Nursing Leadership and

Management
II. Patient Care Delivery System
 Course Outcome/Learning Outcome
Course Outcome
1. Provide safe, appropriate and holistic care to individuals, families, population groups and community
utilizing the nursing process .
Learning Outcomes:
1. Assess with the client (individual, family, population groups and communities), one’s health
status/comprehensively
2. Formulate with the client a plan of care to address the health conditions, needs problems, and issues
based on priorities
3. Implement safe and quality interventions with the client to address the health needs problems and
issues
4. Provide health education using selected planning models to targeted clientele.
5. Evaluate with the client the health status/competence and/or expected outcomes of nurse-client
working relationship
6. Institute appropriate corrective actions to prevent or minimize harm arising from adverse effects
7. Integrate relevant principles of social, physical, natural
Chapter Topics Outline

01 Patient Care Delivery

System 03
Evidence-Based
Practice in Nursing
• Nursing Practice Standards
(PPNPS)Patient Care Safety
Standards
• Standards of Nursing
Practice
02 Model of Patient Care
 Patient Care Delivery
System

● Models of patient care delivery used to describe

different approaches to nursing and patient
treatment
● Also known as “Nursing models and care delivery
system
● An informative guide that provides detail about the
well-known patient care delivery systems, offering
insight into how they ensure ideal patient outcome.
 Models of Patient Care
Total Patient Modular Innovative/
Contemporary
Care/Case Method Nursing Method

Functional Primary Nursing

Team Nursing Nursing Method
 Total Patient care/Case
Method

● Is an intensive form of care delivery, which is

sometimes described as “case nursing”
● One of the oldest models of patient care delivery
and it involves nurses overseeing almost every
aspect of patient care

● Example: : Private duty nursing, methods where in

to one patient for the total delivery of care
 Functional Nursing

● Approach that has been used for several decades.

● Staff member are assigned to a specific tasks for patients.
Example: Medication Nurse, IV Nurse, Vital Sign Nurse
● The approach, aim to work as a team to carry out individual
elements of the treatment plan, rather than enhancing overall
health and well-being.

● Example: one nurse may only administer medications while another nurse
admits and discharges patients..
Characteristics
1. A functional method is a technical approach of nursing
care.
2. The available staff in the unit, for a particular period of
time, are assigned selected functions of nursing practice
such as vital signs, treatments, medications.
3. All the responsibilities are assigned in accordance with
the expertise.
4. The only person who has responsibility of the client is
the head nurse or nurse acting the role
 Team Nursing
● Established in the 1950’s
● Similar to the functional model, but it operate on a larger
scale
● Senior nurse takes charge of delegating tasks throughout
the group.; RN’s cares for most serious ill patients; Aides
assist ambulatory patients with bathing and grooming;
Team leader usually administers medication and monitors
parenteral fluid therapy.

● Example: unit I came utilizes one CN, one RN, and one to work as
a team to care for a group of 9-12 patients
 Primary Nursing
● Model favors a more holistic patient throughout
hospital stay
● A more comprehensive model which can improve
continuity of care and foster stronger relationships
between patients and the care team.
● This model facilitates a better work-life balance for
care providers, but it doesn’t always fit well with the
primary care delivery.

● Example: a nurse’s role is to assess health care needs, and plan,

structure, and evaluate that care while the patient is at the unit
 Modular Nursing

● Similar to team nursing, patient care unit is

divided into geographic modules with an RN as
team leader
● The same team of caregivers is regularly
assigned to the modules. The team will include
RN’s and will also include LPN’s and nursing
assistants.

● Example: the same RN assigned to same

modules.
 Innovative/
Contemporary Method

● New medical technologies are used for

patient care and in the health care system.
● Technologies can be easier and more
efficient for doctors, nurses who manages a
larger patient load
● Technologies: Automatic IV pumps; portable
monitor; smart beds, wearable devices,
electronic health records
● Centralize command center
● Telehealth and Apps
 Patient Classification
System

• A scheme that group patient

according to the amount and
completely of their nursing care
requirements.
 Patient Care
● The services rendered by members of the health
profession and non-professionals under their
supervision for the benefit of the patient.
● The prevention, treatment and management of
illness and the preservation of mental and physical
well-being through the services offered by the
medical and allied health professions.
Purposes of Patient Classification
.
1. Determine the required nursing hours needed to provide
safe and efficient patient care based on standards of
care and practice
2. Determine the number and category of staff (skill mix)
needed for providing quality of patient care.
3. Provide data on each patient care unite that directs and
support staffing in decision making
Purposes of Patient Classification
.
4. Assess level and support services required.
5. Enhance staff satisfaction through stress free work
environment
6. Categorize patients according their needs and the time
and skill needed to satisfy each
7. category needs.
8. 7. Determine work load and nursing care requirements.
9. 8. Recognize time for nursing care needed
Patient Classification
Self-care/Minimal
Maximum Care
care

