Organization And Functions Of Nursing Services And Education At National, State, District, And Institutions: Hospital And Community

ORGANIZATION AND FUNCTIONS OF NURSING SERVICES AND EDUCATION AT NATIONAL,

STATE,

DISTRICT,

AND

INSTITUTIONS:

HOSPITAL

AND

COMMUNITY Definition : organization is a process of identifying and grouping the word to be performed defining and delegating responsibility and authority and stabling relationship for the purpose of enabling people to work together in accomplishing objectives (Allen) organization is a system of cooperative activities of two or more purpose (Chister/Bernard) Impotence of organization 

A sound organization is the first requisite of sound management



Sound organization has following advantages o It facilitates expansion and growth o Scope of the adoption of new technological development o Optimum use of human resources o Promotes better coordination among the employees

Stimulates creativity among members and gives freedom for intuitive to do the work in a better manner. A well defined assignment and grouping of work facilitate better administrators and efficiency Principles of organization Principle of objectives Division of labour and specialization Coordination Authority and responsibility Scalar chain Span of control Unity of command Ultimate responsibility Simplicity Flexibility Balance Continuity Organization and functions of nursing department

Educational administration of school of nursing Administrative head –Principal School of nursing can operate effectively only if it is well organized and has support of a proper administration and controlling authority. 1. Controlling bodies 2 categories: Educational and service institution Educational –universities, college, son which are totally independent of any service institution Service- includes all the hospitals controlled by central and state govt and religious and social agencies. Most of the school of nursing in India, fall in this category. Controlling authority play certain roles like 

Clearly determining and delineating the place of school in total organization



Making necessary physical and human resources available



Delegating administrative responsibility and executive authority to the nurse, who is the administrative head of the school



Shearing the responsibility through all it staff of demonstrating standards of patient care which will provide desirable learning experience for student nurse



Preceding the school of nursing with a budget separate from the of the service.

Staff All the staff of school of school of nursing is made up of 

Nursing tutors



Clinical instructors



External lecturer who may be directly or indirectly associated with the institution

Functions and responsibilities of teaching staff 

Active participation in the formulation of philosophy of school and in subsequent planning and evaluation of curriculum



Implementation of curriculum



Ordering and maintenance of supplies and equipments



Participation in extracurricular activities



Participation in activities of professional advancement



Interpretation of the aims of the school to staffs in the institution and to the public

Administrative head of school of nursing 

The responsibility of regarding curriculum staff student, physical facilities and clinical are under the administrative head of the school



In some institution, school of nursing may be completely separated from hospital and may have its own administration



In such institutions the head of school may be designated as director or principal and will be directly insurable to the controlling authority



Nursing superintendent is marten have the overall responsibility of nursing service Hospital committee /Board Trust, MS

NS

Nursing staff

Housekeeping staff

PRINCIPAL

Teaching and other staff

Housekeeping staff

Functions 

Participation in the planning of controlling authority relates to the school of nursing



Preparation of the school budget and making recommendation with regard to the controlling authority



Organizing and administering of curriculum



Active participation in teaching programme



Periodic evaluation of the total programme



Formulation and implementation of realistic polices in relation to staff and students



Determining staff requirement and recruitment of staff in accordance with the policies of

in trolling authority 

Welfare of student and staff, including account section, health, recreation and vocation



Maintenance of proper system of records



Participation in planning of nursing services in clinical areas in students are employed



Interpretation of nursing education to other related discipline and to public



Submit periodic report to the controlling authority of state, national nursing council and others

Budget 

The administration of school of nursing requires a budget and how it is allotted and managed will depend on the type of controlling authority



If the administration of school is completely separate but in most school of nursing, it will be included in the total budget of hospital.

The items which have to be budgeting for average govt. school of nursing in India are: 

Salaries for professional, clerical, domestic staff and drivers



Stipend for students



New equipment and repairs



Linen and other household supplies



Office supplies including stationary and postage



Maintenance of transport and cost effort



Maintenance of library



Fund for educational tours, professional activities, capping, graduation ceremony, prize, entertainments etc.

