Unit 3

Key Academic Discussion You must have had experience in at least one or two modes of care delivery discussed by the authors YoderWise (pp.366-383) and Marquis & Huston (chp.14). Discuss which of the five modes you think would provide the best outcome for patient care. Take into consideration your staffing resources available at your workplace. However if you do not have any limitation which mode would you consider the best? Why? Please post your response online (250 words maximum). It would be best to do this within the first two weeks of this Unit. Next post at least one response to any of your course mates postings. Your responses should include your opinion on the suggested mode of patient care and your reasons for agreeing or disagreeing. You are encouraged to do extra reading other than the required text, on the various modes of patient care.I believe you will have a very interesting and valuable discussion. I look forward to reading about your experiences and opinions on the five modes of care delivery. You should be able to conclude with the best mode of patient care.This Key Academic Discussion will be part of your overall assessment. Please refer to the Key Academic Discussion criteria for more information. You have weeks 3 & 4 to complete this discussion. Closing date is Friday of week 4, 1700 hrs

Reply Re: Group discussion - Please start here by MITINEE ANAK MAJENG [NS410] - Wednesday, 13 April 2011, 11:19 AM Dear friends, I believe other hospitals also organize patient care delivery are primary nursing nowadays. In the past, my work environment patient care delivery is functional nursing. It is because nurses were in great demand. Disadvantage about this nursing is we only focus on what duty we are doing. Example, if you are assign become medication nurse, then that shift you are giving medication to all patient (e.g. 26 patient in the ward). Good thing is you are very good knowing well all the medication you served but when patient ask you about their condition, nothing you know or maybe little bit only. And worst of all, if you late served medications or served wrong medication, the blamed on your shoulder alone. Currently, in my hospital we are managed and implement back primary nursing patient care delivery. The risk are lessen and the nurse able to enjoy the work better. Thus, they know well about their patient on fingertips and any changes, they can immediately take action instead of asking around to know what is happening to their patient. "This organizational structure provides nurses with high autonomy and responsibility", (Marquis& Huston,pp.317). Show parent | Reply Re: Group discussion - Please start here by EDNA BINTI NASIR [NS410] - Thursday, 14 April 2011, 12:30 AM Thank you Mitinee for the prompt response. Team nursing is used in some of the ward in the hospital. For example is the Surgical Ward 2 which is implementing the team nursing. There are advantages and disadvantages of different type of the patient care delivery methods. I team nursing, ancillary personnel collaborate in providing care to a group of patients under the direction of a registered nurse. The teams will consist of one charge nurse, 2 to 3 team leaders and other nursing staffs. 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 leaders duties vary depending on the patients needs and the workload. Team nursing is usually associated with democratic leadership. Group members are

given as much autonomy as possible when performing assigned task, although the teams shares responsibility and accountability collectively. Disadvantages to team nursing are associated primarily with improper implementation. Frequently insufficient time is allowed for team care planning and communication. This can lead to blurred lines of responsibility errors and fragmented patient care. For team nursing to be effective, the team leader must have good communication, organisational, management and leadership skills and must be an excellent practitioner. Show parent | Reply Re: Group discussion - Please start here by EDNA BINTI NASIR [NS410] - Thursday, 14 April 2011, 12:43 AM Primary nursing I agree can result in high job satisfaction, but this method is difficult to implement because of the degree of responsibility and autonomy required of the primary nurse. However, for these same reasons, once nurses develop skill in primary nursing care delivery, they feel challenged and rewarded. As in primary nursing, its requires a nursing staff comprised totally of RNs. The primary nurse assumes 24 hour responsibility for planning the care of one or more patients from admission to discharge. During work hours, the primary nurse provides total direct care for patient. When the primary nurse is not on duty, associate nurses who follow the care plan established by the primary nurse provide care. Disadvantages to this method as in team nursing, lie primarily in improper implementation. An inadequately prepared or incompetent primary nurse may be incapable of coordinating a multidisciplinary team or identifying complex patient needs and condition changes. I believe many nurses maybe uncomfortable in this role or initially lack the experience and skills necessary for the role. Show parent | Reply Re: Group discussion - Please start here by MITINEE ANAK MAJENG [NS410] - Sunday, 17 April 2011, 10:17 PM It's true about what Edna said the disadvantage of team nursing. Incompetent primary nurse not only result of incapable coordinating the staffs but also lack identify patients needs or condition changes. In addition of what Edna said, team nursing need adequate nurses. Example in Surgical ward I've working before, we are divide into 3 group. Each group have 3 nurses that is 2 RNs and 1 AN. This form of team nursing with adequate nurses able to communicate well, manage patients well and proper documentation. However, when inadequate nurses causing so much works delay and improper implementation and this including improper documentation. Mostly, nurses only document patient chart beginning of the shift, in between shift nothing was written and end of shift then only start write all about in between shift of patient condition. This causing some nurses missed writing important thing that happen to the patient on that day. For team nursing to be effective, the team leader must be an excellent practitioner and have good communication, organizational, management and leadership skills. Regular collaboration/discussion is a strength in team. Team nursing is good can help reduction staff exhaustion after end shift, reduction of irritability-shared loads, and problem solving is shared by team not left to the individual. Show parent | Reply Re: Group discussion - Please start here by KALAISELVY A/P KARUPPAN [NS110] - Thursday, 21 April 2011, 01:07 PM

