BACHELOR OF NURSING SCIENCE WITH HONOURS

JANUARY 2011

NBBS1104

MANAGEMENT AND MEDICO LEGAL STUDIES B

MATRICULATION NO : 740727095068001

IDENTITY CARD NO. : 740727095068

TELEPHONE NO. : 012-4705955

E-MAIL : afiesyana@gmail.com

LEARNING CENTRE : KEDAH LEARNING CENTRE

Model of Nursing Care Delivery System

a) Introduction

Model of nursing care delivery system defined a method of organize and delivering nursing

care in order to achieve desired patient outcome. The structure of care delivery system is to

enable the nurse to provide nursing care include accessing care needs, formulating care plan,

implementing and evaluate patient’s response to the intervention. ). Since World War II,

model of nursing care delivery system had undergone a lot of changes. Each of the nursing

care delivery system had an advantages and disadvantages. However, none of those systems

is considered perfect. Manthey (1990) identified the fundamental elements of nursing care

delivery system as a clinical decision making, work allocation, communication and

management. Marie Manthey’s definitions of nursing care delivery system published in 1990

are still widely accepted (Tiedemen & Lookinland, 2004).

The nursing shortage has historically influenced the types of nursing care delivery systems

used in many heath care settings, and the shortage continues to search for the ideal nursing

care delivery system. The decision to implement a particular nursing care delivery system

will increasingly depend on the complicated and variability within the health care setting. The

availability of the labor pool, the measurement of patient severity of illness and the financial

health of institution are important variables to consider when selecting a nursing care delivery

system.

According to ( Hinshaw & McClure, 2002; Ritter-Tietel, 2004) it is important variable that

must considered when determining the skill level needed to provide appropriate care, and it

takes it account patient's needs, technology required to care for patients, and the amount of

interdisciplinary support needed by the nurse.

The goal of successful patient care delivery includes high-quality and low cost care and the

achievement of patient outcomes and satisfaction level. The ability to reach these objectives

depends on organization’s approach to the matching of human and material resources with

patient characteristics and health care needs. The identification of patients the processes that

are necessary to achieve care goals must be done in order to determine health care provider

roles most appropriate to the specific process.

Now I was working at Obstertric and Gynaecology Department in Maternity Unit, Hospital

Tuanku Fauziah. In my ward, there have 7 beds for delivery and 2 beds for high risk cases.

About 300-400 cases per month were delivered in this hospital. There have 22 Staff Nurse or

Registered Nurse, 18 Community Nurse and include 5 Nursing Sister . Every shift there are

5-6 Staff Nurse, 2 Community Nurse and 1 Nursing Sister will be assigned. It also depends

on the staff available. 1 Staff Nurse will be the leader or in charge as assigned by Sister

Nurse.

The nursed in charge will be follow ward round, communicate with specialist and changes in

patient treatment ensure all care are rendered. The other Staff Nurse will care the patient in

labour, encourage or conducted if patient to bearing down, attending new cases and ordering

drug then helping around if any of the staff need assistant. Another Staff Nurse will be take

care the high risk cases example Pre eclampsia cases.

The Community Nurse will be assigned to care the new baby after birth such as checking

vital sign, top and tail and help mother to give breastfeeding. They are also responsible for

taking vital sign, time contraction, helping delivered, perform vaccination for the baby, intake

output chart updating, checking blood sugar levels and putting IV fluids.

Giving bath the patient, serving food and feeding done by heath care assistant delegation of

assignment according to the staff level. The activity of daily living and procedure which

requires high level of skill will be done by registered nurse. The goal of successful patient

care delivery included high quality and the achievement of patient’s outcome and satisfaction

level. The ability to reach the objective depends of delivery systems and how the care is

delivered.