Advisory committee The efficient, effective democratic way of coordinating the activities is by means of committees Members 

NS



Senior tutors



MS



Representative of controlling authority



Representatives from each of the hospital and committee agencies used for clinical

experience 

Warden



General educationalist



A local community member



An independent representative of medical professional

Functions 

Study the social and educational need of school. To advise the school about the need of society in relation to nursing service.



Advise on policies and support school staff inn implementing them



Support philosophy of school and advice school authorities in its implementation



Show concern with the welfare of staff and students



Assist in interpreting the educational purpose of school to the public

Courses and educational activities in school of nursing 

School of nursing offer the programme of general nursing and midwifery. This programme 3 years duration and has various subjects take



Students are evaluated by class tests and three sessional examination and one final examination at the end. Strict attendance – students participate and organize seminars , workshop

College of nursing 

In colleges under govt.university they have specification of seat for various qurtas



Service institutions are hospitals controlled by central and state govt. and by religious and social agencies



Staff of the director/head of college (principal/dean who is well qualified and experience on nursing)



Staff position vary according to organization pattern and controlling bodies as well as on various departements

A hospital administrator must know what tasks need to be accomplished to achieve the objectives of this institution To execute the task economically and efficiently it is necessary to split the activities These organizing refer to the formal grouping of staff and activities to facilitate achievement of

objectives Director/principal Dpy. Director /vice principal Professor HOD Associate professor Assistant professor Lecturers/clinical instructor The main objective is to prepare the graduates to function as efficient members of health team and as a citizen of the country Budget Controlling authority takes full responsibility for administering budget Item which have to be budgeted includes 

Salaries for professional, clerical, domestic staff and drivers



Stipend for students



New equipment and repairs



Linen and other household supplies



Office supplies including stationary and postage



Maintenance of transport and cost effort



Maintenance of library



Fund for educational tours, professional activities, graduation ceremony, prize, entertainments etc. controlling authority (board/ trust) Director college of nursing

Dy. Direct /Vice principal

office staff

hostel staff

Professor and HOD Asso.professor

Assi. professor Lecturer /clinical instructor Functions of director/principal college of nursing 

General administration of college of nursing



Utilize sound personnel management practices



Manages concerned department student teaching staff



Formulation and implementation of curriculum



Provides opportunity for advanced study for the staff



Promotes professional growth of employees



Encourage activities of prof.organization



Keep up to date current trends in nursing and nursing education



Carry out duties delegated by controlling authority



Establish channels of community



Conducts continuous review and analysis of programme



Interpret finding and initiate appropriate action

Organizational structure Administrative and programme Council Minister of health Secretary of health and family welfare Sr.Asst. Director of health

Academic control: University state board Board of studies in nursing Other responsible bodies

principal

teaching staff

library

office

hostel

University /other authorized body Vice chancellor(in govt.sector, governer is the chancellor) Registrar Dean CON Ass.dean HOD Asso.prof Lecturers Asst.lecturer Asst.prof Office staff

House keeping

Courses and educational activities in CON The CON usually offers the programme of BSc (N), post certificate BSc(N), MSc(N), Mphil nsg and Phd Nsg. Bsc (N) 4 year programme which makes the professional nurse responsible for bedside nursing care as well as teaching Msc (N) 2 year programme aimes at preparing the nurse to specialize in area of interest in nursing Mphil and Phd programme are offered by limited number of college and it is usually offered by university. Institutions functions as a channel. It makes it possible for the professional to undertake and carry out research. INSTITUTIONAL LEVEL – AT HOSPITAL Director of nursing Nursing services must function under a senior competent nursing administrator – variously called as director of nursing, nursing superintendent, principal matron, or matron-in- chief. She is responsible to the hospital administrator for overall programme and activities of nursing care of all patients in the hospital. Nursing programme is administered by her through appropriate planning of services, determining nursing policies in collaboration with hospital management and nursing procedures in collaboration with nursing staff, giving general supervision, delegation of responsibility, coordination of interdepartmental nursing activities‘, and counseling the hospital administration on nursing problems. She has a dual role: the first one is the administrative responsibility towards hospital administration, and the second one is the coordinating of all professional activities of nursing staff with those of medical staff.

