WEEK 3 NCM 119 Nursing Process and Modalities of Nursing Care

Pamantasan ng Cabuyao
Banay banay, Cabuyao City, Laguna 4025, Philippines

COLLEGE OF HEALTH AND ALLIED SCIENCES
COURSE CODE: NCM 119- Nursing Leadership and Management
COURSE DESCRIPTION: This course deals with the concepts, principles, theories, methods and strategies of management
and leadership in the delivery of client care based on professional standards of nursing practice.
The learners are expected to perform beginning professional management and leadership skills
and apply sound ethico-legal and moral decision-making in any setting.
COURSE INTENDED 1. At the end of the course, the student will be able to:
LEARNING OUTCOMES: 2. Apply knowledge of physical, social, natural and health sciences and humanities in the
practice of nursing.
3. Provide safe, appropriate, and holistic care to individuals, families, population groups and
communities utilizing nursing process.
4. Apply guidelines and principles of evidence-based practice in the delivery of care;
5. Practice nursing in accordance with existing laws, legal, ethical and moral principles;
6. Communicate effectively in speaking, writing and presenting using culturally-appropriate
language;
7. Document to include reporting up-to-date client care accurately and comprehensively.
8. Work effectively in collaboration with inter-intra-and multi-disciplinary, multi-cultural
teams;
9. Practice beginning management and leadership skills in the delivery of client care;
10. Conduct research with an experienced researcher;
11. Engage in life-long learning with a passion to keep current with national and global
developments in general and nursing and health development in particular.
12. Demonstrate responsible citizenship and pride of being a Filipino.
13. Apply techno-intelligent care systems and processes in health care delivery.
14. Adopt the nursing core values in the practice of the profession.
15. Apply entrepreneurial skills in the delivery of nursing care.
LEARNING MATERIAL 2
FOR WEEK NUMBER:
I. TITLE: NURSING PROCESS AND PATIENT CARE DELIVERY SYSTEMS
II. OBJECTIVES: After this lesson, the student is expected to:
1. Familiarize on the different concepts of patient care delivery system,

the nursing process, and the different modalities of patient care
delivery system.
III. INTRODUCTION: This lesson gives aims to the concepts of patient care delivery system and
evidenced based practices in Nursing. This will also discuss the different
pros and cons of different patient care delivery systems being used in the
hospitals in their patient care and delivery.
LECTURE NOTES COMPILATION Page 1 of 12

1st Semester A.Y. 2022-2023
IV. CONTENTS:
THE NURSING PROCESS AND PATIENT CARE

DELIVERY SYSTEMS
Nursing Process
The nursing process is a systematic, rational method of planning and providing nursing care. Also, it is
cyclical. That is, its components follow a logical sequence, but more than one component may be involved
at one time. At the end of the first cycle, care may be terminated if goals are achieved, or the cycle may
continue with reassessment, or the plan of care may be modified. Each phase of the nursing process affects
the others; they are closely interrelated.
PURPOSE
• To identify a client’s health care status, and actual or potential health problems
• To establish plans to meet the identified needs and;
• To deliver specific nursing interventions to address those needs.
ASSESSING
The first step in nursing procedure is to conduct a nursing assessment. Assessing is the systematic and
continuous collection, organization, validation, and documentation of data. In effect, assessing is a continuous
process carried out during all phases of the nursing process.

PURPOSE:
To establish a database about the client’s response to health concerns or illness and the ability to manage health
care needs
TYPES OF ASSESSMENT
1. INITIAL ASSESSMENT- Performed within specified time after admission to a health care agency. Example,
nursing admission assessment.
2. PROBLEM-FOCUSED ASSESSMENT- Ongoing process integrated with nursing care. Example, hourly
assessment of client’s fluid intake and urinary output in an ICU.
3. TIME-LAPSED ASSESSMENT- Performed several months after initial assessment. Example, reassessment
of a client’s functional health patterns in a home care or outpatient setting.
4. EMERGENCY ASSESSMENT- During any physiological or psychological crisis of the client. Example, rapid
assessment of an individual’s airway, breathing status, and circulation during a cardiac arrest.
TYPES OF DATA & DATA COLLECTION METHOD