Dear Edna, You are absolutely right about team nursing concept and its advantages and disadvantages. I have practiced team nursing in my early nursing years and been as the team leader as well as the sub ordinate. Sometimes team nursing can be tiring for the team leader because most of the time, you are the person who is accountable for the patient as well as the team you are in charge of. Many a times, I have come across some nurses with an attitude who refuse to be accountable for their action and puts the responsibility on the charge nurse or team leader. Sometimes it can frustrate you as you get exhausted and gets scolded for mistakes done by others. Furthermore, a team leader must be a highly skilled person in order to ensure all care has been delivered during her shift. She also must have people skill and communication skill in order for her to manage her team efficiently. Show parent | Reply Re: Group discussion - Please start here by ONG LEE TING [NS410] - Tuesday, 19 April 2011, 08:36 PM In my opinion, primary nursing is very difficult to be applied in hospital setting due to the shortage of staff which is quite common in every hospital. Primary nursing needs large amount of RN to carry out the care. It is more suitable to practice at home nursing. In the other hand, the primary nursing needs a competent and well-prepared nurse. Some nurses might not be comfortable with this mode especially those who is lack of experience and skills. The primary nurse must able to coordinate a multidisciplinary team and identifying complex patient needs and condition changes. The combination of team nursing and functional nursing is still more suitable to hospital setting organization. Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Tuesday, 19 April 2011, 09:47 PM Dear Ong, Yes, primary nursing is not a preffered method among nurses. Nurses are expected to be responsible 24 hours a day on patient care. Communications among nurses and other healthcare staffs are very important. They are required to provide holistic care, so they must have broad knowledge and required to have high nursing skill. As a primary nurse, we need to be caregiver, advocate, coach and consultant. Nurses need to update their knowledge and skill time to time. It is suitable in clinics and nursing home. I have a lot of experience in primary nursing. It allow me to gain knowledge in different sectors too. Show parent | Reply Re: Group discussion - Please start here by ONG LEE TING [NS410] - Thursday, 21 April 2011, 10:05 PM Dear all, I agree that the primary nursing mode really bring the best outcome of nursing care due to the higher quality and more competent nurses. In viewing of our current nurses'

