SEMINAR

PROGRESSIVE PATIENT CARE

Submitted by Submitted to
Mrs Gayathri R Mrs Jessil
1st year MSc Nursing Lecturer
Upasana College Of Upasana College Of
Nursing Kollam Nursing Kollam

Submitted on 09/11/18

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INDEX
SL CONTENT PAGE NO:
NO:
1 INTRODUCTION 3

2 CONTENT 3-16

 Definition
 Objectives
 Elements
-Intensive Care
-Intermediate Care
-Self Care
-Long Term Care or Extended Care
-Home Care
-Ambulatory Care
 Principles of PPC

3 CONCLUSION 16

4 BIBLIOGRAPHY 16

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INTRODUCTION
Nursing is a service to the individual, family and therefore to society. If this
theory has to be individualised to meet the individual needs of the patient,
progressive patient care is more appropriate. In 1957, under the sponsorship of
the US public health services division of hospital and medical facilities, the
extensory memorial hospital began a project known as “Progressive Patient
Care”, to determine methodology, for classifying patient based on as evaluation
of many factors, to make a determination of the best kind of unit to which the
patient should be assigned. The concept of Progressive Patient Care personifies
the goal of health care delivery; the night services, for the right patient at the
right time.
DEFINITION
 The organization of facilities, services and staff around the medical and
nursing needs of the patient.
- [Abdulla]
 Progressive Patient Care is tailoring of hospital services to meet the
patient needs. The right patient in patient in right bed with the right
services at the right time.
- [Manual Of Intensive Care]
 Progressive Patient Care is defined as the right patient in right bed with
right services at the right time.
- [Haldeman JC 1964]
 Progressive Patient Care is the systematic grouping of patients according
to their degree of illness and dependency on the nurse rather than
classification of disease and sex. It is a method of planning the hospital
facilities both staff and equipment’s to meet individual requirements of
patients.
- [Raven RW 1960]
OBJECTIVES

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  Provide optimum level of care to the patient as per need in a minimum
cost.
 To raise the patient care of critically ill patient with effective use of nursing
personnel and facilities by grouping patients as per the nursing care they
need.
 To control the cost with provision of care as needed by each.
 Provided high quality of therapeutic comprehensive care for each patients
to meet his immediate needs.
 To provide adequate equipment’s and facilities, professional and trained
personnel at a lower cost than traditional.
 To provide difficult level of medical and nursing care in the various units
to meet the patient needs.
 Shorten the average length of patients hospitalizing period.
 To provide effective hospital services under the supervision of efficient
manager.
 Initiate suitable hospital admission procedures so that patient can be
assigned to appropriate units.
 To provide community service in and outside hospital in an organised way
as per family and patient needs.
ELEMENTS OF PPC
 Intensive Care
 Intermediate Care
 Self Care
 Long Term Care
 Home Care
 Ambulatory Care
INTENSIVE CARE
An intensive care unit is one in which patients who are critically or seriously ill
are segregated in order that they may get the required amount of highly skilled
nursing and medical care with the emphasis on constant attention and
observation. Examples of patients in this category would be major surgical cases
following their stay in the recovery room after operation, haemorrhage cases
with shock and so forth. Such a unit is fully staffed on a 24hr basis by people who
have been trained to handle such critical and emergency conditions. Work in
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this area would be decrease conditions of pressure. This is an important factor
to consider from staffing view point. Obviously this is going to be the area of
high costs and high charges.
 Location : it should have a easy reach from operation theatre, OPD,
emergency department.
 Size : 2-8% of total hospital beds.
 Physical facilities: -
- Area : There should be at least 150sq ft for each bed.
- Air conditioning : 60-700 f
- Humidity : 50-60% of humidity.
- Ventilation : Positive pressure ICU should be maintained to prevent
contaminated air from passage into unit. Avoid exhaust fan creating
negative pressure.
- Lights : The patient should be uniformly lit. There should be provision
for light below level of bed to check drainage bottle, water seal etc.
 Piped supply :
- Piped oxygen with outlet of each bed supplying 20 litres per minute
and at a pressure of 60 pounds per sq ft.
- Piped vaccum : Central suction with two outlet with manometer of
each bed is necessary and extraction at 40 litres per minute. The
vacuum in pipeline is 50 mmhg.
 Communication : A call bell is attached to nursing station to doctors room.
There should be at least two telephones. One for internal and other for
external call facilities.
 Electrical facility :
- 4-5 plug points arrangements for each bed and a special socket of
amperes, 230 volts, single phase for the portable radiographic
equipment’s should be provided.
- All outlets and lights should be connected to the emergency power
system.
- There should be provisions for stand by generator for ICU.
 Patient area :
- Ample visibility of all patients from the nurses desk.
- One or two isolation rooms should be attached to unit.
- Each bed should be separated by partitions or curtains.

