Also known as nursing care delivery modalities/systems/framework of care

1. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 1
Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
A health care system is the totality of services offered by all health disciplines. The major
purpose of health care system is to provide care to the ill and injured. However, with
increasing awareness of health promotion, illness prevention, and levels of wellness, health
care systems are changing as are the roles of nurses in these areas. The services provided by a
health care system are commonly categorized according to type and level.
Types of health care services
1. Primary Prevention: Health promotion and illness prevention. Primary prevention
programs address areas such as adequate and proper nutrition, weight control and
exercises, and stress reduction.
 Health promotion activities emphasize the important role clients play in
maintaining their own health and encourage them maintain the highest level of
wellness they can achieve. Illness prevention may be directed at the client or
the community and involve such practices as providing immunization,
identifying risk factors for illness, and helping people take measures to prevent
these illnesses from occurring.
 Illness prevention also include environmental programs that can reduce the
incidence of illness or disability e.g. steps to decrease air pollution include
requiring inspection of automobile exhaust systems to ensure acceptable levels
of fumes. Environmental reduction measures are frequently legislated by
governments and lobbied for by citizens groups.
2. Secondary prevention: diagnosis and treatment. Hospitals and doctor’s clinics
have been the major agencies offering diagnosis and treatment. Hospitals continue to
focus significant resources on patients requiring emergency, intensive, and round-the-
clock acute care.
3. Tertiary prevention: Rehabilitation, health restoration, and palliative care. The
goal of tertiary prevention is to help people move their previous level of health (i.e., to
their previous capabilities) or to the highest level they are capable of given their
current health status.
 Rehabilitation emphasizes the importance of assisting clients to function
adequately in the physical, mental, social, economic and vocational areas of
their lives.
 Sometimes, people cannot be returned to health. A growing field of nursing
and tertiary prevention services is that of palliative care-providing comfort and

2. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 2
treatment for symptoms. End-of-life care may be conducted in many settings
including the home.
Types of health care agencies and services:
Health care agencies are varied and numerous. They include public health, doctor’s
clinics/physician offices, ambulatory care centres, occupational health clinics, hospitals,
subacute care facilities, extended care (long-term care) facilities/nursing homes, retirement
and assisted living centres, rehabilitation centers, home health care agencies, day-care
centers, rural care, hospice services, crisis centers, mutual support and self-help groups.
Providers of health care
Nurse, dentist, pharmacists, occupational therapist, physical therapist, physician, paramedical
technologist, physician assistant, podiatrist, respiratory therapist, social worker, spiritual
support personnel.
Factors Affecting Health Care Delivery
Today’s health care consumers have greater knowledge about their health than in previous
years and they are increasingly influencing health care delivery. Formerly, people expected a
physician to make decisions about their care; today, however, consumers expect to be
involved in making and decisions. Consumers have also become aware of how lifestyle
affects health. As a result, they desire more information and services related to health
promotion and illness prevention.
1. Economics
2. Uneven distribution of resources/services
3. Advances in technology
4. Homeless and poor
5. Increasing number of elderly
6. Access to health insurance
Nursing Care Delivery Modalities/Frameworks for Care
A number of configurations for the delivery of nursing care support continuity of care and
cost effectiveness. They include managed care, case management, patient-focused care,
differentiated practice, shared governance, case method, functional method, team nursing,
primary nursing. These have evolved, some from each other for reasons such as the need to
decrease health care costs and to improve the utilization of limited human and physical
resources. A particular agency may use more than one configuration-for example, team
nursing on the medical surgical units and primary nursing on the cardiac surgery unit.
Managed Care

3. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 3
Describes health care system whose goals are to provide cost-effective, quality care that
focuses on decreased costs and improved outcome for groups of clients.
The care of the client is carefully planned from initial contact to the conclusion of the specific
health problem.
Health care providers and agencies collaborate to render the most appropriate, fiscally
responsible care possible.
Managed care denotes an emphasis on cost controls, customer satisfaction, health promotion,
and preventive services. Health maintenance organizations and preferred provider
organizations are examples of provider systems committed to managed care.
Managed care can be used with primary, team, functional, and alternative nursing care
delivery systems.
Case Management
Describes a range of models for integrating health care services for individuals or groups.
It involves multidisciplinary teams that assume collaborative responsibility for planning,
assessing needs, and coordinating, implementing, and evaluating care for groups of clients
from preadmission to discharge or transfer and recuperation. A case manager however maybe
a nurse, social worker or other appropriate professional.
Case management may be used as a cost-containment strategy in managed care. Both case
management and managed care systems often use critical care pathways to track the client’s
progress. A critical pathway is an interdisciplinary plan or tool that specifies interdisciplinary
assessments, interventions, treatments and outcomes for health-related conditions across a
time line. Critical pathways are also called critical paths, interdisciplinary plans, anticipated
recovery plans, interdisciplinary action plans and action plans.
Responsibilities of case managers/discharge planners
1. Assessing clients and their homes and communities
2. Coordinating and planning client care
3. Collaborating with other health professionals
4. Monitoring clients’ progress
5. Evaluating client outcomes
Patient Focused Care
Is a delivery model that brings all services and care providers to the clients. Cross training,
development of multiskilled workers who can perform tasks or functions in more than one
discipline is an essential element of patient-focused care.

4. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 4
Differentiated practice
Is a system in which the best possible use of nursing personnel is based on their educational
preparation and resultant skill sets. Thus, differentiated practice models consist of specific job
descriptions for nurses according to their education or training. The model is customized
within each health care institution by the nurses employed there. The institution must first
identify the nursing competencies required by the clients within the specific practice
environment. It enables nurses to progress and assume roles and responsibilities appropriate
to their level of experience, capability, and education.
As with managed care and case management, differentiated nursing practice seeks to provide
quality care at an affordable cost.
Shared Governance
This model can be used in concert with other models of nursing delivery. It is an
organizational model in which nursing staff are cooperative with administrative personnel in
making, implementing, and evaluating client care policies.
The focus of this model is to encourage participation of nurses in decision making at all
levels of the organization.
The underlying principle of shared governance is that employees will be more committed to
the organizational goals if they have had input into planning and decision making.
Case Method
Also referred to as total care and is one of the earliest nursing models developed. In this
client-centered method, one nurse is assigned to and is responsible for the comprehensive
care of a group of clients during an 8 or 12 hour shift. For each client the nurse assesses
needs, makes nursing plans, formulates diagnoses, implements care and evaluates the
effectiveness of care.
A client has consistent contact with one nurse during a shift but may have different nurses on
other shifts. The case method, considered the precursor of primary nursing, continues to be
used in a variety of practice settings such as intensive care nursing.
Functional Method
The functional nursing method focuses on the jobs to be completed (e.g., bed making, tpr
measurement).
In this task-oriented approach, personnel with less preparation than the professional nurse
perform less complex care requirements. It is based on a production and efficiency model that
gives authority and responsibility to the person assigning the work, for example, the head

5. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 5
nurse. Clearly defined job descriptions, procedures, policies and lines of communication are
required.
The functional approach to nursing is economical and efficient and permits centralized
direction and control. Its disadvantages are fragmentation of care and the possibility that
nonquantifiable aspects of care such as meeting the client’s emotional needs may be
overlooked.
Team Nursing
Is the delivery of individualized nursing care to clients by a team led by a professional nurse.
A nursing team consist of RN, LPN and unlicensed assistive personnel. This team is
responsible for providing coordinated nursing care to groups of clients.
The RN retains responsibility and authority for client ccare but delegates appropriate tasks for
the other team members. Proponents of this model believe the team approach increases the
efficiency of the registered nurse. Opponents state that inpatients’ high acuity of illness
leaves little to be delegated.
Primary Nursing
Primary nursing is a system in which one nurse is responsible for overseeing the total care of
a number of clients 24 hours a day, 7 days a week, even if he or she does not deliver all the
care personally. It is a method of providing comprehensive, individualized, and consistent
care.
It used the nurse’s technical knowledge and management skills. The primary nurse assesses
and prioritizes each client’s needs, identifies nursing diagnoses, develops a plan of care with
the client, and evaluates the effectiveness of care.
Associates provide some care, but the primary nurse coordinates it and communicates
information about the client’s health to other nurses and other health professionals.
Primary nursing encompasses all aspects of the professional role, including teaching,
advocacy, decision making, and continuity of care. The primary nurse is the first-line
manager of the client’s care with all its inherent accountabilities and responsibilities.

6. Kisii University, School of Health Sciences, Department of Nursing
HEALTH CARE DELIVERY SYSTEM
By Nyaboga Esther
Nyaboga Esther (2019) Page 6
References
1. Audrey Berman, Shirlee J Syder Barbara Kozier, Glenora Erb (2015). Fundamentals
of Nursing, Concepts, Process and Practice; 8th
edition, Pearson Prentice Hall
2. Ruth F Craven and Constance J Hirnle (2015). Fundamentals of Nursing, Human
Health and Function, 5th
edition, Lippincott Williams and Wilkins.
3. Helen Harkreader, Mary Ann Hogan, Marshelle Thababen (2015). Fundamentals of
Nursing, Caring and Clinical Judgement 3rd
edition, Saunders Elsevier.