SAHALI, SALIH, SANAANI, TATEL, USMAN-J, USMAN-Y

MODULE ONE-GROUP WORK

II. Patient Care Delivery System

A. Nursing Process in the Delivery of Nursing Care Services
B. Patient Classification System
C. Modalities of Care

Group work:
1. What are the four categories of the patient classification system?
2. What are the different modalities of care?
3. Give the advantages and disadvantages of each modality of care

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Nursing Process in the Delivery of Nursing Care Services

In 1958, Ida Jean Orlando started the nursing process that still guides nursing care today.
Defined as a systematic approach to care using the fundamental principles of critical thinking,
client-centered approaches to treatment, goal-oriented tasks, evidence-based practice (EDP)
recommendations, and nursing intuition.
● It is a problem-solving model not specifically designed for ethical analysis but appropriate
for it is the nursing process.
● Most nurses are aware of the nursing process and the cyclic nature of its components of
assessment, diagnosis, planning, implementation, and evaluation.
Its holistic and scientific postulates are integrated to provide the basis for compassionate, quality-
based care.
The nursing process functions as a systematic guide to client-centered care with 5 sequential
steps. These are assessment, diagnosis, planning, implementation, and evaluation.

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.
● Data may come from the patient directly or from primary caregivers
who may or may not be direct relation family members. Friends can
play a role in data collection. Electronic health records may populate
data in and assist in assessment.
●
● Critical thinking skills are essential to assessment, thus the need for
concept-based curriculum changes.
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.
● Maslow's pyramid, lay-out the foundation in determining people’s
basic fundamental needs
● Physiological and safety needs provide the basis for the
implementation of nursing care.

Maslow's Hierarchy of Needs

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.

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).

Love and Belonging: Foster supportive relationships, methods to avoid social isolation
(bullying), employ active listening techniques, therapeutic communication, sexual intimacy.

Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control

or empowerment, accepting one's physical appearance or body habitus.

Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of

view of others, reaching one's maximum potential.
Planning

Planning The planning stage is where goals and outcomes are formulated that
directly impact patient care based on EDP guidelines. These patient-
specific goals and the attainment of such assist in ensuring a positive
outcome. Nursing care plans are essential in this phase of goal setting. Care
plans provide a course of direction for personalized care tailored to an
individual's unique needs. Overall condition and comorbid conditions play a
role in the construction of a care plan. Care plans enhance communication,
documentation, reimbursement, and continuity of care across the
healthcare continuum.

Goals should be SMART

Specific
Measurable or Meaningful
Attainable or Action-Oriented
Realistic or Results-Oriented
 Timely or Time-Oriented

Implementation Implementation is the step which involves action or doing and the actual
carrying out of nursing interventions outlined in the plan of care. This phase
requires nursing interventions such as applying a cardiac monitor or
oxygen, direct or indirect care, medication administration, standard
treatment protocols and EDP standards.

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.
Reassessment may frequently be needed depending upon overall patient
condition. The plan of care may be adapted based on new assessment data.

What are the four categories of the patient classification system?

The Patient classification system (PCS), also known as the 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 to determine workload requirements and
staffing needs.

There are different kinds of PCS available, but the three most commonly used are:

Descriptive This is a purely subjective system wherein the nurse selects which category
the patient is best suited to.

Checklist Another subjective system, wherein 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 This is another method where 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.

Among these three, the most commonly used is the descriptive kind of Patient Classification
System. These are subdivided into four classifications namely:
Self-care / The first classification of patients who are recovering normally requires
Minimal Care only diagnostic studies, minimal therapy, less frequent observations, and
daily care for minor conditions and are awaiting elective surgery.

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 The patient needs close attention and complete care all through the shift.
The nurses initiate, supervise, and perform most of the patient's activities.

Intensive care The last category or classification, wherein the patients are acutely ill and a
high level of nurse dependency is required. Intensive therapy and/or
intensive nursing care are 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.

But whatever PCS is used, this will be applied to forecast staffing needs within each
department. Nurses should be informed of the patient care ratios that are relevant to each
department and should understand how to predict the staffing needs.