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  Ancillary area : It include nurses station, medicine, cabinet, medication
preparation room, doctors charting area, consultation office.
 Sanitary area : There should be a soiled holding or dirty utility room; a
toilet. The water closet should be equipped with bed pan and flushing
attachments for cleaning bed pans and for disposing of fluids. Also a sink
in counter will take care of the minor utility function of this room. The
major utility functions should be carried out in the major utility room.
 Auxillary area : It includes a nurses room, relatives waiting room, doctors
resting room, small laboratory.
 Equipments : There is a long list of articles needed in ICU. Some examples
of articles are the following:
- Monitoring equipment such as cardiac monitor, pulse oxymeter, ECG
machine, USG, 2D echo machines.
- Therapeutic equipment such as ventilator, nebulizer, laryngoscope,
bronchoscope, defibrillator, endoscope.
- Instruments such as tracheostomy set, venisection set, pacemaker
attachment set, IV set.
 Staffing :
- There should be medical staff for 24hr and at least one medical officer
per shift. The medical officer in charge of ICU is usually an anaesthetist
for generalised ICU and respective specialist for specialised ICU.
- One nursing sister in charge of ICU is recommended. The nurse patient
ratio is 1:1 (no reference to shift).
- The technical staff like physiotherapist, ECG technician, electrician,
biomedical engineering and lab technician.
Management
Admission and Discharge criteria:
Defined objective criteria should be laid down for admission and discharge of
patient based on patients condition; degree of illness, nursing and medical
needs. As a general rule patient who need continuous observation and
monitoring of vitals and total support of the physiologic system should be
admitted to ICU. Usually the terminally ill, contagious disease patient, post
operative thoracic cases with active tuberculosis, violent patients are not
admitted to ICU, each admission is done with the consent of the medical officer

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in charge of ICU. If required patients can be directly admitted to ICU. A separate
admission and discharge register is maintained in ICU for record and study
utilization in ICU.
 Bed utilization: 75-80%, leaving the rest for unseen emergencies.
 All treatment and medication should be written.
 Special observation chart for patient is maintained.
 Visitors restriction.
 One person is allowed at a time.
 Duration of visit should be short.
 Proper information system for the visitors.
 Discharge summary should be made by the attending physician prior to
discharge of patient from ICU.
 Dietary services.
 Training for each staff.
Problems

 To determine the size of hospital to where this can be implemented.

 To determine the size of ICU.
 Its difficult to decide location.
 Its difficult to staff the unit adequately.
 Problems regarding admission and transfer of patients from ICU.
 Political and outside interferences.
 Lack of team building.
 It post psychological stress on the relations and at times on the patients.

INTERMEDIATE CARE
This unit is where the patients requirements are not of the nature of the
intensive care unit, but still require attention and care by people other than
themselves. We can consider this type of unit as looking after patients with
ordinary illness or routine post-operative recoveries, such as a simple
pneumonia, uncomplicated appendicectomy or hernia etc. In this level the
patient who requires moderate amount of nursing care. The patients are
conscious and can be able to express their need. Constant observation of the
patient not needed here. The vital signs of the patient are stable.