1. SUBJECTIVE DATA - also referred to as symptoms or covert data, are apparent only to the person affected
and can be described or verified only by that person. Subjective data include the client’s sensations, feelings,
values, beliefs, attitudes, and perception of personal health status and life situation.
2. OBJECTIVE DATA - also referred to as signs or overt data, are detectable by an observer or can be measured
or tested against an accepted standard. They can be seen, heard, felt, or smelled, and they frequently, or rarely
and include such data as blood pressure, level of pain, and age.
DATA COLLECTION METHOD

1. OBSERVATION - gather data by using the senses.
2. INTERVIEW - planned communication or a conversation with a purpose
3. EXAMINATION - physical examination or physical assessment is a systematic data collection method that
uses observation (i.e., the senses of sight, hearing, smell, and touch) to detect health problems.

DIAGNOSIS
Diagnosing is the second phase of the nursing process.

In this phase, nurses use critical thinking skills to interpret assessment data and identify client strengths and
problems, Diagnosing is a pivotal step in the nursing process. Activities preceding this phase are directed toward
formulating the nursing diagnoses: the care-planning activities following this phase are based on the nursing
diagnoses.
TYPES OF NURSING DIAGNOSES

1. Problem-focused diagnosis - a client problem that is present at the time of the nursing assessment.
2. Risk nursing diagnosis - these are clinical judgment that a problem does not exist, but the presence of
risk factors indicates that a problem is likely to develop unless nurses intervene.
3. Health promotion diagnosis (also known as wellness diagnosis) is a clinical judgment about
motivation and desire to increase well-being.
4. Syndrome diagnosis is a clinical judgment concerning with a cluster of problem
5. Possible nursing diagnosis -are statements describing a suspected problem for which additional data are
needed to confirm or rule out the suspected problem.
PLANNING

Planning is a deliberative, systematic phase of the nursing process that involves decision making and problem
solving.
PURPOSE
To develop an individualized care plan that specifies client goals/desired outcomes, and related nursing
interventions.
OUR PLANS AND GOALS SHOULD BE SMART

Specific, Measurable, Attainable, Realistic, and Time bound.
TYPES OF PLANNING
• INITIAL PLANNING: The nurse who performs the admission assessment usually develops the initial
comprehensive plan of care.
• ONGOING PLANNING: Ongoing planning is done by all nurses who work with the client. As nurses obtain
new information and evaluate the client’s responses to care, they can individualize the initial care plan further.
•DISCHARGE PLANNING: The process of anticipating and planning for needs after discharge.
IMPLEMENTING
Implementing is the action phase in which the nurse performs the nursing interventions.
Classification of Nursing Interventions

There are three types of nursing interventions: independent, dependent, and collaborative.
• Independent nursing interventions are activities that nurses are licensed to initiate based on their sound
judgement and skills. Includes: ongoing assessment, emotional support, providing comfort, teaching, physical
care, and making referrals to other health care professionals.
• Dependent nursing interventions are activities carried out under the physician’s orders or supervision.
Includes orders to direct the nurse to provide medications, intravenous therapy, diagnostic tests, treatments,

diet, and activity or rest. Assessment and providing explanation while administering medical orders are also
part of the dependent nursing interventions.
• Collaborative interventions are actions that the nurse carries out in collaboration with other health team
members, such as physicians, social workers, dietitians, and therapists. These actions are developed in
consultation with other health care professionals to gain their professional viewpoint.
EVALUATING
Evaluating is a planned, ongoing, purposeful activity in which clients and health care professionals determine
(a) the client’s progress toward achievement of goals/ outcomes and (b) the effectiveness of the nursing care
plan.
PURPOSE
To determine whether to continue, modify, or terminate the plan of care
HEALTH CARE DELIVERY SYSTEMS
I. Case Method
Definition
The case method, or total patient care method, of nursing care delivery is the oldest method of providing care
to a patient and an intensive form of care delivery, which is sometimes described as case nursing. Additionally,
the case method evolved into what we now call private duty nursing.
During an 8-12 hour shift the patient receives consistent care from one nurse. The nurse, patient and family
share mutual trust and work together toward specific goals.
Usually the care is patient-centered, comprehensive, holistic and continuous and it provides the nurses to
have high autonomy and responsibility.
Total patient care can only be applied in certain types of situations, including critical care and home health
care.