Moderate Care Intensive Care

 Self Care/Minimal Care

● Recovering patient who requires

only diagnostic studies, minimal
therapy, less frequent observation,
and daily care for minor conditions
and are awaiting elective surgery.
 Moderate Care

● 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

● Patient needs close attention and

compete care all through the
shift.
● The nurse initiate, supervise and
perform most of the patient’s
activities
 Intensive care

● Patients are acutely ill and high level of

nurse dependency is required.
● Unstable patient condition.
● Requires frequent evaluation, observation,
monitoring and adjustment of therapy is
also required.
● Patients are in critical conditions or in life
and death situations.
Factors Influencing The Quality of Patient Care

• The total number of patient to be nursed

• The degree of illness of patients (physical
dependency)
• Type of service: medical, surgical, maternity,
pediatrics and psychiatric.
• The total needs of the patients
• Methods of nursing care
Factors Influencing The Quality of Patient Care

• Number of nursing aids and other non professional

available, the amount and quality of supervision available.
• The amount, type and location of equipment and supplies
• The acuteness of the service and the rate of turnover in
patients according to the degree or period of illness.
• The experience of the nurses who are to give the patient
care.
Factors Influencing The Quality of Patient Care

• Methods of performing nursing procedures

• Affiliation of the hospital with the medical
school
• Methods of assignment-individual, team or
functional method
• The standards of nursing care.
Factors Influencing The Quality of Patient Care

• The experience of the nurses who are to give the patient

care.
• The number of non-nurses who involve in the patient
care, the quality of their work, their stability in service.
• The physical facilities
• The number of hours in the working week of nurses and
other ward personnel and the flexibility in hours
A picture is worth
a thousand words
Course Outcome/Learning Outcome
Course Outcome
1. Apply guidelines and principles of evidence- based practice in the nursing,
management.
Learning Outcomes:
• Provide appropriate evidence-based nursing care using a participatory
approach-based variety of theories and standard relevant to health and
healing, research, clinical practice, client preferences and client and staff
safely customer care standards
Chapter Topic Outline
Evidence-Based
03 Practice in Nursing
• National Nursing Care
Competency Standards (NNCCS)
• Nursing Practice Standards
(PPNPS)Patient Care Safety
Standards
• Standards of Nursing Practice
 The National Nursing
Care Competency
Standard
The Philippines' Professional Regulation
Commission (2014) developed the National
Nursing Core Competency Standards. This
breakthrough paves the way to the
development of three competency standards
among beginning nurse: on client care, on
management and leadership, and on research.
Purpose of Professional Standards
• To direct and maintain safe and clinically
competent nursing practice
Why National Nursing Care Competency Standard was
promulgated?

Because of….

• Escalating complexity of globalization, dynamics of

information technology, demographics changes, health care
reforms and increasing demands for quality nursing care
from consumers, expectations for contemporary nursing
practice.
History of the NNCCS Promulgation
• Board of Nursing Resolution No. 112 Series of 2005 was adopted and
promulgated the Care Competency Standards of Nursing Practice in
the Philippines was amended

• As mandated, the Board of Nursing, ensured, through

a monitoring an evaluation scheme, that the core
competency standards are implemented and utilized
effectively in nursing education, in the development of
test questions for the Nurse Licensure Examination
(NLE) and in nursing service as basis for orientation,
training and performance appraisal.
• Through years of implementation, global and local development
and nursing developments prompted
History of the NNCCS Promulgation
• Through years of implementation, global and local development
and nursing developments prompted BON to conduct revisitation of
the Core Competency Standards of Nursing Practice in the
Philippines.
• In 2009, the BON created a Task Force on Nursing Core Competencies
Revisiting Projects in collaboration with the Commission of Higher
Education Technical Committee on Nursing Education with the
primary goal of “Determining the relevance of the current nursing
core competencies to expected roles of the nurse and to its current
and future work setting
History of the NNCCS Promulgation
•Process of revisiting the core competencies includes:
•Work setting scenarios analysis

•Benchmarking with nursing core competencies of other

countries
•Validation studies of roles and responsibilities

•Integrative review of outputs from validation strategies,

presentations of validation analysis and core competency
standards of nursing practice in the Philippines
•January 2012, Public hearing on the revised and modified core

competency standards on nursing practice was conducted in

Cities of Manila, Cebu, Davao, and Baguio
History of the NNCCS Promulgation
•January 2012, Public hearing on the revised and modified core
competency standards on nursing practice was conducted in
Cities of Manila, Cebu, Davao, and Baguio.
•May 2012, last phase refinement of the revised and modified core

competency standards was done.