What are the different modalities of care?

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.

Case Method/Total In the case method, the nurse cares for one patient whom the nurse
Patient Care cares for exclusively. The Case Method evolved into what we now call
private duty nursing. It was the first type of nursing care delivery
system.

In Total Patient Care, the nurse is responsible for the total care of the
patient during the nurse’s working shift. The RN is responsible for
several patients.
Advantag Disadvan
es: tage:

● Co ● It
nsis can
ten be
cy ver
in y
carr cos
yin tly
g
out
the
nur
sin
g
car
e
pla
n
● Pati
ent
nee
ds
are
qui
ckly
me
t as
hig
h
nu
mb
er
of
RN
hou
rs
are
spe
nt
on
the
pati
 ent
● Rel
atio
nsh
ip
bas
ed
on
trus
t is
dev
elo
ped
bet
we
en
the
RN
and
the
pati
ent’
s
fam
ily

Functional Nursing It is a task-oriented method wherein a particular nursing function is

assigned to each staff member. The medication nurse, treatment
nurse and bedside nurse are all products of this system. For
efficiency, nursing was essentially divided into tasks, a model that
proved very beneficial when staffing was poor. The key idea was for
nurses to be assigned to tasks, not to patients.

Advantag Disadvan
es: tages

● A ● Car
ver e of
y pati
effi ent
cie s
nt bec
 wa om
y to e
deli fra
ver gm
car ent
e. ed
● Co and
uld dep
acc ers
om ona
plis lize
ha d
lot ● Pati
of ent
tas s
ks do
in a not
sm hav
all e
am one
oun ide
t of nti
tim fiab
e le
● Staf nur
f se
me ● Ver
mb y
ers nar
do row
onl sco
y pe
wh of
at pra
the ctic
y e
are for
cap RN
abl s
e of ● Lea
doi ds
ng to
● Lea pati
st ent
cos and
 tly nur
as se
few diss
er atis
RN fact
s ion
are
req
uire
d

Team Nursing This is the most commonly used model and is still in use today. It was
developed in the 1950’s in order to somewhat ameliorate the
fragmentation that was inherent in the functional model. The goal of
team nursing is for a team to work democratically. In the ideal team,
an RN is assigned as a Team Leader for a group of patients. The Team
Leader has a core of staff reporting to her, and together they work to
disseminate the care activities. The team member possessing the
skill needed by the individual patient is assigned to that patient, but
the Team Leader still has accountability for all of the care. Team
conferences occur in which the expertise of every staff member is
used to plan the care.

Advantag Disadvan
es tages

● Eac ● Req
h uire
me sa
mb tea
er’s m
cap spir
abil it
itie and
s co
are m
ma mit
xim me
ize nt
d to
so suc
job cee
sati d
 sfac ● RN
tion ma
sho y
uld be
be the
hig Tea
h m
● Pati Lea
ent der
s one
hav day
e and
one a
nur tea
se m
(th me
e mb
Tea er
m the
Lea nex
der t,
) thu
wit s
h con
im tin
me uity
diat of
e pati
acc ent
ess car
to e
oth ma
er y
hea suff
lth er
pro ● Car
vid e is
ers still
fra
gm
ent
ed
wit
h
onl
 y8
or
12
hou
r
acc
oun
tabi
lity

Primary Nursing The hallmark of this modality is that one nurse cares for one group of
patients with a 24-hour accountability for planning their care. In
other words, a Primary Nurse (PN) cares for her primary patients
every time she works and for as long as the patient remains on her
unit. An Associate Nurse cares for the patient in the PN’s absence and
follows the PN’s individualized plan of care. This is a decentralized
delivery model: more responsibility and authority is placed with each
staff nurse.