quality, mostly are poor in their skill. This is mainly due to limited place and chance for them to do their practical especially those student nurses who are trained in private nursing colleges. Sometimes we heard about patients' complaints regarding poor nursing skills and negligence happen. As we know, primary nursing mode needs a competent and skillful nurse to organise their nursing care. In my opinion, managers should encourage their staffs to go for further study to gain more knowledge and been trained to be more critical thinking. I am sure that by doing this from now, we can practice primary nursing in every health care setting to improve the quality of nursing care and better patients' outcome. Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Tuesday, 19 April 2011, 09:23 PM Hi Mitinee, I agree with your opinion on the disadvantage. You might know little on patients latest condition as you might not be updated by your other associate. But the advantage on functional nursing is actually we become very efficient at specific tasks and since we are only been given one or two task during a shift, there would not be any delay. So, medications error can be avoid. Again, I agree with you that utilising primary nursing allow us to provide our care efficiently and we gain high job satisfaction. Show parent | Reply Re: Group discussion - Please start here by ONG LEE TING [NS410] - Tuesday, 19 April 2011, 08:15 PM I personally prefer the primary nursing care. The RN primary nurse assumes 24-hour responsibility for planning the care of patients from admission or the start of treatment to discharge or the treatments end. The primary nurse required to establish clear communication among patient, the physician, the associate nurses, and other team members. The combination of interdisciplinary group communication and consistent, direct patient care by relatively few nursing staffs allows for holistic, high-quality patient care. However, thinking of the shortage of staff, my unit would not be able to practice primary nursing. The combination of team and modular nursing, and functional method will be suitable for my unit. Tasks are completed quickly, with little confusion regarding responsibilities, and it only need minimal number of RNs. Team and modular nursing is quite similar to functional mode, where ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. The team leader has to know the patients condition and plan for individual care. The different of team and modular nursing from functional mode is the team leader will assist team members, giving direct personal care to patients, teaching, and coordinating patient activities. I would like to let my staffs to contribute their own special expertise or skills which will result in high job satisfaction. In conclusion, a manager must know all the modes of organizing patient care and apply the suitable method to her unit based on the manpower provided to achieve the

best outcome. Show parent | Reply Re: Group discussion - Please start here by ONG LEE TING [NS410] - Tuesday, 19 April 2011, 08:15 PM I personally prefer the primary nursing care. The RN primary nurse assumes 24-hour responsibility for planning the care of patients from admission or the start of treatment to discharge or the treatments end. The primary nurse required to establish clear communication among patient, the physician, the associate nurses, and other team members. The combination of interdisciplinary group communication and consistent, direct patient care by relatively few nursing staffs allows for holistic, high-quality patient care. However, thinking of the shortage of staff, my unit would not be able to practice primary nursing. The combination of team and modular nursing, and functional method will be suitable for my unit. Tasks are completed quickly, with little confusion regarding responsibilities, and it only need minimal number of RNs. Team and modular nursing is quite similar to functional mode, where ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. The team leader has to know the patients condition and plan for individual care. The different of team and modular nursing from functional mode is the team leader will assist team members, giving direct personal care to patients, teaching, and coordinating patient activities. I would like to let my staffs to contribute their own special expertise or skills which will result in high job satisfaction. In conclusion, a manager must know all the modes of organizing patient care and apply the suitable method to her unit based on the manpower provided to achieve the best outcome. Show parent | Reply Re: Group discussion - Please start here by KALAISELVY A/P KARUPPAN [NS110] - Thursday, 21 April 2011, 01:19 PM Dear Ong, Primary nursing is the nursing method of the century practiced in the western. I work in Saudi Arabia and we practice primary nursing in the emergency room set up to ensure quality care delivered to the patient whom you have been assigned to from the time of arrival until his disposition either he is discharged home or admitted to the wards. I must say it is a highly rewarding method because you have full autonomy on the patient and this motivates you to give your best care because end of the day, the progress of the patient depends on you. I have been so overwhelmed to do my best for the patient that I have personally taken steps to upgrade my skills and knowledge by attending short courses on my own at my own expanse. I always go back home with my head high and with a satisfaction that i have done my best during my shift on my patient. However, in Malaysia, nursing standards still needs improvement. This is because, I find we have very limited resources to send staffs for further training or workshops to upgrade themselves. There is not much of appreciation here in terms of salary and we find many of our senior staffs venture out to get better pay. Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Tuesday, 19 April 2011, 09:06 PM

