The document discusses the management of nursing services in hospitals and communities, focusing on patient classification systems (PCS) and various methods of nursing care. It outlines objectives like the importance of PCS, the types of patient assignment methods including case, functional, team, continuous, and primary nursing care, as well as the roles and responsibilities of nurses and nurse managers. The document emphasizes the need for quality care, appropriate patient grouping based on complexity, and effective team coordination in nursing practices.

1. MANAGEMENT OF NURSING SERVICES
IN HOSPITAL AND COMMUNITY-
PATIENT / POPULATION ASSESSMENT
AND NURSING
CARE RESPONSIBILITIES
KULDEEP VYAS
ASST.PROF HOD –
COMMUNITY HEALTH NURSING
DSSNI

2. Intro-
The client classification system or patient classification
system is the cluster of clients that has been categorized on
the specific characteristics, needs ,requirements and their
severity of the disease conditions based on which patient
assignment is made to provide nursing care.
Objectives-
1.explain the importance e of PCS for the nursing
management.
2.Identify the key characteristics of PCS
3.Differentiate the PCS
4.Explain about the care descriptors
5.Descride diagnosis related groups-DRGs

3. Purpose-
*For grouping the patients according to the amount and
complexity of their nursing care requirements
*Assess the patients condition and group the patients with similar
condition
T
ypes of PCS:-
1.Factor evaluation system-
*the descriptors used to measure a patients dependency are
activities of daily living like feeding, grooming, toileting, comfort
measures and mobility .
2.Prototype evaluation system-
*this is considered subjective and the needs of the patient is
grouped into categories
Cat 1-patient with acute illness
Cat 2-patients with chronic illness restored with antibiotics
Cat 3-patients with chronic illness restored with rehabilitation
therapies

4. Cat 4-patients with terminal illness
Cat 5-patient with end stage of illness.
3.Diagnostics related groups-
*here the patients are classified into groups of payment
system or the price they afford for the nursing care and
hospital facilities
PATIENT ASSIGNMENT AND NURSING CARE RESPONSIBILITIES
The nurse in-charge of the ward is the key person who
coordinates and supports the activities of all groups. During
emergencies, the physician often asks the nursing officer to
carry out certain therapeutic measures for which he alone is
responsible. Similarly, in the absence of a dietician and a
medico social worker the nurse may take an both these
duties

5. The major functions and activities of nurses are
1.Nurses handle the patients who require good or sustain the
optimum physical and psychological health
2. Nurses give emergency care.
3.Nurses carry out the immediate orders and are supervised by
the physician
4. Nurses perform the administrative function.
Different methods of nursing care
1.Case M ethod of Patient Assignment
Case method is not a recent method. It is the oldest mode of
assigning the patient where the nurse assigned to the patent takes
up the complete charge so as to meet all his her requirements
and the doctor's orders for a specific period of time, which is
called the shit duty, which can be day shift, intermediate shit,
night shift or only day and night shift. This shift duty will include
the comprehensive treatments, such as meeting the basic hygienic
care, and nutritional, elimination, psychological, spiritual and
safety needs, and administration of the drugs as ordered.

6. Definition of Case Method
Case method of patient assignment is defined as assigning the
nurses to do the complete assessment of the patent sneeds
based on the assessment, the patient's actual and potential
problems are identified, holistic nursing care interventions are
planned based on solving the problems identified and
implementing the interventions, and the care given is
evaluated.
Nurse as a Case Manager
1.quality patient-oriented and goal output-oriented care
2. cost-benifit, collaborative and team-oriented care.
3. Maintains good interpersonal relationship.
4.The patient will be assigned to the nurse right from
admission based on the specialty and qualification of the
nurse. For example, a case manager with MSc (N) in OBG will be assigned to handle
pregnant women, labour duties and postnatal care; those with MS (N) pediatrics will take
care of children.

