NCM 119-A  Registered
BSN 121571 responsibility for a group of patients
Nursing Leadership & Management
Prof. Leila D. Benito
September 2, 2021 (Thursday)
PATIENT HEALTHCARE DELIVERY
SYSTEM
 The models of patient care delivery
have been used for decades to describe
different approaches to nursing and
patient treatment.
 Also known as “nursing models and
care deliver systems”, there are several
models commonly used by healthcare
providers and professionals.
 The informative guide will provide
details about well-known patient care
delivery systems, offering insight into
how they work to ensure ideal patient
outcomes.
THE MODELS OF PATIENT CARE
1. Total Patient Care/Case Method
2. Functional Nursing
3. Team Nursing
4. Primary Care
5. Modular Nursing
6. Nursing Case Managemement
7. Innovative/Contemporary Method
1. TOTAL PATIENT CARE
 Is an intensive form of care delivery,
which sometimes described as “case
nursing”
 This is one of the oldest models of
patient care delivery in use, and it
involves nurses overseeing almost
every aspect of patient care.
 Nurses plan individual treatment
objectives, working in shifts to cover
everything from personal hygiene and
medication to emotional support and
additional therapies and treatments.
 Therefore, this model is not always a
viable option for healthcare settings. It
is possible that a patient may require
treatment that cannot be administered
by the nurse on duty. It’s also possible
that the staff-to-patient ratio available
does not support this concept.
Nurses assumes
for a shift: provides all care to the
patient
 Advantages: Continuity for the shift,
responsibility is clear, generally
satisfying for nurses.
 Disadvantages: Can be very expensive,
may not utilize RN time wisely and
may not be possible with staffing
shortages.
Registered Registered Registered
Nurse Nurse Nurse
8-hour Shift 8-hour Shift 8-hour Shift
Patient Care
The RN plans, organizes,
and performs all care
TOTAL PATIENT CARE (Case Method)
DELIVERY
2. FUNCTIONAL NURSING
 Is an approach that has been used for
several decades.
 It is underpinned by a hierarchical
structure, which involves experienced,
high-qualified nurses taking care of the
most advanced, complex jobs. This
requires more junior nurses to oversee
basic tasks in order to free up time for
the highly skilled nurses.
 Functional nursing revolves around
team ethic, and it produces a catalog of
processes, which are undertaken by
different individuals to ensure efficient
patient care deliver.
 As well as taking advantage of the
skills of nurses at different stages of
their careers, this model can also save
healthcare providers and facilities
money by increasing efficiency and
productivity.
 One criticism ofthe functional nursing
model is that it fails to provide holistic
care. Hoslistic treatment focuses on the
overall being, rather thn targeting
specific injuries, symptoms, or illnesses.
 With this approach, the aim is to work
as a team to carry out individual
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 elements of the treatment plan, rather  RN Team Leader coordinates care for a
than enhancing overall health and group of patients working with other
wellbeing. team members (RNs, LPNs, and UAPs)
utilixing their skills.
 Staff Members are assigned to a  Advantages: If done well can be very
specific task or group of tasks for satisfying to staff and patients as well
patients: Example Medication Nurse, as cost effective.
IV Nurse, Vital Signs - RN assumes  Disadvantages: Requires high level
overall direction of care. leadership skills from RN - harder to do
 Advantages: Incorporates the use of with high patient acuity and
LPNs and UAPs and maximizes their inconsistent team members.
skills, can be cost effective
 Disadvantages: Can lead to Nurse Manager
fragmentation and gaps in patient care -
Not Holistic
RN Team RN Team
Leader Leader
Nurse Manager RN , RN ,
LPNs/LVNs, LPNs/LVNs,
Nurse Nurse
Nurse Assistants Assistants
LPN RN Nurse
Aids Aids
PO Meds Assessments
VS Hygiene
Tx Care Plans
Hygiene Stocking
Assigned Assigned
Patient Group Patient Group
Assigned Patient
Group TEAM NURSING MODEL

