Neuron Fundamentals of Nursing-I. For [Link].
in Nursing (BASIC)
CHAPTER –5
Nursing Care Delivery Within Health
Care System
SL No. Topic Name Page Number.
01 Nursing care delivery within health care system 112
02 Mode of nursing care delivery 114
03 Type of care facilities within health care delivery system 117
Nursing Care Delivery within Health Care System 111
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
Q. Describe the Nursing Care Delivery within Health Care System in
Bangladesh. (DU-Jan 19, 18, 17)
Q. State the concepts of nursing care delivery within the health care delivery
system. (RU-12)
Answer:
Nursing Care Delivery within the Health Care System in Bangladesh
In Bangladesh, nursing care is an essential component of the healthcare delivery system. It is
organized into three levels: primary, secondary, and tertiary, in line with the country's overall
healthcare structure. The nursing workforce plays a crucial role in achieving national health
goals, particularly in maternal and child health, communicable disease control, and health
education.
Primary Level of Care
Delivered through Community Clinics (CCs), Union Health & Family Welfare Centers
(UHFWCs), and Upazila Health Complexes (UHCs).
Focuses on preventive and promotive care, basic treatment, and referral to higher levels.
Nursing Roles:
Family Welfare Visitors (FWVs)
Sub-Assistant Community Medical Officers (SACMOs)
Community Health Care Providers (CHCPs)
Public Health Nurses (PHNs)
Nursing Responsibilities:
Immunization programs (EPI)
Antenatal and postnatal care
Family planning services
Nutrition education and counseling
School health programs
Basic treatment and referrals
Secondary Level of Care
Provided in District Hospitals and Upazila Health Complexes.
Involves inpatient and outpatient services, basic surgeries, and specialized consultations.
Nursing Roles:
Registered Nurses (RNs)
Midwives
Specialized Nurses (e.g., pediatric, surgical)
Nursing Responsibilities:
Administering medications and IV therapy
Monitoring patient health and maintaining records
Pre- and post-operative care
Nursing Care Delivery within Health Care System 112
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
Assisting in deliveries and obstetric emergencies
Supporting physicians in clinical assessments
Tertiary Level of Care
Provided in Medical College Hospitals, Specialized Institutes (e.g., NICVD, BMU), and
Tertiary Hospitals.
Delivers advanced, specialized services and acts as a referral hub for complicated cases.
Nursing Roles:
Critical Care Nurses (ICU, NICU, CCU)
Operating Room (OR) Nurses
Oncology Nurses
Nurse Educators and Supervisors
Nursing Responsibilities:
Managing complex health conditions and equipment (e.g., ventilators)
Emergency and trauma care
Dialysis, chemotherapy, and other advanced procedures
Intensive monitoring and patient support
Training and mentoring junior nurses
Q. Write down the challenges and Recent Developments and Initiatives in nursing
care delivery in Bangladesh.
Answer:
Challenges in Nursing Care Delivery in Bangladesh:
Shortage of skilled nurses (nurse-to-patient ratio is low)
Uneven distribution between rural and urban areas
Limited scope for advanced practice and career development
Inadequate infrastructure and resources in remote areas
Gender imbalance and low public perception of the profession
Recent Developments and Initiatives:
Establishment of the Bangladesh Nursing and Midwifery Council (BNMC)
Introduction of Bachelor of Science in Nursing (BScN) and Diploma in Nursing and
Midwifery
Upgrading training institutes to colleges
Emphasis on midwifery-led care to reduce maternal mortality
Collaboration with WHO and development partners for capacity building
Nursing Care Delivery within Health Care System 113
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
Q. What are the patterns of nursing care delivery within health care system?
Q. Mention the mode of nursing care delivery within health care system.
Mode of Nursing Care Delivery within Health Care System:
There are 5 (five) patterns of nursing care delivery within health care system. These are:
1. Functional nursing.
2. Team nursing.
3. Total patient care.
4. Primary care nursing.
5. Nursing/Case management.
Functional nursing divides the nursing work into nursing units that are
then assigned to one of the team members. In this method, each has
specific duty of tasks, they are responsible for. For example, one is
assigned to give all the medication, another performs all the treatments
and another works at the desk transcribing physician's order and
Functional Nursing: communicating with other nursing departments about patient care
issues.
