INTRODUCTION

A hospital may be soundly organized, beautifully situated and well equipped, but if the nursing
care is not of high quality the hospital will fail in its responsibility. Nursing service is the part
of the total health organization which aims at satisfying the nursing needs of the patients/
community. In nursing services, the nurse works with the members of allied disciples such as
dietetics, medical, social service, pharmacy etc in supplying comprehensive program of patient
care in hospital.

NURSING SERVICE

1. “The nursing service is the part of the total health organization which aims to satisfy
major objective of the nursing services that is to provide prevention of disease and
promotion of health.”
According to WHO expert Committee on Nursing
2. Nursing service refers to the provision of healthcare by nurses, who are the largest
professional healthcare workforce globally.
3. Nursing service refers to the professional care and support provided by registered
nurses (RNs) and other nursing staff to individuals in need of medical attention or
assistance with their health.

OBJECTIVES OF NURSING SERVICE

PATIENT CARE

ADMINISTRATION AND
ORGANIZATION

EDUCATION

RESEARCH

PERFORMANCE
APPRAISAL

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Objectives in relation to patient care:

The primary emphasis is on total patient care that is:

 To give highest possible quality care in terms of total patients need which include
physical, psychological, social, educational and spiritual needs by collaborating with
other health team members.
 To assist the physician in providing medical care to the patients.
 To provide preventive and rehabilitative services.
 To provide round the clock nursing care to all the patients.
 To render timely and appropriate nursing service to emergency patients.
 To provide cost effective quality care as per the needs of patients.
 Confidentiality and privacy of each patient should be maintained.

Objectives in relation to Education

 Planning of education and training programme for nurses are must for professional
growth and development needs through in-service education and research support.

 To provide regular staff development, in-service education and guidance services for
all members of nursing staff.
 To conduct regular orientation programme for new entrants.
 To conduct training for operating procedure of latest gadgets and on handling
sophisticated bio-medical equipment.
Objectives in relation to Administration and Organization
 To make regular supervision through rounds.
 To ensure that the essential equipment is provided in functional status for nursing care
services.
 To have a proper system of rotation of staff, provision for annual leave and days off for
the nursing staff without hampering patient care.
 The formulation of policies, standards, goals of nursing service, education and practice.
 Maintaining proper documentation of the personnel employed in nursing service.
Objectives in relation to Research
 Establish a system for collection of essential information, research and studies
concerning all aspects of nursing.
 To contribute in research programme conducted by hospitals and by other health
personnel.
 To encourage and support the nurse to conduct research projects/ activities.

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Objectives in relation to Performance appraisal
 Appraise the performance of nursing personnel regularly against set standards and
performance indicators objectively with a view to maintain quality-nursing services.
PRINCIPLES OF NURSING SERVICE
The principles of nursing service are the guiding principles that inform the practice of nursing
and ensure the delivery of quality patient care. These principles are derived from ethical, legal,
and professional standards.
1. Patient-Centred Care: Place the patient at the centre of care, respecting their
individuality, preferences, and values.
2. Evidence-Based Practice: Use the best available evidence to inform clinical decision-
making.
3. Quality Improvement: Continuously monitor and improve the quality of care delivered.
4. Safety: Prioritize patient safety and minimize risks.
5. Collaboration: Work collaboratively with other healthcare professionals to provide
comprehensive care.
6. Professionalism: Adhere to professional standards, ethical principles, and legal
guidelines.
7. Communication: Communicate effectively with patients, families, and healthcare team
members.
8. Cultural Competence: Provide culturally sensitive and appropriate care.
FUNCTIONS OF NURSING SERVICE
 To assist the individual patient in performance of those activities contributing to his
health or recovery that he would otherwise perform unaided if he/she had the strength,
will or knowledge.
 To help and encourage the patient to carry out the therapeutic plan initiated by the
physician.
 To assist other members of the team to plan and carry out the total programme of care.
The organization of nursing care constitutes a subsystem for achieving the hospital‘s
overall objective.
 The director of nursing service is delegated the authority and responsibilities for
organizing and administrating the nursing services in hospital. It is her duty to institute
the essential characteristics of good nursing services in her institute such as:

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  Purposes and objectives of the nursing service:

The purposes should be in accordance with the hospital philosophy regarding patient care and
approved by administration. It must characterize the principles of excellence in service, in
practice and leadership. Objectives are specific, practical, attainable, measurable and
understandable to all the nursing staff.