In this method, nurses assume total responsibility for meeting all the needs of assigned patient during their
time on shift.
During the time of Florence Nightingale nurses were 'hired' and they lived with the family of the patient
provided 24 hours care to the patient and even family.
In the total patient care, the attending nurse typically provides care for the patient from the beginning to the
end of his medical care episode. For example, a nurse might provide a few weeks of around-the-clock, in-home
care for an elderly patient who has broken a hip. The patient might deal with more than one nurse due to work
schedules, but he does not receive care from multiple nurses during a work shift. Total patient care requires
nurses to assume all care for their patients. They must closely monitor the patient’s condition and
communicate closely with the patient’s physicians.
Typically, patients respond favorably to total patient care, because their nurses attend quickly to their needs.
In many cases, the patient and nurse develop a friendship, which makes the experience less stressful and more
meaningful for the patient.
Case Method of patient care for an 8-hour shift
Advantages of Case Method as a Modality of Nursing Care:

1) Nurse can attend to the total needs of the patient.
2) Continuity of care can be facilitated.
3) Patient may feel more secure.
4) Patient receives holistic and un-fragmented care during the nurse's time on duty.
5) Nursing care plans can be carried out consistently.
6) Good trusting relationship between the nurse, patient and the patient's family will develop.
7) Exclusive and direct quality care will be given to the patient.
8) Less/ No hospital exposure for the patient. (Only for home care setting)
Disadvantages of Case Method as a Modality of Nursing Care:

1) In home health care settings, a patient might face a disadvantage if he needs medical care the nurse cannot
readily provide. For example, if an in-home patient suddenly develops a breathing problem, the nurse cannot
quickly summon a respiratory therapist.
2) Many nurses enjoy the autonomy that total patient care offers them. However, focusing effort on one patient
at a time can lead to burnout.
3) Quite expensive
4) Great disadvantage when the nurse is inadequately trained.

II. Primary Care Nursing
The primary nursing model assigns patients to a primary RN, who takes responsibility for their care throughout
the hospital stay. By following a patient’s progress, the RN can provide a more holistic level of care, while offering
the patient the comfort of having a primary caregiver among the nursing staff. It is suitable for patients with
more complex needs, for example, those who suffer from an underlying illness that poses a risk of subsequent
complications. This is a more comprehensive model, which can improve continuity of care and foster stronger
relationships between patients and the care team.
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
Disadvantages:
• 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
• Needed a Flexible work schedules
III. Modular/Team Nursing

Team nursing is a model that uses a team approach consisting of a group of healthcare professionals, including
nurses, who care for a group of patients in the acute care or inpatient setting. In the 1950s and 1960s, this model
developed in response to a growing shortage of nurses as a result of World War II and nurses abandoning
hospitals. (Team Nursing Model: Definition, Pros, Cons & Examples, 2017).
Modular Nursing
Modular nursing is a modification of team nursing wherein most of the team nursing was never practiced
genuinely but was instead of the combination of functional and team nurses.
Modular nursing utilizes a small team, including two or three members with at least one member being an RN,
with members of the modular nursing team sometimes being called care pairs (Marquis & Houston, 2017).
Advantages:
• The strengths of all healthcare professionals are utilized to provide the best care possible.
• Each patient receives individualized care, which has been shown to improve patient outcomes and
patient satisfaction.
• Each team member can perform the skills at which they excel, which helps with job satisfaction and
patient safety. This also provides the nurse with time to document care in the health record.
• The patients are given the most comprehensive care and every member of the team can contribute to
decision making.
Disadvantages:
• Disadvantages of team nursing is establishing a team concept takes time, effort and constancy of
personnel. Unstable staffing pattern make team nursing difficult. This can lead to blurred lines of
responsibility, errors, fragmented and depersonalized patient care.
• When a patient transfers from one bed or room to another, he or she may be assigned to a new patient
group and must become accustomed with a new set of nurses.
• It may make staff assignments more difficult. Putting together a team with all of the skills needed to
care for patients on their module can be difficult, especially on units with a high level of acuity.