The role of the nursing superintendent starts in a new hospital from helping to establish the overall goals, policies and organization, and facilities to accomplish these goals in the most effective and efficient manner. The functional elements of the role of nursing superintendent includes the following  Formation of the aims, objectives and policies of nursing services as an integral part of hospital service  Staffing based on nursing requirements in relation to accepted standard of medical care  Planning and directing nursing services  Maintaining supplies and equipments  Budgeting  Records and reports Nursing supervisor Each department or clinical division, e.g. Medical, surgical, obstetrical, operation theatres, outpatient department, nurseries, etc. should have a supervisor. As they may be more than one nursing unit in each division or department, supervisors have a general administrative and coordinating function within their respective division. However, supervisors will also have limited clinical functions Head nurse / nursing tutor A head nurse is assigned to a nursing unit, or ward, or a section of department. She works under the general direction of the supervisor of the division. Staff nurse / clinical instructor Staff nurses are employed at the floor‘ level for carrying out skilled bedside nursing. This is the real work force of the hospital upon whose competency, state of training and dedication depend the success of the nursing department. Student nurse Students nurse cannot be employed on nursing duties except under supervision of fully qualified staff nurses. Policies and procedures In order that a good standard of nursing care be maintained, the nursing superintendent should develop written policies and procedures to serve as a guides for nurses of the various units of the hospital.

Important topics that should be incorporated are as follows 

Organization



Status and relationship



Responsibilities



Staffing pattern, shift pattern



Departmental functions



Requisitioning of supplies



Utilization, care and maintenance of equipment



Nursing procedures, coordination with domestic services



Handling of the patients clothing and valuables



Isolation technique

Functions of hospital in nursing services and education 

As a basic function, to assist the individual patient in performance of those activities contributing to his health or recovery that he would otherwise perform unaided has had the strength will, or knowledge.



As an extension of the above basic function, to help and encourage the patients to carry out the therapeutic plan initiated by the physician



As a member of health team, to assist other members of the team to plan and carryout the total programme of care

AT COMMUNITY Organizational set up at the distrit level Director nursing services Deputy director nursing services Asst.director nursing service VDy.asst.director nursing service

DMO

Distt nsg officer

Asst Didt Nsg Officer (edu) Nsg supdt/dy NsgSupdt

DHO Asst Dist Nsg officer(comm)

principal tutor

Asst Nsg Supdt

Dist PNO

Tutor

PHN(PHC)

Ward sister clinical instructor Staff nurse

LHV/HS LHV

ANM PHCs (Primary Health Care) Introduction The PHC is the first contact point between the village community and the medical officer. These are established and maintained by the state government under minimum needs/ basic minimum services programme. It acts as a referral unit for six sub centre and has 4-6 beds. A PHC covers population of 30000 in plain area and 20000 in hilly remote and tribal area. The activities of PHC‘s involve curative, preventive, promotive and family welfare services. Definition Primary health centre is the basic structural and functional unit of public health services for rendering primary health care in peripheral areas. Elements of PHC 

Ensure safe water supply



Locally endemic disease control



Education/ expanded programme on immunization



Maternal and child health



Environmental sanitation



Nutritional services



Treatment of minor aliments



School health services

Standards of PHC The PHCs has been prepared keeping in view the resources available with respect to functional requirement for PHCs with minimum standards such as

Building



Man power



Instrument



Equipments



Drugs



Other facilities

The standards prescribed are , a PHC covering 20000-30000 population with six beds on well the block level PHC are ultimately going to be upgraded as CHC with 30 beds of providing specialized services. The objectives of PHCs are:

To provide comprehensive primary health care to the community through the PHC



To achieve and maintain an acceptable standards of quality of care



To make the services more responsible and sensitive to the needs of the community

Minimum requirements are:The assured services cover all the essentials of preventive, promotive, curative and rehabilitative primary health care. This implies a wider range of services that includes 

Medical care



Maternal and child health care



Full rage family planning services including counseling and appropriate referral for couples having infertility