Dear Friends,

As I have mention on academic discussion, I am the only nurse in my aesthetic clinic. It is a small set up. I am practising the primary nursing method. I plan and manage my care even from before my client walk in to my clinic till they go back. (Most of my client comes in by appointment). Through this method, I establish good communication with client, and it gives me a clear picture on clients expectation and need, which allow me to plan my work systematically and communicate effectively with my other associate and doctor. Feedback from my colleagues and doctors allow me to coordinate my care better. I gain high job satisfaction by utilising this method as I get good response from my clients, doctors and other non medical background colleagues. We always work as a team and I would always discuss and allow my client to participate in decision making. Our main goal is clients satisfaction and we mostly receive good feedback from them. Being the only nurse in my clinic, this is the only method that I could utilise. But in future if my management decide to employ more nurses, I prefer functional nursing. This would allow us to plan and manage our work better. Currently, I am incharge of arranging and preparing our treatment room, ordering and maintaining stocks, which frequently I have to source for new and better quality products and drugs with doctors advice, perform treatments on clients, assist doctor during treatments, performing after care, prepare and give medications. Being alone, I could manage all this work by planning my time well. With more nurses around, to avoid any conflicts, especially in misleading clients and maintaining stocks (stocks should be always sufficient so that client's treatments and care will not be interrupted), functional method would be the best. Each nurse can take one responsibilities and there would not be any conflicts and pointing fingers when there is a mistake. Show parent | Reply Re: Group discussion - Please start here by KALAISELVY A/P KARUPPAN [NS110] - Thursday, 21 April 2011, 01:31 PM Dear Gowri, Well done girl! It's not easy to run a practice alone and honestly whatever method of nursing used should be a comfortable one for you. In fact, there shouldn't be any fuss in that. You are responsible and accountable for your own action. But what I'm not agreeable with your practice is what if you are sick or holiday? Who will take over from you? And what type of nursing method used by the person relieving you? Will there not be a conflict of interest? Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Thursday, 21 April 2011, 10:01 PM Dear Kalai, Thanks for your feedback. Most of my client comes in by appointment, so I will plan my holiday early so that it would not conflict with client's appointment. During my absence, my colleagues will perform the treatments that do not require medical attentions, like acne treatment using laser machine and hair treatments. My colleagues are all trained by the technician from companies that sell machines and treatments to

us. Medical related treatments will be cared by doctor or will be postponed. At times I do go back to work during my off day to attend to clients. I agree that I face a lot of problem working alone in my clinic but I manage to overcome all that by discussing with my colleagues and manager. My clients are also aware that they have to make appointment for treatments that require medical attentions. Once you create a good nurse-client relationship, clients will be more understanding and be co-operative.

Show parent | Reply Re: Group discussion - Please start here by VILMA BINTI MADIN [NS410] - Friday, 22 April 2011, 03:53 AM Good job Gowri! I am impressed with you and the way you manage your work in the unit. I think you had implies the planning and organizing process well especially the planning when you are going on-leave. As planning include determining objectives or goals,according to Marquis & Huston, organizing involves establishing a formal structure that provides the best possible coordination or use of resources to accomplish unit objectives. All the best to you! Show parent | Reply Re: Group discussion - Please start here by KALAISELVY A/P KARUPPAN [NS110] - Wednesday, 20 April 2011, 07:27 PM

I would like to start of this academic discussion by giving my friends an overview of the methods of nursing. There are 5 traditional modes of care delivery that is:1) Total patient care - nurses assume total responsibility for meeting all needs of assigned patients during their time on duty. Oldest method of organizing patient care. Typically done by student nurses and in units like Intensive Care Unit (ICU) or post anesthetic care unit (PACU). Advantages are high degree of autonomy, responsibility and accountability is clear and patient receives holistic, unfragmented care. Disadvantages are not cost effective, lack of RN availability and each RN may have a different approach of care. 2) Functional nursing - Staff members assigned to complete specific tasks for a group of patient such as medication nurse, dressing nurse, giving baths, or taking vital signs. Unskilled workers trained to perform routine and simple tasks and usually in area like operating rooms. Advantages are care is provided economically and efficiently, minimum number of RNs required and tasks are completed quickly. Disadvantages are care may be fragmented, patients may be confused with many care providers and caregivers may feel challenged. 3) Team and modular nursing - RN as team leader coordinates care for a group of patients. RN assigns work on team members expertise.

