Nursing Care Delivery System

What is nursing care delivery system?

Nursing Care Delivery Systems are frameworks designed to organize and coordinate care provided to patients across various settings. These systems are designed to provide patients with comprehensive, efficient, and effective nursing care that corresponds to their specific health needs. The primary objective of these systems is to ensure the delivery of safe, quality, and efficient nursing care to all patients, irrespective of their health conditions or personal circumstances.

The structure of the delivery system can have a significant impact on the effectiveness of the nursing care provided, patient outcomes, and overall healthcare experience. These nursing care delivery systems operate on multiple levels and involve various functions.

  • At the individual level, it includes direct patient care, medication administration, patient education, and the coordination of care with other healthcare professionals.
  • On the organizational level, it encompasses the designing and implementing policies and procedures that govern nursing practice within a healthcare institution.

Despite different levels, there are several types of nursing care delivery models, including primary nursing, team nursing, and case management nursing. Every model has its unique characteristics and benefits. For instance, primary nursing emphasizes the establishment of a therapeutic relationship between a nurse and a patient, which facilitates individualized care, trust, and continuity of care. On the other hand, team nursing involves a group of nurses working together to provide care to multiple patients, which promotes collaboration and resource sharing.

By understanding the different models of the nursing care delivery system, healthcare institutions can choose the most appropriate model that aligns with their mission, values, and patient population. Regardless of the chosen model, it is crucial to ensure that it promotes patient-centered care, professional collaboration, and continual quality improvement.

Types of nursing care delivery systems

There are various types of nursing care delivery systems, each with its own characteristics and organizational structure. The choice of a particular system depends on factors such as the type of healthcare facility, the nature of patient needs, and the available resources. Here are some common types of nursing care delivery systems:

  1. Team Nursing
  2.  Primary Nursing
  3. Total Patient Care (Case Method)
  4. Functional Nursing
  5. Modular Nursing
  6. Case Management

1. Team Nursing Care Delivery Model

The Team Nursing Care Delivery Model is a nursing care delivery system that involves organized nursing care within a healthcare setting. In this model, a team of healthcare professionals collaboratively provides patient care. The team generally includes Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Nursing Assistants, and other supporting staff. Following are the characteristics of Team Nursing Care Delivery Model:

nursing care delivery system

Team Collaboration

The model emphasizes collaboration among team members. Each team member has specific responsibilities in the Team Nursing Care Delivery Model. Communication and coordination are essential to ensure comprehensive and effective patient care.

Patient Assignments

One nursing team is assigned to a group of patients in which each team member is responsible for delivering specific aspects of care to those patients. The staff is delegated based on the skills and expertise of the team members.

Team Leader

A designated team leader, often an experienced registered nurse, is responsible for coordinating and supervising the care provided by the team. The team leader helps organize assignments, facilitate communication, and ensure that each team member is contributing to the overall care plan.

Flexibility Tasks and Responsibilities

The Team Nursing model allows for flexibility in assigning tasks and responsibilities based on the needs of the patients and the skills of the team members. This adaptability can be beneficial in responding to changes in patient conditions or unexpected events.

Effective Communication

Effective communication is crucial in the Team Nursing model. Regular team meetings, updates, and clear communication channels help ensure that all team members are informed about the status of patients and any changes in the care plan.

While the Team Nursing Care Delivery Model has its advantages, it’s essential to note that different healthcare settings may prefer or adopt alternative care delivery models based on their specific needs and priorities. The choice of a care delivery model depends on factors such as the size of the healthcare facility, the complexity of patient cases, and the available resources.

2. Primary Nursing Care Delivery Model

The Primary Nursing Care Delivery Model represents a significant shift in healthcare delivery, emphasizing continuity of care, delegation, and the nurse-patient relationship. It is a patient-centered approach that assigns one nurse, known as the primary nurse, to oversee and coordinate all aspects of an individual patient’s care throughout their stay in a healthcare facility. This model was designed to enhance the quality of care by fostering a closer bond between patients and their nurses, thereby improving patient satisfaction and outcomes. Following are the characteristics of Primary Nursing Care Delivery Model:

nurse providing care to patient

Primary Nurse Delegation

In the Primary Nursing Care Delivery Model, a primary nurse is assigned to each patient who takes the lead in coordinating and delivering their care. The primary nurse is responsible for developing a personalized care plan in collaboration with the patient and other healthcare providers. By building a strong relationship with patients, nurses can better comprehend their needs, fears, and expectations, which allows them to provide effective and compassionate care.

