ltnit 3 wa nagement anp) rsing cake

17 Pages·2008·1.01 MB·English

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LTNIT 3 WA NAGEMENT ANP)
RSING CAKE
Structure
3.0 Objectives
3.1 Introduction
3.2 Concept of Ward Management and Nursing Care
3.3 Nursing Needs of Patienl
3.4 Nursing Service DepartmentKJnit
3.5 Organisation and Manageme111o f Units
3.6 Nursing Care Methods
3.7 Management of Patient and Attendants
3.7.1 Coordinating
3.7.2 Counselling
3.7.3 Nursing Records
3.7.4 Nursing Audit
3.8 Let Us Sum Up
3.9 Key Words
3.10 Answers to Check Your Progress
3.0 OBJECTIVES
After studying this unit, you will be able to:
a explain the concept of Ward Management and Nursing Care;
a define the nursing needs of patients;
a enumerate the nursing service of department and organisation of units;
a list the nursing care methods;
a describe the lnanagement of ward personnel, patient and attendant; and
a describe nursing records and nursing audit,
3.1 INTRODUCTION
In the preceding unit, you have learnt nursi~lgs ervices and organisation, In this unit you
will learn about ward managenlent and nursing care. You shall lcarn the concept of
ward management. You shall also learn the nursing needs of patients, how wardslunits
are organised and managed. You shall also learn various nursing care methods. It shall
also be possible to learn how to manage patients and attendants, how to perform
functions of coordination and counselling. You shall also study nursing records and
nursing audil.
3.2 CONCEPT OF WARD MANAGEMENT AND
NURSING CARE
The nursing care was considered as an art and vocation. Now ward management and
nursing care is considered a scientific profession which is an important part of total
hospital management and it is very much demanded for the care providing at the level
of high technologibal areas of the health care organisation such as Operation Theatre
and ICU. The nursirlg care required for the prevention of disease and promotion of
hedth, it also required a) In the interest 'of the physical and mental comfort ofthe
patient b) 'By reason of 'the disease1f rom which the person. is sufFering. As lhursing is
only one part of the total hdth care of the patient, the nursixtg activities Ihust be 3 1
CWCS~e rvicesII coordinated with those carried on by workers such as doctor, social worker and others.
A distinction is sometimes made between the terms nursing care and nursing services.
Nursing care refers to the care of patient with specific regard to nursing, while the term
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nursing servicelward management refers to the coordinating responsibility of the nurse
who in addition to giving nursing care also works with the members of allied
disciplines. In recent years, increased emphasis has been given lo the administration/
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ward management in nursing services as a result of increased scope of activities related
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to hospital services other tlian the true nursing, e.g., supervision of rood, care and
iI I' distribution of linen and compilation of reports and maintenance of patient records.
I I With the ever increasing dimension of medical sciences quantitatively and qualitatively,
1 I nursing care is becoming more and more complex with its management services and the
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i services provided for the patient care scienlifically based on needs of the patientsf
i 1 community,
Florence Nightingale, thc pioncer in modern nursing and modern hospital
administration is the first nurse executive to start the concept of modem nursing carel
intensive nursing care (ICU carc). Shq also recognized medical administration a tool for
improving medical care in civilian hospitals. She was responsible for laying down
nursing standards and started a school of nursing in 1860 for providing the training to
the nurses. The Indian history has also had many advents. Lord Buddha in 500 B.C.
created monasteries and hospitals where running by deploying the monks for nursing
the sick patients. Emperor Ashoka built many hospitals and employed nurses for the
care of the sick. During this time there were no special training for the nurses but they
were selected on Ule basis of the fact that they should be good in cooking and taking
care 01t he patients and experts in various nursing procedures.
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Definition of Nursing Cnre
WHO expert committee on define the nursing as "the conscious practice of human
relationships. It is clear that nurses must keep alerl to observe the needs of their patients
as individual human beings."
Nursing as per the WHO definition is the part of total heallh organisation which lo
satisfy the nursing needs of the community, organisation of nursing service is a complex
process which helps the institution to stand on its own.