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Facilities
 30-35 beds.
 Few single bedrooms, few double bed rooms and rest 4-6 bed rooms.
 The unit requires more toilet and bathrooms.
 Ancillary area include nurses station, store room, treatment room.
 It also include supportive areas such as clinical teaching rooms, side
laboratory, doctors room, nurses changing room, attenders room.
Staffing
Nurse patient ratio
General ward: 1:6
Special ward: 1:2

SELFCARE UNITS/CONVALASCENT CARE

Ambulatory patients who are convalescing or require diagnosis or therapy may
be cared for in a self care unit. This patients are like physically self sufficient
requiring least nursing care and observation. Orem’s defines self care as “that
practice of activities that individual personally initiate and perform on their own
behalf in maintaining life health and wellbeing”. It’s the persons continuous
contribution to his own health. Health maintenance, disease prevention and
patient participation in health care services are the major roles for the self care.
Eg: Pre surgery patients or patient prepare to discharge.
Management
 Patients are allowed a home type environment.
 No restriction to visitors.
 They are permitted to go outside.

Physical facilities
The self care unit should be located convenient to diagnostic facilities, the dining
room or cafeteria and to the main hospital entrance. As these patients demands
maximum privacy single bedrooms with toilet preferred. Since an ambulant
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patient is likely to spend less time in his room than a bed patient the room can
be of minimal size with a small desk and chair, desk lamp, an easy chair and a
bedside small table.
The nurses station can be of minimal size with glazed partitions to permit easy
supervision of the adjoining area. An office with attached toilet should be
provided for the head nurse. An examination cum treatment room should be
provided. There should be a demonstration room where patients can be taught
self treatment. Provision for social recreation facilities for the patient on the self
care unit is important. Self care unit promotes parents self esteem. Emotional
support to the patient is important.
Staffing
One trained nurse with two auxillary nurses in each shift for an average size of
30 beds.
LONGTERM CARE
The require skils and services not available at the home. The patients like
convalescent patient from ICU, post operative cases with infection, patient with
poor progress but requires skilled palliative treatment such as cancer cases,
occupational therapy, physiotherapy are included in this topic. Thorough
nursing care is mandatory.
Physical facilities
 Optimum size for the long term care unit may be 35-40 beds.
 The unit may be located any where in the hospital.
 Patients room should be large enough to permit patients to move freely
on wheel chairs, crutches, canes, walkers.
 Two bedrooms are recommended, 4 bed rooms also be used. A few single
bedroom should be provided.
 The required minimum area per each bed in multiple bedroom is 100sq ft
and for a single bedroom 125sq ft.
 There should be 4-5ft space left in between the adjacent wall and the bed
should be maintained. The space between two ends of beds should be of
minimum 5ft.

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  Provision of toilets adjacent to each patients room is recommended for
the convenience of both patients and staff. Day room and dining space is
recommended to encourage early ambulation.
 Many patients under proper treatment and nursing care will recover
sufficiently and others will benefit by learning to; live with their disability
so that life of them can be much more satisfactory and pleasant.
Ancillary facilities
Clean work room, soiled holding room, treatment room, nurses station,
stretcher and wheel chair storage store.
Staffing
Nursing care and procedure in the long term care unit centre around the theory
that activity rather than the rest will provide the means of helping the patient
to recover the nurse must determine how much activity is required and the
proper time to introduce the activity in the daily schedule.
Nurse patient ratio
Morning 1:3
Evening 1:4
Night 1:6
Services
- Physiotherapist
- Occupational therapist for rehabilitation
- Nurses aid
- Medical social worker
HOME CARE
The organized home care programme is one in which provides coordinates
medical and related services to selected patients at home through a formally
structured group comprising at least a family physician, a public health nurse
and a social service worker assisted by clerical service. In 1960, first national
workshop on home care took place in US. They defined coordinated home care
programmes as “centrally administered through coordinated planning,