Practically, team nursing are being practiced well in Maternity Unit, Hospital Tuanku

Fauziah. However Team nursing is to give the best possible quality of patient care by

utilizing the abilities of every member of staff and providing closed supervision both of

patient care and the individual who give it.

b) Team Nursing

Team nursing was developed in early 1950’s after World War II, is to response the

complaints of that functional nursing created a fragmented care delivery system and resulted

in nursing and patients dissatisfaction with care (Marquis & Huston, 2006). Team nursing is a

method in which group of nursing personnel under the leadership of a qualified nurse, having

the goal of comprehensive nursing care renders service to the patients. A team made up of a

registered nurse & other caregivers provides care to a designated group of patients on a given

shift. “Care through others’’ is the hall-mark of team nursing

Team nursing is a care delivery model that uses a group of people led by knowledgeable

nurse. It was developed in an effort to decrease the problems associated with the functional

model of nursing care. Many people felt that, despite a continued shortage of professional

nursing staff, a patient care delivery model had to be developed that reduced the fragmented

care that accompanies functional nursing. Eleanor Lamberston(1953) & her colleagues

proposed a system of team nursing to overcome the fragmentation of care resulting from the

task-oriented functional approach & to meet increasing demands for professional nurses

created by advances in technological aspects of care.

Team nursing was developed because of social and technological changes and drew many

nursed away from hospitals, learning haps, services, procedures and equipment became more

expensive and complicated, requiring specialization at every turn. It is attempt to meet

increased demand of nursing services and better use of knowledge and skills of professional

nurses. It is a delivery approach that provides care to a group of clients by coordinating a

team of Registered (RNs), Licensed practical nurses (LPNs) and aides under supervision of

one nurse call team leader (Glandon et al., 1989; Hegyvary, 1997).

According to Kron(1978) team nursing is based on philosophy in which groups of

professional and non-professional personnel work together to identify, plan, implemented and

evaluate comprehensive client-centred care. The key concept is a group that works together

toward a common goal, providing qualitative comprehensive nursing care. The goal is for

team uses a skill mix nursing to work together democratically, notes individual to provides to

care to assigned group of patients (Bertram, 1994; Sherman, 1990).

Team nursing model by Marquis (2003), the nurse responsible for knowing the condition and

deeds of all the patient’s assigned to the team and for planning individual care. The team

leader duties different depend on the patient needs and the workload. The duties may include

assisting team members giving direct personal care to patients, teaching and coordinating

patient activities. Team leader is accountable for all the care activities and the team member

possessing the skill needed by the individual patient.

The most skill full team members will provide care for the most seriously ill patient and the

least experience members will provide care for the patient who needs least care. The staff

nurse coordinates and leads the team in assigning, delegating and supervising care. Job

satisfaction should be high when the team member’s capabilities are maximized. Team

members will support the group productivity and growth for the team.

Through extensive team communication, comprehensive care can be provided for patients

despite a relatively high proportion of ancillary staff. This communication occurs informally

between the team leader and the individual team member and formally through regular team

planning conferences. Communication is enhanced through the use written patient

assignments, the development of nursing care plan, and the use of regularly scheduled team

conferences to discuss the patient status and formulate revisions to the plan of care.

According to Black and Hawks (2008) they said team nursing in this type of nursing care, an

experienced RNs the head of the team and generally knows the clients. In addition, the team

leader can provide guidance to new to new or inexperience nurses. The talent and abilities of

each member of the heath care team are used. However it is fairly expensive because care is

fragmented of delegation skills by RN’s may reduce efficiency, and some redundancy may

occur if each team leader must perform several managerial tasks, such as making

assignments.

However, for team nursing to succeed, the team leader must have strong clinical skills, good

communication skills, delegation ability, decision-making, and the ability to create a

cooperative working environment. Team nursing requires team spirit and commitment

because the team leader will be changing, thus the continuity of patient care may differ.

c) Advantage of team nursing

According to Huber (2006) team nursing has advantages because it uses in individual team

member’s strength to the greatest advantage for a large number of patients.

i. Team nursing allows members to contribute their own special expertise or skills. Team

leader should use their knowledge about each member’s abilities when making patient

assignment. Recognizing the individual worth of all employees and giving team members

autonomy result in high job satisfaction.

ii. In team nursing, the registered nurse is able to get work done through others, but patients

often receive fragmented, depersonalized care. Communication in this model is complex.

