Care Delivery Systems

1. Care Delivery Systems

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Managed Care • “new” model • Care coordination that is organized to achieve specific client outcomes, given fiscal and other resource constraints • Prepaid access to care

10. 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

11. 4 Fundamental elements • Clinical decision making • Work allocation • Communication • managment