kuliah 3Nursing Care Delivery Systems

Nursing Care Delivery
Systems/ model

Pn.Siti Fatimah Binti Md.Shariff

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INTRODUCTION

 Basically nurses need to understand the
positive and negative consequences of each
model in order to plan and propose to
decision-makers the most efficient and
effective way to deliver care.

 models of care are essentially consider
about staffing issues: types of staff, the
numbers of staff, when they are needed, for
what hours, etc.

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? nursing care delivery system

 defines on how work is organized, how nursing staff are
deployed, and who does what in providing nursing care.

 Delivery systems identify who has the accountability for
nursing care and clinical outcomes.

 Delivery systems provide the organization, rules and
structure that define responsibility and accountability (who
does what).

 the external environment has significantly influenced health
care and more specifically, nursing practice.

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TYPE OF NURSING CARE
DELIVERING SYSTEM

Total Patient
Care.

Patient TYPE OF NURSING Team/
focus care CARE DELIVERING Functional
nursing.
SYSTEM

Primary Case
nursing. managemnet

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Total Patient Care.

 The oldest system for organizing patient care.
Commonly used in intensive care unit (ICU) and
post anesthetic care unit (PACU).

 an RN is responsible for planning, organizing, and
performing all aspects of nursing care. TPC
provides a high degree of autonomy, clear lines of
responsibility and accountability, holistic patient
care, unfragmented care.

 TPC is not cost effective. It requires abundant
availability of nurses.

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Total Patient Care.

• the RN is responsible for all of the care provided to
a patient for a shift.

• This is the way most nursing students were taught
– take one patient and care for all of their needs.

• The consequences of teaching nursing this way
was that reality shock hit upon graduation when
the new graduate hit the floors and had to care for
more than one patient. Even in the case of the
student nurse, the students frequently do not
provide all of the care as they may not be qualified
to do the work.

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Total Patient Care.

Advantages: Disadvantages:
 Cost are expensive
 RNs were self-employed
Patient needs were quickly
met
Close relationship between
the RN and the patient

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Primary nursing.

 A primary nurse, usually an RN, is
responsible for the same patient’s care
throughout the patient’s stay.

 Primary nursing focuses on continuity of
care, beginning with the admission and
ending with the discharge

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Primary nursing.

 Primary nursing is a method of nursing practice
which emphasizes continuity of care by having one
nurse provide complete care for a small group of
inpatients within a nursing unit of a hospital.

 comprise the majority of the care delivery staff, are
required to perform both direct care activities and
indirect care activities.

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Primary nursing.

 All nurses are RNs. They do personal care as
well as care planning, documentation, etc.

 CNAs assist the nurses, but do not have
autonomous roles in patient care. This
approach can provide better continuity and
more expertise than the Team Nursing
model.

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Primary nursing.

 a Primary Nurse (PN) cares for her primary
patients every time she works and for as
long as the patient remains on her unit.

 An Associate Nurse cares for the patient in
the PN’s absence and follows the PN’s
individualized plan of care.

 Associate nurses may be responsible for
care when the primary nurse is absent

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Primary nursing.

 late 1980s found that patients cared for by primary
nurses received a higher quality of care than
patients in team nursing units.

 Primary nursing was related to higher levels of job
satisfaction, significantly higher retention rates,
and lower costs per patient day

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Primary nursing.

 Study by Horvath found that patients on primary
nursing units had significantly lower stress scores
than patients on team nursing units.

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Primary nursing.

Advantages: Disadvantages:

• Increased satisfaction for  Intimidating for new
patients and nurses graduates who are less
More professional system: skilled and knowledgeable
RN plans and communicates Where do we get all these
with all disciplines. RNs are RNS during times of
seen as more knowledgeable shortage?
and responsible.
RNs more satisfied because
they continue to learn as a
function of the in-depth care
they are required to deliver.

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Team/Functional Nursing

• commonly used model
• the goal of the Team method is for a team to work

democratically.
• Each ward has a supervisor, which is responsible for

the whole ward. Nurses like working in teams.
• Care is given by a TEAM comprised of several health

care staff of registered nurses (RNs), nursing
assistant (NAs) ,MW
• In the ideal team, an RN is assigned as a Team
Leader for a group of patients-staff reporting to her
and together they work to disseminate the care
activities.