Advantages are high-quality, comprehensive care with a high proportion of ancillary staff and team members participate in decision making and contribute their own expertise. As for disadvantages are team leader must have good leadership skills, excellent practitioner and gave good communication skills, insufficient time for planning and communication and due to daily assignments vary, continuity of care suffers. 4) Primary nursing a type of patient care delivery which requires one-toone nursing relationship between a RN and a patient, assumes 24-hour responsibility for planning, directing, and evaluating care. Advantages are high-quality, holistic patient care, establish rapport with patient, RN feels challenged and rewarded. Disadvantages are primary nurse must be able to practice with a high degree of responsibility and autonomy, RN must accept 24-hour responsibility and more RNs needed and not cost-effective. C Case management method - a system of client care delivery that focuses on the achievement of client outcomes within effective and appropriate time frames and resources. Advantages are provides well coordinated care which improves care outcome, decrease in length of hospitalization and patients and families receive continuous care across all disciplines. Disadvantages are financial barriers, lack of administrative support and lack information support system. Being a registered nurse since 1993, I have actually undergone a modification and collaboration of all this methods of nursing. In my early years of nursing, I have actually started off as a total patient care nurse with a mix of functional nursing method. This is due to those days; we had assistant nurses to help with the daily staffing and assignments. As nursing developed towards higher degree, many hospitals are getting away with assistant nurses to give quality care to patient. With this advancement, the concept of primary nursing is becoming more prominent. However, Malaysia still have a long way to go in order to practice primary nursing method which is actually good and more rewarding as the nurses will be motivated to upgrade their skills and competent to be an independent nurse practitioner with full autonomy in their line of duty. I work in a first trauma centre in Saudi Arabia which is a 800 bedded hospital. The staffs here comprises of more than 60 nationalities from all over the world. Here we practice a lot of primary nursing. This actually makes you a very competent nurse because its a rule that you have to have all your skills and competencies done before you can actually perform. Staffs are also rewarded high in term of allowances if you are skilled and up to the managements expectation.

Show parent | Reply Re: Group discussion - Please start here by VILMA BINTI MADIN [NS410] - Friday, 22 April 2011, 01:37 AM Dear Kalai, Tq for the overview of the different types of patient mode care.Thanks also for sharing your experience working abroad. Show parent | Reply Re: Group discussion - Please start here by GLADYS VITALIS [NS410] - Thursday, 21 April 2011, 11:20 AM Dear friends and colleagues, When I was a student nurse, we were introduced to functional method of nursing care delivery system. It is where RN's are the one who is in-charged in administering medicine, following doctor's rounds, doing bed-side procedures such as removing of surgical tubes, phlebotomy and etc, doing the admission and also the discharged teaching to patient and family. And on the other hand, the assistant nurse and the nurse aids will be assisting in doing the hygiene task and other simpler task. A charge nurse will be in charge to overlook the flow of the unit. When I look at it, functional method is a very costeffective kind of system because the organisation can minimize the number of RN and an unskilled person could be trained to a specific task. Not only that, large number of task could be done in a short period of time. But, this method has its disadvantage too. And then, team nursing method was introduced to improve the deliverance of a good nursing care. This method indeed improved the patient satisfaction rate and staffs are much more happy and satisfied because they are able to participate in decision making regarding the plan and objective for their patients. Now, the organisation where I worked is working on implementing the primary nursing method where one RN functions autonomously as the patients main nurse. I see this as a positive approach to better improve the nursing care deliverance in my organisation. This may take awhile to set up because of many constraints but it will be worth it in the end. Show parent | Reply Re: Group discussion - Please start here by KALAISELVY A/P KARUPPAN [NS110] - Thursday, 21 April 2011, 01:41 PM Dear Gladys, Its great to hear that your hospital is implementing the primary nursing method. Believe me it is a very rewarding method and this will encourage our nurses to pursue their degree and not just be a diploma nurse. You will be surprised to see the fruit of this method and patient will benefit from care given by highly skilled and knowledged nurses. However, I do understand the constraints like shortage of nurses that we are

