Nursing supervision is deliberately maximised in critical care units, where the patient is very ill and need for privacy is reduced. When the patient is getting better, observability can be reduced.
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Gradually, the recovering patient is transferred to a medically less sophisticated unit. Different kinds of units that offer varying degrees of patient adjusted care are replacing standard nursing units.
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A system of progressive patient care has been adopted in most hospitals which has a considerable effect on nursing unit design. Under this system, the inpatient area is divided into various sections based on the intensity and type of nursing care required, as follows:
1. Intensive Care:
The intensive care unit is for patients in acute stage of illness who are unable to communicate their needs. They require continuous observation and extensive nursing care with personnel specially trained for the job.
The aim is to first support life in a crisis, prevent threat to life, and then to eliminate the cause of disfunction by specialised treatment and extensive nursing care. Therefore, the unit is equipped with life-saving equipment, and all necessary life-saving drugs and supplies are immediately available.
2. Intermediate Care:
The intermediate care unit is for patients who are moderately ill, including patients transferred from intensive care unit who require moderate amount of nursing care. A large proportion of all hospital patients will be directly admitted to this unit.
3. Self Care:
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The self care unit is for those patients who, after the acute phase of illness is over, become ambulant during the period of convalescence, or are admitted for diagnostic procedures and are able to look after themselves. Nursing care required for this category of patients will be minimal.
4. Long-term Care:
The long-term care unit is for patients requiring prolonged nursing care and where such services not normally available at home, including adjustment to disabilities by physical and rehabilitation therapy.
The basis of progressive patient care system is the amount and type of nursing care required and the degree of dependence of the patient on others.
The design of the nursing unit and facilities to be provided differ from intensive care through intermediate, self-and long-term care units.
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However, it is debatable whether the system results in economy in bed utilisation because, if each section is capable of taking only patients of a particular category, bed utilisation would get adversely affected due to fluctuations in demand in each category.