1. ginera SUBJECT: NURSING MANAGEMENT TOPIC: PRIMARY NURSING CARE
DHARAJIYA CHANDRIKA M
S.Y.M.SC NURSING

2. Introduction:
In primary nursing, registered nurses to do individualize client care and accept responsibility and accountability for total client care. Ideally, staffing for this method requires a nursing staff composed entirely of registered nurses. Each nurse is assigned a maximum of 6 clients. There are no team leaders in this method. Each primary nurse is a bedside nurse, who has received the assignment from and intern reports to the nurse manager

3. Origin:
In the late 1960’s as a results of dissatisfaction of nurses from functional and team nursing.

4. Definition:
Primary nursing is a configuration of care that promotes greater professional accountability and autonomy to improve a continuity of care.

5. Purpose of primary nursing:
Identify actual and potential problems.
Understanding health problems and helping to cope with the health problem.
Individualized nursing care is enhanced when general care , treatment and medications and planned in relation to one another.
Better nursing education – primary nurse gains a better knowledge of disorders and the ways in which they affect physically and socially.
The satisfaction to the nurse for greater when she has personal contact with the patient and opportunity to see her plans for his care materialize.

6. Primary nurse assesses the client’s needs to develops a plan of care and ensures that nursing interventions are delivered.
It maintains continuity of care across shifts, days of visits. It can be applied in any setting , including clients , emergency department and home health.
Single professional can potentially reduce cost by maintaining delays in therapies improving, collaboration with other professional and enhancing client – nurse relationship.
She can use the nursing care plan, conference and referrals.
She is having responsibility and accountability for total client care.
She can supervise and guides the associate nurses about the patient care when she is not on duty.

7. Principles of primary nursing:
Safely performed individual patient by primary nurse
Responsibility
Care of that client 24 hours, a day until discharge.
No team leaders- individual autonomy

8. Scope:
Expansion of nurses role in practice.

9. Structure of primary nursing
The primary nursing structure lands it self well to home health nursing, hospice nursing and other health care delivery enterprises.

10. . physician Charge nurse Hospital resources Primary nurse
Patient/client
Associate nurse(night)
Associate nurse(evening)
Associate nurse(day)

11. Responsibilities of primary nurse:
primary role is to extended their roles
extended their clinical role by diagnosing, treating and managing simple or chronic conditioners
responsible for the care of the client for 24 hours , a day until discharge
Primary nurse to establish clear communication among the patient and physician and other associate nurses and health team member

12. Functions of primary nurse:
Providing physical care and emotional support for the support for sick and disabled.
Planning and teaching the patient and his family in relation to the restoration and promotion of health and prevention of diseases.
Co-ordinating all the activities of the care.

13. Contd….
Providing care that requires more specialized knowledge and judgement.
Teaching clients, family and other members of the health care team.
To supervise or guide the patient in rehabilitative activities related to daily living.
To provide basic nursing care.

14. Contd…
Helping a patient to carry out the therapeutic plan initiated by doctor.
Primary care nurses treats a wide variety of patients and conditions.

15. Contd…
Primary nurse provide care to individuals, families and communities in their homes, schools and local surgeries
Primary care nurses are finding innovative and collaborative ways the meeting the health care needs of their patients and are taking a major role in the delivery of primary health care.

16. Nursing process for primary care
Assessment of patients condition or needs.
Direct observation.
Data collected to use scientific knowledge or technical skill.
Information gathering shaped by theory, pattern recognition or judgement.
Verification/ collaboration of data collected by other personal.
Interpretation or synthesis of data.
Formulation of nursing diagnosis including psychosocial and educational needs.

17. Planning or coordinating nursing care
Application of theory to individual patients finding.
Communication to enhance mutual respect or job satisfaction or to promote coordination of care.
Delegation, assignment of clinical guidance for other caregivers.
Partnership with patient regarding plan of care.

18. Implementation not fragmentation
Functions including manual, requiring substantial scientific knowledge or technical skill.
Functions requiring or closely related need for on-going assessment.
Functions requiring RN assessment.
Initiate/ change treatment following standardising procedures.

19. Patient education:
On going integration or application of new scientific knowledge to individual patients signs and symptoms.
Assessment of educational needs and delegation of implementation as appropriate to registered nurse.
Advice on dependent scope of registered nurse and / or standardized procedures.

