity of the tasks to be completed.
Functional nursing- specific assigned to nurses. The nurse assigned to carry it out at all patients and complex nursing tasks. The idea behind functional nursing is that there is a specialist for each task. The leader of the ward assigns the different tasks to specific nurses based on the nursing care plans for the different patients.
Team nursing – The registered nurses (RNs), Licensed Practical Nurse/ Vocational Nurses (LPNs) and certified nursing assistants (CNAs) are team composed care of patient. In this model, the RNs spend more of their time at the nursing station while the CNAs most direct bedside care to the patient. The nurses are divided in a number of teams when a ward is organized according to the team nursing system. Each team has to provide care for a fixed group of patients. So nurses have a close relation with the patients they have to take care. Team leader who is responsible for the performance for each team. Each ward has a supervisor, which is responsible for the whole ward.
Primary nursing – All nurses are RNs. They do personal care as well as care planning, documentation, etc. CNAs assist the nurses, but do not have autonomous roles in patient care. Compared with team nursing model, this primary nursing model system can provide better continuity and more expertise. Primary nursing is a method of nursing practice by having one nurse can provide complete care which emphasizes continuity of care for a small group of inpatients in unit of hospital.
Total Patient Care – Commonly used in intensive care unit (ICU) and post-anesthetic care unit (PACU). RN is fully responsible for organizing, planning, and performing all aspects of nursing care. Total Patient Care provides a high degree of autonomy, clear lines of responsibility and accountability, holistic patient care and unfragmented care. Total Patient Care is not cost effective, it requires abundant availability of nurses.,
2.0 TEAM NURSING AS A METHOD OF NURSING CARE DELIVERY SYSTEM IN ULU KINTA HOSPITAL
Team nursing is a care model that uses a group of people led by a knowledgeable nurse. It is a delivery approach that provides care to a group of clients by coordinating a team of Registered Nurse (RNs), Licensed Practical Nurses (LPNs), and aides under the supervision of one nurse, called the team leader. Team nursing has been defined as the assignment of a group of clients to a small group of workers under the direction of a team leader. In my hospital we use team nursing and functional nursing according to the situation.
Team Nursing Model
In the team nursing registered nurse (RN) functions as a team leader and coordinates the small group (no more than four or five) of ancillary personnel to provide care to a small group of patients. The team leader is also responsible for encouraging a cooperative environment and maintaining clear communication among all team members.
The team leader’s duties include planning care, assigning duties, directing and assisting team members, giving direct patient care, teaching and coordinating patient activities. The team leader assigns each member specific responsibilities dependent on the role. The members of the team report directly to the team leader, who then reports to the charge nurse or unit manager. Communication is enhanced through the use of written patient assignments, the development of nursing care plans, and the use of regularly scheduled team conferences to discuss the patient status and formulate revisions to the plan of care.
However, for team nursing to succeed, the team leader must have strong clinical skills, good communication skills, delegation ability, decision-making ability, and the ability to create a cooperative working environment.
2.1 Male Ward 1
Male Ward 1 are inpatient area for people with multiple discipline and acute case. The ward also called observation ward.ListenRead phonetically Dictionary – View detailed dictionaryIt is a 26-bed ward with 1-2 patients are bed-ridden, 9-10 patients are unsteady gait and need help from staff and others can ambulating well. Totally patient is around 20-25 persons. The ward is divided into two teams. We use the Team A and Team B concepts together. The ward has a head nurse, 8 registered nurses (RN) and 4 medical assistants (MA) and 20 health care assistants (HCA). They all work in a group that has divided the duties of a head nurse. Morning and afternoon shifts with 8 person staff nurse / medical assistant and 10 health care assistants while the night shift with 2 staff nurse / assistant medical officers and 3 health care assistants were working together.