Continuity of Care

Continuity of care is a key element of primary nursing care. The primary nurse observes the patient throughout their healthcare journey, ensuring continuous care. This includes involvement in the admission process, care planning, implementation of care, and discharge process.

Nurse-Patient Relationship

The nurse-patient relationship is essential for effective healthcare. The primary nurse supervises a patient’s entire care journey, fostering a strong bond founded on trust and respect. This bond allows nurses to understand each patient’s specific requirements, values, and preferences, enabling them to provide tailored and holistic care. Engaging patients actively in their healthcare not only improves their health outcomes but also increases their overall satisfaction.

Collaboration with Healthcare Professionals

The core of this model lies in collaboration. It involves working with other healthcare professionals such as doctors, physiotherapists, dietitians, and social workers to provide multidimensional care for the patient. Collaboration in this model is not limited to interprofessional interactions but extends to include the patient and their family. This inclusive approach ensures that the care plan is designed keeping in mind the unique needs and preferences of the patient, thereby improving the quality of care and patient satisfaction.

Coordination of Care

Coordination of care is intrinsic to the Primary Nursing Care Delivery Model. The primary nurse coordinates all aspects of care, including diagnosis, treatment, recovery, and discharge planning. This coordination ensures a seamless transition throughout different stages of care and helps prevent potential lapses or gaps in care.

Patient Education

The Primary Nursing Care Delivery Model emphasizes the importance of patient education. As part of this model, the primary nurse serves as an educator, providing patients with clear and understandable information about their health condition, treatment options, and preventative measures. This education process empowers patients by equipping them with the knowledge necessary to manage their health. By doing so, patients are more likely to adhere to treatment plans, avoid complications, and prevent hospital readmissions.

Patient Empowerment

Patient empowerment is a central principle of the Primary Nursing Care Delivery Model. This model accords patients the ability to actively participate in their care by making informed decisions about their health.

The Primary Nursing Care Delivery Model aims to enhance care quality and patient satisfaction while improving health outcomes by adopting a personalized and patient-focused approach to nursing.

3. Total Patient Care (Case Method)

Total Patient Care, often referred to as the Case Method, is an approach to healthcare that emphasizes comprehensive and holistic patient management. In this method, healthcare professionals, particularly nurses, take responsibility for the overall care of an individual patient throughout their entire healthcare journey. The goal is to provide seamless and integrated care, considering the physical, emotional, social, and spiritual aspects of the patient. Following are the Characteristics of Total Patient Care (Case Method):

five nurses standind in que

Patient-Centered Approach

The focus is on the individual patient and their unique needs. Care is tailored to the specific characteristics, preferences, and circumstances of each patient.

Holistic Care

Total Patient Care considers the whole person, not just the specific condition or disease. This includes addressing psychological, social, and spiritual aspects of health in addition to the physical aspects.

Continuity of Care

The same healthcare professionals often follow the patient throughout their entire healthcare journey, ensuring continuity and consistency in care. This can enhance communication and understanding of the patient’s needs.

Individualized Care Plans

Care plans are personalized based on the patient’s unique circumstances. This can involve tailoring interventions and treatments to meet the patient’s needs.

Patient and Family Involvement

Patients and their families play an active role in the decision-making process. Effective education and communication are essential to ensure that patients and their families comprehend the care plan and are involved in the management of the patient’s health.

Multidisciplinary Team Collaboration

Different healthcare professionals collaborate as a team to address various aspects of a patient’s health, including nurses, social workers, physicians, therapists, and other specialists.

Total Patient Care is often contrasted with other models, such as Team Nursing or Functional Nursing, which may involve a more fragmented approach to patient care. The Case Method is particularly prevalent in settings where personalized and comprehensive care is essential, such as in critical care units, long-term care facilities, or when dealing with complex and chronic health conditions.

4. Functional Nursing Model

The Functional Nursing Model is a nursing care delivery system that divides patient care tasks among different nursing staff based on their specific skills and expertise. In this model, each nurse or healthcare professional is assigned specific tasks or functions to perform for a group of patients. The goal is to efficiently utilize the skills of the healthcare team and streamline the delivery of care. Following are the  characteristics of Functional Nursing Model:

nurse holding the hand of patient

Task-Orientation

Nursing care is organized around specific tasks or functions rather than the comprehensive care of individual patients. Nurses focus on performing specific procedures or interventions assigned to them.

Specialized Care

Healthcare professionals are assigned tasks based on their specialization and expertise. For example, a nurse might be responsible for administering medications, while another nurse handles wound care.

