Modalities of Nursing Care

By: Lhizle Amor E. LASIN

Introduction:

To ensure that nursing care is provided to patients, that work must be organized. The Modalities of Care organizes the work of caring for the patient . It 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. Over the history of nursing, there

have been many modalities of nursing care which is used, based on the needs of the patients, and the availability of competent staff in the different skill levels. The Modalities of Nursing Care utilized is often determined by the nurse leader and applied across an organization. Managers have the responsible to implement models and evaluate the outcomes in their area. Staff have the responsibility to engage in the implementation and evaluation process. Each modalities has strengths and weaknesses that should be

considered when deciding whichimplement.

Objectives:

General Objective:

Within 45 minutes of lecture, the BSN 4N students will be able to identify the Modalities of Care that would help them to enhance their knowledge, skills and attitude.

Specific Objective:

a.) present the Modalities of Nursing Care;b.) identify the advantages and disadvantages

of each Modalities of Nursing Care;c.) discuss the importance of Modalities of

Nursing Care;d.) encourage students to ask questions; ande.) evaluate students by asking questions.

**CASE METHOD

-the nurse cares for one patient whom the nurses care for exclusively. It evolved into what we now call private duty nursing. It was the first type of nursing care delivery system.

Case Method Structure

Charge Nurse

Nursing Staff Nursing Staff Nursing Staff

PatientsPatients

Patients

Advantages:

Consistency in carrying out the nursing care plan

Patient’s needs are quickly met as high number of nurse hours are spent on the patient.

Relationship based on trust is developed between the nurse and the patient’s family

The nurse has more opportunity to observe and monitor progress of the patient.

Disadvantages:

It can be very costlyMay be that the nurse may not have the same

patients from day to day and therefore looks at the patient on a shift-by-shift basis rather than on a continuum of care.

Utilize a high level of nurse’s nursing hours to deliver care.

** 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.

- The key idea was for nurses to assigned to tasks, not to patients.

Functional Nurse Organization Structure

Charge Nurse

RN MedicationNurse

RN TreatmentNurse

Nursing AssistanceHygienic Care Clerical/

Housekeeping

PATIENTS

Advantages:

A very efficient way to delivery care.Could accomplish a lot of tasks in a

small amount of time.Staff members do only what they are

capable of doing.Least costly as fewer nurses are

required.

Can be delivered to a large number of patients

Utilizes other types of health care workers when there is a shortage of nurses.

Disadvantages:

Care of patients become fragmented and depersonalized

Patients do not have one identifiable nurse

Very narrow scope of practice for nurses

Leads to patient and nurse dissatisfaction.

**TEAM NURSING

- It is the most commonly used model.- Is a care delivery model that assigns

staff to teams that then are responsible for a group of patients.

- The goal is for a team to work democratically.

Team Nursing Organization Structure

Charge Nurse

Team Leader Team Leader

Team Leader

Nursing StaffNursing Staff

Nursing Staff

Patients PatientsPatients

Advantages:

Each member’s capabilities are maximized so job satisfaction should be high.

Patients have one nurse (Team leader) with immediate access to other health providers.

Disadvantages:

Nurse may be a team leader one day and a team member the next, thus continuity of patient care may suffer.

Care is still fragmented with only 8 or 12 hours accountability.

**PRIMARY NURSING

- The hallmark of this modality is that one nurse cares for one group of patients with a 24-hours accountability for planning their care

- It is clearly delineates the responsibility and accountability of the nurse and designates the nurse as the primary provider of care to patients.

Primary Nursing Structure

Physician Charge Nurse

Health CareOrganizations

Resources

Primary Nurse

Patient

Associate Nurse(evening)

Associate Nurse(nights)

Associate Nurse(as needed)

(days)

Primary Nursing Model

Staff RN Staff RN Staff RN Staff RN

16 Patients

Advantages:

Patients and families are able to develop a trusting relationship with the nurse.

There is defined accountability and responsibility for the nurse to develop a plan of care with patient and family.

Holistic approach to careIncreased satisfaction for patients

and nursesMore professionals systemNurses more satisfied

Disadvantages:

High costOnly confines a nurse’s talents to a

limited number of patientsCan be intimidating for nurses who

are less skilled and knowledgeable

**MODULAR NURSING

- this is a modification of team and primary nursing. It is 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.

Advantages:

Useful when there are few nursesNurses plan their care

Disadvantages:

Paraprofessionals to technical aspects of nursing care.

**Nursing Case Management- Is another work design proposed to meet

patient needs.

- Is a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality, cost effective outcomes.

Care Managers

- handle each case individually, identifying the most cost-effective providers, treatments and care settings for insured individuals.

- In planning patient care, they do critical pathways and multidisciplinary action plans.

Multidisciplinary action plan is a combination of a critical pathway and a nursing care plan.

- Indicates times when nursing interventions should occur.

Cycle Time Reduction involves reviewing an existing process that provides a product or service; determining where there is wasted time or effort; and developing an improved, streamlined way to achieve the same results more efficiently.

Acute-care case management

- Integrates utilization and discharge planning functions and may be unit based, assigned by patient, diseased based, or primary nurse case managed.

Advantages:

Additional work efficiency Benefit of establishing solid working

relationships with the nursing and ancillary staff working on the unit

Summary:

The Modalities of Nursing Carea. Case Methodb. Primary Nursingc. Functional Nursingd. Modular Nursinge. Team Nursingf. Modified Method

The End………..