facing right now, but like you put it, it may take a while but it's definitely worth the while. Show parent | Reply Re: Group discussion - Please start here by GLADYS VITALIS [NS410] - Friday, 22 April 2011, 10:53 AM Dear Kalai, Thank you for the input and for enlightening us on the methods of care delivery in nursing. Like I said, my hospital are slowly implementing the primary nursing method but due to the constraints (shortage of RN) they are combining the primary nursing method with the case method or total patient care method and team nursing method. Primary nursing method requires one registered nurse to give a total patient care for 24hour a day. And as we know, nobody would want to work for a 24-hour period. It is tiring and not flexible. On the other hand, case method is where one nurse will provide total care for one patient during the entire shift which is 8 hour shift. The advantage of this method is similar to primary nursing but the most important fact is that, a mutual trust between patient, their family and nurse and they are able to work together to achieve goals and objective. Case method and the primary nursing method are indeed costly because total patient care by registered nurse are expensive. So, in order to tackle this problem, my organisation came up by combining the primary nursing method with case method and team nursing. Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Thursday, 21 April 2011, 10:19 PM Dear Gladys, Good to hear that your organisation is in the mid of implementing primary nursing. This method will encourage you to update your knowledge and nursing skills constantly in order to achieve your nursing goal. You will have a lot of responsiblities which will give you high job satisfaction if you manage it well. Good luck! Show parent | Reply Re: Group discussion - Please start here by VILMA BINTI MADIN [NS410] - Friday, 22 April 2011, 02:04 AM You are absolutely right Gladys! I am also having the same experience with you during my training. I just want add on some of the disadvantages of the functional nursing. Functional nursing may lead to the possibility of overlooking patient needs such as psychological and spiritual need. We knew that in this nursing mode care has various staffs of looking after a patient, therefore no one care provider sees patient care from the beginning to the end. Staffs may be busy with their assigned task and having little time to communicate with each other about the patients progress. As a result, this may lead to patient dissatisfaction and frustration (Yoder-Wise). Show parent | Reply Re: Group discussion - Please start here by GOURISWARY ARUMUGAM [NS110] - Thursday, 21 April 2011, 11:22 PM Dear friends,

We are moving towards holistic nursing approach where nurses are expected to care for their patients physiologically, psychologically, and spiritually. Any of those 5 modes of care delivery will allow us to care for our patient holistically, but in my opinion the best mode will be primary nursing mode. When we care for a patient continuously, it easier to understand and approach them psychologically, and spiritually. Quality health would be best achieved when we care them psychologically and spiritually. Nurses will have added responsibilities where they would take initiative to update their knowledge and skill to achieve their goal. When goal are achieved we gain job satisfaction and confidence. We are all aware that patients are usually confused when they are been cared and advised by different nurses. Primary nursing method can avoid this problem. Patient will receive quality and continuous care as planned by the primary nurse without the interference of other nurses. The associate nurse will work together and suggest care but would not modify the care. We could establish a good rapport with patients and patient will have confidence in us. It easier to work as a team in primary nursing; one patient to one nurse, and all nurses will work towards the goal that planned by the primary nurse. Show parent | Reply Re: Group discussion - Please start here by VILMA BINTI MADIN [NS410] - Friday, 22 April 2011, 03:35 AM Wow!Well done everyone for all the input! I have been working in A&E unit since I graduated few years back and experienced few modes of care delivery that we've been discussed in Unit 3. As I looked back to my early working experiences, I think we have been practicing functional nursing but modified in such as way that fits to our unit's need. We do not have like a nurse as the medication nurse or treatment nurse, but when a patient came there will be 2 or 3 attending nurse. One will be taking the vital signs, one will inform the doctor and another one will key-in the charges for patient. As we worked in acute care setting, our priority is always to render quality care with aim of completing task quickly. Yes, it enhance teamwork and nursing efficiency but problem that we encountered the most during those days is accountability of staff. We hardly know the responsible nurse because there too many nurses attended to the patient especially when matter arises. But as new management takes place, they has introduced the primary nursing to our unit which I found is more beneficial to us. Though we had a hard time at the beginning but we are slowly adapting to it now. As Yoder-Wise stated that primary nursing is a method of patient care delivery where one RN functions autonomously as the patient's main nurse throughout the hospital stay,which to apply into our acute setting begin when the patient came to the unit till they are discharge to the ward or as outpatient, with responsibility for clearly established planning and managing for the patient. As primary nurses are the nurses responsible for the care of the patient and they frequently consult with, or carry out the directives of the doctor to assist the patient with all levels of care(Jessica W.). So,when matter arises we can look for the responsible nurse compare to what happened back then when functional nursing is practiced. Despite of experiencing job satisfaction, I also found that primary nursing allows for holistic and high quality patient care. In primary nursing, patients also are satisfied because of the clear communication and rapport that established between the primary nurse. However, even though we