MTP services



Health education for prevention and management of malnutrition, anemia and vitamin A

deficiency and co-ordinates with ICDS 

School health services



Adolescent health care



Disease surveillance and control of epidemics

Collection and reporting of vital events 

Promotion of sanitation



Testing water quality



Nutritional health programme



Training health workers



Training of ASHA

Staffing pattern The man power that should be available in the PHC is as follows STAFF

EXISTING

RECOMMENDED

Medical officer

1

3(at least 1 female)

AYUSH practitioner

-

1

Accountant manager

-

1

Pharmacist

1

2

Nurse midwife(staff) nurse

1

5

Health worker

1

1

Health educator

1

1

Health assistant (m/f)

2

2

Clerks

2

2

Laboratory technician

1

2

Driver

1

OPTIONAL vehicle

/ may

be from out side Class IV

4

Major role of nurse in PHC 

Facilitative role



Developmental role



Clinical role



Supportive role

Functions of PHC 

Medical care



Maternal and child health



Control of communicable diseases



Collection and reporting of vital statistics



Immunization services



Improvement in environmental sanitation



School health programmes

CHCs (community health centers) Introduction The community health centers are established and maintained by state government under MNP/BMS programme. It has 30 indoor beds with x-ray labour room, operation theatre, and laboratory facilities. It is managed by four medical specialists i.e. surgeon, physician, gynecologist and pediatrician. On 31st march 2003, 3076 CHC were established each covering a population of 80000 to 1.20 lakh. Definition Community health centres are the nonprofit community governed health organizations that provide primary health care, health promotion and community development services, using them inter disciplinary terms of health providers. Principles 

Excellence



Innovations



Accountability



Collaboration



Accessibility



Integrity



Environment

Elements 

Primary care



Illness prevention



Health promotion



Community capacity building



Service integration

Standards of CHC In order to provide quality care in CHCs IPHS are being prescribed to provide optimal expert care to the community and achieve and maintain an acceptable standards of quality of care. These standards would help to monitor and improve the functioning of CHCs. CHCs has to provide the following services like 

Care of routine and emergency cases in surgery



Care of routine and emergency cases in medicine



24 hour delivery services



Essentials of emergency obstetric care.



Full range of family planning services including laparoscopic services



Safe abortion services



New born care



Routine and emergency care of sick children



Other management of medical and accidental conditions



All the national health programmes should be delivered through CHCs

Nursing service Nursing service is the part of the total health organization which aims at satisfying the nursing needs of the patients/community. Nursing service administration

Nursing service administration is a complex of elements in interaction and is organized to achieve the excellence in nursing care services Definition of the nursing service WHO expert committee on nursing defines the nursing service as the part of the total health organization which aims to satisfy major objective of the nursing services is to provide prevention of disease and promotion of health. OBJECTIVES OF NURSING SERIVCE IN HOSPITAL  Management of nursing service and care  Initiate a set of human relationships at all levels of nursing personnel.  Establish adequate staffing pattern.  Develop and implement proper communication system.  Develop and initiate proper evaluation and periodic monitoring system.  Proper job description for nursing personnel.  Assist hospital authorities for effective personnel management.  Share nursing information system with other discipline.  Formulate and interpret nursing service policies.  Assist hospital authorities for preparation of budget.  Participate in inter departmental programs and other programs.  Education training and staff developments  Encourage a stimulating environment in which the personnel have opportunities to be creating innovators.  Develop and initiate orientation and training programs.  Create an atmosphere that conducive to give proper learning experiences for students.  Assist in the development of a sound, constructive program of leadership in nursing.  Initiate programs to improve the practice of nursing in keeping with advances in the relative areas and disciplines affecting the quality of nursing Research   

Participate in identifying the areas of research. Participate in the application of data and research. Produce conducive environment for research.