Patients are admitted to the ward for various reason, the most acute phase of the illness or relapse, so these patients require expert care from psychiatric nurses and other members of the multidisciplinary team while acute cases such as high fever, severe diarrhoea and vomiting, uncontrolled hypertension, uncontrolled diabetes, bronchial asthma, to rule out pneumonia, seizures, hyponatremia and etc will be sent to the ward to be observed closely.Read phoneticallyDictionary – View detailed dictionary Every patient that admitted to the ward will usually for blood investigations like Full Blood Count (FBC), Renal Profile (RP), Liver Function Test (LFT), Blood Culture And Sensitivity (Blood C / S) if they have high fever, chest x-ray (CXR), so when results come back are abnormal. Patients admitted with acute case are often severely unwell therefore require urgent specialist care for example patients will be sent to another hospital for intensive care where adequate medical equipment.Listen
Each team consists of 7 staff – 2 staff nurse/ medical assistant and 5 health care assistants. This ward is covering various requirements and aspects of patient care. For staff nurse 1 as a team leader will be doing receiving a report, key, ensuring proper and adequate number of patients and ensuring Dangerous Drug Act (DDA) enough. In addition, ensure that all staff attend work as scheduled, check the medication that was ordered to be sent to the pharmacy, providing medications to patients, tell the doctor in charge of cases the problem or need immediate attention, with the doctor during the round and carried out their new plan.
Staff nurse 2 will be served medicine to the patients and recorded in medical charts, take a vital sign such as high blood pressure, pulse, temperature and record it properly, if abnormal regarding vital sign, the staff nurse is responsible to inform the doctor. Other tasks are carrying out the treatment in terms of nursing, such as cleaning the wound, do Electro Cardiogram (ECG) if any, giving medication via injections, accept the entry of new or re-entry cases, assist other staff in the course of treatment, to help in bathing patients and identify patients who have skin problems, to help update the patient’s bed, help staff nurse 1 to organize and carry out all the doctor’s instructions, such as X-Ray, Dental, discharge process or home leave, accompany the patient when moving out or refer to hospital or follow-up cases, and so on.
Health care assistant will be responsible in terms of hygiene, such as helping patients to bathe patients disabled, bedridden patients, help patients put on clothes if necessary, assist in feeding patients, assisting nurses like to send specimens to the lab, assisting in any procedure such as dressing and make observations of each patient.
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Staff will be divided into 2 teams according to their assignment by the charge nurse. In team nursing, ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. As the team leader, the nurse is responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care. The team leader’s duties vary depending on the patient’s needs and the workload. These duties may include assisting team members, giving direct personal care to patients, teaching, and coordinating patient activities. As team leader of the group, each member will be given assignments to give care to the patient, for example patients have acute illness or reduced mobility or immobility should be considered as the potential for bed sore.
Bed sores are damaged skin areas of the body’s tissues that usually develops when certain pressure are sustained. This condition is very common to those patients who are bedridden for an extended period of time because of health conditions or patients who uses a wheelchair, wears a cast or patient who are unconscious and oblivious to pain. The treatment and prevention of bed sore is a challenge in the care of patients with compromised mobility. Prediction through accurate assessment and prevention of bed sore using appropriate measures are of primary importance. However, for patients who have already developed bed sore, the intervention can reduce mortality and morbidity rates. The concerted effort of patients, nurses, health care assistants, doctors, and other paramedical personnel is necessary for optimal outcomes.
As a team leader, it is important to ensure that each patient is given treatment are rewarded with the treatment provided by nurses. Preventive measures to avoid getting bed sore is essential to the effectiveness of the care provided by each member in the team is successful. The team leader must be fully inform and involved in decisions about care of bed sore. The team leader who look after patient should have a knowledge and experience especially if a patient have been at risk of bed sore for a long time. To prevent bed sore, the health care staff must do skin inspection regularly. How often will depend on how quickly the areas identified as vulnerable in risk assessment. The position must be encouraged to change frequent intervals and advised staff to help to correct patient seating positions, supporting feet and posture. Make sure patient look comfortable about a position. In addition, avoid the friction that is too rough when changing the position is. Tell the staff to suggest any equipment to reduce bedsore on the skin such as water filled gloves, synthetic sheepskins and doughnut-type devices. It is possible to recommend any particular type to use for pressure redistribution purposes. The staff must do frequent observation of the part is identified to be risk. If notice possible or actual signs of damage, the staff nurse in charge should be inform the doctor when review patient. All this treatment to be noted in the patient’s nursing notes.