• Continuity suffers if daily team assignments vary

• Team leader must have good leadership skills
• Insufficient time for planning and communication (communication is complex).
• Patients often receive fragmented, depersonalized care
• Shared responsibility and accountability can cause confusion and lack of accountability.
IV. Functional Nursing

Functional nursing is a supervisory model that delegates tasks to nursing and auxiliary personnel. The head
nurse assigns functions to other nurses who perform the nursing tasks to all the patients in a unit. The
functional nursing model is hierarchical as the registered nurses take care of complex jobs while the junior staff
and orderlies oversee the basic tasks. For example, one nurse may only administer medications while another
nurse admits and discharges patients.
Advantages:
Functional nursing has many advantages that ensure hospitals around the world use it. Here are four benefits
of this model:
• Nurses complete work within the shortest time possible
• Functional nursing uses a division of labor where a team leader assigns each nurse a task. This reduces
redundancy and also enhances teamwork.
• Nurses gain career skills faster
• As individual nurses perform their assigned tasks repetitively, they can do the tasks instinctively. The
brain imprints tasks that a person does repeatedly, enabling nurses to complete tasks efficiently and is
especially useful in learning new skills.
• Efficiency in providing nursing care. Functional nursing can be economical because hospitals use
personnel with other skills, also called orderlies, to perform the essential functions. Using these
orderlies often comes at a decreased cost to the hospital.
• Promotes teamwork. Delegating individual tasks to specific workers promotes a healthy team ethic.
Working together builds confidence and trust in the abilities of colleagues, promoting teamwork and a
fulfilling workspace.
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

V. Innovative Contemporary Nursing

Innovative means featuring new methods; advanced and original while contemporary states belonging to
or occurring in the present, marked by characteristics of the present period. According to a report by ICN
(2009), innovation in nursing applications is extremely important for improving health, preventing
diseases, describing, and avoiding risk factors, developing healthy life standard attitudes and qualifying the
care and treat methods. The world has changed beyond recognition, and models of patient health care
delivery that worked seamlessly within the 1950s, 60s, and 70s now face challenges.
Advantages:
• With this type of modality, patients can enjoy peace of mind that help is at hand if they need it, and
they can get more involved in the treatment process.
• Especially this time that people spend more time online, it’s good to utilize and consider of
interactive care and benefits of providing advice and health care support on the go. Nurses and
advanced healthcare providers can provide health information and care to patients in rural settings
from a distance.
• Healthcare professionals can tailor advice, update, and review previous notes, and assign
personalized instructions, providing a contemporary model that responds to new patient care
trends.
• During or after treatment, patients can download the app and then access bespoke advice to take
home with them.
Disadvantages:
• In our situation right now, health care professionals, organizations, and budget are not sufficiently
prepared to provide this care.
• An important disadvantage of Innovative method in modalities of care is that some patients may not
be savvy with technology. Some patients may not have mobile phones or Internet access, making
applications and video visits useless for them.
• Some disadvantages include malfunctioning equipment, power outages, lack of attention to detail
and security breaches on privacy.
• People can come to rely on it a little too much. This means that because their tech is supposed to the
fastest, smartest, and most accurate there is, they are less likely to question it or think for themselves
when something seems off or is inaccurate. While innovation in handling care in nursing should lead
to fewer medical errors, there is no guarantee that it will eradicate ALL errors.
VI. Total Patient Care
Total patient care is a nursing model where one nurse provides total care to a single patient or a group of
patients during his/her shift. During that shift, all the patient needs are addressed by the nurse, and in some
cases, the nurse issues care until the end of the patient’s medical needs. The nurse will have all the patient
data on hand.
Since they are dealing with a single or a handful of patients at a time, they can respond promptly as needed.
Patients also tend to respond more favorably to this type of care, mostly due to the level of trust developed
throughout their interactions.
Types of Care
Different situations require various types of care to support physical needs like ambulation, or patient-
specific conditions, such as those suffering from mental health decline. Total care is a high-touch level of care,
sometimes providing 24-hour monitoring. As with most care models, the necessity of total care depends on
the patient’s health.

