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chapter 9 | Delegation of Client Care 127 CikguOnline
delegation and communication skills are essential to of care, transcribing and communicating orders and
successfully follow through with any given model of treatment changes to team members, and solving
care delivery. problems of clients and/or team members. The
nurse manager confers with the team leaders,
Functional Nursing supervises the client care teams and, in some insti-
Functional nursing or task nursing evolved during tutions, conducts rounds with the health-care
the mid-1940s due to the loss of RNs who left providers.
home to serve in the armed forces during the For this method to be effective, the team leader
Second World War. Prior to the war, RNs com- needs strong delegation and communication skills.
prised the majority of hospital staffing. Because of Communication among team members and the
the lack of nurses to provide care at home, hospitals nurse manager avoids duplication of efforts and
used more LPNs or licensed vocational nurses and decreases competition for control of assignments
UAP to care for clients. that may not be equal based on client acutity and
When implementing functional nursing, the the skills sets of team members.
focus is on the task and not necessarily holistic
client care.The needs of the clients are categorized Total Client Care
by task, and then the tasks are assigned to the “best During the 1920s total client care was the original
person for the job.” This method takes into consi- model of nursing care delivery. Much nursing was
deration the skill set and licensure scope of practice in the form of private duty nursing, in which nurses
of each caregiver. For example, the RN would per- cared for clients in homes and in hospitals. Schools
form and document all assessments and administer of nursing located in hospitals provided students
all IV medications; the LPN or LVN would who staffed the nursing units and delivered care
adminster treatments and perform dressing under the watchful eyes of nursing supervisors and
changes. UAP would be responsible for meeting directors. In this model, one RN assumes the
hygiene needs of clients, obtaining and recording responsibility of caring for one client.This includes
vital signs, and assisting in feeding clients. This acting as a direct liason among the client, family,
method is efficient and effective; however, when health-care provider, and other members of the
implemented, continuity in client care is lost. Many health-care team. Today, this model is seen in high
times, re evaluation of client status and follow-up acuity areas such as critical care units, postanesthe-
does not occur, and a breakdown in communication sia recovery units, and in labor and delivery units.
among staff occurs. This model requires RNs to engage in non-nursing
tasks that might be assumed by individuals without
Team Nursing the educational level of an RN.
Team nursing grew out of functional nursing; nurs-
ing units often resort to this model when appropri- Primary Nursing
ate staffing is unavailable. A group of nursing In the 1960s nursing care delivery models started
personnel or a team provides care for a cluster of to move away from team nursing and placed the
clients. The manner in which clients are divided RN in the role of giving direct client care.The cen-
varies and depends on several issues: the layout of tral principle of this model is to distribute nursing
the unit, the types of clients on the unit, and the decision making to the nurses caring for the client.
number of clients on the unit. The organization of As the primary nurse, the RN devises, implements,
the team is based on the number of available staff and is responsible for the nursing care of the client
and the skill mix within the group. during the time the client remains on the nursing
An RN assumes the role of the team leader. The unit. The primary nurse along with associate nurs-
team may consist of another RN,an LPN,and UAP. es gives direct care to the client.
The team leader directs and supervises the team, In its ideal form, primary nursing requires an
which provides client care.The team knows the con- all-RN staff. Although this model provides conti-
dition and needs of all the clients on the team. nuity of care and nursing accountability, staffing is
The team leader acts as a liason between the difficult and expensive. Some view it as ineffective
clients and the health-care provider/physician. as many tasks that consume the time of the RN
Responsibilities include formulating a client plan could be carried out by other personnel.