Patient

classification
System
Definition

A patient classification system is

a method for grouping patients
according to the amount and
complexity of their nursing care
requirements.

It is a system developed to
objectively determine workload
requirement, staffing needs and
Objectives

Patient classification, staffing, scheduling and

strategies used in the delivery of pa tient care
should all be sensitive to cost containment,
length of hospitalization and improvement of
patient care. They should do the following:

1. Explain the importance of the PCS for nursing

management.
2. Identify the key characteristics of a PCS.
3. Differentiate between the types of PCS.
4. Enumerate the care descriptors commonly
Importance of patient classification
system

PCS provides a method of quantitatively

estimating and assessing patient needs
in relation to nursing care. It is a way of
determining the amount and type of
care a patient requires as well as
providing a means of standardizing
nursing care practice
Types of patient classification system

1. Factor evaluation system: Patient needs are

scored on multiple care descriptors.

2. Prototype evaluation system: Describes

typical patient and varying need levels.

3. DRGs: Grouping patients for prospective

payment.
Factor evaluation system

Most health care agencies use PCS, where several

care elements or descriptors are identified, each
element being divided into subelements with a
standard time being determined for
accomplishing each subelement.

The descriptors used to measure a patient's

dependency needs are activities of daily living:
feeding, grooming, toileting, comport measures
and mobility. The re- quirement to assist a patient
with each activity is quantified from the least
Common care descriptors

Hygiene, nutrition, medications, fluid

management, skin and wound care, respiratory
care, circulatory care, elimination, mobility, special
diagnostic and treatment proce- dures, health
teaching and daily activities of living. After the care
descriptors have been selected, the levels of care
are defined for

each descriptor. The level is differentiated by the

amount of nursing time and fre- quency of each
care measure
Prototype evaluation system

This is considered subjective and

uses broad descriptive categories
to describe the patient needs.
Characteristics are listed for a
typical patient in each of the
categories.

Category I: Patients with acute illness

wherein the disease has affected the body.
They need immediate treatment so that
their health can be restored quickly in short
Category II: Patients with illness in the chronic
stage. The treatment is given to
reduce the complication and prevent the
duration of chronic illness. The health of the
patient can be restored back if appropriate
antibiotic treatment is given al the right time by
the right physician.
Category III: Patients with long duration of chronic
illness. The patient needs to live life with disability
caused by the disease. Therefore, the patient needs
the right type of rehabilitation to restore the
maximum functioning level so as to meet the daily
needs with his/her disability.

Category IV: Patients with illness wherein the

disease has reached the terminal stage and the
patient cannot be cared for in the house and needs
special health centre's assistance to survive without
any complications.
Category V: Patient with end stage
of illness. However, the most effective
PCS is one that is specifically tailored
to the clinical situation where it will be
used.
Diagnosis-related groups (DRGs)

This is a prospective payment system. It

has a predetermined price for patient
hospital care for Medicare recipients according to
the patient's placement in 1 of 467 DRGS. The DRG
system is a strategy for grouping patients according to
demographic, diagnostic and therapeutic
characteristics that correlate with their use of hospital
facilities. Under this prospective payment system,
hospitals are paid a fixed price for all inpatients,
according to the DRGs into which the patients are
classified at time of discharge from the hospital.
If the hospital cost for the patient care is less
than the fixed rate, the hospital gets a profit.
If the cost exceeds the fixed rate, the hospital
is at a loss. The DRG system provides
incentives for early hospital discharge but the
quality of care is affected.
Patient assignment and nursing care
responsibilities
Given below are the different methods of
nursing care-
Case method of patient assignment
Case method is not a recent method. It is the
oldest mode of assigning the patient wherein
the nurse assigned to the patient 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 shift
duty, which can be day shift, intermediate shift,
night shift or only day and night shift.
Definition of case method

Case method of patient assignment

is defined as assigning the nurses to
do the complete assessment of the
patient's needs. Based on the assessment, the
patient's actual and po- tential 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. If needed, referrals are
made to other health centres for further
treatment.
Approach used in case method

This is the method wherein the nurses can

function independently providing satis fied
care to the patients assigned. This method is
used in the intensive care unit and intensive
coronary care unit successively. Nursing
students also learn the in-depth nursing care
by applying this method of patient assignment. In
this method, the particular nurse has the
responsibility to complete the nursing care that has
to be provided in her shift. Based on the shift, the
care given to the patient varies. For example,
morning shift includes oral hygiene, bathing etc.
Nurse as a case manager

1. Provides quality patient-oriented and goal

output-oriented care.

2. Provides cost-benefit, collaborative and

team-oriented care.

3. Maintains good interpersonal relationship

with the patient and gets cooperation from the
patient in providing nursing care.