7. 5.Provides care until the patient gets discharged or
transferred to another ward.
6.Applies standard method to provide care such as critical
care path, multidisciplinary action planned method, etc.
7.lakes up the responsibility in monitoring the progress of
the patient's condition until the desired outcome is seen in
the patent s condition.
8.Provides care working in a team, thereby reducing the
hospital stay of the patient.
9.Eradiates illness, reduces complications, restores health by
providing coordinated care reducing the expenditure and
readmission.

8. 2.Functional M ethod of Patient Assignment
This method of nursing care started during the World War IL,
since there were great demands for the nurses. Qualified nurses
were not easily available; therefore, unskilled and under
qualified personnel were trained to carry out the procedures
such as checking blood pressure, administering medications,
changing the linen and meeting the hygienic care of the patients.
These health personnel were not qualified as the nurses in the
case method.
Definition of Functional Method
This method of nursing care involves staff members who are
trained and licensed to carry out only limited or specific
procedures tor the large numbers of patients in the ward at a
stretch in order to complete the day's task.
Approach Used in Functional Method
The nurses allotted in this method will do the delegated jobs
such as checking vitals, administering l drugs, making the beds,
cleaning the unit, etc.

9. 3.T
eam Nursing or M odular Nursing
It is defined as inter collaborative nursing wherein the
professional and non-professional nurses work together to
provide complete care to the patient. The team nursing
was first formed by Elea. i nor Lambertson from Columbia,
New York, in the year 1950.
Definition of T
eam Nursing
1. Team nursing is defined as the philosophy where both
the professional and non-professional nurses work together
to assess, plan, diagnosis, implement and evaluate the
nursing care given to the patients. 2. Team nursing involves
combined comprehensive care given to the patient to meet
the complete nursing care.

10. Approach Used in T
eam Nursing
The basic idea behind the team nursing is to provide
quality care to the patients. Auxiliary nurses are directed by
the professional nurse, and the head nurse who is the
registered nurse will be the leader of the team. Under her
leadership, all the nurses work. The work is delegated as
per their skill and efficiency and after completing the task
the nurses have to report the care.
The head nurse has to plan the entire care for the
individual before delegating the care to the nurses. The
head nurse has to collect the complete details of the
patients, and based on the skill and efficiency, the head
nurse has to categorize the care, taking into account the
needs and workload.

11. 4.Continuous Patient Care
This method has five different categorization of nursing care.
First category will be for intensive care unit. Second category
will be for post intensive care unit. Third category will be for
regular care unit or general nursing care unit. Fourth category
will be for convalescent unit or recovery unit and the fifth
category will be for the self-care unit. Based on the severity of
the disease condition, the patient's health conditions are
appraised and then the patient is admitted. As the patient
reaches the self-care unit, the best care is given by the staff.
5. Primary Nursing Care Method
This system of nursing was prevalent during the initial
period of nursing care in the year 1970. It applies the few
concepts of case method. This method has a primary nurse who,
from admission till discharge, is held responsible.
Under this primary nurse functioning as head, several
registered nurses work to provide the nursing care. This primary
nurse plans the nursing care plan and implements nursing care
with the help of the nurses under her leadership. The primary
nurse should be available on call all the time.

12. Approach Used in Primary Nursing Care
The nurse has to complete care right from the admission till
the patient gets discharged. The i primary nurse has to plan
the complete care for the patient for 24 h. The primary
nurse i plans the nursing process for the patient and staff
nurses under her follow her instructions. It the primary
nurse is not present, then in her absence, nothing can be
changed in the nursing care
Roles and Functions of Nurse Manager
1.Appraises regularly about the plan of nursing care given
to the patient.
2.Checks about adequate resources available to make any
important changes in the nursing
3.Evaluates the work of each and every nurse under her
control and helps the staff under crisis care. with the
nursing care.

13. 4.Uses committees to facilitate group goals, not to
delay decision.
5.Teaches group members how to develop group
thinking.
6. Inspires the workgroup towards a team effort.
7.Organizes work activities to attain
organizational goals.
8.Organizes group activities in a manner that
facilities coordination within and between
departments.