Nursing care is defined as Ule care of the patient with the specific regard to nursing.
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3.3 NURSING NEEDS OF PATIENT I
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The plan for the care of a patient in the hospital begins wit11 the plan made by the
physician for medical care. The plan for nursing care begins whcn the patient is
admitted to the ward. An analysis of the nursing nceds of the paticnt necessarily
includes consideration of the plan for medical care, and thc facilities for patient care
provided by the hospital.
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The patient being the central figure, his needs are paramount:
a) First need is an accurate assessment of his illness in as shorl a time as possible
with least disturbance to him.
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I b) The second need is the appropriate and effective action in accordance with the 1
assessment of Ius condition. 1 I
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she has the role of coordinaling professional activities of nursing stair Ward Management and Nurslng Care
with those of medical staff. She has also the responsibility of entire nursing service as
well as the paticnt care serviccs. In the ward/unit the ward incharge/Sr, incharge ANS is
the key person.
In the hospilals, nwsing care is broadly classified inlo general wards, speciality wards
and intensive care units, casually or enlegency ~uilila, inbulatory care unit and operation
theatres unit. In general wards one can ensure sufficient nursing care by segregating
patients according to the categories (according lo the sickness of the palienls).
. Chcck Yo18s Progress 1
Enumerate the nursing needs of patients.
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What is Florence Nightingale's contribution towards nursing?
2)
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3) Define nursing care.
4) Fill in the blanks:
a) .................is the pioneer of the modern nursing, modern hospital and
nursing.
.................
b) In Indian history rnonastrics and hospitals were run by in
500 B.C.
........................
c) Emperor built many hospitals and employed nurses for
the care of sick.
3.5 ORGANISATION AND MANAGEMENT OF UNITS
There are two accepted types of organisation in the nwsing services, which run parallel
to each other. They are the Line and Functional Organisation about which you have
learnt in the earlier unit.
You will recall that in the Line organisation the Director of Nursing or Chief Nursing
Officer or the Nursing Superintendent is responsible for the selection~rwruitment,
appointment, training and deployment of nurses in various areas. The post of Chief
Nursing Officer (CNO) was created in 1992 and filled by all central govenunent
hospitals as well as undertaking e.g, All India Institute of Medical Sciences, New Delhi.
There are other nursing administrators like Nwsing Shperintendent, Deputy Nursing
Superintendent and Assistant Nursing Superintendent who have direct contrd over the
nurses activities. In the functional organisations the nurse takes the instructions from the
physicians so far as the medioal care of Ihe patient is concerned. The physician,
h~weveris not authorized to'act or take the action against the nursing personnel for the
nursing activities. If a nurse does not perform her duties, she should refer the matter tp
the nursing in-charge whose responsibility is to deal with such' matters, The physician,
however is not authorized to act in the line organizational manner. Effective
coordination and coopration is ensured for the proper functioning of dual activities.
Normally there is no conflict but controversy exists whether the nurse should.be wunted
as an assislant to the physician or from her background knowledge and training she
should plan nursing care independently within the framework of the physicians policy.
More and Inore emphasis is laid on the coordinating member of the team, coordinating
the orders of the pl~ysiciana nd the work of the other services to achieve efficient patient
care based on the above lines, the organisation of the nursing service of a general
hospital may be drawn as under: (In tlus Diagram both the Line and FunctionaVStaff
authority has beell showned.
