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DEFNITION OF NURSING

According to international council of nursing, nursing encompasses autonomous and collaborations care of individuals of all ages, families, groups and communities, sick or well in all settings. Nursing includes promotion of health ,prevention of illness and care of ill , disabled and dying people.

Advocacy, promotion of a safe environment, research , participation in shaping health policy and in patent and health systems management and education are also key nursing roles.

HISTORY OF NURSING

Nurse evolved from latin word “nutritious” which means nourishing.

In 100 BC – Hippocrates – father of scientific medicine, established ethical code of conduct for all who practiced medicine.

In 12 & 13 century – nursing became differentiated from medicine and surgery.

1854- Crimean war – service to wounded soldiers- title- lady with the lamp.

HISTORY OF NURSING

1860- first school of nursing by Nightingale.

1865-Suggestions for system of nursing for hospitals in India1949 by Florence Nightingale.

1890-1900-National nursing association. 1949- Indian nursing council was established. 1949- Council was constituted.

- ICN, Nurses auxillary of CMA of India, Indian nursing council & state level registration council- connected with promotion and upliftment of nusing profession.

FUNCTIONS OF NURSING ADMINSTRATION UNIT

Establishing objectives

Formulating nursing service policies and procedures.

Executing these policies. Maintaining stable staffing pattern. Selecting and assigning nursing personnel.

Planning and directing orientation & in service training programmes.

Constantly evaluaating.

FUNCTIONS OF NURSING ADMINSTRATION UNIT

Maintaining

proper nursing records .

Assisting in preparation of and administering the budget for the dept.

Coordination of activities of various nursing units.

Maintaining interpersonal relationships.

Participating in community and health education programmes.

LOCATON

It generally generates moderate to heavy traffic.

In administrative block generally it is centrally located.

To decentralize nursing adminstration many hospitals place supervisory nursing staff in patient care areas.

Organization

Organization

DESIGN

General nursing unit Pediatric nursing unit Obstetrical nursing unit Psychiatric nursing unit Isolation rooms Intensive and coronary care units.

GENERAL NURSING UNIT

Functions- handling materials , maintain communication and medical records social and physical needs of patients and specific needs of staff.

Location- close relationship with operating rooms, pharmacy, central stores, laboratory and the dietary. Design- the possible configuration may be round, square, straight, triangular, oval , y- shaped, H- shaped, T-shaped, and circular. They can be single corridor or double corridor.

General Nursing Unit Plan

General Nursing Unit Plan

PRIVATE ROOMS

Size of one bed patient room- not less than 11.61 sq. mtrs & width at least 3.81 mtrs.

Two bed rooms should be minimum of 14.86 sq, mtrs. Four bed rooms – minimum floor are- 29.722 sq.mtrs. 0.37 sq.mtrs (4 feet) space between the beds. Windows should be parallel to windows, there should be well build in wardrobe, nursing call signal card, movable furniture, telephone, TV, bedside locker, Doors should open outward with outside lock. Toilet should be provided with grab bar, emergency call button, flush valve for bedpan cleaning, and night lighting should be provided.

OBSTETRICAL NURSING UNIT

LOCATION- close to labor suite room and nursing room

Space requirements- A conference room Near to ultrasound screening room. Private rooms- preferably double rooms.

Obstetric Nursing Unit Plan

Obstetric Nursing Unit Plan

PSYCHIATRIC NURSING UNIT

Location- floor with separate entrance Design- open type Light, paint, décor should provide therapeutic effect.

Single exit, tamper- proof fittings, precautions against suicide and escape, and 24-hour security.

3 types of patients-

Acutely disturbed patients- isolation rooms must be provided.

Chronic , deteriorated a- motivated patients

Patients who come for diagnosis and not pose management problems.

PSYCHIATRIC UNITS

4 sub units-

Tretment consultation area

Conference therapy area

Inpatient area

Area for therapeutic activities.

Psychitric nursing units should have 20 to 30 beds.

2 seclusion rooms. Continuous observation by staff. Toilets- central in location Patient laundry facilities.

ICU’S AND CCU’S

LOCATION – close to operating rooms Electronic instruments for observation, signalling, recording, measuring physiological functions Nurse :patient= 3:1 No. of beds= 10% of total beds.(not more than 12-16 beds) Non cubicled curtained area Medical gas outlets Entrancee door-1.11mtrs &1.21 mtrs wide Nurses call button Room should be sound proof &air conditioned. Respiratory therapist Code blue- emergency for cardiac arrest.

Nursing station

Medical area, linen stores, clean supply, equipment, etc should be located close to control station.

Facilities needed are- Desk Nurses call system panel Wall clock & bulletin board Hand washing facilities Storage facilities Refrigerator Chart desk

Nursing adminstrtion unit

Space requirements- Nursing director’s office Asst. and supervisor’s office Receiption control area Secretarial and clerical area Conference room Toilet facilities Storage for files, office supplies

PAEDIATRIC NURSING UNIT

12 to 15 % of total beds. Location- away from main stream of hospital traffic,adjacent to play area.

Design- floor room of one bed room- 100sq. Feet

- 2 bed room – 14.86 sq. feet

Nursing station – centrally located 25% beds – sigle rooms for critically ill patients. Recreation room, play room.

STAFFING PATTERN

ICU’s – Nurse : Bed = 1 : 1 General Ward – Nurse : Bed = 1 : 3 OT’s – Nurse : Table = 3 : 1

3 Categories of patients 1 st Category : Severely ill 2 nd Category : Moderately ill

3 rd Category : Need less nursing care/ambulatory patient

Nursing and budget

Budget committee- Director of nursing Director of HR Director of SCM Director of engineering &plant operations Chief of medical staff

Chief executive officer, chief operating officer, chief financial officer.

FACTORS IN BUDGET PLANNING

The type of patient, length of stay, acuteness of illness. Size &facility and its bed occupancy.

Physical layout of facility, the size & plan of ward- open, small, private etc.

personal policies – salaries, vacation, educational programs. Grouping of patients-ICU,CCU Standards of nursing care. Methods of nursing procedures-records, charts etc. Amount of supervision Addition of non nursing services.

BUDGET APPROACHES

Zero base budgeting Fixed budgets Flexible budgets Rolling or moving budgets Variable budgets Program budget

KEY BUDGETARY INDICATORS

Patient volume Occupancy rate Patient acquits Direct hours/ patient day Paid hours/ patient day Salary cost / patient day Non-salary cost / patient day

KEY BUDGETARY INDICATORS

Patient volume Occupancy rate Patient acquits Direct hours/ patient day Paid hours/ patient day Salary cost / patient day Non-salary cost / patient day

COMPLEXITIES

Interruptions in nursing service delivery. Wasted transportation. Increased wastage of time in paper documentation or chart work. Irrational documentation of usage of drugs to procurement. Iv solutions and drugs unused are thrown away.

COMPLEXITIES

Interruptions in nursing service delivery. Wasted transportation. Increased wastage of time in paper documentation or chart work. Irrational documentation of usage of drugs to procurement. Iv solutions and drugs unused are thrown away.

Role of middle level managers

They have low decision making authority for attacking and solving problems .

Functions-

Meet with unit staff to identify symptoms and causes of productivity and quality of care problems.

Determine cause and magnitude of problem. Evaluate recommendations by top management. Implement solutions. Publicize results to entire hospitals.

RECOMMENDATIONS

Audit committee – consists of 6 nurses and pharmacists .

Combined and coordinated work by nurses and fiscal services.

Usage of technology Facility layout structures. Return of all unused medicines.