In general, the greatest benefit of total patient care is the one-on-one attention and monitoring a skilled
nursing professional provides. The drawback to total patient care is the price. A dedicated nurse
providing medical assistance is more expensive than a professional caregiver who is hired for
companionship services.
Advantages:
• RN to RN report creates good communication and continuity/collaboration about patient
condition and plan of care
• Nurse maintains a high degree of practice autonomy
• Lines of responsibility and accountability are clear
• Reduces the need for supervision
• 1 on 1 care, un-fragmented care
• 1 RN per shift for this patient
• Less caregiver involved
• Established rapport with patient with high level of advocacy
Disadvantages:
• Number of RN required to provide TPC may not be available
• Future nursing shortage
• Financial constraint + larger
• Patient loads per RN = Burnout
• Performs many tast that could be performed by a caregiver with less training at a lower cost
• Often RN has a team to back them up or they too have large pt loads
V. REFERENCES:
Diane K. Whitehead, "Essential of Leadership and Management," Fifth Edition
VI. ASSESSMENT TASK:

Answer the following scenario based on you own understanding of the topic that you’ve read. DO NOT COPY PASTE,
paraphrase the answers of your classmates or other works. It can be detected EASILY. Please answer based on your honest
understanding of the topic.
Scenario. As the Chief nurse and member of the top management of the hospital, one of your major tasks is to review
the different policies and procedures based on your hospital and patient needs. Given the following scenarios, what will
be your action.
1. The intensive care unit (ICU) of the hospital currently has 3 patients. One with traumatic brain injury damage, with
GCS at 5 and non-responsive to treatment modalities. The other one with sustained spinal cord injury secondary
to vehicular injury. Patient is conscious and coherent but has been dependent to the care and assistance of the
HCP. The last one is a patient who is diagnosed with Chronic SLE and with exacerbations of the disease and with
kidney damage. There are currently 3 staff nurses assigned for the duty with 1 nursing assistant for the shift. Based
on your own judgement, what will be your health care delivery system to advise for the unit? Explain your answer.
2. The medical ward of the hospital has been very busy for the past week due to the surge of different cases more
specifically dengue fever, leptospirosis, and acute viral infections due to the current weather season. The cases
exceeded the bed capacity threshold of the ward area which is 15. The staff nurses present on the shift is only 3
(1 senior and 2 junior staff) with 2 nursing assistants. Obviously, there is an issue of understaffing. Based on your
own judgement, what will be your advised healthcare delivery system to be utilized for the shift for the medical
ward area. Justify your answer.



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Pamantasan ng Cabuyao

Banay banay, Cabuyao City, Laguna 4025, Philippines

COURSE CODE: NCM 119- Nursing Leadership and Management

I. TITLE: NURSING PROCESS AND PATIENT CARE DELIVERY SYSTEMS

II. OBJECTIVES: After this lesson, the student is expected to:

1. Familiarize on the different concepts of patient care delivery system,

LECTURE NOTES COMPILATION Page 1 of 12

THE NURSING PROCESS AND PATIENT CARE

LECTURE NOTES COMPILATION Page 2 of 12

TYPES OF DATA & DATA COLLECTION METHOD

DATA COLLECTION METHOD

LECTURE NOTES COMPILATION Page 3 of 12

Diagnosing is the second phase of the nursing process.

TYPES OF NURSING DIAGNOSES

LECTURE NOTES COMPILATION Page 4 of 12

OUR PLANS AND GOALS SHOULD BE SMART

Classification of Nursing Interventions

LECTURE NOTES COMPILATION Page 5 of 12

HEALTH CARE DELIVERY SYSTEMS

LECTURE NOTES COMPILATION Page 6 of 12

Case Method of patient care for an 8-hour shift

Advantages of Case Method as a Modality of Nursing Care:

Disadvantages of Case Method as a Modality of Nursing Care:

LECTURE NOTES COMPILATION Page 7 of 12

II. Primary Care Nursing

III. Modular/Team Nursing

LECTURE NOTES COMPILATION Page 8 of 12

• Continuity suffers if daily team assignments vary

IV. Functional Nursing

LECTURE NOTES COMPILATION Page 9 of 12

V. Innovative Contemporary Nursing

VI. Total Patient Care

LECTURE NOTES COMPILATION Page 10 of 12

VI. ASSESSMENT TASK:

LECTURE NOTES COMPILATION Page 11 of 12

LECTURE NOTES COMPILATION Page 12 of 12

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