This pattern is been used less often becomes its focus tends to be more
on completing the task rather than caring for individual patients.
Team nursing is a care delivery model that assigns nurses to teams that
then are responsible for a group of patient. Team nursing is organized
and directed by a nurse called the team leader. The team leader and
supervisors, co-ordinates all the care provided by those on his
team. The team is most commonly made up of various level of nursing
staff and personnel.
Team Nursing: All team members report the outcomes of their care to the team leader,
the outcomes of their care to the team leader. The team leader is
responsible for evaluating whether the goals of patient care are met. .
Conferences are important part of team nursing. They may cover a
variety of subjects but are planned with certain goals in mind, such as
determining the best approaches to each patient's health problems,
increasing the team member’s knowledge and promoting a cooperative
spirit among nursing personnel.
Total patient care is a system of comprehensive patient care that
considers the physical, emotional, social, economical and spiritual of an
Total patient care
individual. The nurse is responsible for the total care for the patient
assignment for the shift she/he is working.
Nursing Care Delivery within Health Care System 114
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
Primary Nursing is the care delivery system that best supports
professional nursing practice. The focus is on the nurse-patient
Primary Care
relationship, strengthens accountability for care, and facilitates patient
Nursing:
and family involvement in the planning of care. Our care delivery
system allows the Primary Nurse to establish a therapeutic relationship
with each patient and family. High quality nursing care that is
individualized to a particular patient and administered compassionately,
competently, and with continuity is achieved through Primary Nursing.
Nursing/Case management is a strategy to improve patient care and
reduce hospital cost through co-ordination of care. A nurse/case
manager is responsible for co-coordinating care and establishing goals
Nursing/Case from preadmission through discharge. In this model a nurse is assigned
Management: to a specific high risk patient, such as cardiac surgery patients.
The case manager has the responsibility to work with all disciplines to
work with all disciplines to facilitate care. The advantage is that it
ensures the higher quality compared to other models.
The disadvantage is that it requires enough nurse time allocated for this
activity
Q. What do you mean by total patient care? Mention the advantages and
disadvantages of total patient care? (SUST-12)
Total Patient Care:
Total patient care is a system of comprehensive patient care that considers the
physical, emotional, social, economical and spiritual of an individual. The nurse is responsible
for the total care for the patient assignment for the shift she/he is working.
▪ Total patient care is the consistency of one individual caring for
patients for an entire shift.
Advantage of Total ▪ This enables the patient, nurse and family to develop a
Patient Care relationship based on trust.
▪ This model provides a higher number of nurse hours of care
than other models.
▪ The nurse has more opportunity to observe and monitor progress
of the patient.
▪ It disadvantage may be that the nurse may not have the same
Disadvantage of Total patients from day to day and therefore looks at the patient on a
Patient Care shift by shift basis rather than on a continuum of care.
▪ The model utilizes a high level of nurse hours to deliver care,
Nursing Care Delivery within Health Care System 115
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
and this level of nurse intensity is not warranted.
▪ It is more costly than any others.
Q. What do you mean by primary care nursing?
Answer:
Primary Care Nursing:
Primary nursing is a care delivery model that clearly describes the responsibility and
accountability of the registered nurse and designates her as the primary provider of care to
patients. It consists of four elements. These are -
a) Allocation and acceptance of individual responsibility for the decision making to one
individual.
b) Assignment of daily care by the case method.
c) Direct person to person communication.
d) One person is operationally responsible for the quality of care administered to patient on
a unit for care 24 hours a day, 7days a week. It is a method of providing comprehensive,
individualized and consistent care.
The nurse has accountability and responsibility to develop a plan of care with the patient and
family. There is a holistic approach to care, which facilitates continuity of care rather a shift to
shift focus.
Disadvantages include a high cost, a requirement of knowledgeable nurses to ensure the
appropriate matching of nurse to patient etc.
Q. What do you mean by nursing management?
Q. What do you mean by case management?
Answer:
Nursing/Case Management:
Nursing/Case management is a strategy to improve patient care and reduce hospital cost through
co-ordination of care. A nurse/case manager is responsible for co-coordinating care and
establishing goals from preadmission through discharge. In this model a nurse is assigned to a
specific high risk patient, such as cardiac surgery patients.