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evaluation and follow up procedures provides for physician directed, medical
social nursing and related services to selected patients at home”.
Common home care services include home medical equipment’s, personal care
services, new born care, oncology programme, pediatric home care etc.
Community health care workers are responsible for providing home care. In
present days many hospitals extended their services to local people through
home care services.
AMBULATORY CARE/OPD CARE
OPD is one of the first point contact between hospital and patient. This is a very
important wing of hospital serving as a mirror since it is visited by large section
of community. The human relation skills are utmost important. The OPD staff
should be polite, cheerful, cooperative and efficient.
Categories of out patient
- General outpatient
- Referred outpatient
- Emergency outpatient
Services
- Preventive and promotive services
- Follow up care and rehabilitation
- Referral for admission
- Health education
- Modern investigation
- Specialist consultation
- Medical statistics
- Training of medical students
Physical facilities
The physical facilities of OPD are categorized into following areas.
- Patient area: It include entrance, reception, record room, registration
desk, waiting area, public utility services, snack bar, mobile charging,
ATM , clock room etc.

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 - Clinical area: It include sub waiting areas, consultation chambers,
special exam rooms, injection room, dressing room, minor OT, plaster
room, pharmacy, laboratory, radiology and imaging, medico social
worker, blood bank, counselling services, physiotherapy.
- Administrative area: It includes administrative office, business office,
house-keeping, public relations, accounts and billing, store rooms,
security, transport.
- Circulation area: It include stairs, lifts and corridors.
STAFFING PATTERN

Name of the Department Number of staff

Blood bank 2
Pediatric 1
Immunization 2
Eye 2
ENT 1
Pre anaesthetic 1
Cardio lab 1
Bronchoscopy lab 1
Vaccination anti rabies 1
Family planning 1
Medical 2
Dental 1
Central sample collection centre 1
Orthopaedic 1
Gynaecology 1
X ray 2
Skin 2
V D centre 3
Chemotherapy 2
Neurology 2
Microbiology 2
Psychiatry 1
Burns 2

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 PRINCIPLES OF PPC
 Study the concept: become thoroughly familiar with the PPC
concept. A major organizational change should not be attempted
overnight. Representatives of all disciplines should become familiar
with the programme while laying the ground work. Review
literature, consult with experts visit hospitals practicing PPC would
be beneficial.
 Develop team work: If planning is to proceed and result in action,
team work is needed. The governing body, medical staff, the
nursing staff and hospital administrator from the nucleus of over all
committee to workout the details for setting up implementing the
programme. The committee is needed to carry out specific facts of
the programme, success or failure of the programme depends on
team work.
 Evaluate needs: No two hospitals are identical in every aspect.
There are variations in many areas and areas of hospital operations.
So carefully study should be done to plan and determine the need
of PPC in light of the conditions prevailing in specific hospitals. The
need will indicate type of units patients, medical and nursing needs,
staffing requirements and size of the unit. The architectural and
equipment planning for each unit will depending up on the scope
of services and size of the unit. The architectural and equipment
planning for each unit will depending up on the scope of services
and size of the unit. Better services can be provided in space
specially designed for the purpose and the real value of each unit
can be enhanced by the availability of other units.
 Orient staff: This should begin before PPC is introduced into the
hospital. Medical staff, hospital administrator and others involved
in the operation of the programme should be included. This
stimulates staff interest, enthusiasm in initiating the programme
and become acquainted better with PPC concept.
 Estimate cost: This depends up on the variation between the
hospital from the stand point of nurse staffing pattern and the use
of special equipment etc and the policy laid down on the type of
changing pattern. It is better to analyse the hospital needs and

