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Selasa, 08 November 2011

Models of Nursing Care Delivery

INTRODUCTION
  • Nursing care can be carried out through a variety of organizational methods.
  • The model of nursing care used varies greatly from one facility to another and from one set of patient circumstances to another.. 
TEAM NURSING
  • Originated in the 1950s and 1960s.
  • Involves use of a team leader and team members to provide various aspects of nursing care to a group of patients.
  • In team nursing, medications might be given by one nurse while baths and physical care are given by a nursing assistant under the supervision of a nurse team leader.
  • Skill mixes include experienced and specially qualified nurses to nursing orderlies.
  • The quality of patient care with this system is questionable, and fragmentation of care is of concern.
PRIMARY NURSING
  • Primary nursing refers to comprehensive, individualized care provided by the same nurse throughout the period of care.
  • Primary nursing is a method of nursing practice which emphasizes continuity of care by having one nurse provide complete care for a small group of inpatients within a nursing unit of a hospital.
  • This type of nursing care allows the nurse to give direct patient care.
  • The primary nurse accepts total 24-hour responsibility for a patient’s nursing care.
  • Nursing care is directed toward meeting all of the individualized patient needs.
  • The primary nurse communicates with other members of the health care team regarding the patient’s health care.
  • This care method is rejected by many institutions as too costly.
PROGRESSIVE PATIENT CARE
  • PPC is a system of nursing care in which patients are placed in units on the basis of their needs for care as determined by the degree of illness rather than on the basis of a medical specialty.
  • Organization of medical and nursing care according to the degree of illness and care requirements in the hospital.
  • Progressive patient care is the systematic grouping of patients according to their degree of illness and dependency on the nurse rather than by classification of disease and sex.It is a method of planning the hospital facilities, both staff and equipment, to meet the individual requirements of the patient. (Raven. RW, 1960)
  • PPC has been defined as "the right patient, in the right bed, with the right services, at the right time" (Haldeman JC, 1964).
  • Elements of PPC are (Raven RW, 1960)
    1. Intensive care units for critically ill patient
    2. Self-care units for convalescent patients or those requiring investigation.
    3. Intermediate care units for those patients not requiring to be housed in either of the foregoing, and who would constitute approximately 60%, of all patients in hospital.
    4. Beds attached to out-patient departments for " one day" patients.
  • The elements can also be named as intensive care, intermediate care, self-care, long-term care, and organized home care.
CONCEPT OF PROGRESSIVE PATIENT CARE
  • PPC is defined as better patient care through the organization of hospital facilities, services and staff around the changing medical and nursing needs of the patient
  • PPC is tailoring of hospital services to meet patients needs
  • PPC is caring for the right patient in the right bed with the right services at the right time
  • PPC is systematic classification of patients based on their medical needs
ELEMENTS OF PPC
INTENSIVE CARE
  • Critically and seriously ill patients requiring highly skilled nursing care, close and frequent if not constant, nursing observation are assigned to the ICU. One patient in an ICU requires at least three nurses to observe him in 24 hrs
  • Intermediate care Patients assigned to this unit are both the moderately ill and those for whom the treatment can only be palliative
  • Self care Ambulatory patients who are convalescencing or require diagnosis or therapy may be cared for in this unit
  • Long term care unit This unit will provide services to certain patients now cared for in the general hospital, in nursing homes, or in their own homes and who would benefit by care in a hospital environment to achieve its maximum potential
  • Home care This programme makes it possible to extend needed services to the patient after he leaves the hospital and returns to his home in the community
BENEFITS OF PPC
PATIENT
  • better attention
  • better adjustment
  • minimized problems
  • life saving care
  • constant medical and nursing care
PHYSICIAN
  • assuring best nursing care
  • drugs and equipments at hand
  • orders carried out effectively
  • better clinical an team service
HOSPITAL
  • effective and efficient use of staff
  • improved public image
NURSING PERSONNEL
  • individual skills can be used
  • more time with patient
  • helping pt. and family to solve problems
  • job satisfaction
  • in-service education
COMMUNITY
  • continuity with hospital services
  • minimize the need of hospitalization
IMPLICATIONS OF PPC FOR NURSING EDUCATION
  • PPC hospital where all five phases of care are available can provide clinical experience in which the nurse can learn to solve basic nursing problems in meeting patients’ needs.
  • The three month assignment of professional nurses may no longer be realistic in such a setting.
  • Organization of hospital and community services based on patients needs
  • In the intensive care unit, the critically ill patients are concentrated regardless of diagnosis.
  • These patients are under the constant audio-visual observation of the nurse, with life saving techniques and equipment immediately available
  • In the intermediate care unit are concentrated patients requiring a moderate amount of nursing care, not of an emergency nature, who are ambulatory for short periods, and who are beginning to participate in he planning of their own care
  • The self-care unit provides for patients who are physically self-sufficient and require diagnostic and convalescent care in hotel-type accommodations. This unit serves as a link between the hospital and the home.
  • In the long-term care unit are concentrated patients requiring prolonged care. The grouping of such patients will permit staffing patterns that are less costly
  • Home care, the fifth element of progressive patient care, extends hospital services into the home to assist the physician in the care of his patients
USEFULNESS
  • The patient centered approach was constructed to be useful to nursing practice, with impetus for it being nursing education.
  • Abdellah’s publications on nursing education began with her dissertation; her interest in education for nurses continues into the present.
  • Abdellah has also published on nursing, nursing research, and public policy related to nursing in several international publications. She has been a strong advocate for improving nursing practice through nursing research
VALUE IN EXTENDING NURSING SCIENCE
  • It helped to bring structure and organization to what was often a disorganized collection of lectures and experiences.
  • She categorized nursing problems based on the individual’s needs and developed developed a typology of nursing treatment and nursing skills..
NURSING RESEARCH
  • She has been a leader in nursing research and has over one hundred publications related to nursing care, education for advanced practice in nursing and nursing research.
LIMITATIONS
  • Very strong nursing centered orientation
  • Little emphasis on what the client is to achieve
  • Her framework is inconsistent with the concept of holism
    Potential problems might be overlooke

References
  1. Smeltzer SC, Bare BG. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 10th Edition. Lippincott Williams and Wilkins.  Philadelphia. 2003.
  2. Raven RW. Progressive patient care. British Medical Journal, 1960. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959304/pdf/brmedj02849-0077.pdf
  3. Pearson, DA. , Rove DS., Golberg B.,Seigel E. Elements of progressive patient care In the Yale Health Plan HMO. Public Health Reports, Vol. 90, March-April 1975, pp. 119-125.
  4. Haldeman, J. C.: Elements of progressive patient care. In Progressive patient care-an anthology, edited by L. E. Weeks and J. R. Griffith. University of Michigan Press, Ann Arbor, 1964

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