Team nursing

Team nursing is a system of integrated care that was developed in 1950s (under grant from W.K. Kellogg Foundation) directed by Eleanor Lambertson at Teachers College, Columbia University in New York, NY. 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. 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.

Team nursing was developed because of social and technological changes in World War II drew many nurses away from hospitals, learning haps, services, procedures and equipment became more expensive and complicated, requiring specialisation at every turn. It is an attempt to meet increased demands of nursing services and better use of knowledge and skills of professional nurses.

Definitions

Objective of team nursing

The objective of team nursing is to give the best possible quality of patient care by utilizing the abilities of every member of the staff to the fullest extent and by providing close supervision both of patient care and of the individual who give it.

Line of organization of team nursing

A clear line of organization structure is needed for team nursing to provide a mechanism for horizontal and vertical communication, and an organized pattern is employed.

Functioning of team nursing

The two important points of functioning are:

  1. The head nurse must know at all times the condition of the patients and the plan for their care and must be assured that assignments and workmanship contribute to quality nursing
  2. The team leader must have freedom to use their initiative and the opportunity to nurse, supervise, and teach unencumbered by the responsibility for administrative detail

Functions of RN

Channels of communication in team nursing

  1. Reports
  2. Work or assignment conference
  3. Patient care conference
  4. Written nursing care plan

The greatest single distinguishing feature of team nursing is the team conference. In general, there are three parts to the conference;

It is essential that the conference be well planned, brief but comprehensive and interesting. The team leader is the chair person for the conference. They offer opportunity for all personnel to evaluate patient care and solve the problems through team discussion.

Advantages: (Marquis and Huston, 2003) 1. High quality comprehensive care can be provided despite a relatively high proportion of ancillary staff. 2. Each member of the team is able to participate in decision making and problem solving. 3. Each team member is able to contribute his or her own special expertise or skills in caring for the patient. 4. Improved patient satisfaction. 5. Organisational decision making occurring at the lower level. 6. Cost-effective system because it works with expected ratio of unlicensed to licensed personnel. 7. Team nursing is an effective method of patient care delivery and has been used in most inpatient and outpatient health care settings.

Other advantages: 1. Feeling of participation and belonging are facilitated with team members. 2. Work load can be balanced and shared. 3. Division of labour allows members the opportunity to develop leadership skills. 4. Every team member has the opportunity to learn from and teach colleagues 5. There is a variety in the daily assignment. 6. Interest in client’s wellbeing and care is shared by several people, reliability of decisions is increased. 7. Nursing care hours are usually cost effective. 8. The client is able to identify personnel who are responsible for his care. 9. Continuity of care is facilitated, especially if teams are constant. 10. Barriers between professional and non-professional workers can be minimised, the group efforts prevail. 11. Everyone has the opportunity to contribute to the care plan.

Disadvantages: 1. 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’. 2. Unstable staffing pattern make team nursing difficult. 3. All personnel must be client centred. 4. There is less individual responsibility and independence regarding nursing functions. 5. Continuity of care may suffer if the daily team assignments vary and the patient is confronted with many different caregivers. 6. The team leader may not have the leadership skills required to effectively direct the team and create a “team spirit”. 7. Insufficient time for care planning and communication may lead to unclear goals. Therefore responsibilities and care may become fragmented.

Modifications: In an attempt to overcome some of its disadvantages, the team nursing design has been modified many times since its original inception, and variations of the model are evident in other methods of nursing care delivery such, as modular nursing.

Modular nursing

Modular nursing is a modification of team nursing and focuses on the patient’s geographic location for staff assignments. (Magargal 1980)

Advantages: (Yoder Wise 2003)

  1. Continuity of care is improved when staff members are consistently assigned to the same module
  2. The RN as team leader is able to be more involved in planning and coordinating care.
  3. Geographic closeness and more efficient communication save staff time.

Disadvantages: (Yoder Wise 2003)

  1. Costs may be increased to stock each module with the necessary patient care supplies (medication cart, linens and dressings).
  2. Long corridors, common in many hospitals, are not conducive to modular nursing.

See also

Team nursing also signifies "helping each other" by the nurse and the patient. team nursing is a team of nurses caring for a group of patients NOT task allocation as described above!

The description above implies Functional Nursing, not Team Nursing. Teams as used in nursing are typically a group of nurses caring for a group of patients who are divided among the nurses. They work cooperatively and share group responsibility for the caseload.

See QE Foundation, Inc. Nursing Trial Research Project at www.qefoundation.org

References

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