Community health program  Participate in community health programs, associated with hospital.  Interpret the roles and responsibilities in community health programs.  Participate in extramural health programs of the hospital and other related organization Functions of Nursing services   

To assist the individual patient in performance of those activities contributing to his health or recovery To help and encourage the patient to carry out the therapeutic plan initiated by the physician To assist other members of the health team to assist other members of the team to plan

and carry out the total program care SOUND ORGANISATIONAL PLANNING FOR HOSPITAL NURSING SERVICES  A written statement of the purpose and objectives of the nursing service  A plan of organization  Policy and administrative manuals  Nursing practice manuals  Nursing service budget  A master staff planning  Plans of appraisal of nursing  Nursing service administrative meetings  Advisory committees:  Adequate facilities, supplies and equipments  Written job descriptions and job specifications  Personnel records  Health services  In-service education of nursing personnel  Meeting with personnel from other departments  Factors influencing patient care ORGANIZATION AND MANAGEMENT OF NURSING SERVICE UNIT Factors influencing patient care  The type of service.  The acuteness of the service and the rate of turnover in patients.  The experience of the nurse.  The number of non-nurses  The amount and quality of teaching.  The amount and quality of supervision and ward teaching.  The method of appointment of the medical staff.  The plan of ward floor plan.  The physical facilities.  The amount, type and location of equipments and supplies.  The number of working hours  The morale of the worker.  Methods of performing nursing procedures.  The time required for hospital routines  The method of assignment.  The standards of nursing care.  Good ward management. Management  Assessment or data gathering.  Implementation-directing groups of nurses to implement planned actions.  Evaluation step in management process includes the action of multiple care givers, patient outcomes and costs.

DETERMINING THE NURSING STAFF REQUIREMENT  Calculating staff needs based on the number of beds in the hospitals  Estimating the number of staff according to the degree of dependency of the patients as determined on a scale.  This method relies on observations of nursing activity. ORGANISATION OF NURSING SERVICES Chief nursing officer ↓ Nursing Superintendent ↓ Deputy Nursing Superintendent ↓ Ward Sister - Clinical Supervisor ↓ Staff nurse ↓ Student nurse ROLE AND FUNCTION OF NURSE ADMINISTRATOR Administration  Organizes, directs and supervises the nursing services both day and night.  Coordinates assignments of staff.  Establishes the general pattern of delegation of responsibilities and authority.  Formulates standing orders for the nursing care.  Ensures appropriate allocation of duties and responsibilities to all nursing staff working under her.  Formulates nursing policies to ensure quality patient care and adequate attention at all times.  Responsible for efficient functioning of the nursing staff.  Evaluates the personal performance of the nursing staff.  Discipline  Ensure that a standard of discipline of nursing staff is high at all times.  Maintain good order and discipline in wards / departments.  Makes daily rounds of the hospital wards / departments and also seriously ill patients.  Brings immediately to the notice of the medical superintendent all matters concerning neglect of duty, insubordination either by nursing staff, patients or visitors or any untowards incident.  Public Relations  Promotes and maintains harmonious and effective relationship with the various

administrative departments of the hospital and related community agencies.  Maintain cordial relationships with the patients and their families. Office duties  Scrutinizes the reports and returns and submits in accordance with existing orders.  Confidential Reports  Initiates the confidential reports of nursing staff on due dates.  Responsible for the nursing budget Education  Carries out in-service training for all categories of nursing staff and paramedical personnel and keeps the records of such trainings.  Conduct various update courses based on the needs.  Encourages the personnel to participate in the continuing education program. Welfare  Responsible for health and welfare of nursing staff.  Ensures annual and periodical health examination and maintenance of health records. Conferences  Responsible for organizing and conducting staff meeting of the nursing staff once in three months.  Holds conference in nursing care problems and discuss policies as regards to working conditions, working hrs and other facilities. Supervision  Supervises nursing care given to the patients and all nursing activities within the nursing unit.  Supervises the work of all paramedical staff of the hospital. Records and Reports  Maintains various records such as duty roster nursing staff, day off book, personal biodata, leave plan, staff conference book, courses file etc. ORGANIZING PATIENT CARE Definition of patient care The services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient. PATIENT CLASSIFICATION SYSTEMS Patient classification system (PCS), which quantifies the quality of the nursing care, is essential to staffing nursing units of hospitals and nursing homes. In selecting or implementing a PCS, a representative committee of nurse manager can include a representative of hospital administration. The primary aim of PCS is to be able to respond to constant variation in the care needs of patients. Characteristics  Differentiate intensity of care among definite classes.  Measure and quantify care to develop a management engineering standard.  Match nursing resources to patient care requirement.  Relate to time and effort spent on the associated activity.  Be economical and convenient to repot and use.  Be mutually exclusive, continuing new item under more than one unit.  Be open to audit. Be understood by those who plan, schedule and control the work.

