PATTERNS OF NURSING CARE DELIVERY

SYSTEM IN INDIA

PRINCY FRANCIS M
I yr MSc (N)
JMCON
 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”.
 Clinical decision making
Work allocation
ELEMENTS Communication
Management
Coordination
 PRINCIPLES OF NURSING CARE
DELIVERY
 Holistic approach is used to identify nursing care needs.
 Nursing care is based on a helping relationship.
 Itis 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.
 Factors influencing nursing care delivery system

 Availability of adequate staff in words or units.

 Patient census.
 Extend of staff deficiency.
 Organizational policies regarding its practice.
 Patient preference for care.
 Availability of skilled staff.
 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.
 methods
1. Traditional methods 2. Advanced methods
# Case method # Case Management
# Functional method # Critical pathway
# Team method
# Modular nursing
# Primary nursing method
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
Case method - principles

 Accountability of care planning

 Continuity
 Co-ordination
 Documentation
 Nursing process
 Cost effectiveness
Case method - pattern
 Case method - Merits
 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.
 Case method - demerits
 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.
 Thismethod has to be modified is nonprofessional health
workers are to be used.
 Itis difficult for nurses to use this method to become
involved in long term planning and evaluation of care
 Functional nursing
 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.
Task method
Good for long term care setting with improved coordination,
care planning and communication.
Functional Nursing
 Functional Nursing - MERITS

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
 Functional Nursing - DEMERITS

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
 TEAM NURSING
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.
 TEAM NURSING

The spectrum of nursing functions includes

 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.
 CHARACTERISTICS
 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.
ADVANTAGES

High-quality, comprehensive care with a high

proportion of ancillary staff.
Team members participate in decision making
and contribute their own expertise.
 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
 MODULAR NURSING
• THE NURSING STAFF INCLUDES TECHNICAL AND
NURSE AIDES, AS WELL AS 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.
 MODULAR NURSING - ADVANTAGES
• CONTINUITY OF CARE IS IMPROVED
• RN MORE INVOLVED IN PLANNING AND
COORDINATING CARE
• GEOGRAPHIC CLOSENESS AND EFFICIENT
COMMUNICATION
 MODULAR NURSING - DISADVANTAGES

• INCREASED COSTS TO STOCK EACH

MODULE
• LONG CORRIDORS NOT CONDUCIVE TO
MODULAR NURSING.
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
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.
PROCESS

 The head nurse

 The professional Staff nurse
 Primary nurse
 Associate nurse
 Technical nurse
 Nursing aide
 Ward clerk.
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
 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.
• 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.
Case Management method
Collaborates with
Patient and family

NURSE CASE
Onset of Assess, plans, implement, monitors and Resolution
Illness evaluates patient care options and services of illness
to meet health

Collaborates with Nursing, Coordinates Services:

Physicians, Physical/Speech/ Home care, Hospice,
occupational Therapists, Dietary Extended/ Long-term care,
and Ancillary services. Ambulatory care services
 advantages
a) 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
b) 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.
 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.
Progressive patient care
• Medical /surgical care is delivered in various areas or units
according to the health status of the patient.
• Principal Elements
• Intensive / critical care
• Intermediate care
• Convalescent and self care
• Long term care
• Home care
• Ambulatory care
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.
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
 Patient Care provider
Advocate
Educator

Entrepreneur
Counsellor

Change
Agent
Manager

Collaborator Researcher
 JOURNAL ABSTRACT
• The Effects of the Primary Nursing Care Model: A
Systematic Review
Since the 1980s, the primary nursing model has gained
increasing prominence. The study aims to describe the effects
of the primary nursing model for patients, their family
members, nursing staff and the care organization. Based on
the findings of this review, it seems that the primary nursing
model may have beneficial effects for patients in the contexts
of care , it seems to add to patient satisfaction with care and
reduce health problems.
JOURNAL ABSTRACT CONT….
It is also possible that the model contributes to nurses’
increased sense of job control and autonomy. There is also
preliminary evidence that the costs of the primary nursing
model are lower than those of the team nursing model. In the
future, family members will be increasingly involved in patient
care, and therefore it is important to understand how nursing
under the primary nursing model supports the coping of the
patient’s family members during periods of hospitalization.
 JOURNAL ABSTRACT CONT….
• Team Nursing : A collaborative approach improves patient care
This article describes an evidence based project to improve the
delivery of care and patient and staff satisfaction with team nursing.
The primary benefit of this approach is that pairing nurses provides a
resource and supplement to patient care. The results of a baseline
survey to evaluate staff satisfaction and morale indicated staff
members were dissatisfied because of a lack of team work and
support from peers in patient care. Believing that poor nurse
satisfaction is related to undesirable patient outcomes and decreased
quality of care, the authors of article , who were the stakeholders,
decided that a team nursing model of care would be implemented
Assignment

Write an assignment on “Patterns of Nursing

care delivery system in ICU’s”.
 Bibliography
• Basheer PS, Khan YS. A concise textbook of advanced nursing
practice. Bangalore: EMMESS medical Publishers; 2012.
• Soni S .Ttextbook of advanced nursing practice. India: Jaypee
Publication; 2013.
• Basvanthappa BT. Nursing Administration. Second edition. India:
Jaypee Publication; 2009.
• Dickerson J, Latina A. Team Nursing: a collaborative approach
improves patient care. Nursing 2017. Volume 47 (issue 10); 16-17.