20. Evaluation:
The registered nurse is responsible for evaluation of patients overall condition or treatment. This achieved by the registered nurses direct observation or assessment.

21. Nurses role in Primary Nursing Care:
Whether in hospital – based or community health care setting, nurses assume the extend their role to include increased emphasis on health promotion and illness prevention as well as concern for the client as a whole.
Variety of roles available the nurses need to take the opportunity to construct a career path way in primary care.

22. Care giver:
Decision maker:
Client advocate:
Protector:
Leader:
Manager:
Co-ordinator
The curative aspects:
Rehabilitator:
Comforter:
Communicator:
Teacher:
Counsellor:
Mother surrogate:

23. ADVANCED PRACTICE NURSES ROLE
A) NURSE PRACTITIONERS
Involves action that directly meet the health care and nursing needs of patients, families and others include staff at all level of the clinical leader, advanced nurses practice and community based nurses, there are five major practitioner.
1. An adult nurse practitioner:
2. A family nurse practitioner
3. A paediatric nurse practitioner
4. An obstetrics-gynaecology nurse
practitioner
5. An geriatric nurse practitioner

24. B) CERTIFIED NURSE MIDWIFE
Providing primary care for women during normal pregnancy, labour and delivery and for new born
C) NURSE ADMINISTRATOR
Managing client care and delivery of specific nursing services within health care agency.
D) NURSE RESEARCHER
Investing problems to improve nursing care.
Implement studies to determine the actual effect of nursing care to further specific base of nursing and the scientific base of nursing and expanding the scope of nursing practice.

25. COMMUNITY BASED PRACTICE NURSE ROLES
In focused on health promotion and maintenance; education and management and coordination continuity of restorative care within the clients in community.
Primary care nurses need to let go of the purely medical model of care working in and with the broader community is the only way to change health.

26. community health centres
Activities of comprehensive program for health maintenance and promotion , education and coordination of care within the community.
Ambulatory care.
School:
Nurses working in schools may provide care for students with non emergency acute illness such as respiratory infection, influenza etc.

27. Occupational health setting
Conducting program regarding health and safety at work place.
Treating of non-emergency acute illness.
Giving emergency care and first aid.
Referring the client to health resources.
Some health care agencies
It provide creative, adaptive care to clients in the home. Holistic non-judgemental and family centered philosophy is essential for the nurse in the home.

28. ADVANTAGES:
Nurses have more autonomy in this mode than in the functional or team approaches and are challenged toward to their full capacity.
Nurses tend less time in the coordinating and supervising activities and more time in direct care activities.
Along with the increase autonomy and involvement in the direct care the primary nurse is also more accountable because responsibility is focused rather than defuse.

29. Contd…
Primary nurses generally feel that they are more effective working under the system. They also gain more satisfaction from being involved in the entire care of patient and from being able to give more holistic care.
People from other discipline also appreciate the fact that they can consult with one particular, indefinable nurse who knows all about the patient.
Positive aspects of the primary method include shorter hospital stays for clients,improved communication staff and more holistic focus of care.

30. DISADVANTAGES:
As with the term nursing most of the disadvantages of primary nursing come from problems with implementation.
While proponents of primary care argue that it is no more costly than other ways to deliver care, its detractors point out that it required some much higher proportion of professional nurses to auxiliary personnel.
It has also been noted that even with primary nursing the hospitalized person is a cared for by at least six nurses.(three nurses to cover the three 8 hours shift in a day and another three associate to substitute for them open other day off).

31. Some are threatened by this additional demands, others find that they need additional education for assuming the primary nurse role, auxiliary workers often feel a sense of loss when their direct care activities are reduced under primary nursing.
Primary nursing focuses on the nurse as the care gives and dose not clearly define the roles of auxiliary personnel in fact there is much disagreement over the issues of practical nurses assuming the primary nursing have arisen from attempts to make appropriate auxiliary personnel in the primary nursing approach to delivering nursing care.

32. SUMMARY
Primary nursing incorporates the concept of assigning total care and responsibility for one patient or client from the case method into modality particularly designed for in patient care, through adaptable to ambulatory care as well. Primary nursing returns to the focus on the nurse as care giver with associate nurse covering the other hours of the day. It has some advantages and disadvantages. Both team and primary nursing are more difficult to implement them the functional or case method.

33. Thank you