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 determine the needed innovations, set up a pilot unit of ICU with
available equipment and space and see how its works and benefit
before constructing new building and implementing programme
fully.
 Establish policies: These are very essential for the effective
operational management. Establish criteria for admitting and
transferring the patients, develop needed forms records and
reports. A check list of some criteria should be established to assess
the assigning patient to right unit. Special procedures need to be
developed to notify the lab, X ray and other dependents. Criteria
can differ in different hospital.
 Provide flexibility: Classifying and categorizing patients to each unit
may result in some empty beds. Most of time some beds in the unit
should be flexible and may be used in two areas as required.
 Staffing : Evaluation of requirements of each patient care unit is
important. Adequate staffing in intermediate care is essential. Staff
should be specially trained to care for the critically ill. The nursing
staff in each area becomes more stable and has been trained to
care for special type of patients.
 Instructs patient: Prior to transfer, patients should be specially
instructed regarding the new unit and why they are being
transferred. Each unit will have new staff and new surroundings.
 Inform public: Patients, relatives and general public should be
advised of the many advantages of PPC as means to ensuring
patients acceptance of the programme.
ADVANTAGES OF PPC
1. Effective use is made of personnel equipment.
2. Patient are in the best place to receive the care they require.
3. Use of nursing skills are maximised due to different staffing pattern.
4. Extra privacy is appreciated by the patient.
5. Centralization of costly equipment’s both diagnostic and therapeutic
instead of having them in different words.
6. Centralization of skilled personnel to take care of critically ill persons
instead of nursing them in different wards.

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 7. Reducing the hospital cross infection.
8. Centralizing of acutely ill patients which affects maximum care for each
case and eliminate the disturbance to other conclusive patients.
9. Patient feels confident and encouraged.
DISADVANTAGES OF PPC
1. There may be discomfort to the patients who are mourned often.
2. Continuity of care is difficult.
3. Long term nurse patient relationship is difficult to arrange.
4. Heavy emphasis is placed on comprehensive written care plans.
5. Meeting administrative needs of the organization staffing are many times
difficult.
6. Low morale if patient has to go back from intermediate ward to ICU.
BENEFITS OF PPC
For the patient:
 Patient receives special attention when he needs it.
 Patient is assisted in making adjustment first with the hospital
atmosphere and later his return with home and community.
 The patient who are critically ill are not deprived of nursing and medical
attention as the critically ill patients are separated.
For the physician:
 The physician give greater assurance that the patient is receiving high
quality nursing care.
 Emergency treatment if necessary is in the immediate vicinity of the
patient.
For the Nurse:
 The nurse make use of her capabilities.
 It help the nurse to devote the full attention and skill to the best to meet
the needs of the patient.
 It help the nurse to plan the nursing care for patients better as the needs
are almost same degree in each count.

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  The problems of providing nursing care services to the critically ill patients
are reduced.
 The nursing staff can also get the benefit of in service training programme.
For the Hospital:
 The beds, physical facilities, equipment’s, supplies and funds available in
the hospital may used efficiently.
 Use of trained personnel reduces personnel turn over and improved
administration.
 Improves public image of the hospital in the community.
 Home care programme as a part of progressive patient care helps the
hospital to coordinate its activities with community health and social
services.
CONCLUSION
A progressive patient care programme may be the answer in dealing with our
major present day hospital problems, namely the paucity of trained nurses/
personnel and improving patient care with out increasing the cost to the patient.
The public demands and deserves increased hospital services. They also
demands these same services but do not expect or deserve the increased cost
that to date they have been charged. The PPC touches the heart of each and
every patient by providing good care. It attempted by various means to keep
expenses and costs at a minimum and at the same time not to diminish the
quality of care. The complete fulfilment of all five stages of PPC programmes
should result in making available

BIBLIOGRAPHY
 Neelam kumari,Text book of nursing services and administration,PV
books,2011 edition,Pageno:163-165
 www.scribd.com
 www.pubmed.com

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