are now practicing primary nursing but it does not hinder us to work as a team in our unit. We are still helping each other out such as one will obtained ECG or taking vital signs for the patient but we will clearly know that nurse A is the primary nurse and will take responsibility of the patient. Show parent | Reply Re: Group discussion - Please start here by VILMA BINTI MADIN [NS410] - Friday, 22 April 2011, 04:16 AM Dear all, I believed most of us agreed that primary nursing would provide the best outcome for the patient care. Again, I just want to stress the benefits of this mode through the different perspective of author, Diane Huber in her book which include a research conducted to compare team nursing and primary nursing. Primary nursing models has been found to have higher quality of nursing care, higher levels of nurse satisfaction, increased continuity of care, improved nurse retention and positive client outcome. Even though, we may not able to practice 100% of primary nursing models but I think we can modified and adjust it according to the needs of our workplace. Show parent | Reply Re: Group discussion - Please start here by GLADYS VITALIS [NS410] - Friday, 22 April 2011, 11:07 AM
Dear friends and colleagues, In the article by Yoder-Wise, she mentioned that nursing care is viewed as a cost and it is indeed logical for an organisation to evaluate their method of providing patient care for the purpose of saving money while still providing excellent quality care. So, in my opinion, I do believe that primary nursing method is the best method to implement in any organisation. But as we all know, due to the many constraint of implementing this method, many hospital opt to choose a simpler method such as the team nursing method combined with functional method for the wards and primary nursing method combined with case method for specialized department such as the intensive care unit, high-dependency unit, cardiac care unit and also the neonatal intensive care unit. This kind of combination makes it easier for the organisation in terms of saving the cost and still maximizing the quality of care being delivered to patients and clients.

Show parent | Reply Re: Group discussion - Please start here by GLADYS VITALIS [NS410] - Friday, 22 April 2011, 11:20 AM
Dear friends, Primary nursing, a system for the distribution of nursing care in which care of one patient is managed for the entire 24-hour day by one nurse who directs and coordinates nurses and other personnel; schedules all tests, procedures, and daily activities for that patient; and cares for that patient personally when on duty. In acute care the primary care nurse may be responsible for only one patient; in intermediate care the primary care nurse may be responsible for three or more patients. Nurse midwives and other nurse practitioners practice primary nursing. Some advantages are continuity of care for the patient; accountability of the nurse for that care; patient-centered care that is comprehensive, individualized, and coordinated; and the professional satisfaction of the nurse. It is pretty obvious that this is the best nursing care delivery method for any hospital. It will take awhile or probably years to fully implement primary nursing in our organisation but it will be worth it. In books and literature, primary nursing can be viewed both as a philosophy of care and an organisational design (Hegyvary, 1982). It is a forum for increasing the respect and autonomy of the nurse, who in a primary nursing role is responsible for a caseload and is