 Plan of organization:

Every hospital has the basic system of coordination of vast number of activities i.e. the Director
of Nursing service, she is responsible for maintaining standards for patient care in terms of
quality nursing service must be familiar with the formal organizational structure of the hospital
and its relationship in various department and their functions. The plan of organization should
indicate inter as well as intra-department relationship. The plan also should indicate area of
responsibility and to whom and for whom each person is accountable and the channels of
communication.

 Policy and administrative manuals:

The policy and procedure manual are required for the operation of the hospital. Policies are
established within the department to guide the nursing staff, which includes duty hrs, rules and
regulations etc. These are periodically revised and reviewed at regular intervals.

 Nursing practice manual:

This the written procedure available as evidence of the standards of performance established
by nursing service organization for safe and effective practice after taking into consideration
the best use of available resources. Liberal use of diagram and precautions in nursing manual
helps to keep instruction direct and exact. The advantages are ensuring economy of time effort
& material and provides basis for training for new personnel to acquire knowledge and current
skill.

 Nursing service budget:

It is required for personnel budget, nurse‘s welfare activities, staff development programme,
equipment and capital expenditure, supplies and expenses. Budget preparation should include
analysis of past operation and anticipating the future revenue and expenses.

 Master staffing pattern:

It is the number and composition of nursing personnel assigned to work in a hospital in different
department / wards at a given time. This helps the director to visualize the equitable distribution

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of nursing personnel among various nursing unit. It serves as a guide for planning daily, weekly
and monthly schedules.

 Nursing care appraisal plan:

Employing various techniques such as supervision, ward rounds, conference, anecdotal record,
rating scale, checklist, suggestion box and peer review can do performance appraisal of nurses.
This is done to improve the quality of service provided, determine the job competence and to
enhance staff development.

 Nursing service administrative meetings:

This meeting gives opportunity for free communication, planning and evaluation of the nursing
service through regular meeting of the director of nursing with total nursing staff. The purposes
are regular exchange of view between management and nursing service for improving working
condition, welfare of patient and improvement in methods and organization of work.

 Adequate infrastructure facilities, supplies and equipment:

The director of nursing evaluates periodically the adequate resources and arranges new
facilities needed for patient care in discussion with the hospital administrator.

 Written job descriptions and job specifications:

In job description the responsibility is clearly spelt out as precisely including the job content,
activities to be performed, responsibility and result expected from various role required by the
organization. It is useful for reducing conflict, frustration, overlapping duties and acts as a
guide to direct and evaluate person.

 Personnel records:

Personnel records include the information relating to the individual such as recruitment and
selection, medical records, training and development, transfer records, promotion, disciplinary
action records, performance records, absenteeism data, leave record and salary records, etc.

 Personnel policies:

It reflects an analysis of the total job of nursing in accordance with the types of functions to be
performed. It also indicates the qualitaty and quantity of service to be maintained and the
purpose for which the hospital exists.

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  Health services:

Supervision of health of each employee by means of pre-employment physical examination,

periodic examination, immunization and provision of diagnostic, preventive and therapeutic
measures.

 In-service education:

It is the essential components of staff development programme, which aims at augmenting,

reinforcing nurse‘s knowledge, skill and attitude. It includes orientation programme, skill
training, leadership and management training, on the job training, staff development.

 Co-ordination:

Regular consultation and discussion between the heads of departments and /with members of
the medical staff could be an integral part of the administration.

 Advisory committee:

Each committee has a clear statement and its membership is appropriate to the purpose. After
carefully weighing the advice of the committee, she makes the final decision about the matter
within her area of responsibility and becomes accountable for implementation.

ORGANIZATION OF NURSING SERVICES

The organization of nursing services typically involves several key components to ensure
effective delivery of care.