 Legal Bases
Article III, section 9 (c) of Republic Act No. 9173 or the Philippine
Nursing Act of 2002, states that the Professional Regulatory
Board of Nursing is empowered to “monitor and enforce quality
standards of nursing practice in the Philippines and exercise the
powers necessary to ensure the maintenance of efficient, ethical
and technical, moral and professional standards in the practice
of nursing taking into account the health needs of the nation.” It
is, therefore, incumbent upon the Board of nursing to take the
lead in the improvement and effective implementation of the
core competency standards of nursing practice in the
Philippines to ensure safe and quality nursing care, and
maintain integrity of the nursing profession.
Key Phases in the Process of Revisiting the Core Competency Standards
Phase I – Work setting scenario analysis
Phase II – Validation studies of roles and responsibilities/ Benchmarking Of core
competencies with other
Phase III- Integrative review of outputs from the validation strategies.
Phase IV- Consensual Validation of Core Competency Standards
Phase V – Conduct of Public hearing
Phase VI – Promulgation of the Revised and Modified Core Competency Standards
Phase VII- Printing of the Revised and Modified core competency Standards (2012
NNCCS)
Phase VIII- Training in the implementation of the 2012 National Nursing Core
Competency Standards
Phase IX - Implementation of the 2012 National Nursing Core Competency Standards
Phase X – Evaluation of the effectiveness of the 2012 National Nursing Core
Competency Standards
Significance of the 2012 National Nursing Core Competency Standards
The 2012 National Nursing Core Competency Standards (2012
NNCCS) will serve as a guide for the development of the
following:

• Basic Nursing Education Program in the Philippines through the

Commission on Higher Education (CHED).

• Competency-based Test Framework as the basis for the

development of course syllabi and test questions for “entry level”
nursing practice in the Philippine Nurse Licensure Examination.
 Significance of the 2012 National Nursing Core Competency Standards

The 2012 National Nursing Core Competency Standards (2012

NNCCS) will serve as a guide for the development of the
following:

• Standards of Professional Nursing Practice in various settings in

the Philippines.

• National Career Progression Program (NCPP) for nursing practice

in the Philippines.

• Any or related evaluation tools in various practice settings in the

Philippines
2012 National Nursing Core Competency
Standards
1. Beginning Nurses Roles on Client care
2. Beginning Nurses Role on Management and Leadership
3. Beginning Nurses Role on Research
Beginning Nurses Roles on Client care
Responsibility 1: Practices in accordance with legal principles and the code of
ethics in making personal and professional judgment.

Responsibility 2: Utilizes the nursing process in the interdisciplinary care of

clients that empowers the clients and promotes safe quality
care.

Responsibility 3: Maintains complete and up to date recording and reporting

system.

Responsibility 4: Establishes collaborative relationship with colleagues and other

members of the team to enhance nursing and other health
care services.

Responsibility 5: Promotes professional and personal growth and development.

Beginning Nurses Role on Management and Leadership

Responsibility 1: Demonstrates management and leadership

skills to provide safe and quality care.
Responsibility 2: Demonstrates accountability for safe nursing
practice.
Responsibility 3: Demonstrates management and leadership
skills to deliver health programs and services
effectively to specific client groups in the
community settings
Responsibility 4: Manages a community/village based health
facility/component of a health program or a
nursing service.
Responsibility 5: Demonstrates ability to lead and supervise
nursing support staff.
Responsibility 6: Utilizes appropriate mechanisms for networking, linkage
building and referrals.
BEGINNING NURSE’S ROLE ON RESEARCH
Responsibility 1: Engages in nursing or health related
research with or under the
Supervision of an experienced
researcher.
Responsibility 2: Evaluates research study/report
utilizing guidelines in the conduct of a
written research critique.
Responsibility 3: Applies the research process in
improving client care in partnership
with a quality improvement /quality
assurance/nursing audit team.
Philippine Professional
Nursing Practice
Standards (PPNPS)
Promulgation of the Philippine
Professional Nursing Practice Standards
Article III, Sec. 4 (h) of the Republic Act No. 7164 or the
“Philippine Nursing Act of 1991 provides the powers, duties
and functions of the PRBON which include the power to
promulgate decisions or adopt measures as may
necessary to ensure quality standards of nursing practice
in the Philippines and exercise the power necessary to
ensure the maintenance of efficient, ethical and
professional standrads in the practice of nursing into
account the health of the nation
Patient Care safety
Standards
Standard of Nursing
Practice
A picture is
worth a
thousand
words
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