Advantag Disadvan
es: tage:

● Incr ● Onl
eas y
ed con
sati fine
sfac sa
tion nur
for se’s
pati tale
ent nts
s to a
and limi
nur ted
ses nu
● Mor mb
e er
pro of
fess pati
ion ent
al s,
syst so
 em: oth
RN er
pla pati
ns ent
and s
co can
m not
mu ben
nic efit
ate if
s the
wit RN
h is
all co
hea mp
lthc etiti
are ve
me ● Can
mb be
ers. inti
RN mid
s atin
are g
see for
n RN
as s
mo wh
re o
kno are
wle less
dge skill
abl ed
e and
and kno
res wle
pon dge
sibl abl
e. e
● RN
s
mo
re
sati
sfie
d
 bec
aus
e
the
y
con
tin
ue
to
lear
n
as
as
par
t of
the
in-
dep
th
car
e
the
y
are
req
uire
d to
deli
ver
to
thei
r
pati
ent

Modular Nursing This is a modification of team and primary nursing. It is a

(District Nursing) geographical assignment of patient that encourages continuity of
care by organizing a group of staff to work with a group of patients in
the same locale.

Advantag Disadvan
es tage:

● Use ● Par
apr
 ful ofe
wh ssio
en nal
s
the
do
re tec
are hni
a cal
few asp
Rns ect
● RN s of
nur
s
sin
pla g
n car
thei e
r
car
e

● In Case management, the formal method of nursing care

Nursing Case delivery is being highlighted as a modality of care.
Management ● It focuses on assigning and addressing registered nurses with
various roles such as primary nurse providing clinical care, a
clinical case manager with additional formal functions related
to fiscal personnel and budgeting personnel, as well as
administration/management role.
● It is largely unit based and not organization based and usually
nurses are group based on the Diagnostic Related Group.
● In addition, it also maintains and focuses on the close
interdisciplinary collaboration of the social worker, and reviews
team members throughout the course of care.

Advantag Disadvan
e tages

● ●
inte Not
ract fre
ion que
s at ntly
the use
pati d in
ent’ inp
s atie
con nt
 ven deli
ien ver
ce y
● syst
Allo em
ws the
earl refo
y re
det ma
ecti y
on cau
and se
pre det
ven rim
tion ent
of al
rela effe
ted cts
co in
mpl the
icat syst
ion em
● Allo ● Sin
ws ce
opp it is
ort bas
uni ed
ty on
to a
disc cert
uss ain
wel dia
lne gno
ss stic
and gro
lifes up,
tyle dev
mo elo
difi pm
cati ent
on of
● skill
Pro s
mo ma
te y
val be
ue- limi
bas ted
ed
car
e
■
● can
be
ver
y
cos
t
effe
ctiv
e
and
 sati
sfyi
ng
for
pati
ent
s
wh
o
are
hig
h
risk
/pr
obl
em
pro
ne.

Innovative / ● This form of treatment modality, focuses on interdisciplinarity

Contemporary Method which means research based that involves all fields of science,
constitutes a real challenge in research.
● · It aims to adopt various research approaches such as
theoretical, methodological, normative, empirical-descriptive
studies
● · It is flexible and focuses on scientific problems- solving,
while patient’s needs.

Advantag Disadvan
es tages

● It ● Not
cro fre
sse que
s ntly
the use
bou in
nda em
ries erg
bet enc
we y
en sett
the ing
 nur s
sin
g
fiel
d of
pra
ctic
e
and
soci
al
scie
nce
s, in
an
atte
mp
t to
ide
ntif
y
pro
ble
ms
● ·
It
enh
anc
es
nur
ses’
skill
s
tha
t in
tur
n
ma
kes
the
ma
co
mp
ete
nt
pro
fess
ion
al
● ·
It
 allo
ws
per
son
al
dev
elo
pm
ent
am
ong
indi
vid
ual
tea
m
me
mb
ers
● ·
It
bre
aks
the
ster
eot
ypi
cal
wa
ys
of
thi
nki
ng
in
the
pro
ces
s of
solv
ing
pro
ble
ms
and
anti
cip
atin
g
fut
ure
 eve
nts
are
all
feat
ure
s of
an
aca
de
mic
cult
ure

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nursing-care/

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Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
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