The organisation of nursing services at hospital level is as follows:

Chief Nursing Officer

Nursing Superintendent

Deputy Nursing Superintendent

Assistant Nursing Superintendent

Ward sister-Clinical Supervisor

Staff Nurse

Student Nurse

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Organizational set-up at Directorate General of Health Services

Director General of Health Services

Addl. DG (PH) Addl. DG (N) Addl. DG (M)

ADG ADG ADG

(Community & Nsg officer) (Nursing Education & Research) (Hospital Nsg Service)

Deputy Asst. Director General Deputy Asst. Director General Deputy Asst. Director General

Community Nsg Officer Principal Nsg Superintendent

PHN supervisor Senior Tutor Deptt. Nsg Supdt

PHN Tutor Asst. Nsg Supdt

LHV Clinical instructor Ward Sister

ANM Staff Nurse

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Organizational set-up of Nursing Service at Central Level

Secretary, Health

Director Nursing Service

Joint/Deputy Director Nursing Service

Add. Director of Nsg Service(ADNS) ADNS ADNS

(Community Nsg Service) (Nsg-education & Research) (Hospital Nsg service)

Dept. ADNS Dept. ADNS Dept ADNS

(Community Nsg officer) (Nursing Education & Research) (Hospital Nsg Service)

Community Nsg Officer Principal Nsg Superintendent

PHN supervisor Senior Tutor Deptt. Nsg Supdt

PHN Tutor Asstt. Nsg. Supdt

LHV Clinical instructor Ward Sister

ANM Staff Nurse

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Organizational Set-up of nursing Service at State Level:

Director Nursing Services

Deputy Director Nursing Services

Assistant Director Nursing Services

Deputy Assistant Director Nursing Services

DMO DNO DHO

ADNO (Hosp & Nsg Edu) ADNO (Community)

Nsg Supdt Principal Tutor Distt. PNO

Asst. Nsg Supdt Tutor PHN Supervisor

Ward Sister Clinical Instructor LHV

Staff Nurse ANM

KEYS:
 Addl. DG (PH) - Additional Director General (Primary Health)
 Addl. DG (M) - Additional Director General (Medical)
 Addl. DG (N) - Additional Director General (Nursing )
 ADG - Assistant Director General
 PHN - Primary Health Nurse
 LHV - Lady Health Visitor
 ANM - Auxiliary Nurse Midwives
 DMO - Director of Medical Office
 DNO - Director of Nursing Office
 DHO - Director of Health Office

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ORGANIZING PATIENT CARE
The overall goal of nursing is to meet the patient nursing needs with the available resources for
providing smooth day and night 24 hrs quality care to patients and to honour his rights. To
ensure that nursing care is provided to patients, the work must be organized. For organizing
function to be productive and facilitate meeting the organization‘s needs, the leader must know
the organization and its members well.

 The top-level manager who influences the philosophy and resources necessary for any
selected care delivery system to be effective
 The first and middle level managers generally have their greatest influence on the
organizing phase of the management process at the unit or departmental level. The
managers organize how work is to be done, shape the organizational climate, and determine
how patient care delivery is organized.
 The unit leader-manager determines how best to plan work activities so organizational
goals are met effectively and efficiently, involves using resources wisely and coordinating
activities with other departments.

DEFINITION OF PATIENT CARE

1. The services rendered by members of the health profession and non-professionals under
their supervision for the benefit of the patient.
2. The prevention, treatment and management of illness and the preservation of mental
and physical well-being through the services offered by the medical and allied health
professions.
3. Patient care is the provision of health services to patients, which can include physical,
mental, and emotional well-being.

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.

 Match nursing resources to patient care requirement.

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  Relate to time and effort spent on the associated activity.
 Be economical and convenient to use.
 Be open to audit.
 Be understood by those who plan, schedule and control the work.
 Separate requirement for registered nurse from those of other staff.

Purposes

 The system will establish a unit of measure for nursing, that is, time, which will be
used to determine numbers and kinds of staff needed.

 Program costing and formulation of the nursing budget.

 Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service

 Determining the values of the productivity equations

 Determine the quality: once a standards time element has been established, staffing is
adjusted to meet the aggregate times. A nurse manager can elect to staff below the
standard time to reduce costs.