There is shared responsibility and accountability, which can cause confusion and lack

accountability. This model required the registered nurse to have very good delegation and

supervision skills.

iii. Team nursing usually associated with democratic leadership. Group members are given as

much autonomy as possible when performing assigned task, although the team shares

responsibility and accountability collectively. The need for excellent communication and

coordination skills makes implementing team nursing difficult and requires great self-

discipline on the part of the team members.

iv. Advantages team nursing by (Marquis & Huston, 2003) is

a) High quality, comprehensive care can be provided with a relatively high proportion of

ancillary staff.

b) Each member of team able to participate in decision making and problem solving and to

contribute his or her own special expertise skill in caring for the patient.

d) Disadvantage of team nursing

i. The team leader may not the leadership skill required to effectively direct the team and

create a “team spirit”. There is less individual responsibility and independence regarding

nursing function.

ii. Insufficient time for care planning and communication may lead to unclear goals.

Therefore responsibilities and care may become fragmented.

iii. Establishing the team concept takes time, effort and constancy of personnel. Merely

assigning people to a group does not make them a “group” or “team”. Unstable staffing

patterns make team nursing difficulty.

iv. Continuity of care may suffer if the daily assignments vary and the patient is confronted

with many different caregivers.

v. It can be difficult to find time for team conferences and care plans.

vi. If team members are constantly being re-shuffled, the continuity of care can be

interrupted, leading to patient dissatisfaction.

e)Suggestion

i. In order for teams to function well, there must be a leader. We must create a leadership role

for nurses with the obligation they have to give directives to the other members of the team.

The terms leadership and responsibilities are inseparable. Nurses must thus exercise authority

not only via the directives that are inscribed in the therapeutic nursing plan (TNP) for the

other team members, but also because nurses no longer directly dispense basic health care,

and must thus see to it that the directives are well executed and the needs of the patients

satisfied.

ii. A flexible focus is essential in maintaining the success of team nursing. The staff structure

had to be decided before handover. Every staff‘s were allocated patients report to write, can

readjust the allocation of report writing as per their discussion later.

iii. Team nursing consists of charge nurse leading assistants and other personnel to provide

care to a group of patients. Health care professionals work in a team to complete all

assignments for each shift. As a registered nurse, charge nurse held accountable for

unlicensed personnel. More supervision and support available for junior and inexperienced

staff

iv. Nursing conferences help problem solving and staff development. Problem solving is

shared by team not left to the individual. Everyone's suggestion is valued and often utilized.

v. Team nursing can reduce sick leave, staff injury and reduction in irritability “shared

loads”. Increase collaboration amongst team members and staff satisfaction.

f) Conclusion

Model of nursing care delivery system have changed by cost control factor to meet the patient

expectation. The patient concern with the cost but the same time they demand for

competency and quality outcome. However, the nurses’ role is crucial in managing of the

care delivery system to meet the need of health care outcome in the future. The goal for

successful patient care delivery there included high-quality cost care, the achievement and

satisfaction level of patient outcome. Team nursing model has been modified when nurses

shortage become critically. It is direct patient care accomplished by a specific group of nurses

and allows for comprehensive nursing care for a high level of efficiency.Team leader who

coordinates patient care and supervises team members, and team members who are

responsible for total care given to an assigned group or number of patients. Cooperation and

effective communication is important that all staff members to achieve satisfaction in their

work. However, for team nursing to succeed, the team leader must have strong clinical skills,

good communication skills, delegation ability, decision-making, and the ability to create a

cooperative working environment. Team nursing requires team spirit and commitment

because the team leader will be changing, thus the continuity of patient care may differ.

Practically, team nursing are being practiced well in Maternity Unit, Hospital Tuanku

Fauziah. However Team nursing is to give the best possible quality of patient care by

utilizing the abilities of every member of staff and providing closed supervision both of

patient care and the individual who give it.

Total words: 2321

Reference

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Chitty, Kay Kitrell (2007). Professional nursing:concept and challenges/ Kay Kitrell Chitty,

Beth Black. (5th ed), Edinburgh: Elvier Saunders.

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http://www.free-d.net/sweethaven/medtech/nursefund/default.asp?iNum=3&fraNum=070101

http://www.tpub.com/content/armymedical/MD0906/MD09060135.htm

http://en.wikipedia.org/wiki/Team_nursing