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 Patient Care In case method, the nurse cares for one patient whom the nurse 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 nurses working shift. The RN is responsible for several patients. Advantages:

Consistency in carrying out the nursing care plan Patient needs are quickly met as high number of RN hours are spent on the patient Relationship based on trust is developed between the RN and the patients family

Disadvantage:

It can be very costly

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. 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 RNs are required

Disadvantages:

Care of patients become fragmented and depersonalized Patients do not have one identifiable nurse Very narrow scope of practice for RNs Leads to patient and nurse dissatisfaction

Team Nursing This is the most commonly used model and is still in use today. It was developed in the 1950s 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. Advantages:

Each members capabilities are maximized so job satisfaction should be high Patients have one nurse (the Team Leader) with immediate access to other health providers

Disadvantages:

Requires a team spirit and commitment to succeed RN may be the 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 hour accountability

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 PNs absence and follows the PNs individualized plan of care. This is a decentralized delivery model: more responsibility and authority is placed with each staff nurse. Advantages:

Increased satisfaction for patients and nurses More professional system: RN plans and communicates with all healthcare members. RNs are seen as more knowledgeable and responsible. RNs more satisfied because they continue to learn as as part of the in-depth care they are required to deliver to their patient

Disadvantage:

Only confines a nurses talents to a limited number of patients, so other patients cannot benefit if the RN is competitive Can be intimidating for RNs who are less skilled and knowledgeable

Modular Nursing (District Nursing) This is a modification of team and primary nursing. It is a 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 a few Rns RNs plan their care Disadvantage:

Paraprofessionals do technical aspects of nursing care