Components

 The first component of a PCS is a method for grouping patient‘s categories. Johnson
indicates two methods of categorizing patients. Using categorizing method each patient
is rated on independent elements of care, each element is scored, scores are summarized
and the patient is placed in a category based on the total numerical value obtained.
Johnson describes prototype evaluation with four basic categories for a typical patient
requiring one –on- one care. Each category addresses activities of daily living, general
health, teaching and emotional support, treatment and medications.
 The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of
reporting data.
 The third component of a PCS is the average amount of the time required for care of a
patient in each category.
 A method for calculating required nursing care hours is the fourth and final component
of a PCS.

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 Patient Care Classification

Area of care Category I Category II Category III Category IV

Eating Feeds self Needs some help in Cannot feed self but is
Cannot feed self
feeding. able to chew and
swallowing any may have
difficulty
swallowing

Grooming Almost Need some help in Unable to do much for Completely

bathing, oral hygiene. self dependent
entirely self
sufficient

Excretion In bed, needs bedpan / Completely

Up and to Needs some help in
urinal placed; dependent
bathroom getting up to bathroom
alone /urinal

Comfort Self Needs some help with Completely

sufficient adjusting position/ bed. Cannot turn without dependent
help, get drink, adjust
position of extremities.

Good Mild symptoms Acute symptoms Critically ill

General
health

Treatment Simple – Any Treatment more Any treatment more than

supervised, than once per shift, foley twice /shift. Any elaborate/
simple catheter care, delicate procedure
dressing. requiring two
I&O.
nurses, vital signs
more often than
every two hours.

Health Routine More intensive items; Teaching of resistive

education & follow up Initial teaching of care of teaching of patients,
teaching teaching ostomies; new diabetics; apprehensive/ mildly
patients with mild resistive patients.
adverse reactions to their
illness.

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METHODS OF PATIENT ASSIGNMENT
The most well-known means of organizing nursing care for patient care delivery are,

 Case method or Total patient care

 Functional nursing
 Team nursing
 Modular or district nursing
 Progressive patient care
 Primary nursing

Each of these basic types has undergone many modifications, often resulting in new
terminology. For example, primary nursing has been called case method nursing in the past
and is now frequently referred to as a professional practice model. Team nursing is sometimes
called partners in care or patient service partners and case managers assume different titles,
depending on the setting in which they provide care. When closely examined most of the newer
models are merely recycled, modified or retitled versions of older models. Choosing the most
appropriate organizational mode to deliver patient care for each unit depends on the skill and
expertise of the staff, the availability of registered professional nurse, the economic resources
of the organization and the complexity of the task to be completely.

CASE METHOD

Features:

It was the first type of nursing care delivery system. In this method, nurses assume total
responsibility for meeting all the needs of assigned patients during their time on duty. It
involves assignment of one or more clients to a nurse for a specific period of time such as shift.
The patient has a different nurse each shift and no guarantee of having the same nurses the next
day. This model is used in critical care areas, labor and delivery, or any area where one nurse
cares for one patient‘s total needs. Here nurses were self-employed when the case method came
into being, because they were primarily practicing in homes.

Advantages

 The nurse can attend to the total needs of clients due to the adequate time and proximity
of the interactions.
 Good client nurse interaction and rapport can be developed.
 Client may feel more secure.
 RNs were self-employed.

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  Work load can be equally divided by the staff.
 Nurse‘s accountability for their function is built-it.
 It is used in critical care settings where one nurse provides total care to a small group
of critically ill patients.

Disadvantages

 Cost-effectiveness.
 The greater disadvantage to case nursing occurs, when the nurse is inadequately trained
or prepared to provide total care to the patient.
 Nurse may feel overworked if most of her assigned patients are sick.
 She/he may tend to neglect the needs of patient when the other patient’s problem or
need demands more time.

FUNCTIONAL NURSING

Features:

This system emerged in 1930s in U.S.A during WWII when there was a severe shortage of
nurses in US. A number of Licensed Practice Nurses (LPNs) and nurse aides were employed
to compensate for a smaller number of registered nurses (RNs) who demanded increased
salaries. It is task focused, not patient-focused. In this model, the tasks are divided with one
nurse assuming responsibility for specific tasks. For example, one nurse does the hygiene and
dressing changes, whereas another nurse assumes responsibility for medication administration.
Typically, a lead nurse responsible for a specific shift assigns available nursing staff members
according to their qualifications, their particular abilities, and tasks to be completed.

