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Nursing Professional Practice Model, Domain III - Care Delivery System

Domain III is the Care Delivery System.  The Care Delivery System  is a “system for the provision of care that delineates the nurse’s authority and accountability for clinical decision-making and outcomes” (ANCC). Integrated throughout the Nursing Professional Practice Model, it is adapted to regulatory considerations and describes the context of care, the manner in which care is delivered, skill set required, and expected outcomes of care. Being a professional nurse also means more than doing tasks. We need to differentiate between performing tasks and practicing nursing. As nurses, we place patients in the best position to heal.

The Green color symbolizes safety, growth, hope, harmony, and healing. 

The three components in the Care Delivery System Domain promote continuous, consistent, efficient, and accountable nursing care: 1) Nursing Practice, 2) Information Systems, and 3) Quality Management.

Nursing Practice
Nursing practice is what we do every day we come to work – what every direct care nurse will probably relate to the most. This component involves clinical decision making, how work is allocated, how we communicate with patients and other professionals, and how we manage our nursing care. Our nursing practice is evidence-based and patient-centered. 

Information Management
Information Systems include the management and decision support processes integrated within the electronic health record (EHR). It is basically what we do every day--which is chart in Epic. These clinical documentation applications provide the information base and structure for nurses to deliver evidence-based and patient-centered care, as well as communicate with others on the healthcare team.

These processes enhance nursing care delivery by:

  • Providing reference material at the point-of-service through the Nursing Reference Center Plus (NRC+) to access clinical evidence for making practice decisions.
  • Using evidenced-based care plans and patient education materials in Epic and NRC.
  • Using best practice alerts as a decision support tool at the point-of-care service and documentation.

Quality  Management

  • Evidence-based practice standards congruent with professional and regulatory requirements
  • Planning and operations oversight of quality management functions
  • Evaluation of outcomes associated with nursing practice--called "nurse sensitive" metrics, such as:
    • National Database for Nursing Quality Indicators (NDNQI) (falls, infections – CAUTI, CLABSI, HAPI)
    • CMS Core Measures (Foley removal, immunizations, breastfeeding
    • Patient satisfaction
    • RN satisfaction
  • Validation of effectiveness of care delivery systems and nurse practice patterns
  • Recommendations for quality or process improvement related to patient care on unit. Remember, this is clinical inquiry, which feeds right back into establishing evidenced-based standards. 

At Harris Health, we practice the PDCA model for improvement, which is a cycle of high-quality care: 1) develop standards, 2) put them into practice, 3) evaluate outcomes and benchmarks, and 4) validate performance and/or make plans for improvement. If improvement is not demonstrated, the cycle starts again.