Care Delivery Systems

Nursing Care Delivery Models

A method of organizing and delivering nursing care

The manner in which nursing care is organized and delivered to meet the needs of the clients

How work is delegated

Private Duty

Oldest model One nurse caring for one client Often seen in the home, may be seen in some

settings in hospital, i.e. family provided private duty care

Advantage: focus on only one client, develop strong relationships

Disadvantage: costly, difficult in current climate

Functional Nursing

Uses the division of labour according to specific tasks and technical aspects of the job, e.g. “Med Nurse”

Focus is on completing the tasks assigned to you Advantages: seen as efficient, worked during times

of nursing shortages (during war) Disadvantages: reduces role to tasks, not supported

by CNO, does not support autonomy and professional practice

Team Nursing

Uses a group of people led by a knowledgeable nurse Provides care to a group of clients by coordinating a team of

RNs and RPNs Each team member would provide most of the care to his/her

assigned clients under the direction of a team leader Advantages: each team members capabilities can be used to

the maximum, supports productivity, working together Disadvantages: needs a strong team leader, can lead to

fractioning care, may create underutilization of skills of individuals

Primary Nursing

An approach in which the nurse has responsibility and accountability for the continuous guidance of specific clients until they are discharged

Provide total patient care: nurse plans, delivers and monitors care under 24 hour responsibility from admission-discharge

Autonomy, authority and accountability are basic to the model

Advantages: focus on client’s needs, greater nurse autonomy and greater continuity of care

Came to be associated with all RN staffing Disadvantages: difficult to do effectively with reduced

los, may be difficult to implement causing confusion and lack of structure to enable autonomy. Also risk of burnout and may create tensions between nursing personnel

Case Management

Fastest growing “new model” Defined as both a process and a care

delivery model A system of health assessment, planning,

service procurement, coordination, delivery, and monitoring through which multiple service needs of clients are met.

Often associated with the use of critical paths

Managed Care

“new” model Care coordination that is organized to

achieve specific client outcomes, given fiscal and other resource constraints

Prepaid access to care

Patient Centred Care Models

Based on the principles of primary nursing and case management

Addresses existing structures, systems, roles/reporting relationships, and the work of each stakeholder group

Puts the patient at the centre of all of the redesign and restructuring efforts

4 Fundamental elements

Clinical decision making Work allocation Communication managment