Efficiency

The model aims to improve efficiency by allowing healthcare providers to focus on specific aspects of care for multiple patients. This can be particularly useful in settings where there is a high patient volume.

Clear Roles

Each member of the healthcare team has a clearly defined role and set of responsibilities. This clarity helps in organizing and managing the workflow efficiently.

Limited Patient Interaction

The Functional Nursing Model may result in less direct interaction between the nurse and the patient. Instead, patients may encounter different nurses for various aspects of their care.

Applicability to Routine Tasks

The model is often applied to routine and standardized tasks, such as medication administration, vital sign monitoring, and specific treatments. It may not be as well-suited for managing complex or holistic patient care needs.

Potential Fragmentation

Since care is divided into specific tasks, there is a risk of fragmentation in patient care. It may be challenging to maintain a holistic view of the patient’s needs and preferences.

The Functional Nursing Model contrasts with other care delivery models, such as Total Patient Care (Case Method) or Team Nursing, where the emphasis is on providing holistic and comprehensive care for individual patients.

While the Functional Nursing Model can enhance efficiency in certain healthcare settings, it may be less suitable for situations where personalized and holistic care is a priority, such as in critical care units or when dealing with patients with complex health conditions. Each care delivery model has its strengths and weaknesses, and the choice of model depends on factors such as the nature of the healthcare setting, patient population, and organizational preferences.

5. Modular Nursing Care Model

The Modular Nursing Care Model is a nursing care delivery system that combines elements of both functional and team nursing. In this model, patient care is organized into modules, with each module comprising a team of healthcare professionals led by a registered nurse. This approach aims to provide comprehensive and patient-centered care while optimizing the use of the healthcare team’s skills and resources. Following are the characteristics of Modular Nursing Care Model:

nurses on nursing counter

Module Formation

Care is organized into modules, which are small teams led by a registered nurse. These modules are responsible for the care of a group of patients, allowing for a more personalized and coordinated approach.

Team Collaboration

Within each module, healthcare professionals collaborate as a team to provide care to their assigned patients. This may include licensed practical nurses (LPNs), nursing assistants, and other support staff.

Patient-Centered Care

The model emphasizes providing holistic and patient-centered care. By working together within a module, healthcare professionals can address the various aspects of a patient’s needs, including physical, emotional, and social well-being.

Task Assignment

Similar to the functional nursing model, specific tasks may be assigned to different members of the healthcare team based on their skills and expertise. This allows for efficient use of resources and specialization in certain areas of care.

Registered Nurse Leadership

Each module is led by a registered nurse who serves as the primary coordinator of care. The registered nurse is responsible for overseeing the care provided by the team and ensuring that each patient’s needs are met.

Flexibility

The modular approach allows for flexibility in adapting to the changing needs of patients and the healthcare environment. It can accommodate variations in patient acuity and workload by adjusting the size and composition of modules as needed.

Communication

Effective communication within and between modules is crucial for the success of the model. Regular communication ensures that all team members are informed about the status of patients and can collaborate efficiently.

The Modular Nursing Care Model aims to balance task-oriented care and a patient-centered approach through team nursing. By organizing care into modules, it aims to provide a more coordinated and responsive system that can adapt to the unique needs of patients and the healthcare setting. Like any care delivery model, its success depends on factors such as the nature of the patient population, the healthcare setting, and the effectiveness of communication and collaboration within the healthcare team.

6. Case Management Nursing Model

The Case Management Nursing Model is a method of healthcare delivery that focuses on organizing and supervising the care of patients through multiple healthcare settings. Case managers, generally registered nurses with specialized training, are the key players in this model. Their primary responsibility is to ensure that patients receive timely and appropriate care while making the best use of the resources available and promoting positive health outcomes. Following are the characteristics of Case Management Nursing Model:

nurse dealing with patient

Patient Advocacy

Case managers act as advocates for patients, ensuring that their needs and preferences are considered in the care planning process.

Coordination of Care

Case managers coordinate and facilitate communication among different healthcare providers, services, and settings to ensure seamless transitions of care.

Assessment and Planning

Case managers conduct comprehensive assessments of patient’s health needs and collaborate with the healthcare team to develop individualized care plans.

Resource Optimization

Efficient utilization of healthcare resources is a key aspect. Case managers work to ensure that services are delivered cost-effective manner while maintaining quality.

Interdisciplinary Collaboration

Collaboration with a multidisciplinary team is essential. Case managers work closely with physicians, nurses, therapists, social workers, and other healthcare professionals to address diverse aspects of patient care.

Patient Education

Case managers provide education to patients and their families, helping them understand their health conditions, treatment options, and how to manage their care effectively.

