PATIENT CARE DELIVERY SYSTEM

LOVELITES D. ZAMORA, RN, MAN

Introduction
 A Nursing Care Delivery System defines the way we
use our nursing values to care for our patients,
families, colleagues, and selves.
 The care delivery system is actually a subsystem of the
professional practice model that describes our
approach to delivering patient care by: 1.) Detailing
assignments, responsibilities and authority to
accomplish patient care, 2.) Determining who is going
to perform what tasks, who is responsible, and who
makes decisions; and 3.) Matching number and type of
caregivers to patient care needs.
Nursing Process in the Delivery of
Nursing Care Services

 FIVE SEQUENTIAL STEP

– assessment
– diagnosis
– planning
– implementation
– evaluation.
1.Assessment

 Assessment is the first step and involves

critical thinking skills and data collection;
subjective and objective.
– Subjective data involves verbal statements from the
patient or caregiver.
– Objective data is measurable, tangible data such as
vital signs, intake and output, and height and
weight.
2.Diagnosis
 The formulation of a nursing diagnosis by employing
clinical judgment assists in the planning and
implementation of patient care.
 A nursing diagnosis, according to NANDA, is defined
as a clinical judgment about responses to actual or
potential health problems on the part of the patient,
family or community.  
 A nursing diagnosis encompasses Maslow's Hierarchy
of Needs and helps to prioritize and plan care based on
patient-centered outcomes.
Maslow's Hierarchy of Needs
 1.Basic Physiological needs: Nutrition (water and food),
elimination (Toileting), airway (suction)-breathing
(oxygen)-circulation (pulse, cardiac monitor, blood
pressure) (ABC's), sleep, sex, shelter, and exercise.

 2.Safety and Security: Injury prevention (side rails, call

lights, hand hygiene, isolation, suicide precautions, fall
precautions, car seats, helmets, seat belts), fostering a
climate of trust and safety (therapeutic relationship),
patient education (modifiable risk factors for stroke,
heart disease).
 3.Love and Belonging: Foster supportive relationships,
methods to avoid social isolation (bullying), employ
active listening techniques, therapeutic communication,
sexual intimacy.
 4.Self-Esteem: Acceptance in the community,
workforce, personal achievement, sense of control or
empowerment, accepting one's physical appearance or
body habitus.
 5.Self-Actualization: Empowering environment, spiritual
growth, ability to recognize the point of view of others,
reaching one's maximum potential.
3.Planning

 The planning stage is where goals and

outcomes are formulated that directly impact
patient care.
 Goals should be: (SMART)
– 1.Specific
– 2.Measurable or Meaningful
– 3.Attainable or Action-Oriented
– 4.Realistic or Results-Oriented
– 5.Timely or Time-Oriented
4. Implementation

 Implementation is the step which

involves action or doing and the
actual carrying out of nursing
interventions outlined in the plan of
care.
5. Evaluation

 This final step of the nursing process is vital to

a positive patient outcome. Whenever a
healthcare provider intervenes or implements
care, they must reassess or evaluate to ensure
the desired outcome has been met.
Patient Classification System

 The Patient classification system (PCS), also

known as patient acuity system, is a tool used
for managing and planning the allocation of
nursing staff in accordance with the nursing
care needs. Thus, PCS is used to assist nurse
leaders determine workload requirements and
staffing needs.
Kinds of Patient classification system (PCS)

 Descriptive
– This is a purely subjective system wherein the nurse selects
which category the patient is best suited.
 Checklist
– the patient is assigned to a numerical value based on the level
of activity in specific categories. The numerical value is added
up to give the nurse an overall rating.
 Time Standards
– the nurse assigns a time value based on the various activities
needed to be completed for the patient. This time value is
sum up and converted to an acuity level.
Four Classifications of Descriptive

1. Self-care / Minimal Care. The first

classification of patients who are recovering and
normally requires only diagnostic studies,
minimal therapy, less frequent observations, and
daily care for minor conditions and are awaiting
elective surgery.
2. Moderate care. The patient in this category is
moderately ill or under the recovery stage from a
serious illness or operation. They require nursing
supervision or assistance that is related to
ambulating and caring for their own hygiene.
 Maximum care. Patient needs
close attention and complete care all
through the shift. The nurses initiate,
supervise and perform most of the
patient's activities.
4. Intensive care.
-patients are acutely ill and high level of nurse
dependency is required. Intensive therapy
and/or intensive nursing care is needed because
of the unstable condition of the patient. Frequent
evaluation, observation, monitoring and
adjustment of therapy is also required. Patients in
these levels include those in critical conditions or
in life and death situations.
Modalities of Nursing Care

 This refers to the manner in which

nursing care is organized and provided. It
depends on the philosophy of the
organization, nurse staffing and client
population
1.Functional Nursing

 It is a system of care that concentrates on

duties. It can be seen as an “assembly line” of
care. The RN coordinates care for an entire
unit or team. Other nurses are assigned to
pass medications and perform treatments.
Personnel with less training are assigned to
provide more basic care such as bed bath and
bed making. It began during the World War II
when the demand for client care outstripped
the supply of nurses. (Black and Hawks, 2008)
2.Primary Nursing
 It is a model of care delivery that emerged during the
1980’s to meet the increasing complex needs of
clients. The goal is for each client’s care to be
comprehensive and coordinated, from the admission to
discharge. Each client is assigned to a primary nurse,
who is a RN, and that the nurse provides care for that
client when he or she is working. Advantages are: the
client has the same nurse, the client’s psychosocial
needs can be met, communication with the physician
has improved and the nurse feels autonomous. (Black
and Hawks, 2008)
3.Team Nursing

 In team nursing, the RN works with one or

more health care personnel to provide care for
four or more clients. Advantages are that an
RN is usually head of the team and generally
knows the clients. In addition, the team leader
can provide guidance to new or inexperienced
nurses and other staff. (Black and Hawks,
2008)
4.Case management
 It is a care delivery model that incorporates concepts of
continuity and efficiency in addressing both long and
short-term physical needs, psychological and social
needs of clients. The primary goals are promoting self-
care, upgrading the quality of life and using resources
efficiently. Case managers are nurses who coordinate
care of a group of clients, monitor the implementation
of interdisciplinary care plans, and maintain
communication with third party payers and referral
sources. The nurse follows the client through the entire
stay in the health care system and back into the
community. (Black and Hawks, 2008)
5.Case method

 It is the oldest patient care delivery method. In

this method one professional nurse assumes
total responsibility of providing complete care
for one or more patients (1-6) while she is on
duty. This method is used frequently in
intensive care units and in teaching nursing
students.
6.Total Patient care

 Is the oldest of the care delivery system. One

nurse is assigned to one client and provides all
care. The one-to-one pattern is common in
critical care, with student nurses, and with
private duty nurses. The advantage is that the
client needs to work with only one nurse and
that one nurse can focus on meeting all the
biopsychosocial1 needs of the client and the
family. (Black and Hawks, 2001).
7.Modular Nursing

 Modular nursing is a modification of team

nursing and focuses on the patient’s
geographic location for staff assignments. The
patient unit is divided into modules or districts,
and the same team of caregivers is assigned
consistently to the same geographic location.
Each location, or module, has an RN assigned
as the team leader, and the other team
members may include LVN/LPN or UAP.
THANKYOU!!!!!