FUNCTIONAL NURSING CARE 4. PRIMARY CARE

DELIVERY MODEL
3. TEAM NURSING
 Is a patient care delivery model, which
was established in 1950s
 In essence, it is similar to the functional
model, but it operates on a larger scale.
At the head of the team, a senior nurse
takes charge of delegating tasks
throughout the group. The collective
cares for a number of patients at the
same time, and jobs are assigned based
on skill level, training, and experience.
 This model enables healthcare
professionals with limited experience to
learn from peers with expertise
andknowledge, and it also provides
support for those with more experience,
enabling them to focus on core tasks
that match their skill set.
 For healthcare providers, the team
nursing models improves efficiency
and provides valuable training
opportunities for those keen to progress
during the early stages of their careers.
 This primary care delivery modelcame
to the fore in the 1970s and it quickly
became popular.
 This model favors a more holistic
patient throughout their hospital stay.
 This model is suitable for patients with
more complex needs, for example,
those who suffer from an undelying
illness that poses a risk of subsequent
complications.
 Primary care nursing is more
comprehensive model, which can
improve continuity of care and foster
stronger relationships between patients
and the care team.
 One of the main issues with the
primary care model in the modern
healthcare setting is the shift towards
flexible working arrangements. Many
healthcare professionals now choose to
work hours that follow patterns of days
or nights on duty followed by a period
of time off.
 This can facilitate a better work-life
balance for care providers, but it

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 doesn’t always fit well with the primary
care delivery.
 Registered Nurses assumes 24/7
accountability for their Primary
Patients: Establish plan of care and
coordinate care even in their absence
 Advantages: Can result in high job
satisfaction and excellent holistic care
for patients.
 Disadvantages: Requires high RN mix,
difficult to do with today’s flexible
scheduling, some staff don’t want the
accountability and responsibility.
Primary Nurse
24H Responsibility Associatiate
Physician & for: Planning, Nurse
Other Directing, &
Provide care
Members of Evaluating Pt. Care
when Primary
the HCT Nurse is Off
Duty
Patient
PRIMARY NURSING MODEL
5. CASE MANAGEMENT
 Case management is a coordinated
effort between community-based, often
nonprofit, organizations that work to
provide quality health care solutions
that are customized to a client’s
specific and individuals needs.
 This health care approach is designed
to be customized to the client to best
address unique needs on the client’s
own timeline.
 In addition to traditional health services,
case management can also aide with
employment searches, transportation
solutions, and community involvement.
This collaborative process involves
assessment, planning, plan
implementations, and evaluation to
successfully achieve the client’s desired
outcome.
There are FOUR BASIC LEVELS
involved with case management: Intake,
Needs Assessment, Service Planning, and
Monitoring and Evaluating.
1. Level One: INTAKE - is the
foundation for all the steps that follow.
In this step, as much information as
possible is gathered with an eye toward
creating an accurate picture of the
client’s current situation. This
information is provided by the client
and at this stage, the client’s needs are
made expressly clear.
This information is provided by the
client and at this stage, the client’s
needs are made expressly clear.
 Gathering of demographic
information
 Identifying immediate needs
the client may have
 Establish a relationship with
the client
 Determine if the client can
benefit from the organization
2. Level Two: NEEDS ASSESSMENT -
the case manager assess all of the
information at their disposal and
develops an understanding with the
client about what their needs and goals
are what the road may look like to
achieving those.
Steps that are takes at this level:
1) Identify kep problems, needs, and
interests: individualized custom plans
2) Establishment of specific goals: helps
to ensure that all parties involved - the
case manager, client, the client’s family,
and health service stakeholders - are on
the smae page regarding the end goal
3) Communicate potential challenges to
the client: the client and their family
should have a clear picture of the
challeneges that may be encountered
along the way.
4) Reassess needs periodically: to make
sure the agreed-upon plan is still
servicing the client in a way that helps
them most.
3. Level Three: SERVICE PLANNING
- very specific taks andobjectives are
identified that will help the client move
toward their goal. The plan is often
subject to input from the client’s
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 support system and their other health
rpoviders.
The steps involved with creating a service
plan include:
1) Specific actions are outlined to achieve
goals: An outline is put together of
actionable steps to take.
2) Development of a timeline for goals:
Timelines help to keep all parties
focused and motivated on the tasks at
hand.
3) Establish metrics to measure progress:
identifying measurements creates
accountability. It will keep all
interested parties laser-focused on
achieving their goals and will keep
them in the loop as to where they are
toward the goal at all times.
4. Level Four: MONITORING AND
EVALUATION - evaluate the efficacy
of the plan and to make sure that the
client’s specific needs are being met by
the casemanager and the organization.
Monitor established metrics. Ensure
quantified data is used rather than
anecdotal: rely on data gathered during
the implementation of the plan with an
eye toward using the metrics
established.
Skills and Attributes of a successful case
manager:
1) High Degree of Empathy: the ability
with the struggles of their client is
critical for being able to effectively
aide that client.
2) Organizational Skills: keeping
calendars, notes, and confidential client
paperwork organized and secure is a
must.
3) Advocacy Skills: act as the contact
point between their clients and health
service providers; case managers
advocated on behalf of their clients
4) Communication Skills: Given the
diverse groups that have to be
communicated with, case managers
need to be able to tailor their
communication style to their audience.
5) Patience: is required not only with the
clients who are often in difficult
personal circumstances but also with
the red tape that accompanies working
in any health care profession.
6) Adaption: being able to think quickly
and adapt to these circumstances can
deermin how successful the manager
will be in servicing the client.
Collaborates
with Pt. And
Family
Onset of NURSE CASE Resolution of
Illness MANAGER Illness
Assesses, plans,
implements,
coordinates,monitors, and
evaluates patient care
options and services to
meet health needs
Collaborates with
Coordinates Services:
Nursing, Physicians,
Home Care, Hospic,
Physical/Speech/Occupati
Extended/Long-term Care
onal Therapists, Dietary
Ambulatory Care Services
and Ancillary Services
NURSING CASE MANAGEMENT
MODEL
6. MODULAR NURSING
 A patient care unit is divided into
geographic modules with an RN as
team leader.
 The same team of caregivers is
regularlyassigned to the modules. The
team will include RNs and will also
include LPNs and nursing assistants.
 Typically, each module will have
access to the medications, supplies, and
linens needed within the module. The
goal of modulat nursing is to make
patient care lessfragmented and is most
frequently used in inpatient and
outpatient care areas.
ADVANTAGES
 Geographic proximity and a smaller
team can make for more efficient
communication between team members
and patients and families
 Allows for RNs to be more involved in
the planning and coordination of
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 patient care, which can result in better
continuity of care and make transitions
of care more seamless
 Make it easier to assign teams based on
patient acuity
 The smaller, more focused patient care
teams can result in higher levels of
accountability for individual team
members-an important element of
teammember job satisfaction.
WEAKNESS
 Requires a high level of nursing
leadership-education
 Can be difficult o execute with
inconsistent team members. Assigning
a consistent group of caregivers to a
specific set of patients within a specific
area.
 May complicate staff assignments -
creating a team that has all of the
competencies needed for patients on
their module can be a challenge
 They can also assist patients in getting
the care they need with more convenien
and accessible options
 The nursing profession finds many of
these new medical technologies help
them with routine processes, as well as
decrease human mistakes and errors
that can come from too few nurses who
are working hong hours with too many
patients
 While nurses agree that new healthcare
technology and innovative medical
devices can help them, they also agree
that technology should not replace day-
to-day human interactions
 Professionals also largely agree there
should not be an overreliance on
healthcare software and technology,
and that human eyes on both symptoms
and needs should be as important as
what healthcare technology is saying.
NURSING TECHNOLOGIES THAT
ARE BEING USE:

1. Automated IV pumps
NURSE CASE 2. Portable Monitor
MANAGER 3. Smart Beds
4. Wearable Devices
5. Electronic Helath Records
Geographic Geographic Geographic 6. Centralized Command Center
Patient Unit Patient Unit Patient Unit 7. TeleHealth and Apps
Patient Care Patient Care Patient Care
Team: Team: Team:
RNs, RNs, RNs, 7. INNOVATIVE METHOD
LPNs/LVNs, LPNs/LVNs, LPNs/LVNs,
Nurse Aides Nurse Aides Nurse Aides INNOVATION PROCESS
Meds Meds Meds
Supplies Supplies Supplies
Linens Linens Linens
Step 1
Strategic Thinking
MODULAR NURSING MODEL

7a. INNOVATIVE METHOD Step 7 Step 2

 New medical technologies are crucial Taking Action Portfolio Management
for continued patient care and the
healthcare system
 New medical technologies can make Step 6 Step 3
life easier for medical professionals and Market Development Research
patients alike
 Certain technologies can make patient
care easier and more efficient for the Step 5 Step 4
Innovation Dlv’t Insight
doctors and nurses who manage a large
patient load

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7b. CONTEMPORARY METHOD
 Defines the evolving role of the nurse
in treating patient in a technologically
advanced setting
 Nurses assume roles which were
formerly ascribed to doctors
 Nurses are legally accountable for their
actions
 Advanced Practiced (APN) - are used
in front-line primary care clinics,
hospitals and similar venues
 Nurses in these facilities, diagnose and
treat illnesses, provide immunizations
and performs physical exams
 Provide health care in oncology,
cardiology, and pediatrics
 Nurses can be certified registered nurse
anesthetics, and can prescribe
medicines