Charge Nurse

RN RN LPN UAP
Medication Nurse Treatment Nurse Vital signs Nurse Hygiene
Nurse

Patients assigned to the team

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Advantages

 Each person become very efficient at specific tasks and a great amount of work can be
done in a short time (time saving).
 It is easy to organize the work of the unit and staff.
 The best utilization can be made of a person‘s aptitudes, experience and desires.
 The organization benefits financially from this strategy because patient care can be
delivered to a large number of patients by mixing staff with a large number of
unlicensed assistive personnel.
 Nurses become highly competent with tasks that are repeatedly assigned to them.
 Less equipment is needed and what is available is usually better cared for when used
only by a few personnel.

Disadvantages:

 Client care may become impersonal, compartmentalized and fragmented.

 Continuity of care may not be possible.
 Staff may become bored and have little motivation to develop self and others.
 The staff members are accountable for the task.
 Client may feel insecure.
 Only parts of the nursing care plan are known to personnel.
 Patients get confused as so many nurses attend to them, e.g. head nurse, medicine nurse,
dressing nurse, temperature nurse, etc.

Research application: Ding Yang et al (2021) conducted a retrospective study on effects of

comprehensive functional nursing and functional recovery and quality of life in patients
with spinal cord injury at Affiliated Hospital of Anhui Medical University. Results shows
that Comprehensive functional nursing for patients with spinal cord injuries can
significantly restore their neurobehavioural, cardio-pulmonary, intestinal and bladder
functions, improve their emotional state and improve their quality of life.
TEAM NURSING

Features:

Developed in 1950s because the functional method received criticism, a new system of nursing
was devised to improve patient satisfaction. Care through others became the hallmark of team
nursing. Team nursing is based on philosophy in which groups of professional and

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nonprofessional personnel work together to identify, plan, implement and evaluate
comprehensive client-centred care. In team nursing an RN leads a team composed of other
RNs, LPNs or LVNs and nurse assistants or technicians. The team members provide direct
patient care to group of patients, under the direction of the RN team leader in coordinated
effort.

Charge Nurse RN

Team Leader RN Team Leader RN

RN LPN NA RN LPN NA

Group of Patients Group of Patients

Advantages:

 High quality comprehensive care can be provided to the patient

 Each member of the team is able to participate in decision making and problem solving.
 Each team member is able to contribute his or her own special expertise or skills in
caring for the patient.
 Improved patient satisfaction.
 Work load can be balanced and shared.
 Division of labour allows members the opportunity to develop leadership skills.
 There is a variety in the daily assignment.
 The client is able to identify personnel who are responsible for his care.
 Barriers between professional and non-professional workers can be minimized, the
group efforts prevail.

Disadvantages:

 Establishing a team concept takes time, effort and constancy of personnel. Merely
assigning people to a group does not make them a group or team.

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  Unstable staffing pattern make team nursing difficult.
 There is less individual responsibility and independence regarding nursing functions.
 The team leader may not have the leadership skills required to effectively direct the
team and create a ―team spirit.
 It is expensive because of the increased number of personnel needed.
 Nurses are not always assigned to the same patients each day, which causes lack of
continuity of care.

Research Application: Ju Jieun, Kihye Han, Baek Hyang (2023) conducted a cross-sectional
study on importance of nursing teamwork in promoting patient-centered care. Result shows a
significant positive association between nursing teamwork and patient-centered care after
controlling for personal and work-related characteristics.

MODULAR NURSING

Features:

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. The goal is to increase the involvement of the
RN in planning and coordinating care. 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. 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.

Advantages:

 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 when staff members are consistently assigned to the
same module
 The RN as team leader is able to be more involved in planning & coordinating care.
 Geographic closeness and more efficient communication save staff time.
 Feelings of participation and belonging are facilitated with team members.
 Work load can be balanced and shared.

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  Division of labour allows members the opportunity to develop leadership skills
 Continuity care is facilitated especially if teams are constant.
 Everyone has the opportunity to contribute to the care plan.

