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INTRODUCTION:As nursing has evolved over a period, nursing is still focused on caring. Rapid
technologic advances , knowledge explosion, emphasis on quality cost effectivenessaccessibility of health care and increased demand by the patients for advanced alternative health
care modalities present many challenges for nursing profession.
How are nurses responding to these challenges? .So how can we best utilize professional
nurses across various practice settings? The answer for this question is that it is possible by
reshaping organizational (administrative) policies and developing such system of nursing care
delivery as best suited to client needs.
MEANING OF NURSING CARE DELIVERY SYSTEM:A system may be defined as a whole made up of integrated or joined and interrelated
parts. Although each component of the system has its specific function, yet all of them work
harmoniously for common out come.
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.
There are various types of nursing care delivery system include case method, functional
method, team nursing, primary nursing, modular nursing, nursing care management, patient
focused care.
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I ) CASE METHOD
The case method or total patient care method of nursing care delivery is the oldest
method of providing care to a patient. The premise of the case method is that one
nurse provides total care to one patient during her entire work period of one shift.This
method was used in the era of Florence nightingale when patient received total care
in the home. That time nurses were hired and they lived with in the family of the
patient provided 24 hrs care to patient and even family including cooking and
cleaning. But the case method developed over the years to the specialty of private
duty nursing especially in critical care nursing where one nurse cared one or two
clients.
.
Model analysis:During an 8-12 hour shift the patient receives consistent care from one nurse. The
nurse , patient , family share mutual trust and work together toward specific goals.
Usually the care is patient centered, comprehensive, holistic and continuous
Areas where this method can be used:Community health agencies often use this method to assign cases to individual nurses
, intensive care agencies and also nurse educators often select this method of care
when students are assigned for caring patients
Organization of the case method-model(Leadership-A.Bernhard page-43)
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NURSE
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Important points:
Merits:-
In 1930s when few registered nurses and only some practical nurses
available , much patient care was given by nursing aids.
RNs were keep busy with managerial and non-nursing duties and nurses aids
eliver the majority of patient care
The functional method of delivering nursing care evolved as a result of world
war II as the lack of graduate , registered nurses became critical
Auxiliary personnel were used to assist in patient care
Unskilled workers were trained and assigning persons to complete certain
tasks ,Eg; checking BP, changes linen, patients etc
As a whole the nurses were assigned for certain tasks, not to patients
Demerits:-
CHARGE NURSE RN
TEAM
LEADER RN
RN
LVN
GROUP OF
PATIENTS
TEAM
(RN)LEAD
ER
N
A
RN
LVN
RN
GROUP OF
PATIENTS
Important points
After the 2nd world war RN were still scarce , although the number of
auxiliary personal had increased.
It was introduced during the 1950s
To improve nursing service by giving the knowledge and skill of
professional nurses , and supervise the work of auxiliary nurses . the result
was an improvement in patient and self satisfaction.
Auxiliary personal collaborate in providing care to a group of patients
under the direction of a professional nurse.
Based on the philosophy that supports the achievement of goals through
group actions
Team is lead by a professional or technical nurse who plans , interprets,
co-ordinates , supervise and evaluates the nursing care
Responsibilities of team leader: Team leader assign team members to patients by matching patients needs
and staff knowledge and skill.
Advantages:-
Disadvantages:
MODULAR NURSING
It is a modification of team nursing In modular nursing , staff are
geographically assigned to patients for whom they co-ordinate and provide comprehensive care.
It focuses on geographic location of patient rooms and assignment of staff members.
It was developed by Magargal in 1987
Delivery model:The total unit is divided in to modules or districts and the same team of staff is assigned
consistently to the module. Modular nursing is enhanced when nursing units are physically
designed and built with this nursing delivery system in mind but it can also be used in nursing
units that are not so designed. Each module has a modular, or team leader RN, who assigns the
patient to module staff
Each module ideally consists of at least one RN, one LPN/LVN and one nursing assistant.
A charge nurse will co-ordinate the work of all the modules in a unit. She expects the module
leaders to be accountable for patient care but assist in problem solving when necessary. Staff
nurses work independently or together, depending on the size of a modular districts . Modules
may have same or different number of patients
Head
nurse
District
leader
(RN)with
patients
RN,LPN/LVN,
patients
District leader
(RN)with
RN,LPN/LVN,AN
If patient changes room , he will also changes nurses , so patient satisfaction may be less
Its a costly method as it should have a redesign of the work environment to allow
medication cart , supplies and charts to be located in each module.
Primary nursing
Primary nursing developed by Manthey at al in 1970 as a method for
organizing patient care delivery in which one RN functions autonomously as the
patients primary nurse through out the hospital stay . This method is based on the
concept of my patient-my nurse In this nursing care delivery system, each
registered nurse is assigned to the care of group of patientfor which she plans
complete 24 hrs care and writes the nursing careplan.
The primary nurse cares for her patients every time she works for as long as
the patient stay on her unit.(ideally from admission to discharge) .When she is not
there , an associate nurse who will follow the primary nurses careplan is assigned
to the care of primary nurses patient . The primary nurse is intensively involved
with the patients. Licensed practical nurses function as associate nursesand are
supervised by the head nurse. When nursing assistants are used in primary nursing
system , they are generally assigned to assist primary and associate nursesby
doing specific tasks for each nurse they assist.
Communicat
e Associate(days)
with
when
primary nurse
supervisers
is not available
Total patient
care
24hr/day
Associate
Primary nurse
(evenings)
when
primary nurse is
Associate
Consults
(nights)when
withphysicians
primary
nurse is
or other
health
CASE MANAGEMENT:Case management is considered as the newest type of nursing care delivery system
developed in 1985 as an outgrowth of primary care , nursing case management is a model
used to co-ordinate the care , maintain quality, and contain cost while focusing on the
outcomes of care
Nursing administration
Medical
nurse
case
manage
All medical
pts
Pediatric
nurse
case
manager
Pediatric pts
OB nurse
case
manager
manager
All Ob
patients
Trauma nurse
case
manager
Role of nurse case manager: Delivers client focused and outcome oriented care
Cost effective care through integration of clinical services in combination
with
financial services
Serves as an advocate for patient and family
More patient and nurse satisfaction is achieved through
intensive care
They attend to a specific high risk population
Advantages: Patient receives high standard care
Nurse is highly qualified and skilled in the particular area,
More satisfaction to the patient
Increased professional standards can be developed by the
nurses
Disadvantages: Sometimes discomfort to clients
Continuity care is difficult
Long time nurse patient relationships are difficult to arrange
Costly
Time consuming