Models of Nursing Care Delivery.pptx

NURSING CARE DELIVERY
MODELS
Ms Nelly Nzingo

Objectives:
 differentiate among various types of patient care delivery
systems
 list the essential components of total patient care, team
nursing, primary nursing, and case management
 explain what effect staff mix has on work design and the
patient care organization

Nursing Care Delivery
 The practice of nursing has emerged as an aggregate of
complicated duties and responsibilities.
 There is, therefore, a need to develop certain systems,
methods or modalities to ensure delivery of quality care.
 There are five methods of assignment of patient care in a
hospital.
1. Total Patient Care
2. Functional Nursing
3. Team Nursing
4. Primary Nursing
5. Case Assignment

Total Patient Care
 This was the first method to be identified in nursing
care delivery. It is the oldest mode of organizing
patient care
 It was popular in the 1920's.
 Each patient is assigned to a nurse for total patient
care while the nurse is on duty. It provides nurses with
high autonomy and responsibility.
 If they go off duty, the work is handed over promptly
to another nurse.
 This means that the patient has a different nurse each
shift.
 Assignment is made according to the severity of illness
and tends to be mostly for acutely ill patients

Total Patient Care
 The lines of responsibility and accountability are
clear.
 The patient theoretically receives holistic and
unfragmented care during the nurse’s time on
duty.
 Each nurse caring for the patient can, however,
modify the care regimen, meaning that the
patient could receive different approaches to care
in 24hrs
 requires highly skilled personnel and thus may
cost more than some other forms of patient care.

Advantages and disadvantages
Advantages
 Consistency in carrying out the nursing care plan
 Patient needs are quickly met as high number of RN hours
are spent on the patient
 Relationship based on trust is developed between the RN
and the patient’s family
Disadvantage:
 It can be very costly

Functional Nursing
 The second method is known as the functional nursing
method.It was the first major deviation from case method.
 The functional method of delivering nursing care developed
due to an increased demand of nurses
 This method emphasizes the division of labor according to
specific tasks.
 It is ‘task or thing oriented’ and is determined by the
technical aspects of the job to be done.
 Each nurse has a clearly defined set of tasks determined by
complexity, including skills, knowledge and experience in
certain nursing techniques, for example, drug
administration, wound dressing, bed baths and so on

Functional nursing
 It requires relative skill to do simple tasks and proficiency is
gained by repetition.
 Personnel are assigned to complete certain tasks rather
than care for specific patients
 In this model, Registered nurses became managers of care
rather than direct care providers, and “care through others’’

Functional nursing
 It is considered, an economical means of providing care.
This is true if quality care and holistic care are not regarded
as essential.
 A major advantage of functional nursing is its efficiency;
tasks are completed quickly, with little confusion regarding
responsibilities.
 May lead to fragmented care and the possibility of
overlooking patient priority needs.
 Because some workers feel unchallenged and under
stimulated in their roles, functional nursing also may result
in low job satisfaction

Advantages:
 A very efficient way to delivery care.
 Could accomplish a lot of tasks in a small amount of time
 Staff members do only what they are capable of doing
 Least costly as fewer RNs are required
Disadvantages:
 Care of patients become fragmented and depersonalized
 Patients do not have one identifiable nurse
 Very narrow scope of practice for RNs
 Leads to patient and nurse dissatisfaction

Team Nursing
 Team nursing was introduced in the late 1950's to improve
nursing services by utilizing the knowledge and skills of
professional nurses and to supervise the increasing number
of
auxiliary staff.
 The philosophy supports achieving goals through group
action or team spirit.
 The team member possessing the skill needed by the
individual patient is assigned to that patient, but the Team
Leader still has accountability for all of the care. Team
conferences occur in which the expertise of every staff
member is used to plan the care.

Team nursing
 In team nursing, ancillary personnel collaborate in
providing care to a group of patients under the direction of a
professional nurse.
 The team leader is responsible for knowing the condition
and needs of all the patients assigned to the team and for
planning individual care.
 The team leader’s duties vary depending on the patient’s
needs and the workload and may include assisting team
members, giving direct personal care to patients, teaching,
and coordinating patient activities.
 Team nursing is usually associated with democratic
leadership. There is much autonomy as possible when
performing assigned tasks.

Team Nursing
 Team nursing can be organized in the following manner:
1. A group or team of nurses with different levels of skills are
assigned to a group of patients. The size and composition
of the team is dependent upon the setting.
2. The team works together to accomplish a goal.
3. They focus on patient centered as opposed to task
oriented assignments. These are based on patient needs
and the knowledge, skills and experiences of team
members.
4. A member of the work group is assigned as a leader. In the
original concept, the team was led by a registered nurse.

