Nursing Care Delivery Systems

00:01 So welcome back, everyone.

00:02 When you're thinking about health care organizations, the nursing care that is delivered to patients is sometimes organized in different ways.

00:09 Today, we're going to be talking about nursing care delivery systems.

00:14 Care delivery models are the operational mechanisms by which care is provided to patients and families.

00:20 And there are several traditional models that we're going to discuss today, these include total patient care, functional nursing, team or modular nursing, primary nursing, and case management.

00:36 When you think about total patient care, this is the type of care where the registered nurse assumes responsibility for a group of patients for a shift and provides all care to the patient.

00:45 There are some advantages to this particular model of care.

00:48 This provides continuity for the shift.

00:51 Provides clear responsibility, we know who is taking care of the patient.

00:55 And it's generally satisfying for nurses.

00:57 But there are some disadvantages, one, it can be very expensive, and it may not utilize the RN time wisely because they're doing activities that might not require an RN license, and it may not be possible with staffing shortages today.

01:12 The next one is functional nursing.

01:14 Staff members are assigned to specific tasks or group of tasks for the patient.

01:19 For example, you could have a medication nurse, you might have an IV nurse, or someone who is exclusively taking vital signs.

01:26 The registered nurse, however, assumes overall direction of care for all of the patients.

01:32 The advantages to this model is that it actually incorporates the use of licensed practical nurses and unlicensed assisted personnel.

01:40 This gives them the opportunity to maximize their skills and it can be very cost effective.

01:45 There are some disadvantages to functional nursing.

01:48 First, it can lead to fragmentation because one team member may not know what the other team member might be doing.

01:54 And that can lead to a gap in patient care which means it's not holistic.

01:58 So, for example, if you have one nurse who's only doing medications and you have one nurse or team member who's only taking vital signs, you may not connect the dots to know that a certain vital sign or certain parameter might prohibit the need to take a medication in the event that there's not good communication between the team members.

02:16 The next one is team or modular nursing.

02:19 The registered nurse team leader coordinates care for a group of patients working with other team members, such as other registered nurses other LPNs, and other unlicensed assisted personnel.

02:29 Also, utilizing their skills.

02:31 the advantages to this particular model is that it's very satisfying for both staff and patients, and it is very cost-effective.

02:39 Some disadvantages include: it does require a high-level leadership skill from the registered nurse.

02:45 And, actually, today is harder to do when you have high patient acuity, meaning you have a patient load, it has very complex health situations, or you have inconsistent team members.

02:56 When you have inconsistent team members, you always have to recalibrate and get to know each other a little bit better every time you're assigned to different team members.

03:03 If you have a consistent team, then it can definitely be an advantage.

03:07 The next model is primary nursing.

03:09 This is where the registered nurse assumes 24/7 or complete accountability all of the time for their primary patients, and they establish a plan of care and coordinate care even in their absence.

03:21 The advantage to this one is that it has a high job satisfaction and it does provide excellent holistic care for the patient.

03:29 The disadvantages, however, is that it does require a high RN mix.

03:34 And it's difficult to do with today's flexible scheduling needs of most nurses, and some staff, honestly, don't want the accountability and responsibility of a patient load 24 hours, seven days a week.

03:45 The last one is case management.

03:47 The RN case manager supervises the care of the patient and the use of resources across the continuum and lays focus on individual patients.

03:56 The advantage to this model is that it is very cost-effective and it, again, is satisfying for patients who are high risk or problem prone.

04:04 There's really only one disadvantage to the case management model and that it's not a true inpatient delivery system but rather it's a management of patient care.

04:14 So, for example, a case manager or some nurses who are in this role may be called care coordinators, they don't necessarily work inside a hospital system, but they work outside of a hospital system to help the patient navigate the continuum of care from the beginning of an issue all the way to its resolution whether it could be services they need at home or maybe after hospitalization in a rehabilitation center.

04:36 So, remember, nursing shortages and health care reform will continue to have a strong impact on the creation of current and evolving types of patient care delivery models.

04:46 So what do we learn today? We've learned that since the nursing profession began, there have been various care delivery models used.

04:54 Each model has its advantages and its disadvantages.

04:57 And the model chosen should be the most appropriate for the current situation.

05:01 And, finally, we understand that the healthcare landscape is ever-changing.

05:05 Therefore, nursing care delivery models may be required to change as well to adapt to current organization and patient needs.

05:12 I hope you've enjoyed this video on care delivery models.

05:15 Thanks so much for watching.