Reference care

from Wikipedia, the free encyclopedia
The interpersonal relationship between the resident and the carer as a new key feature

Referring care (English: Primary Nursing , abbreviation: PN ) describes a holistically oriented approach within the organization of work of the hospital and care for the elderly , in which the assignment of a caregiver to a particular group requiring care structured workflow within a care unit. The main principle of primary nursing is the decentralized and nursing process- oriented delegation of responsibility for all nursing activities to a specific nurse, the so-called primary nurse. This also includes the patient-related administration and work organization of assigned nursing assistants, trainees and other assistants as well as the temporary handover to the functional care of neighboring departments of diagnosis or therapy.

In contrast to activity-oriented functional care or the system of time-based responsibility for a shift, which is referred to as area care or group care, reference care is a care system that is patient-oriented and geared to the care process .

The designation ´related person care´ is more appropriate, since a ´related person´, in the form of a nurse with established responsibility for the responsibility and control of the care process, carries out ´care´ for a person in need of care. And this happens over a longer period of time on the basis of an honest interpersonal relationship. Caregiver care is primarily an organizational system. It should be realized with the systematic interplay of the established competence of a nurse and thus his responsibility, as well as the honest interpersonal relationship between the person in need of care and the carer. Caregiver care is defined by the fixed personal responsibility and the honest, partnership-based and reliable relationship. Relationship and responsibility are basic elements or main features of this care organization system. (J.Schumacher / 2001)

history

Caregiver care was developed and introduced as primary nursing by Marie Manthey at a university hospital in Minneapolis (USA) in the late 1960s. Since the mid-1990s there have been approaches to implement this care organization system in Germany as well. In 2007, the DBfK founded the German Primary Nursing Network in Berlin , which works as a group of experts under the umbrella of the association and creates a link to nursing practice.

Core elements

Caregiver care is characterized by four core elements:

  • The responsibility for nursing decisions is transferred or assumed by a nurse.
  • Continuity in care results from the allocation of daily nursing work according to the case management method
  • Direct communication reduces the risk of information loss.
  • The care planner is also the care provider.

Process orientation

In reference nursing , all basic and treatment nursing measures that are carried out for a person in need of care or a specific group of caregivers are assigned to a specific caregiver who independently plans and largely takes over all care processes and their documentation. Individual tasks can be delegated by the primary nurse to assigned auxiliary staff such as nursing assistants or community service providers, and trainees can also be entrusted with care measures.

Classification and assignment

The allocation of a group of people in need of care to a reference carer must first take place according to the expected average service duration per patient and shift. The assignment can also take into account both spatial criteria, for example a corridor section, a floor (area maintenance) or a few specific rooms (room maintenance), but also selected nursing criteria. These can be, for example, the requirements of the recipients of the services in a certain care level or a certain illness such as diabetes mellitus or dementia , which can be assigned to a suitably qualified carer depending on the time required and the level of difficulty of the care and the level of training and further education of the caregiver (group care) .

advantages

The advantages of primary care lie in the decentralization and the associated self-control by the caring staff, and above all in the caregiver's personal responsibility for timing. The better support of the care activity is also achieved through a constant flow of information between the permanently assigned caregiver and the person in need of care. This facilitates the somatic as well as the psychosocial nursing anamnesis and the implementation of nursing planning is more needs-oriented ( outcome ).

The process cycle of planning one's own care implementation as well as the implementation of the services of other caregivers and the evaluation is closed. The care documentation is facilitated by the connection to the reference person with the direct flow of information and the knowledge of all related care processes at the reference person.

In this system, the nursing staff have appropriate freedom of action and decision-making according to their level of knowledge, the general motivation and the satisfaction achieved is higher than in the area nursing system. The task load of the ward and shift managers in the area of ​​administration and coordination is largely shifted to the reference nurses. Often the time required for coordination is less than in departmental care, care activities for individual patients and residents can be better structured, travel times and process-related waiting times decrease. For those in need of care, primary care results in easier contact with the nurse and the establishment of a relationship of trust is encouraged. The daily structure can be more easily adapted to the individual needs of the individual ( working time model ) within the care system.

disadvantage

Beyond the reference person, the need for coordination increases and the transfer of information to other employees in function maintenance remains as necessary. However, handover times can be significantly reduced through conscientious and well-structured documentation. At the same time, a hierarchy of primary caregivers and those employed in the same area but otherwise unrelated to assistants is introduced. Mutual support must not fail because of the assignment of the reference person.

If the nursing staff feel overwhelmed in the sometimes very intensive dealings with residents or patients, especially in areas with high psychological stress such as dealing with mentally ill or demented people, it is the role of the ward management to support these carers. Many primary caregivers report that they could not work in the nursing department again because they can no longer take overall responsibility, which makes the work more "chaotic" and less professional.

The flow of information between employees must be organized in primary care. In order to inform all nursing staff about the individual in need of care, emphasis should be placed on suitable and conscientious documentation. The necessary proportion of qualified nursing staff is not necessarily higher, but individual, isolated tasks can only be separated from the nursing process and delegated to a limited extent.

Because care planning is differentiated according to individual patient or resident needs, the training of new employees takes longer than with purely activity-oriented care.

literature

Web links

Individual evidence

  1. ↑ a b German Network Primary Nursing; accessed on July 13, 2019