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Team/Functional Nursing

 unlicensed staff (UAPs), working within
separate, but complementary roles to
perform patient care tasks.

 Nursing tasks are allocated among team
members according to skill level needed and
qualifications of the person providing care.

 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.

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Team/Functional Nursing

• Team conferences occur in which the
expertise of every staff member is used to
plan the care; a hallmark is that each
member’s input (RN, stdn nurse, NA, etc) is
considered essential for the process to work.

• As is obvious, the Team Leader must be both
a skilled clinician and an effective group
leader is who is responsible for the
performance of the team.

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Team/Functional Nursing

 When a ward is organized according to the
team nursing system, the nurses are divided
in a number of teams. Each team has to
provide care for a fixed group of patients.

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 For example, the RN functions as the team
leader and the AN and HA perform such
activities as bathing, feeding, and other
duties common to nurse aides and orderlies.

 Each team assumes the responsibility of
nursing a group of patients for a given shift.

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 The team leader coordinates the activities
of the team staff, delegating the major
aspects of work-flow, making assignments,
and rounding with MDs

 By doing so nurses have a close relation with
the patients they have to take care for.

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 This model has been criticized as being too
task-oriented, increasing fragmentation of
care, and reducing the amount of direct
nursing care provided by the RN.

 However, team nursing may conserve costs
and human resources when the ratio of care
givers to patients is low.

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 Specific tasks are assigned to nurses. The nurse
assigned to a specific task has to carry it out at
all patients. Registered nurses (RNs) carry out
complex nursing tasks.

 The idea behind functional nursing is that there
is a specialist for each task.

 The head of the ward assigns the different tasks
to specific nurses based on the nursing care
plans for the different patients.

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Team/Functional Nursing

Advantages: Disadvantages:

 A very efficient way to  Care of persons became
delivery care. Could fragmented
accomplish a lot of tasks in Patients did not have one
a small amount of time identifiable nurse and the
Staff did what only they nurse had no
were capable to do: no accountability.
extraneous work was Very narrow scope of
added that could be done practice for RNs
by assistive personnel. Lead to patient and nurse
dissatisfaction

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Team/Functional Nursing

Advantages: Disadvantages:

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

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Patient-focused Care

 is a model popularized during the hospital
reengineering era of the 1990s.

 This model involves the use of multi-skilled workers
and a team approach to nursing.

 aims of PFC as “appropriately grouping patients,
structuring services for improved responsiveness,
decentralizing services, empowering employees,
and providing continuity of care in order to achieve
predetermined outcomes

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4 main principles

 simplifying processes,
 grouping similar patient
populations together,
 bringing services closer to patients,
 broadening staff skills by cross-training care

providers,
 are designed to improve the quality of care, create a

working environment that will attract and retain
staff, enhance physician efficiency, and decrease
costs.

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support systems

 important in delivering efficient quality nursing
care. Adequate support systems including

 distribution of medication from pharmacy to
patients,

 linen from laundry to patient rooms,
 supplies from central supply to patients and staff

on the units
 transportation of patients,are critical in allowing

nurses time to care for patients

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Patient-focused Care

 Inadequate support systems necessitates
utilizing nursing resources to perform these

support (i.e., non-nursing) functions.
 RNs as care managers and in expanded

roles such as drawing blood, performing
EKGs, and performing certain assessment
activities

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Nursing Case Management

 NCM refers to a diverse group of programs,
linked by a common set of identified
problems and proposed strategies.

 improving quality through interdisciplinary
 collaboration, nursing case management

focuses on specific patient populations,
following the patient through an entire
episode of care.

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Nursing Case Management

 The goals of nursing case management
 include: decreasing fragmented care;

improving patient self-care and quality of
life; optimizing efficient use of resources,
and decreasing costs

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Conclussion

 The research to date does not support the
assumption that more RN staffing is always better.

 Patient care is most effectively delivered by a team
whose composition varies according to patient
need,case and staff mix.

 there is ample evidence that
 an adequately staffed unit and a richer staff mix

have a positive effect on patient outcomes and
nurse and patient satisfaction.

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