Nursing Foundations · Health care delivery system

Health Care Delivery System

Preventiondefinition

Measures taken at different stages of disease to stop it starting, catch it early, or limit its damage.

in simple words: Stop it, spot it, soften it.

Levels of prevention

Primordial

Prevents risk factors arising at all — societal policy and community measures

Primary

Prevents initial occurrence in at-risk persons — specific protective measures

Secondary

Early detection and treatment to halt progress — screening is the hallmark

Tertiary

Manages established long-term disease — rehabilitation, vocational training, preventing relapse

Spot the level

Primary – Calcium and vitamin D supplements in a geriatric patient to reduce osteoporosis risk
Secondary – Screening asymptomatic persons; crisis stabilisation in mental illness; screening for high blood pressure
Tertiary – Rehabilitation to return the patient to highest possible functioning

Health Care Delivery System · Nursing Foundations

Levels of Care

Three tiers

Primary health care is the first point of contact with the health system, not a referral level. Secondary care is the first referral level, linking primary and tertiary care. Tertiary care is the highest level of specialized and super-specialized care, to which patients are referred from secondary care.

Levels of care in India

Level	Facility	Key point
Primary	Sub-Centres (SCs), Primary Health Centres (PHCs)	First point of contact; initiates referrals
Secondary	Community Health Centres (CHCs), district hospitals	First Referral Units (FRUs); specialist doctors
Tertiary	Medical colleges, national research hospitals	Super-specialized, highly complex care

Health Care Delivery System · Nursing Foundations

Hospitals & Agencies

Hospitaldefinition

A health care agency providing inpatient care — beds and admission are its defining feature.

in simple words: Beds mean admission; a clinic has none.

Polyclinic – Outpatient only

Consultations across many specialties
Defining staff member is the doctor
Treated and go home the same day

ICU / CCU – Intensive / Coronary Care Unit

Severe or life-threatening conditions
Constant monitoring, advanced support
CCU is for heart conditions, not ICU

Hospice / extended care

Care continued beyond acute hospitalisation
Rehabilitation centres restore function

Health care agencies

Where care is given

Hospital records

Admission sheet – Completed on first entry — demographics, reason for admission, allergies, baseline assessment
Nurse's notes – Ongoing chronological shift-by-shift record of status and care given
Discharge summary – Consolidated end-of-stay document — condition, progress, prognosis, rehabilitation and teaching needs; main link to post-discharge care

Health Care Delivery System · Nursing Foundations

Nursing Care Models

Care delivery modeldefinition

The way nursing staff and responsibilities are organised to give care to a group of patients.

in simple words: Who does what, for whom, and for how long.

Models at a glance

Model	Key feature	Accountability
Primary nursing High yield	One RN, 24-hour accountability from admission to discharge; associate nurses cover off duty	24 hours
Functional nursing High yield	Task-oriented; different nurses do specific tasks for all patients	Fragmented care
Team nursing High yield	Group of staff led by an RN team leader shares a group of patients	Team leader
Modular nursing High yield	Team assigned to a geographic area/module; RN leads, delegates tasks	RN within module
Case method (total patient care)	One nurse gives all care for a shift only	Shift only

Also know

Case management – Coordinates services and resources across settings — cost and quality, not bedside continuity
Progressive patient care – Organises care by acuity — intensive, intermediate, self-care units
Float nursing – A staffing strategy, not a care delivery model

Health Care Delivery System · Nursing Foundations

Health Care Team

Who does what

The Staff Nurse (Nursing Officer) is the primary caregiver giving direct hands-on bedside care — medications, vital signs, treatments, comfort and safety. The senior nurse of the unit holds immediate responsibility for patient care and supervises trainee procedures. The charge nurse supervises a shift, managing staffing and patient flow.

Other members

Nursing Superintendent – High-level administration — staffing, budgeting, policy; not direct patient care
Nursing Tutor – Educator for students; no primary patient care responsibility
Dietician – Allied health professional; therapeutic diet plans; not nursing personnel
Pharmacist – Medication management, dispensing, consultation; not bedside nursing
Intern nurse – Invasive procedures like NG tube insertion only under direct supervision of a qualified senior nurse