 Be individually standardized as to the procedure needed for accomplishment.  Separate requirement for registered nurse from those of other staff.  Purposes  The system will establish a unit of measure for nursing.  Program costing and formulation of the nursing budget.  Tracking changes in patients care needs.  Determining the values of the productivity equations  Determine the quality LEADERHIP ROLES AND MANAGEMENT FUNCTION ASSOCIATED WITH ORGANIZING PATIENT CARE Leadership roles:  Evaluate the effectiveness of the organizational structure  Determines adequacy of resources and support  Examines the human element  Inspires the work group towards a team effort.  Inspires subordinates to achieve higher.  Ensures that chosen nursing care delivery models advance the practice of professional nursing.  Management functions:  Examines the philosophy.  Select nursing delivery system.  Use scientific research and current literature.  Uses patient care delivery system that maximizes human and physical resources as well as time.  Ensure that non- professional staff are appropriately trained and supervised.  Organizes work activities to attain organizational goals.  Groups activities in a manner that facilitates communication and co-ordination  Organizes work so that it is cost- effective possible.  Makes changes in the work design  Clearly delineate criteria to be used for differentiated practice roles  Organizes work activities to attain organizational goals.  Groups activities in a manner that facilitates communication and co-ordination  Organizes work so that it is cost- effective possible.  Makes changes in the work design  Clearly delineate criteria to be used for differentiated practice roles MODES OF ORGANIZING PATIENT CARE  Case method nursing or total patient care.  Functional nursing  Team nursing or modular nursing  Primary nursing  Case management or managed care Case method In this method, nurses assume total responsibility for meeting all the needs of assigned patients during their time on duty. Characteristics:

  

Complete care. Nurses with high autonomy and responsibility. It is developed and communicated through written sources, its usage remains in contemporary practice.  The lines of authority and accountability are clear. Merits:  The nurses attend to total needs of clients  Continuity of care.  Client/ nurse interaction/rapport can be developed.  Client may feel more comfortable  Educational needs of the client can be closely monitored.  Family and friends became better known by the nurse  Workload of the patient can be equally divided.  Nurse’s accountability for their function is built-in. Demerits:  Many clients do not require the inherent care of intensity in this type of service.  This method need to be modified if professional workers are to be involved effectively.  It is difficult for the nurses to use this method to become involved in long term planning and evaluation of care.  It is not possible if the nurses are not adequately trained for the total care of the patient Functional method: In this, persons were assigned to complete certain tasks rather than care of specific patients. Eg. Checking BP, administering medications Characteristics:  Afunctional method is a technical approach of nursing care.  The available staff in the unit, for a particular period of time, are assigned selected functions of nursing practice such as vital signs, treatments, medications.  All the responsibilities are assigned in accordance with the expertise.  The only person who has responsibility of the client is the head nurse or nurse acting the role. Merits:  Person becomes specifically skilled in performing certain assigned task.  Best utilization of a person’s aptitudes, experiences and desires.  Less equipment is needed.  Saves time.  Development of technical skill  Sense of productivity for the task oriented nurse  Easy to organize the work of the unit and staff Demerits:  Client care becomes impersonal, compartmentalized and fragmented.  Diminishing continuity of care.  Staff may become bored and have little motivation.  Only the nurse in-charge has accountability for the client.  Little avenue for the staff development.  Client may tend to feel insecure.  Only parts of the nursing care plan are known

