Nursing; Case Management Powerpoint by nvl14341

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									TEAM NURSING


      Medical Ward
 Broken Hill Health Service
        Team Nursing
The reintroduction of team nursing was
proposed by our Director of Acute Care and
Nursing in May 2004

Afternoon and night duty staff worked
attending patient care with a team focus yet
day shift staff had maintained the case
method process of patient care.


                  Team Nursing                 2
   Case Method Process
“In the case method each patient is assigned a
   nurse for total patient care while that nurse is
   on duty. The patient has a different nurse
   each shift and no guarantee of having the
   same nurses the next day. Popular during
   the 1920’s along with private duty nursing,
   the case method emphasizes following
   physicians orders”
                      Marriner-Tomey, Ann (1996) Fifth ED
                      Nursing Management and Leadership


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 Change was necessary
 Patient acuity was consistently high
 Staff sick leave and injuries were increased
 Staff turn-over meant a shortage of senior
 RN’s
 Staff exhausted after day shifts


Team Nursing was implemented
 successfully
                   Team Nursing                 4
          Team Nursing
“After World War II RN’s were still scarce,
  although the number of auxiliary personnel
  had increased. Team nursing was
  introduced during the 1950’s to improve
  nursing services by using the knowledge and
  skills of professional nurses and to supervise
  the increasing numbers of auxiliary nursing
  staff. The result was an improvement in
  patient and staff satisfaction

                     Team Nursing                  5
          Team Nursing
Team Nursing is based on a philosophy that
  supports the achievement of goals through
  group action. Each member is encouraged to
  make suggestions and share ideas. When
  team members see their suggestions
  implemented, their job satisfaction increases,
  and they are motivated to give better care.”
                       Mariner-Tomey Ann (1996) Fifth Ed
                     Nursing Management and Leadership


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               Day Shift
  The daily staffing is influenced by
   available staff, skill mix, patient
       acuity, ward occupancy.
          NUM – Management
   Shift Co-coordinator – Senior RN

Team Leader (RN/EN) Team Leader (RN/EN)

RN or EN             RN or EN


RN or EN             RN or EN

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 Changes to Day Shift
A flexible focus is essential in maintaining the
success of team nursing
We found the staff structure for the day had to
be decided before handover. Staff were
allocated patients reports to write, yet can
readjust the allocation of report writing as per
their team discussions later in the day
Regular collaboration/discussion is a strength
in teams.

                   Team Nursing                8
  Changes to Day Shifts
A minimum of 3 RN’s is necessary for day
shift. With less RN’s, the EN’s attend patient
observations after handover, and encourage
independent patients to attend showering.
Meanwhile, RN’s administer prescribed
medications. Once observations/medications
completed the team leader further discusses
workload with team members.
Collaboration/discussion can occur at any
time and be initiated by any member of the
team

                  Team Nursing                   9
   Changes to Day Shift
Patients with high acuity are attended by 2 –4
staff.
Introduction of the Red Dot System has
assisted staff in better management of
manual handling.
As well, the position of manual handling co-
ordinator supports, assesses and monitors
staff.
The purchasing of pelican belts, slide sheets,
lifters, high-low chairs, low beds and bariatric
beds all assisted staff in performance and
providing improved patient care
                   Team Nursing                10
What is evident since team
 nursing was introduced.
 Reduced sick leave and staff injuries
 Reduction in staff exhaustion
 Increased collaboration amongst team members
 Continuity of care – same patients for a number of
 days. Patient and staff satisfaction
 Reduction in irritability – “shared loads”
 Everyone's suggestion is valued and often utilized.
 Problem solving is shared by team not left to the
 individual.
 More supervision/support available for junior and
 inexperienced staff
                      Team Nursing                     11
Some Team Members require
 more support than others in
  adjusting to team nursing
                      Teams pull together
                      in the one direction
                      to achieve a
                      common goal.
                      There are more
                      hands in teams to
                      share the load.



           Team Nursing                  12
               Handover
  Having no overlapping shifts which allowed
  for adequate time for handover, staff
  adjustments to past practices were essential.
Previous Practices
  Team leader read all patients notes to staff
  who were commencing duty. This practice
  was time consuming taking >60 minutes.
  Staff listening would often lose concentration.
  They didn’t read their patients notes. It is a
  legal requirement to read your patients
  notes.

                     Team Nursing               13
              Handover
Present Practice
  A comprehensive verbal handover is given by
  a member of the previous shift:- over 15
  minutes when ward a 100% occupancy.
  Then staff read notes of allocated patients.
  Time is not wasted and staff fulfill the legal
  requirement by reading own patients notes.



                    Team Nursing               14
               Handovers
Present Practices
  Rostering staff to ensure the ward is covered during
  handover was reviewed.
  1 RN and 1 EN commence duty at 0700hrs . They
  receive a verbal handover from the in-charge ND RN
  – then read allocated area patients notes.
  1 EN commences duty at 1400hrs – handover from
  co-ordinator and reads patients notes
  1 RN commences duty at 1600hrs – handover from
  co-ordinator of evening shift than reads patients
  notes

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      Acknowledgements
Medical Ward staff acknowledge with
 appreciation:

DAC&N           Linda Lynott

CNS ICU/CCU     Denise McCallum

CNC             Coral Bennett

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