Transition Planning

Planning for transitions between care settings is a crucial component. Case managers coordinate discharges, transfers, and post-acute care to ensure continuity of care.

Chronic Disease Management

The Case Management Nursing Model is often employed in the management of chronic conditions, where long-term coordination and support are necessary.

Quality Improvement

Case managers contribute to quality improvement initiatives by monitoring outcomes, identifying areas for improvement, and implementing strategies to enhance patient care.

Documentation and Evaluation

Accurate documentation of patient information and ongoing evaluation of care plans are integral to the model. Case managers assess the effectiveness of interventions and make adjustments as needed.

The Case Management Nursing Model is especially suitable in healthcare systems where patients receive care from different providers across different settings. The model aims to improve the quality of care, enhance patient satisfaction, and ensure the efficient use of healthcare resources. It is commonly used in situations such as caring for individuals with chronic illnesses, post-surgical care, or transitioning between hospital and home care.

Comparison of different nursing care delivery models

Various nursing care delivery models exist, each with its approach to organizing and providing patient care. Here’s a comparison of several common nursing care delivery models:

Total Patient Care:

  • Focus: Individual patient care, holistic approach.
  • Responsibility: The individual nurse takes overall responsibility for the patient’s care.
  • Communication: Close communication with the patient and their family.                               
  • Setting: Often used in critical care or with complex health conditions.
  • Pros: Personalized care, continuity, and a holistic approach.
  • Cons: Resource-intensive, may be less efficient in high-volume settings.

Team Nursing:

  • Focus: Shared responsibility for patient care among a team.
  • Responsibility: Tasks are divided among team members, led by a registered nurse.
  • Communication: Regular communication and collaboration among team members.
  • Setting: Common in general medical-surgical units.
  • Pros: Efficient use of personnel, good communication.
  • Cons: Potential for fragmented care, dependence on effective teamwork.

Functional Nursing:

  • Focus: Task-oriented care, specialized functions.
  • Responsibility: Nurses specialize in specific tasks (e.g., medication administration, wound care).
  • Communication: Limited direct interaction with patients; communication is task-specific.
  • Setting: Often used in settings with high patient volumes.
  • Pros: Efficient use of skills, and task specialization.
  • Cons: May lack a holistic view of the patient, potential for fragmented care.

Primary Nursing:

  • Focus: Individual patient care, continuity, and a personal relationship.
  • Responsibility: One primary nurse takes overall responsibility for the patient.
  • Communication: Close communication between the primary nurse, patient, and healthcare team.
  • Setting: Common in specialty units or settings with long-term relationships.
  • Pros: Personalized care, continuity, strong nurse-patient relationship.
  • Cons: Resource-intensive, the potential for increased workload.

Modular Nursing:

  • Focus: Care is organized into modules with a team led by a registered nurse.
  • Responsibility: Division of tasks within the team; registered nurse provides oversight.
  • Communication: Effective communication within and between modules.
  • Setting: Offers flexibility and adaptability in various healthcare settings.
  • Pros: Combines efficiency with a team approach, adaptable to changing needs.
  • Cons: Requires effective communication and coordination.

Case Management:

  • Focus: Coordinating care for a group of patients across settings.
  • Responsibility: Case managers ensure the efficient delivery of services and resources.
  • Communication: Coordination among various healthcare providers and services.
  • Setting: Often used in chronic disease management and post-acute care.
  • Pros: Optimizes resources, and focuses on patient outcomes.
  • Cons: It may involve less direct patient care, and requires strong coordination skills.

Conclusion

In conclusion, nursing care delivery systems play a pivotal role in the healthcare setting. Their effectiveness and efficiency directly influence patient outcomes and satisfaction, making them an integral part of healthcare provision. These systems include various models, such as primary nursing, team nursing, and patient-centered care, each with its own set of advantages and disadvantages.

However, the successful implementation of these nursing care delivery systems hinges on a plethora of factors. Adequate staffing levels, appropriate skill mix, ongoing training, and institutional culture are just a few of these critical elements. Without these fundamental requisites, even a well-designed system can fail to deliver expected outcomes.

In essence, nursing care delivery systems are not static constructs. They evolve in response to changes in healthcare needs, technological advancements, and policy shifts. Hence, it is crucial for healthcare institutions to regularly review and update their nursing care delivery systems to ensure they remain effective and relevant.

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*We express our gratitude towards the various sources referred in this blog post for their valuable contributions and insights. Their expertise and dedication have significantly enriched the content, and we extend our sincere appreciation to each of them for their valuable contributions.

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