The case manager has the responsibility to work with all disciplines to work with all disciplines to
facilitate care. The advantage is that it ensures the higher quality compared to other models.
The disadvantage is that it requires enough nurse time allocated for this activity.
Nursing Care Delivery within Health Care System 116
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
Health Care Delivery System
Health care delivery system or healthcare system is the organization of people, institutions, and
resources that deliver health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories
and organizational structures as there are nations. Implicitly, nations must design and develop
health systems in accordance with their needs and resources, although common elements in
virtually all health systems are primary healthcare and public health measures. In some countries,
health system planning is distributed among market participants. In others, there is a concerted
effort among governments, trade unions, charities, religious organizations, or other coordinated
bodies to deliver planned health care services targeted to the populations they serve. However,
health care planning has been described as often evolutionary rather than revolutionary.
(Ref by- [Link])
Q. What are the types of care facilities within health care delivery system?
(SUST-11, 12)
Answer:
Type of Care Facilities within Health Care Delivery System:
There are mainly six types of health care facilities within the health care delivery system, this
include-
1. Acute care
2. Sub-acute care
3. Chronic care
4. Rehabilitation care
5. Ambulatory care (Outpatient care)
6. Home health care.
Q. Explain the different types of care facilities within the health care system.
(DU Aug.13 14/CU 16)
Q. Briefly describe the different types of care facilities within the health care
system.
Q. Explain the nature of different types of care facilities. (DU 09, SUST 11)
Care Facilities within Health Care Delivery System:
A. Acute care: Acute care is a branch of secondary health care where a patient receives active
but short-term treatment for a severe injury or episode of illness, an urgent medical
condition, or during recovery from surgery. In medical terms, care for acute health
conditions is the opposite from chronic care, or longer term care.
Nursing Care Delivery within Health Care System 117
Neuron Fundamentals of Nursing-I. For [Link]. in Nursing (BASIC)
It is provided in patient settings, such as in hospital, clinic, emergency room, health center.
Acute care involves the care of patient in acute condition e.g. acute appendicitis, acute
abdomen, perforation, high temperature, severe bleeding.
B. Sub-Acute care: Sub acute care is a level of care needed by a patient who does not require
hospital acute care, but who requires more intensive skilled nursing care than is provided to
the majority of patients in a skilled nursing facility.
It is also provided in patient settings. When the acute condition moderately subsides is called
sub-acute condition.
C. Chronic care: Facilities is described the institutions such as nursing homes, convalescent
homes, some residential institution, whose primary purpose is to care for people with
chronic illness and physical impairment. The chronic care is focus on who do not need
hospitalization, ‘but who are unable to care for themselves.
D. Rehabilitation care:
The aim of rehabilitation is-
a) Restore individuals to their forms level of functioning.
b) To maintain or maximized remaining function.
Rehabilitation is carried out in all health care settings by a variety of health care
professionals with the active involvement.
E. Ambulatory care: Most ambulatory care centers have diagnostic and treatment facilities
providing medical, nursing, laboratory and radiological services. Some ambulatory care
centers provide services to people who require minor surgical procedures that can be
performed outside the hospital. After surgery, the client returns home, often the same day.
They permit the client to live at home while obtaining necessary health care, and they free
costly hospital beds for seriously ill clients.
F. Home health care: Home care derived to persons at home who are recovering from illness,
are desirable or chronically or terminally ill and need various services to progress, maintain
function services to manage health care needs at home care involves the team of
multidisciplinary professional including-
a) Social worker: Social worker counsels clients and support persons regarding social
problems, such as finances, marital difficulties and adoption of children. Finding a
more suitable living arrangement can be the responsibility of the social worker.
b) Physical therapist: Physical therapists treat movement dysfunctions by means of
heat, water, exercise, massage and electric current. The physical therapist function
includes assessing client mobility and strength, providing therapeutic measures.
Some physical therapists provide their services in hospitals.
c) Occupational therapist: Occupational therapist might teach a man with serve
arthritis in his arms and hands how to adjust his kitchen utensils so that he can
continue to cook. The occupational therapist teaches skills that are therapeutic and at
the same time provide some fulfillment. Also exercises the arthritic man's arms and
hands.
Nursing Care Delivery within Health Care System 118