2. DEFINITION
• The nursing care delivery system means “the process
of delivering care to the client by combining various
aspects of nursing service which will fit to various
patient care settings to produce a common outcome
of delivering quality care and meeting the needs of
clients”.
3. ELEMENTS OF HEALTH CARE DELIVERY SYSTEM
Clinical decision
making
Work allocation
Communication
Management
Coordination
4. PRINCIPLES OF NURSING CARE DELIVERY
• Holistic approach is used to identify nursing care needs.
• Nursing care is based on a helping relationship.
• It is the unique function of nurse to provide nursing care
according to client s needs.
• The aspect of patient care has to be initiated and
controlled by nurse.
• There should be justification for selecting each delivery
system.
• Before planning care organizational polices to be
considered.
5. Factors influencing nursing care delivery system
• Availability of adequate staff in wards or units.
• Patient census.
• Extend of staff deficiency.
• Organizational policies regarding nurses practice.
• Patient preference for care.
• Availability of skilled staff.
6. Factors influencing nursing care delivery system
cont…
• Opportunities for continuing and in-service education
for the staff.
• Budget of the organization.
• Socioeconomic condition of the patient.
• Organizations mission.
• Patient and community needs.
7. Methods of nursing care delivery
TRADITIONAL METHODS
• Case method
• Functional method
• Team method
• Modular nursing
• Primary nursing method
ADVANCED METHODS
• Case management
• Critical pathway
• Practice partner ship
• Differentiated practice
8. CASE METHOD
• Oldest method
• Total patient care method
• Total responsibility of
meeting patient need is of
nurse on duty
• Assignment of one or more
clients to a nurse for a
specific period of time.
• Accountability of
care planning
• Continuity
• Co-ordination
• Documentation
• Nursing process
• Cost effectiveness
PRINCIPLES
10. MERITS OF CASE METHOD
• The nurse can see better an attend to the total needs of
clients.(physical , emotional, medical regimen, teaching)
• Continuity of care can be facilitated with care
• Rapport can be build.
• Client may feel more secure.
• Educational needs can be monitored.
• Family and friends become well known by nurse and get
more involved in the care of the client.
• Workload can be equally divided among staffs.
• Nurses are accountable for their function.
11. DEMERITS OF CASE METHOD
• The greatest disadvantage is when the nurse is
inadequately trained or prepared to provide total care
to the patients.
• Nurses are not enough to comply the demand of this
model: cost effectiveness should be considered.
• This method has to be modified is nonprofessional
health workers are to be used.
• It is difficult for nurses to use this method to become
involved in long term planning and evaluation of care
12. Functional nursing
• Introduced in 1930, USA
• Functional nursing is a
method of providing patient
care by which each licensed
and unlicensed staff members
perform specific tasks for a
large group of patients.
• Good for long term care
setting with improved
coordination, care planning
and communication
Task method
13. Merits of functional nursing.
• The person can be skilled in the assigned task, it can
be efficient and economical.
• The best use of persons aptitudes and experience and
desires.
• Saves time
• Easy to organise the work
• Useful in emergency
14. Demerits of functional nursing.
• Clients can become impersonal, accomplished and
fragmented
• Tremendous risk in diminishing continuity of care.
• Staff may have very little motivation to develop self
and others, as work becomes monotonous
• Clients may feel insecure not knowing who their staff
is .
• It is difficult to establish clients priorities
15. TEAM NURSING
• Introduced in the year 1950’s
• A nursing team made up of professional nurses,
nursing auxillaries and nursing aids. They can work
together co- operatively under a well qualified team
leader to provide a range of nursing services which
may vary from the simple to the most complex
nursing functions.
16. TEAM NURSING- Functions
• Simple nursing functions - nursing aides
• Intermediate nursing functions - trained nursing
personnel.
• Professional functions - a nurse with professional
nursing education background.
Better coordination, supervision and efficiency.
Potential for high quality care.
17. CHARACTERISTICS OF TEAM NURSING.
• Common agreed goals
• Clear division of labour
• Adequate resources human and material
• Supportive and cooperative interpersonal
relationships
• Open, honest communications
• Provision for evaluation and improvement
• Good scope for utilization of nursing process by the
team.
18. ADVANTAGES OF TEAM NURSING
• High-quality, comprehensive care with a high
proportion of ancillary staff.
• Team members participate in decision making and
contribute their own expertise.
19. DISADVANTAGES
• No direct care may be given by the team member.
• Individual members may not have comprehensive
knowledge about the patient as a whole due to lack
of communication.
• Team members may become too much dependent on
the leader for the decision making.
• Nursing care may become fragmented.
• Continuity suffers if daily team assignments vary
• Team leader should have good leadership skills.