Disadvantages:

 Costs may be increased to stock each module with the necessary patient care supplies
(medication cart, linens and dressings).
 Establishing the team concepts 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 centred.
 The team leader must have complex skills and knowledge.

Research Application: Campagna S et al (2011) conducted an experimental study on

effectiveness of the implementation of Modular Nursing in a medical ward. Results showed
that modular nursing did not enhance the quality of care but the healthcare professionals
expressed high satisfaction with modular nursing due to improved organization and continuity
of care, despite the additional workload from completing and updating clinical and nursing
records.

PROGRESSIVE PATIENT CARE:

Features:

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. Here the clients
are evaluated with respect to all level (intensity) of care needed. As they progress towards
increased self-care (as they become less ethically ill or in need of intensive care or monitoring)
they are marred to units/ wards staffed to best provide the type of care needed.

Principal elements of PPC are:

i) Intensive care or critical care: Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute MI, fatal, those who need artificial ventilation, major
burns, premature neonates, immediate post or cardiothoracic, renal transplant, neurosurgery
patients. These units have 9-15 numbers of beds, life-saving equipment and skilled personnel
for assessment, revival, restoration and maintenance of vital functions of acutely ill patients.
Nursing approach in these units is patient-centered.

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 ii) Intermediate care: Critically ill patients are shifted to intermediate care units when their
vital signs and general condition stabilizes, e.g. cardiac care ward, chest ward, renal ward.

iii) Convalescent and Self-Care: Although rehabilitation programme begins from acute
care setting, yet patients in these areas participate actively to achieve complete or partial self-
care status. Patients are taught administration of drugs, life style modification, exercises,
ambulation, self-administration of insulin, checking pulse, blood glucose and dietary
management.

iv) Long-term care: Chronically ill, disabled and helpless patients are cared for in these
units. Nurses and other therapists help the patients and family members in coping, ambulation,
physical therapy, occupational therapy along with activities of daily living. Patients and
family who need long-term care are, cancer patients, paralyzed and patients with ostomies.

v) Home care: Some hospital/centers have home care services. A hospital based home care
package provides staff, equipment and supplies for care of patient at home, e.g. paralyzed
patients, post-operative, mentally retarded/spastic patient and patient on long chemotherapy.

vi) Ambulatory care: Ambulatory patients visit hospital for follow up, diagnostic, curative
rehabilitative and preventive services. These areas are outpatient departments, clinics,
diagnostic centers, day care centers etc.

Advantages:

 Efficient use is made of personnel and equipment.

 Clients are in the best place to receive the care they require.
 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.

Disadvantages:

 There may be discomfort to clients who are moved often.

 Continuity care is difficult.
 Long term 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.

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Research application: Colamesta V, Dugo V, Milia La I D, Sommella L(2019) conducted a
systematic literature review on intermediate care units in progressive patient care model
through various databases. The results showed enhancements in the quality of care, suitability,
and efficiency in healthcare facilities that implemented the Progressive patient care program.

PRIMARY CARE NURSING

Features:

It was developed in the 1960s with the aim of placing RNs at the bedside and improving the
professional relationships among staff members. The model became more popular in the 1970s
and early 1980s as hospitals began to employ more RNs. It supports a philosophy regarding
nurse and patient relationship.

It is a system in which one nurse is caring for all the needs of a patient or more within a 24
hour from admission to discharge. He or she is responsible for coordinating and implementing
all the necessary nursing care that must be given to the patient during the shift. If the nurse is
not available, the associate nurse responsible for filling in for the nurse‘s absence will provide
hospital care to the patient based on the original plan of care made by the nurse. 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 This type of nursing care can also be
used in hospice nursing, or home care nursing.

Patients

Total patient care 24 hrs/day

Communicates with PRIMARY Consults with physician

supervisors NURSE or other healthcare

Associate (days) Associate (afternoon) Associate (evenings)

when primary nurse is When primary nurse is when primary nurse is
not available not available not available

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Advantages:

 Primary Nursing Care System is good for long-term care, rehabilitation units, nursing
clinics, geriatric, psychiatric, burn care settings where patients and family members can
establish good rapport with the primary nurse.
 Primary nurses are in a position to care for the entire person-physically, emotionally,
socially and spiritually.
 High patient and family satisfaction
 Promotes RN responsibility, authority, autonomy, accountability and courage.
 Patient-centered care that is comprehensive, individualized, and coordinated; and the
professional satisfaction of the nurse.
 Increases coordination and continuity of care.

