7 Integrated Management of Care Practice

Managing care as a connected process

Integrated management of care means coordinating safe, timely care while respecting each client’s goals, rights, and choices. Decisions about priority, delegation, consent, and teamwork are connected: a time-saving assignment is not appropriate if it delays urgent assessment or bypasses the client’s informed decision.

A practical sequence is to identify immediate risks, protect client rights, confirm informed consent, delegate only appropriate tasks, coordinate and close the loop, then document and reassess. New information can change priorities, so this sequence requires ongoing attention rather than a one-time decision.

Prioritize by acuity and risk

Address threats to life or safety first, followed by urgent changes in condition, time-sensitive treatments, and routine needs. Reassess when new information arrives because priorities can change.

In the practice scenario, one client reports new chest pressure and shortness of breath. Promptly assess this client and initiate appropriate escalation; this potential acute change takes priority over routine assistance to another client.

Prioritizing urgency does not remove the need to protect the other clients’ rights or maintain continuity of care. The team must respond to the immediate safety risk while continuing to address consent, appropriate delegation, and a pending discharge handoff.

Protect client rights and confirm consent

Communicate respectfully, protect privacy, and include the client in decisions. A client with decision-making capacity may accept or refuse recommended care. Explore concerns, provide understandable information, and avoid coercion.

Informed consent is a communication process, not merely a signed form. The appropriate clinician explains the proposed intervention, its purpose, material risks and benefits, and alternatives—including no treatment—and checks that the decision is voluntary and understood. Follow applicable law and facility policy.

If the client has unanswered questions, appears unsure, or withdraws consent, pause and contact the responsible clinician before proceeding. In the scenario, the client scheduled for a procedure says they do not understand its risks. Do not treat the client’s signature as a substitute for understanding: pause the procedure process, clarify the questions, and contact the clinician responsible for explaining the procedure. Respect the client’s decision, including refusal.

Delegate tasks with appropriate oversight

Apply the five rights of delegation: right task, circumstance, person, directions and communication, and supervision and evaluation. Consider the client’s stability, the delegatee’s demonstrated competence, available supervision, state law, and facility policy.

The licensed nurse retains responsibility for the delegation decision and follow-up. Do not delegate nursing judgment or an assessment that requires a licensed clinician.

In the scenario, routine bathroom assistance may be delegated only if policy permits it, the assignment is appropriate to the client’s condition, and a competent person receives clear instructions about what to report. The nurse remains responsible for follow-up.

Coordinate communication and handoffs

Share relevant updates with appropriate team members, clarify who is responsible for each next step, and confirm that messages and handoffs are understood. A structured handoff should cover the client’s condition, recent changes, response to treatment, pending tasks, and contingency plans.

Responsibility is not fully transferred until the receiving caregiver acknowledges and accepts it. In the scenario, the client is ready for discharge, but the receiving home-care service has not confirmed the handoff. Confirm the discharge plan, communicate essential information, identify outstanding needs and contingencies, and verify that the receiver has accepted responsibility before treating the transition as complete.

Document, reassess, and follow through

Record assessments, client preferences and decisions, notifications, delegated tasks, responses, and handoff details according to policy. Reassess outcomes and adjust the plan as needed.

Documenting decisions and following through support safe, timely care and continuity. The overall approach combines prioritization by acuity and risk, respect for informed choices—including refusal of treatment—appropriate delegation with clear directions and supervision, and timely communication with acknowledged handoffs.