• Insufficient time for planning and communication
20. MODULAR NURSING
• The nursing staff includes technical and nurse aides,
as wellas professional nurses.
• Two or three persons are assigned to each module,
the greatest responsibility for the care of assigned
patients falls on the professional nurse. The
professional nurse is also responsible for guiding and
teaching non-professional nurse.
21. MODULAR NURSING
• Modular nursing is a modification of team nursing
and focuses on the patient's geographic location for
staff assignments.
• The patient unit is divided into modules, and the
same team of caregivers is assigned consistently to
the same geographic location.
• Each location, or module, has an RN assigned as the
team leader, and the other team members may
include LVNs/LPNs and UAP
22. MODULAR NURSING
• The concept of modular nursing calls for a smaller
group of staff providing care for a smaller group of
patients.
• The goal is to increase the involvement of the RN in
planning and coordinating care.
• Communication is more efficient among a smaller
group of team members (Marquis and Huston, 2000).
• To maximize efficiency, each designated module
should contain all the supplies needed by the staff to
perform patient care.
23. ADVANTAGES AND DISADVANTAGES OF
MODULAR NURSING
ADVANTAGES
• Continuity of care is
improved
• Rn more involved in
planning and coordinating
care geographic closeness
and efficient
communication
DISADVANTAGES
• Increased costs to stock
each module
• Long corridors not
conducive to modular
nursing.
24. PRIMARY NURSING METHOD
• Comprehensive, continuous and coordinated nursing process
for meeting the total needs of each patient.
• Primary nursing concept was to promote individualized
nursing care and to make qualified registered nurses assume
responsibilities for nursing care provided to patients .
• One registered nurse is responsible for patient care over 24
hours period , 7 days a week from the time the patient
admitted.
25. CONCEPT OF PRIMARY NURSING
• Patient assessment by a primary nurse
• Complete communication of care given in the nursing
staff daily reporting method.
• Discharge planning including teaching, family
involvement and appropriate references
26. PROCESS OF PRIMARY NURSING CARE METHOD
• The head nurse
• The professional Staff nurse
•
Technical nurse
Nursing aide
Ward clerk.
Primary nurse
Associate nurse
27. PRIMARY NURSING METHOD
ADVANTAGES
• High-quality, holistic patient
care
• Establish rapport with patient
• RN feels challenged and
rewarded
• Increased communication with
physician and other health
care provider
• Works with professional staff
• Autonomy, Motivation.
DISADVANTAGES
• RN may be inexperienced
and lack of autonomy.
• RN must accept 24-hour
responsibility
• More RNs needed; not
cost-effective
28. CASE MANAGEMENT METHOD
• Case management is a process of monitoring an
individual patient’s health care by the case manager,
for the purpose of maximizing positive outcomes and
containing costs
Quality of care plus cost.
29. CASE MANAGEMENT METHOD
• From the diagnostic phase through hospitalization,
rehabilitation and back to home care.
• Planning, implementing, coordinating and evaluating
care for the patient throughout the period of illness
• Plans are made in advance for the next needed step
30. Advantages and Disadvantages
Advantages
• For the patient: - standardized
patient care outcomes for each
patient.
- early patient discharge
- Using the fewest possible
appropriate health care resources -
Facilitating the continuity of patient
care
• For the nurse: - Enhancing nurse’s
professional development and
job satisfaction.
• - Facilitating the transfer of
knowledge of expert clinical staff
of novice staff
Disadvantages
• lack of administrative support.
• Expensive
• client focused and outcome
oriented
• Facilitates and promotes co-
ordination of cost- effective care
• It is a professionally
autonomous role that requires
expert clinical knowledge and
decision-making skills
31. Critical pathway
• Clinical pathways/ care pathways
/critical pathways/ integrated care
pathways/care maps
• Manage the quality in healthcare
concerning the standardization of
care processes
• Clinical pathways promote
organized and efficient patient
care based on evidence based
practice.
• Clinical pathways optimize
outcomes in the acute care and
home care settings.
32. Progressive patient care
• Medical /surgical care is delivered in various areas or
units according to the health status of the patient.
• Principal Elements
33. BENEFITS
• Specialized attention
• Patient gets assistance in making adjustment to
hospital , home and community
• Effective use of special skills and abilities of nurses
• Quantity of nursing services can be increased by use
of semi-skilled staff
• Quality nursing can be improved
• Efficient use of highly skilled, personnel and expensive
high tech equipment
• Continuity of care.
34. Palliative care concept
• The goal of palliative care is achievement of the best
quality of life for patients and their families.
• Palliative care affirms life and regards dying as a
normal process neither hastens nor postpones death
provides relief from pain and other distressing
symptoms integrates the psychological and spiritual
aspects of care.
• Offers a support system to help family cope during
the patient’s illness and in their own bereavement