4. The patient will be assigned to 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 MSc (N) paediatrics will take care
of children.
Advantages of case method

1. This is an ideal method to provide

nursing care by the case manager.
2. It concentrates only on the patient care not on
other areas that benefit the patient's health
prognosis.
3. It allows the nurse to function independently,
requiring excellent problem-
solving skills and in-depth patient care knowledge.
4. This method of care helps the patient to have
less period of stay in the hospital, experience
interdisciplinary care and get quality nursing care.
Disadvantages of case method
1. Requires adequate training and skill, and
updated knowledge.
2. Requires long-term planning and
evaluation of care that has to be as per the
hospital policies.
3. This method has to be changed if non-
professional nurses are included.
Functional method of patient assignment
This method of nursing care started during the
World War II, since there were great demands for
the nurses. Qualified nurses were not easily
available; therefore, unskilled and underqualified
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 for the
large numbers of patients in
the ward at a stretch in
Approach used in functional method
The nurses allotted in this method will do the
delegated jobs such as checking vitals,
administering drugs, making the beds and
cleaning the unit. Specific procedures are chosen
by the head in charge and delegated to the
functional nurses based on their skills, judged by
the head nurse. The head nurse has to check
whether the nursing care procedures on the
patient have been completed.
Advantages of functional method

1. Needs only specific or less supplies

to do the procedure.
2. Helps to complete the procedures in time.
3. Specific skills in the nurses improved and
identified.
4. Easy coordination of the work.
5. Based on the personal skill preference, the task
can be done.
6. Good output on the nursing care possible.
7. Less expense involved in this type of task and
nursing care can be done in an efficient manner
Disadvantages of functional method

1. Monotonous work as with the same

task all the time, staff will get bored.
2. Head in charge responsible for any
problems in the ward.
3. There is no time, place and space for the staff
development programmes.
4. With many nurses working out the care, the
patient will have confusion on whom to trust.
5. Complete component of the nursing process
cannot be implemented.
6.Difficult to carry out the priorities and needs of
Team nursing or modular nursing

It is defined as intercollaborative
nursing wherein the professional and
nonprofes- sional nurses work together
to provide complete care to the
patient. The team nursing was first formed
by Eleanor Lambertson from Columbia, New York, in
the year 1950. This kind of nursing care was formed
with the objective of avoiding the fragmented care
and providing complete quality nursing care.
Definition of team nursing

1. Team nursing is defined as the

philosophy where both the
professional and nonprofessional
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
Approach used in team 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
Advantages of team nursing

1. Each and every team member has the

opportunity to experience the different
aspects of care.
2. There will be diversity in daily
assignment of nursing care.
3. There is more of client-oriented care,
accountability and responsibility.
4. Cost-effective nursing care
5. Client satisfaction is more.
6. Client is able to develop trust and faith in the nurse
Disadvantages of team nursing

1. Each and every member of the health

team needs to focus on the patient care.
2. Completely individualized decisions
are not possible with regard to the
nursing.
3. The continuous care will not be possible if the team
members are changed.
4. Nursing will be difficult to manage if there is
frequent staff turnover.
5. This method takes up more time, needs more staff,
Continuous patient care

This method has five different

categorizations of nursing care. First
category will be for intensive care
unit. Second category will be for
postintensive care unit. Third
category will be for regular care unit
or general nursing care unit. Fourth
category will be for convalescent unit
Definitions of continuous
patient care

1. According to Faye Abdellah, the progressive

or the continuous patient care is defined as
systemically organizing, planning and
implementing medical and nursing care in the
patient care units as per the stages or the
severity of the disease condition.
Major objectives

1. Providing high quality of therapeutic

comprehensive care for each patient to

meet his immediate needs

2. Providing adequate equipment and facilities,

professionals and trained personnel at a lower
cost than traditionally required

3. Providing difficult level a meet patient needs

of medical and nursing care in the various units
Advantages of progressive patient care

1. Independence is fostered where

indicated; patients are moved towards
self-care.

2. Efficient use and placement of

equipment are possible.

3. Personnel have more chance of

functioning towards their best capacity.
5. Use of expertise and nursing skills is
maximized because of various staffing
patterns of each unit.

6. Efficient use is made of equipment and

personnel.
Disadvantages of progressive patient care

1. There may be discomfort to the patients

who are mourned.

2. Continuity of care is difficult.

3. Long-term nurse-patient relationship is

difficult.

4. Heavy emphasis is placed on

comprehensively written care plans.
5. Meeting administrative needs of the
organization staffing are very difficult.

6. There is low morale if the patient has to go

back from intermediate ward to ICU.
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.
Approach used in primary nursing care
The nurse has to complete care right from the
admission till the patient gets dis- charged. The
primary nurse has to plan the complete care for the
patient for 24h. The primary nurse plans the nursing
process for the patient and staff nurses under her
follow her instructions. If the primary nurse is not
present, then in her absence, nothing can be
changed in the nursing care plan. What has been
planned by the primary nurse should be
implemented by the staff nurses under her.
All fragmented care is given. There will be confusion
in the team members if the primary nurse did not
explain the plan of nursing care to the doctors, nurses
and other members involved in the team. The
capability and the competency of the primary nurse
are challenged in provid- ing primary nursing care.
Since she plans the nursing care, it is possible to
provide quality care and she evaluates the
implementation of the nursing care. It gives her job
satisfaction and she also gets feedback from the
patients to improve the nursing care.
Advantages of primary nursing care

1. The individual nurse competency is revealed

and the talent is appreciated.

2. The nursing reflects the creativity and

innovative techniques of the nurse in
providing care.

3. This type of nursing gives nurses job

satisfaction and the patients also show
satisfaction about the nursing care given.
Disadvantages of primary nursing care

1. This type of nursing requires adequately qualified

and competent nurses.

2. Group planning or discussion of patient care is not

possible.

3. The nurse should be independently allowed to

plan the nursing care.

4. Hospital policies should accept the concept of

primary nursing.