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Difficult to establish the client priorities.  Only safe when the head nurse co-ordinate all the activities of the members. Team nursing: Team nursing is based in the philosophy in which a group of professional and non- professional personnel work together who identify, plan, implement and evaluate comprehensive centered care. Characteristics:  Ancillary personnel collaborate in providing care.  Team nursing involves decentralization of nursing unit and professional head nurse authority.  Each team composed of a team leader, team members and patients.  Comprehensive care is the responsibility of the entire team.  The head nurse has the responsibility to know the conditions of all patients assigned to the team and planning individual care.  Democratic leadership.  Group members are given as much as autonomy Merits:  Includes all health care personnel in the group functioning and goals.  Feelings of participation and belonging  Workload can be balanced and shared.  Division of labour allows members the opportunity to develop leadership skills  Every team members has the opportunity to learn from and teach collegues. Demerits:  Establishing the team concept takes time, effort and constancy of personnel.  Unstable staffing patterns make team nursing skills difficult.  All personnel must be client centered.  This leads to blurred lines of responsibility, errors, and fragmented care.  For the team nursing to be effective the leader must be excellent practitioner and have good communication, organizational, management, and leadership skills. Primary nursing: It is also called relationship based nursing. It involves total nursing care, directed by a nurse on 24 hour basis as long as the client is under the care. Characteristics:  The RN primary nurse assumes 24-hour responsibility from admission or start of treatment to discharge or the treatment’s end.  During work hours, primary nurse provides total direct care for that patient.  When the primary nurse is not on duty, care is provided by other junior nurses.  An integral responsibility of the primary nurse is to establish a good communication  The combination of clear interdisciplinary group communication and consistent, direct patient care by relatively few nursing staff allows for holistic, high quality patient care Merits:  Opportunity for the nurse to see the client and family as one system.  Nursing accountability, responsibility and independence are increased.  The nurse is able to use wide range of skills, knowledge and expertise.  Potentiates creativity by the nurse and thereby work satisfaction increases

 Increased trust and satisfaction for both Demerits:  The nurse may be isolated from the colleagues.  Little avenue for group planning of care.  Nurse must be mature and independently competent.  It must be cost effective.  Staffing patterns may necessitate a heavy client load.  It may be difficult to recruit and retain enough staff, especially in times of nursing shortage.  An inadequately prepared or incompetent primary nurse may be incapable of coordinating a multidisciplinary team or identifying complex patient needs and condition changes. Case management: Case management is defined as a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates opinions and services to meet an individual health needs through communication and available resources to promote quality, cost-effective outcomes. Case management society of America Characteristics:  Case mangers handle each case individually.  In general case manager can handle a load of 25 patients.  Case mangers use critical pathways and multidisciplinary action plans to plan patient care. Responsibilities of case managers:  Assessing clients and their homes and communities.  Coordinating and planning client care.  Collaborating with other health  Monitoring client progress and client outcomes.  Advocating for clients  Serving as a liaison with third party Merit:  Additional work efficiency due to geographical proximity.  Establishes solid relationships with nursing and ancillary staff working on the unit.  Case management provides a well-coordinated care.  Provides comprehensive care  It seeks the active involvement of the patient, family and diverse health care professionals Demerits:  Some experts are argued that this role should be reserved for the advance practitioner nurse or an RN with advanced training or need 3 to 5 year experience.  The case manger should also be extremely bright, have well developed interpersonal skills, be able to multitask, have a strong foundation in utilization review, and understand payer-patient specifics and hospital reimbursement mechanisms.  Nurses identify major obstacles in the implementation of this service, financial barriers and lack of administrative support.  Expensive  Nurse is client focused and outcome oriented  Facilitates and promotes co-ordination of cost effective care

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Nursing case management is a professionally autonomous role that requires expert clinical knowledge and decision making skills. Modular nursing Modular nursing is a modification of team nursing and focuses on the patient‘s geographic location for staff assignments. The concept of modular nursing calls for a smaller group of staff providing care for a smaller group of patients. Characteristics:  The patient unit is divided into modules or districts, and the same team of caregivers is assigned consistently to the same geographic location.  Each location, or module, has an RN assigned as the team leader, and the other team members may include.  The team leader is accountable for all patient care and is responsible for providing leadership for team members and creating a cooperative work environment.  The success of the modular nursing depends greatly on the leadership abilities of the team leader. Merits:  Nursing care hours are usually cost-effective.  The client is able to identify personnel who are responsible for his care.  All care is directed by a registered nurse.  Continuity of care is improved  The RN as team leader is able to be more involved in planning & coordinating care.  Save staff time.  Feelings of participation and belonging  Work load can be balanced and shared.  Develop leadership skills  Continuity care is facilitated  Everyone has the opportunity to contribute to the care plan. Demerits:  Costs may be increased to stock each  Takes time, effort, and constancy of personnel.  Unstable staffing pattern make team difficult.  There is less individual responsibility and autonomy regarding nursing function.  All personnel must be client centered.  The team leader must have complex skills and knowledge. Progressive patient care: It is a method in which client care areas provide various levels of care. The central theme is better utilization of facilities, services and personnel for the better patient care. Principal elements of PPC are:  Intensive care or critical care  Intermediate care  Convalescent and Self Care  Long-term care  Home care  Ambulatory care Merits:

 Efficient use is made of personnel and equipment.  Clients are in the best place to receive the care .  Use of nursing skills and expertise are maximized.  Clients are moved towards self care, independence is fostered where indicated.  Efficient use and placement of equipment is possible.  Personnel have greater probability to function towards their fullest capacity. Demerits:  Discomfort to clients who are moved often.  Continuity care is difficult.  Nurse/client relationships are difficult to arrange.  Great emphasis is placed on comprehensive, written care plan.  There is often times difficulty in meeting administrative need of the organization, staffing evaluation and accreditation. DIFFERNTIATED NURSING PRACTICE Differentiated nursing practice refers to an attempt to separate nursing practice roles based on education or experience or some combination of both. Education model: Role differentiation based upon type of educational preparation [BSN, MSN etc] Competency model: Role differentiation based on individual nursing skills, expertise, experience etc. Merits:  Match patients’ needs with nursing competencies.  Efficient use of nursing resources.  Provide equitable compensation  It increase nurse satisfaction, built loyalty and increase the prestige of the nursing profession.  A prominent characteristic among the new models being tried is the nurse as a clinical expert leading other members of the team partners. Review of literature A cross sectional study was conducted on organization of hospital nursing, provision of nursing care and patient experience with care in Europe by Luk Bruneel, Baoyue Li et al(2015) This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor’s degree reduce the effect of worse nurse staffing on more clinical care left undone. Another research study was conducted on Organisational structure and nursing service management of select Hospitals by Sushma Kumari Saini, Charanjeev Singh. They find that

Organisational structure means the formal structure of authority calculated to define, distribute and provide for the co-ordination of tasks and contributions to the whole which is very essential for fulfilling the objectives of an organisation. In order to understand the functioning of an organisation, it is important to study its organisation structure. Keeping it in mind a study was conducted to study the organisation structure of nursing department and nursing service management of three select hospitals i.e. one Autonomous hospital, one private hospital and one state government hospital. Investigator visited all the three hospitals and information related to organisation structure and nursing service management was collected from the nursing office. Results revealed that all the three hospitals had different organisational structure with different nursing positions and cadres. None of the hospital had all the positions as recommended by the Indian Nursing Council (a statuary body) and High Power Committee 1990. However, there was partial implementation of the recommendations in all the select hospitals. There was a wide scope for improvement in these hospitals as regards the nursing personnel is concerned. If the decision making regarding nursing is vested in the hands of nursing administrators then better nursing services can be rendered which will help in turn in providing better services to patients. Bibliography 

k.park preventive and social medicine 21st edition japee publication new delhi

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www.Nih.Govt

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kk Gulani community health nursing

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basavanthappa BT nursing education japee Brothers medical publishers New Delhi

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neeraja KPText book of nursing education Japee Brother medical publishers New Delhi Basavanthappa BT. Nursing Administration. 1st edition. Jaypee Brothers Medical Publishers; New Delhi 1998. http://www.uta.edu/nursing/simulation/smart hospital.php Bruyneel L, Li B, Ausserhofer D, Lesaffre E, Dumitrescu I, Smith HL, Sloane DM, Aiken LH, Sermeus W. Organization of hospital nursing, provision of nursing care, and patient experiences with care in Europe. Medical Care Research and Review. 2015 Dec;72(6):643-64. Saini S, Singh C. Organisational structure and nursing service management of select hospitals. Nursing and Midwifery Research Journal. 2008 Jul;4(3).

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