supported by a small team of associate nurses (Binnie, 1989). The essential elements of primary nursing are recognised in the nursing literature as accountability, authority, autonomy, advocacy, assertiveness, continuity, collaboration, communication, commitment and coordination. These features complemented the hospital vision for the each unit, confirming their belief in the appropriateness of primary nursing. Many literature also have highlighted the pitfalls we might encounter if we are to implement this. Implementing primary nursing would involve nurses undertaking a critical analysis of their traditional nursing practice, which could be challenging but rewarding. And in the long run, if the change to primary nursing were to be successful, each member of the nursing team and the wider multidisciplinary team would need to value nursing, and consider it worthwhile, important and therapeutic (Wright, 1990). And in order for us to make changes in our organisation, a careful planning and a very sensitive approach would be needed and the involvement of everyone would make the process of implementing it becomes a great success and as Walker and Avant (1988) suggested, being precise about our definition of the concepts or method would make it even easier to promote understanding among our colleagues.

Show parent | Reply Re: Group discussion - Please start here by ONG LEE TING [NS410] - Friday, 22 April 2011, 04:26 PM Dear all, To conclude all the opinions, we can see that primary nursing is the most preferable mode of organizing care and it brings the higher quality of care for patients. There was a study carried out by Jonsdottir in 1999, he concluded that primary nursing brought in terms of higher quality of care for patients. One of the most important components is to know and understand patients' experiences. The other study was carried out by Suzanne in 2006, said that primary nursing affords increased quality of care, a more coherent philosophy of nursing and increased job satisfaction for nurses. In conclusion, we should encourage all the health care sectors can be able to practice this mode in their management of care by educate their staffs in this mode. Furthermore, the organization must aware of their staffing issue as primary nursing is more sensitive to low staffing than the system it was meant to replace. Show parent | Reply Re: Group discussion - Please start here by Lim Pek Hong - Friday, 22 April 2011, 04:56 PM So far I have only 4 in the group contributing to the discussion. Before the deadline this week, I hope to have all in the group coming in with your ideas as well as giving comments of postings of your colleagues.

UNIT 3 Notebook 1 Organising is the process of defining and grouping activities and establishing authority relationships among them to attain organizational objectives. Five functions of each phases of the management process: Planning is deciding in advance what to do and how to do. It is one of the basic managerial functions. Before doing something, the manager must formulate an idea of how to work on a particular task. Thus, planning is closely connected with creativity and innovation. It involves setting objectives and developing appropriate courses of action to achieve these objectives. Organising is the process of defining and grouping activities and establishing authority relationships among them to attain organizational objectives. Staffing is that part of the process of management which is concerned with acquiring, developing, employing, appraising, remunerating and retaining people so that right type of people are available at right positions and at right time in the organisation. In the simplest terms, staffing is putting people to jobs. Directing means giving instructions, guiding, counselling, motivating and leading the staff in an organisation in doing work to achieve Organisational goals. Directing is a key managerial function to be performed by the manager along with planning, organising, staffing and controlling. From top executive to supervisor performs the function of directing and it takes place accordingly wherever superior subordinate relations exist. Directing is a continuous process initiated at top level and flows to the bottom through organisational hierarchy. Controlling always maximise the use of scarce resources to achieve the purposeful behaviour of employees in an organisation. In planning stage, it is decided that how the resources would be utilised but where as in the controlling stage it is observed that whether the resources are being utilised in the same way as planned or not. Thus, control completes the whole sequence of management process.

Notebook Reflection As I am working in an operating theatre as a co-ordinator, I am responsible in making sure sufficient and quality team is assigned in various unit such as daycare, theatre rooms, holding bay and also in recovery bay. Daycare: has 20 beds 1 charge nurse, 2 senior nurse and 2 junior nurse and a porter. Team A 1 senior nurse and 1 junior nurse ( 10 patients)

Team B 1 senior nurse and 1 junior nurse ( 10 patients) Charge nurse is responsible on over all of the unit and a porter in assisting patients and the nurses. OT rooms: 8 theatres. Each theatre 1 team = 8 teams. Each team consists of 4 members ( 2 senior nurses, 1 junior and a technician) 1 charge nurses responsible in making sure the flow in the rooms are running smoothly.

Holding bay: 8 bays 3 nurses Recovery room: 8 bays 4 nurses ratio of 1:2

This staffing planned is well planned after observations and is successful in providing the best nursing care for the patients.