PATTERNS OF

NURSING CARE
DELIVERY IN INDIA
PATTERN OF NURSING CARE
SYSTEM IN INDIA

AT CENTRAL
LEVEL

AT STATE
LEVEL

AT DISTRICT
LEVEL
ORGANIZATION SET UP OF
NURSING AT CENTER LEVEL
ORGANIZATION SET UP OF
NURSING AT STATE LEVEL
 ORGANIZATION SET UP OF
NURSING AT DISTRICT LEVEL
HEALTH CARE SERVICES IN RURAL
AREAS
PRIMARY HEALTH CARE IFRASTRUCTURE

LEVEL POPULATION SIZE FUNCTIONARIES

VILLAGE 1000 HEALTH VOLUNTEERS, ANGANWADI

WORKER, VILLAGE HEALTH GUIDE,
TRADITIONAL BIRTH ATTENDANT, MAHILA
SWASTHYA SANGH,ASHA

SUBCENTER 5000 MULTIPURPOSE HEALTH WORKERS

PHC 30,000 HEALTH PROFESSIONALS

CHC 1,20,000 SPECIALISTS

 VILLAGE HEALTH GUIDE

A person with an aptitude for social service

Not a full time Govt. functionary
Village health guide scheme was introduced on 2nd October 1977.
The scheme was launched in all states except Kerala, Karnataka, Tamil
Nadu, Arunachal Pradesh and Jammu and Kashmir.
VHG are women.
Chosen are chosen by the community in which they work
 ANGANWADI WORKER

Under the ICDS scheme

Undergoes training in various aspects of health, nutrition and child
development for 4 months.
Her services:
 Health check up
 Maintenance of growth chart
 Immunization
 Supplementary nutrition
 Health education
 Non formal pre school education
 Referral services
 ACCREDITED SOCIAL HEALTH ACTIVIST(ASHA)

Works under NRHM

Resident of the village
Women
married/ widow/divorced
Age group of 25-45 years
Formal education up to 8th class
Good communication skill and leadership qualities
TYPES OF PATIENT CARE DELIVERY SYSTEM

1.FUNCTIONAL NURISNG
2.TEAM NURSING
3.PRIMARY NURSING
4.CASE MANAGEMENT NURSING
 1. FUNCTIONAL NURSING

Need to provide care to large number of patients.

Organizing and distributing the tasks, functions or care.
Trained nurses provide care that requires high skill levels and
untrained workers performed less complex tasks.
Goal is efficient management of time, tasks and energy.
 ADVANTAGES

1. Efficient – can complete many tasks in a reasonable time frame.

2. Workers do only tasks they are educate to do and become very
efficient.
3. Promotes organizational skills
4. Promotes worker autonomy.
 DISADVANTAGES

1. Lack of holistic view of patient

2. Lacks continuity
2. TEAM NURSING
 Team nursing is the delivery of nursing care by a designated group of staff
members including both
professional nurses and non-professional staff .

This method of nursing care was introduced in early 1950’s.

Several elements are considered necessary:

 Team leader is the delegated authority to make assignments for team

members and guide the work
of the team.

 The leader is expected to use a democratic or participative style in interactions

with team members.

 The team is responsible for the total care given to an assigned group of
patients or clients.
 Communication among team members is essential to its success.
 In team nursing, a team leader is responsible for coordinating the group of licensed and

unlicensed personnel to provide patient care to a small group of patients.

 The team leader is a highly skilled leader, manager, and practitioner who assigns each member

specific responsibilities according to role, licensure, education, ability, and the complexity of the

care required.

The members of the team report directly to the team leader, who then reports to the charge
Improved patient satisfaction

Cost effectiveness for the agency

Care is less fragmented because of
communication and extensive co-
ordination efforts of team leader

Allows comprehensive, holistic nursing care

when the team function best.

Good interpersonal relationships

among staffs and with the patients

Satisfaction to the patient and the nurses

Disadvantages:-
Continuity of care is not given
Changing team membership makes it
difficult for the team leader to assign
the patient.

Team nursing requires a great deal of

co-operation communication from all
staff members

Thelarge number of people attending

the same is causing some discomfort to
the patient.
3. PRIMARY NURSING
Primary nursing is a method for organizing patient care delivery in which
one RN functions autonomously as the patient’s primary nurse throughout
the hospital stay.

In this nursing care delivery system, each registered nurse is assigned to

the care of group of patient for which she plans complete 24 hrs. care and
writes the nursing care plan.

the primary nurse communicates with other members of health care

team regarding the patient.
Promotes continuity of care
 The primary nurse cares for her patients every time she works for as long
as the patient stay on her unit. (ideally from admission to discharge).
 When she is not there, an associate nurse who will follow the primary
nurse’s care plan is assigned to the care of primary nurse’s patient.
 The primary nurse is intensively involved with the patients.
 Licensed practical nurses function as associate nurse sand are supervised
by the head nurse.
Model of primary nursing:-
Advantages: -

 Satisfaction for both patients and nurses

 The relationship between nurses and patient is intimate

 Autonomy for the nurses

 Nurse is the person who is planning and providing complete care

 She communicates with all other health team members involved in client care

 Other health team members including physician tend to view her more knowledgeable
and responsible
 Patient receives quality and continuity of care

 Reduces the number of errors than can result from a relay of orders

 Increased satisfaction both to patients and nurses

 Nurse can identify patient outcome as a result of their work

Demerits: -
 Nurse may be isolated from colleagues

 Nurses talent to a limited number of patients

 Nursing care plan can be changed only with the permission of

primary nurse

 Creates separation anxiety in patients when nurse

 Nurses should be well educated and trained in all area of patient
care, most of the time which may lack
4. CASE MANAGEMENT
Most recent evolution in nursing care delivery system.
It is a collaborative process which assesses, plans,
implements, coordinates, monitors and evaluate options and
services to meet an individual’s health and needs through
communication and available resources to promote quality
and cost effective outcomes.
ASSESSOR PLANNER

NURSE CASE
MANAGER

ADVOCATE FACILITATOR
 Role of nurse case manager:-

 Delivers client focused and outcome oriented care

 Cost effective care through integration of clinical services in
combination with financial services

 Serves as an advocate for patient and family

 More patient and nurse satisfaction is achieved through

intensive care

 They attend to a specific high risk population

Advantages:-

Patient receives high standard care

Nurse is highly qualified and skilled in the particular area,

More satisfaction to the patient

Increased professional standards can be developed by the nurses

Disadvantages:-

Sometimes discomfort to clients

Continuity care is difficult

Long time nurse patient relationships are difficult to arrange

Costly

Time consuming

No proper attachment between nurses and patients

THANK YOU