PATIENT

CARE
DELIVERY
SYSTEM
“PATIENTS NOW MORE
THAN EVER NEED REASSURANCE
THAT THEY ARE INDEED THE FOCUS
OF THE HEALTH CARE TEAM.”
—
JOAN SHINKUS CLARK
 Describe how the delivery
system structures nursing care.

Learning Describe what types of nursing

Objectives care delivery systems exist.

Describe evolving types of

delivery systems that have
emerged.
Nursing Care Delivery Models

ARE METHODS USED TO EACH MODEL HAS IT IS A METHOD TO

PROVIDE CARE TO ADVANTAGES AND EVALUATE PATIENT CARE
PATIENTS. DISADVANTAGES. AND IS COST-EFFECTIVE.
 Organizational goals
Managers
must Budget
examine the
following Staff availability
when
selecting Unit objectives
model:
Patient population
 Assessing care
needs

NURSING Evaluating the

patient’s responses
Identify the care

PROCESS
needed
to interventions.

in
DELIVERY
of Implementing the
plan
Formulating a plan
of care
CARE
 MODELS OF CARE DELIVERY

TRADITIONAL MODELS of INTEGRATED MODELS OF

CARE DELIVERY CARE
• Total Patient Care (Case Method) • Case Management
• Functional Nursing • Practice Partnership
• Team Nursing • Differentiated Practice
• Primary Nursing • Patient Centered Care
TRADITIONAL MODELS OF CARE
TOTAL PATIENT CARE
• Oldest mode of organizing
patient care.
• Nurses assume total
responsibility for meeting the
needs of all assigned patients
during their time on duty.
• To have one nurse give all care to
the same patient(s) for the entire
shift.
TRADITIONAL MODELS OF CARE
TOTAL PATIENT CARE

Advantage?

• Continuous, holistic, expert

nursing care

Disadvantage?

• RNs spend some time doing tasks

that could be done more cost-
effectively by less skilled persons.
 • Evolved because of WW II.
• Uses relatively unskilled
FUNCTIONAL workers who have been trained
NURSING to complete certain tasks.
• Care is assigned by task rather
than by patient.
FUNCTIONAL NURSING

• Advantage?
• efficient and tasks are
completed quickly
• Disadvantage?
• fragmented care and
may overlook patient
priority needs
 TEAM NURSING
• Ancillary personnel
collaborate in providing care
to a group of patients under
the direction of a professional
nurse.
• Requires extensive team
communication and regular
team planning conferences.
 TEAM NURSING
• Advantage?
• holistic care and increase
client and employee
satisfaction
• Disadvantage?
• time-consuming and
expensive delivery system
 PRIMARY NURSING

• As originally designed, it requires an

all-RN nursing staff.
• RN primary nurse assumes 24-hour
responsibility for planning the care
of one or more patients from the start
of treatment to discharge.
• During work hours, the primary nurse
provides direct care for those
patients.
PRIMARY NURSING
• Advantage?
• improved continuity and
coordination of care

• Disadvantage?
• Although the concept of
24-hour accountability is
worthwhile, it is a fallacy.
INTEGRATED
MODELS
OF
CARE
INTEGRATED MODELS OF CARE
PRACTICE PARTNERHSIP
• An RN and an assistant—UAP, LPN, or less
experienced RN—agree to be practice partners.
• The relationship between the senior and junior
partner is designed to create synergistic energy
as the two work in concert with patients.
• Advantage?
• offer more continuity of care and
accountability for patient care
• less expensive and more satisfying for the
partners
• Disadvantage?
• potential for the junior member of the team
to assume more responsibility than
appropriate
 CASE MANAGEMENT
• Coordinates care throughout an episode
of illness.
• 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.
• Focus is on individual clients, not
populations of clients.
 Recognizes that education,
clinical expertise, experience,
and willingness to assume a
more advanced role are what
set registered nurses apart.
DIFFERENTIATED
PRACTICE
Focuses on the division of labor
needed to meet client needs
and to provide distinct levels of
practice.
Provision of Care…
Associate Degree Bachelor Degree Masteral Degree

• Monitor and • Monitor, evaluate, • Analyze delivery

evaluate and trend patient systems and
immediate responses to client care using
patient response nursing and theoretical
to nursing and medical frameworks to
medical treatments over promote the
treatments. hospital stay. delivery of holistic
care.
PATIENT CENTERED CARE

The focus of patient-

The role of the nurse is
centered care is
broadened to coordinate a
decentralization, the
team of multifunctional
promotion of efficiency and
unit-based caregivers.
quality, and cost control.
“Patients now more than ever
need reassurance that they
are indeed the focus of the
health care team.”

—Joan Shinkus Clark

• A 30-year-old male client is admitted to a
hospital that employs the functional model of
patient care delivery.
• He had undergone a BKA procedure, and his
son asked the nursing assistant for pain
medication, the NA said, “I’ll tell the medication
nurse.” The medication nurse comes to the
room and says that the client’s medication is to
be administered intravenously and the IV nurse
will need to administer it.
• The IV nurse is busy starting an IV on another
patient and cannot give the client the
medication for at least 10 minutes. This whole
communication process has taken 40 minutes,
and the client is still in pain.
• What is your perception of the
effectiveness of a functional method
of patient care in this situation?
• As the charge nurse, what would you
do?
 Group Discussion • You are the head nurse of an oncology unit. At present, the patient
care delivery method on the unit is total patient care. You have a
staff composed of 60% RNs, 35% practical nurses (licensed
professional nurses [LPNs]/licensed vocational nurses [LVNs]), and
5% clerical staff. Your bed capacity is 28, but your average daily
Design a new nursing care delivery census is 24. An example of day-shift staffing follows:
Describe the patient care delivery
system. Select the system or • One charge nurse who notes orders, talks with physicians,
system(s) utilized from the
combination of systems you would organizes care, makes assignments, and acts as a resource
scenario. How well does it work?
use. Explain your rationale. person and problem solver
• Three RNs who provide total patient care, including
administering all treatments and medications to their
assigned patients, giving IV medications to the LVN/LPNs’
Why have different systems been assigned patients, and acting as a clinical resource person for
used in earlier times? Would any of the LVN/LPNs
them be useful today? Explain • Two LVN/LPNs assigned to provide total patient care except
As a manager, which system would
what characteristics of the health for administering IV medications
you prefer? Why?
care system today would make
them appropriate or inappropriate • Your supervisor has just told all head nurses that because the
to use. hospital is experiencing financial difficulties, it has decided to
increase the number of nursing assistants in the staffing mix. The
nurses on your unit will have to assume more supervisory
responsibilities and focus less on direct care. Your supervisor has
asked you to reorganize the patient care management on your unit
If you were a patient, which system to best use the following day-shift staffing: three RNs, which will
do you think would provide you include the present charge nurse position; two LVN/LPNs and two
with the best care? nursing assistants.
Self and Peer Assessment
THANK
YOU!
ANY
QUESTIONS???