Team Nursing
5. The leadership role may be permanent or rotated.
6. The team works together with each member performing
the tasks for which they are
best prepared.
7. Team members report to the team leader who reports to
the head nurse.
8. Success is dependent upon effective communication.

Advantages:
 Each member’s capabilities are maximized so job
satisfaction should be high
 Patients have one nurse (the Team Leader) with immediate
access to other health providers
Disadvantages:
 Requires a team spirit and commitment to succeed
 RN may be the Team Leader one day and a team member
the next, thus continuity of patient care may suffer
 Care is still fragmented with only 8 or 12 hour accountability

Primary Nursing
 This is a newer approach to the delivery of nursing services.
 The concept was developed in the early 1970s and is used by
many institutions in the developed world.
 People are becoming more aware of it in this country and
some institutions have begun to incorporate it.
 Primary nursing, also known as relationship-based nursing,
uses some of the concepts of total patient care and brings
the registered nurse back to the bedside to provide clinical
care

Primary nursing
 Primary nursing requires a nursing staff comprised totally of
RNs. The RN primary nurse assumes 24-hour responsibility
for planning the care of one or more patients from
admission or the start of treatment to discharge or the
treatment’s end.
 During work hours, the primary nurse provides total direct
care for that patient. When the primary nurse is not on duty,
another will follow the care plan established by the primary
nurse .
 job satisfaction is high in primary nursing, this method is
difficult to implement because of the degree of
responsibility and autonomy required of the primary nurse.

Primary Nursing
 A professional nurse, usually a registered nurse, is assigned to a
patient for their total hospital stay or to a small group of patients,
not more than four or five
 This nurse assumes responsibility for twenty four hours a day for
the duration of the patient’s stay in hospital.
 The primary nurse assesses plans and executes the plan or may
delegate to a secondary or associate nurse to execute the plan
during her absence.
 Every nurse serves as the primary nurse for a few patients and as
an associate nurse for other patients on other shifts.
 The primary nurse communicates with the physician and
coordinates care with other health workers.
 The chief nurse functions as a coordinator of the unit and is a
resource person for the primary nurses.

Advantages:
 Increased satisfaction for patients and nurses
 More professional system: RN plans and communicates with all
healthcare members. RNs are seen as more knowledgeable and
responsible.
 RNs more satisfied because they continue to learn as as part of
the in-depth care they are required to deliver to their patient
Disadvantage:
 Only confines a nurse’s talents to a limited number of patients,
so other patients cannot benefit if the RN is competitive
 Can be intimidating for RNs who are less skilled and
knowledgeable

Case management
 Case management is a collaborative process that assesses,
plans, implements, coordinates, monitors, and evaluates
options and services to meet an individual’s health needs
through communication and available resources to promote
quality, cost-effective outcomes (Powell, 2000).
 Case managers handle each case individually, identifying the
most cost-effective providers, treatments, and care settings
for insured individuals (Finkleman, 2001).
 length of stay and profit margin per confinement used as
measures of efficiency,

Case management
 case management may be unit based, assigned by patient,
disease based, or primary nurse case managed (Powell,
2000). Assignment by unit is most common, particularly in
mid- to large-sized hospitals because patient units typically
care for patients with like diagnoses
 The premise of inpatient case management is that hospitals
are better off “managing the demand for care’’ than
attempting to try to increase the “supply of resources’’ such
as beds or personnel (Smith, 2003).

 Advantages – can be very cost effective and satisfying for
patients who are high risk/problem prone.
 Disadvantages – Case Management is not a true inpatient
delivery system but rather the management of patient care.

The Future
 Nursing shortages and health care reform have had
a strong impact on the creation of new and evolving
types of patient care delivery models.
 We’re seeing pt focus teams. By that she means
the teams have nurses, Dietary, any body else that
you can possibly thing of. Everyone gets an input,
and you have all the teams working together.

The challenges
 Cost containment
 Demand for quality outcomes
 Information age
 Patient population
 Multigenerational workforce
Fall 2010

Integrating Leadership Roles
• No one best mode
• Accomplishment of unit goals
• Seeking solutions not finding fault
– Working together
• Facilitates innovative thinking
• Ensures adequate resources
• Reduce resistance
• Remember, change is inevitable
Fall 2010

The Optimum Mode of Care
Carefully constructed
Not based solely on economics
Fall 2010

Models of Nursing Care Delivery.pptx

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