Functional Nursing Care Case Assignment

Functional Nursing Care Case Assignment

Functional Nursing Care Case Assignment

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Disadvantages of functional nursing include:

● Uneven continuity ● Lack of holistic understanding of the patient ● Problems with follow-up

Because of these problems, functional nursing care is used infrequently in acute care facilities and only occasionally in long-term care facilities.

Team Nursing Team nursing (Figure 3-2) evolved from functional nursing and has remained popular since the middle to late 1940s. Under this system, a team of nursing personnel provides total patient care to a group of patients. In some instances, a team may be assigned a certain number of patients; in others, the assigned patients may be grouped by diagnoses or provider services.

The size of the team varies according to physical layout of the unit, patient acuity, and nurs- ing skill mix. The team is led by an RN and may include other RNs, LPNs, and UAPs. Team members provide patient care under the direction of the team leader. The team, acting as a uni- fied whole, has a holistic perspective of the needs of each patient. The team speaks for each patient through the team leader.

Typically, the team leader’s time is spent in indirect patient care activities, such as:

● Developing or updating nursing care plans ● Resolving problems encountered by team members ● Conducting nursing care conferences ● Communicating with physicians and other health care personnel

With team nursing, the unit nurse manager consults with team leaders, supervises patient care teams, and may make rounds with all physicians. To be effective, team nursing requires that all team members have good communication skills. A key aspect of team nursing is the nursing care conference, where the team leader reviews with all team members each patient’s plan of care and progress.

Charge nurse

UAP responsible for transportation

UAP responsible for vital signs

UAP with bath duty

Treatment nurse

Medication nurse

Patients

Figure 3-1 • Functional nursing.

Charge nurse

Team/module leaderTeam/module leaderTeam/module leader

RN, LPN, UAP RN, LPN, UAP RN, LPN, UAP

Patients Patients Patients

Figure 3-2 • Team/modular nursing.

32 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS

Advantages of team nursing are:

● It allows the use of LPNs and UAPs to carry out some functions (e.g., making beds, trans- porting patients, collecting some data) that do not require the expertise of an RN.

● It allows patient care needs requiring more than one staff member, such as patient trans- fers from bed to chair, to be easily coordinated.

● The geographical boundaries of team nursing help save steps and time.

Disadvantages of team nursing are:

● A great deal of time is needed for the team leader to communicate, supervise, and coordi- nate team members.

● Continuity of care may suffer due to changes in team members, leaders, and patient assignments.

● No one person considers the total patient. ● There may be role confusion and resentment against the team leader, who staff may

view as more focused on paperwork and less directed at the physical or real needs of the patient.

● Nurses have less control over their assignments due to the geographical boundaries of the unit.

● Assignments may not be equal if they are based on patient acuity or may be monotonous if nurses continuously care for patients with similar conditions (e.g., all patients with hip replacements).

Skills in delegating, communicating, and problem solving are essential for a team leader to be effective. Open communication between team leaders and the nurse manager is also im- portant to avoid duplication of effort, overriding of delegated assignments, or competition for control or power. Problems in delegation and communication are the most common reasons why team nursing is less effective than it theoretically could be.

Total Patient Care The original model of nursing care delivery was total patient care, also called case method (Figure 3-3), in which a registered nurse was responsible for all aspects of the care of one or more patients. During the 1920s, total patient care was the typical nursing care delivery system. Student nurses often staffed hospitals, whereas RNs provided total care to the patient at home. In total patient care, RNs work directly with the patient, family, physician, and other health care staff in implementing a plan of care.

The goal of this delivery system is to have one nurse give all care to the same patient(s) for the entire shift. Total patient care delivery systems are typically used in areas requiring a high level of nursing expertise, such as in critical care units or postanesthesia recovery areas.

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