The goals is the prevention of the bed sores by providing health care team with early identification of patients at risk of developing pressure ulcers, the provision of preventative interventions, and by identifying practice that may be harmful or ineffective. This is the importance of experience and knowledge provided by team leader to manage the nursing team on a patient performed in Ulu Kinta hospital. Teamwork necessary when handling patients to yield effective prevention measures can be addressed to prevent bed sore among patients.
3.0 ADVANTAGES AND DISADVANTAGES OF TEAM NURSING
The advantages of team nursing is usually associated with democratic leadership. It allows members to contribute their skills or their own special expertise. As team leaders, they should use their knowledge about each member’s abilities when making patient assignments. Recognizing the individual worth of all employees and giving team members autonomy result in job satisfaction.
In team nursing, the registered nurse is able to get work done through others. Each member of the team is able to participate in decision making and problem solving. Team nursing is an effective method of patient care delivery and has been used in most inpatient and outpatient health care settings. The team nursing also improved patient satisfaction and able to identify personnel who are responsible for his care. Every team member has the opportunity to learn and teach colleagues because a variety in the daily assignment given.
Disadvantages of team nursing is establishing a team concept takes time, effort and constancy of personnel. Unstable staffing pattern make team nursing difficult. This can lead to blurred lines of responsibility, errors, fragmented and depersonalized patient care. Sometimes the team leader may not have the leadership skills required to effectively direct the team and create a “team spirit”. There is less individual responsibility and independence regarding nursing functions.
Communication in these models is complex. Insufficient time for care planning and communication may lead to unclear goals. The need for excellent communication and coordination skills makes implementing team nursing difficult and requires great self-discipline on the part of the team members. There is shared responsibility and accountability, which can cause confusion and lack of accountability. These factors contribute to registered nurse dissatisfaction with these models. Continuity of care may suffer if the daily team assignments vary and the patient is confronted with many different caregivers. Frequently, insufficient time is allowed for team care planning and communication.. For team nursing to be effective, the leader must have a good communication, organizational, management, and leadership skills must be an excellent practitioner.
4.0 SUGGESTION TO IMPROVE TEAM NURSING DELIVERY CARE
For team nursing to be effective and improvement, the leader must have good communication, organizational, management, leadership skills and must be an excellent practitioner. For any team to be successful there has to be a leader called ‘team leader’. The team leader should possess leadership qualities. The leader should be able to inspire the team spirit in the members of his team and should openly encourage each and every team member. At the same time, it should be firm in his attitude as well as commitment and make his members understand that the team comes first and personal ambition should be pushed aside to the background. It is very essential to have open communication frequently. There should be mutual respect among each and every member of the team. While referring, it is important that they refer as team and not as individuals.
The important thing and contributes to the success is a teamwork. It is the contribution of each and every team member which works together as a team for the success. All staff must working as a teamwork without selfishness because it is the backbone of teamwork. Unless and until there is co-operation from each and every member, one cannot find success. All the team members tend to support each other whole-heartedly and work for the benefit of the team. In fact, there is a lot of co-operation, give-and-take as well as no selfish behavior.
Everyone must work together and recognize, know and respect each other’s contribution to the goal, which is quality patient care. Every member is important regardless of their title and rank, for example, if there are any problems or assignment conflicts, a team member should be allowed to voice their concerns.
To avoid problems and conflicts, all assignments are reviewed and discussed with the team. Communication mistakes can cause team division and dissention, which is counteractive to the whole concept. That is the purpose of the initial team conference, especially for resolving team issues. Effective communication is important in team nursing. In team nursing, communication is ongoing and reciprocal, the registered nurse should also report their task results to the team, especially new orders and treatments. Each team must work in their communication skills. It will be a better team leader if them clear in setting goals, assigning responsibilities and detailing what needs to be done so that team members can focus their energy most productively.
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