Disadvantages:

 More nurses are required for this method of care delivery and it is more expensive than
other methods.
 Level of expertise and commitment may vary from nurse to nurse which may affect
quality of patient care.
 Associate nurse may find it difficult to follow the plans made by another if there is
disagreement or when patient‘s condition changes.
 It may be cost-effective especially in specialized units such as the ICU.
 May create conflict between primary and associate nurses.
 Stress of round the clock responsibility.
 Difficult hiring all RN staff
 Confines nurse‘s talent to his/her own patients.

Research Application: Silva Ventura JM et al (2024) conducted a quasi-experimental study

on Implementation of the Primary Nursing Care Model in a Hospital Service. The outcomes
of using the Primary Nursing Care Model were favorable when compared to before its
implementation. Primary Nursing Care Model in a hospital setting has demonstrated
valuable contributions, underscoring its potential to improve the quality of nursing care and
promote patient-centred care approaches.

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CONCLUSION
A hospital can be well-structured, ideally located, and properly outfitted, but if the nursing care
is lacking in quality, the hospital will fall short of its obligations. The effective organization of
nursing services and patient care is central to improving healthcare outcomes, enhancing
patient safety, and optimizing the use of resources. Well-structured nursing services ensure that
care is delivered efficiently, consistently, and with compassion, fostering an environment where
patients receive high-quality, individualized care. A well-organized nursing service model is
integral to ensuring that patient care is effective, safe, and of the highest quality. By fostering
teamwork, prioritizing patient needs, and utilizing resources wisely, healthcare systems can
improve both patient outcomes and staff satisfaction, ultimately leading to a more sustainable
and effective care environment. Patient assignment is a critical component of nursing practice,
directly influencing the quality of care provided, staff efficiency, and patient outcomes. The
choice of assignment method depends on factors such as patient acuity, the complexity of care,
staff skill levels, and the healthcare setting. Each method has its own advantages and
challenges, and selecting the right approach requires careful consideration to ensure optimal
care delivery. Primary nursing care offers a patient-centered approach that can significantly
enhance the quality of care, improve patient outcomes, and increase nurse satisfaction. It fosters
continuity, accountability, and strong therapeutic relationships between nurses and patients.
However, successful implementation of primary nursing requires careful planning, adequate
staffing, and consideration of the specific needs and structure of the healthcare setting. When
executed well, primary nursing care can lead to better patient experiences, more effective care,
and a more fulfilling professional environment for nurses.

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BIBLIOGRAPHY
Book References:

 Vati J. “ Principles and Practice of Nursing Management Administration for BSc and
MSc Nursing. Second edition 2020. Published by JP Brothers Medical Publishers Pvt
Ltd. Page No. 215-219
 Masih S. “Essentials of Nursing Management in Service and Education”. Second
Edition 2012. Published by Lotus Publishers. Page No. 42-43, 127-128.
 N. Anoop, M.R. Kumar Chetan et al. “A textbook on Nursing Management”.
Padmashree institute of nursing. Page No. 163-186.

Net References:

 https://www.slideshare.net/slideshow/organizing-nursing-services-and-patient-
care/236940292
 https://www.scribd.com/document/407931679/ORGANIZING-NURSING-
SERVICES-AND-PATIENT-CARE-INTRODUCTION-docx
 https://www.slideshare.net/slideshow/organizing-nursing-services/41953132
 https://www.who.int/campaigns/world-patient-safety-day
 https://onlinelibrary.wiley.com/doi/10.1155/2024/5549115
 https://pmc.ncbi.nlm.nih.gov/articles/PMC10519484/
 https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-023-01592-3
 https://pubmed.ncbi.nlm.nih.gov/21747577/
 https://www.researchgate.net/publication/330261993_Intermediate_care_units_in_pro
gressive_patient_care_model_a_systematic_literature_review

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