Universidad de Manila

College of Health Sciences

Department of Nursing

A Research
on
Patient Care Management

Submitted by:
Tuazon, Jennah Ricci J.
NR41 Group 6
Submitted to:
Prof. Ben O. de Paz
Clinical Instructor

Patient Care Management

Patient care management is one of the roles of the head nurse. In this area of
management, the head nurse must have a body of scientific knowledge and proper competencies
to be able to use the five steps of nursing process and ensure that each staff nurse is able to use
nursing process to provide patient care.
Definition of Patient Care
Patient care is the service rendered by members of the health profession and nonprofessionals 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 associated activity.
Be economical and convenient to report 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 equality.

Classifications:
Level I Self-care or minimal care patients
- Capable of carrying ADLs
Level II Intermediate or moderate care
- Requires some help from the nursing staff with special treatment or certain

aspects of personal care.

Level III Total, complete, or intensive care
- Usually those who are bedridden and who lack strength and mobility to do

average ADLs.
Level IV Highly specialized critical care
- Those who are critically ill and in constant danger of death or serious injury.

Levels of Care

Nursing Care Hours

Needed/ Patient/Day

Ratio of Professional to
Non - Professional

Level I

1.50

5:45

3.0

60:40

4.5

65:35

6.0 7.0 or HIGHER

70:30 / 80:20

Self/minimal care
Level II
Moderate/intermediate care
Level III
Total/complete/intensive care
Level IV
Highly specialized critical care
Leadership Roles and Management Functions Associated with Organizing Patient Care
1. 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.
2. Management functions:
Examines 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 coordination.
Organizes work so that is cost-effective possible.
Make changes in the work design.
Clearly delineate criteria to be used for differentiated practice roles.

Modes of Organizing Patient Care

1. Case Method Nursing/Total Patient Care
In this method, nurses assume total responsibility for meeting all the needs of assigned
patients during their time of 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.
Educational needs of the client can be closely monitored.
Family and friends become better known by the nurse.
Workload of the patient can be equally divided.
Nurses accountability for their functions 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.
2. Functional Nursing
In this method, persons were assigned to complete certain tasks rather than care of
specific patients. E.g. Checking BP, administering medications
Characteristics:

A functional 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 become specifically skilled in performing certain assigned task.
Best utilization of a persons 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 become 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
Difficult to establish the client priorities.
Only safe when the head nurse co-ordinate all the activities of the members.
3. Team Nursing
This method is based in the philosophy in which a group of professional and nonprofessional 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 labor allows members the opportunity to develop leadership skills
Every team members has the opportunity to learn from and teach colleagues.
Demerits:
Establishing the team concept takes time, effort and constancy of personnel.
Unstable staffing patterns make team nursing skills patterns make team nursing 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.

4. 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 treatments 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.
5. 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.
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
Merits:
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 manager 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
Nursing case management is a professionally autonomous role that requires expert

clinical knowledge and decision making skills.

6. Modular Nursing
Modular nursing is a modification of team nursing and focuses on the patients
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 LVN/LPN or UAP.

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.
7. 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.
Principle elements:

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.

8. Differentiated Nursing Practice
Differentiated nursing practice refers to an attempt to separate nursing practice roles
based on education or experience or some combination of both.
Models:

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.

Reference:
- http://www.google.com.ph/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF8#q=head+nurse+duties+ppt+
- http://www.slideshare.net/deepthyphilipthomas/organizing-nursing-services