Dimctor of Nursing or Chiel Nursing Officer
NURSING SUPERWTENDENT
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DEPUTY NURSING SUPERINTENDENT
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ASSISTANT NURSING SUPERINTENDENT
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N Sr. UC Medical Ward N Sr. Surgical Ward \N Sister J/C N Sister I/C N Sister I/C
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Staff Nurses Staff Nurses Staff ~urses\ Staff Nurses Staff Nurses I
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\ II
Clinical Supervisor I
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It could be seen that the work of the various nursing units/wards in a service is I
coordinated by a supervisor (Ward Sister, Assistant Nursing Superintendent, Deputy 1
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Nursing Superintendent) and the general coordination is affected by the Nursing
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SuperintendentIChief Nursing Officer through her deputy. In case of a teaching hospital
there may be an inservice education coordinator or instructor who may be functioning. I
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under the Nursing Superintendent,'Chicf Nursing Officer or independently with same I
status depending on the policy of the hospital and the size of the schooVnursing college. ,
The appointment of one person as supervisor of a service is followed mostly in advanced
countries, with a view to relieving the nursing staff from a lot of administrative duties. I
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In USA the trend is to appoint unit managers for each nursing unit, in England the 1 '
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trend is to appoint a clinical manager for each unit, in India in All India Institute of
Medical Sciences there is an Assistant Nursing Superintendent posted in each ward, so i
that the sister in-charge of the unit is free to concentrate on purely nursing duties. These
unit illanagers look after the administration of the units and their work in turn is
coordinated by service supervisors.
4) Accurate assessment of illncss. Ward Management and Nurslng Care II
5) Adequate material resources at all tlie times.
Health cducntion to tlie patient and attendants.
6) '
7) Managerial skills as and whcn required,
8) Privacy at dl levels.
Managenlent in tllc Ward
Management dcfined in a simple language is to get the work done in a systematic way
for accon~plislimcnto f defined objectives based on lnanagement of Man, Money and
Materials. Management gives us the clue to how Lo get best possible services and how to
nlake the ward administration successii~la nd f1.uiUu1. It is also said that management is
a process by which a cooperative group directs actio~lto wards common goals.
Ward nlanagc~nenti s facilitated by thc devclopulcnt of systematic procedures for dealing
with the dctails of ward adnlinistrr~tionb y adoplio~oi f a system of day-to-day tasks.
While managing a wardtunit tl~em anager has lo apply various nlanagerial skills which
differ as per the level of the managclucnl. These can be shown diagra~nn~aticallays
under.
CONCEPTUAL SKILL
MANAC;lXIZ
1-IUMAN SKILL TECtINIChL SKILL
A diagrani of the applicatio~lo r managerial process has been drawn in the next page to
its application as per Ule level of nurse managers.
For an cEective management, a Nurse Manager must apply tlre ~nanagerials kills.
Though the above mentioned skills are nceded in all levels of nursing managcrnent, to
provide the egective nursing care to the patient by a nurse manager in the ward/unit,
but the use of them vary as per the level of thc managerial role of the nursing
personnel, according to their category.
At the top level, the nurse manager, the Cllier Nursing Ofiicer/Nursing Superintendent
has to apply the conceptual skill for planning the nursing service, nursing man power,
and to make the decisions of various aspects of nursing. It is the top level of nursing
where the Nurse manager has lo play the role in planning, policy making, liasoning,
co-ordinating, and controlling for these Ule conceptual skill is needed. In the middle
level the nurse manager, the Dcputy Nursing SuperintendenUAssistant Nursing
Superintendent has to apply the Iru~uans kill as well as tlic conceplual skill to manage
hislher unit effectively. As shethe 11as to keep coordination wilh various departlncnts for
the day-to-day management of the unit and has to plan the nursing care as well as to
take some decisions to solve various problems a1 her own level. Being a middle level
lnanager the nurse manager has to ploy a crucial role in the midline supervision by
liasoning, and co-ordinating will1 the various departments for smoothening or work and
strive professional growth. For this sl~cllien eeds to apply the human skill as well as the
conceptual skill. Besides this the middle level nurse manager has lo apply the technical
skill also.
At the base level of the Management the ward sisters and the sW nurses are responsible
to provide the total/comprellehsive care to the patients of their respective unit. For this
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they have to apply the techni~als kills mainly though they have also to i~pplyt he human
skill to manage the patient care sonlices effeotively. The base leveVcore level nurse
manager is responsible for diiect a~rdto tal patient care.
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Establishing Objectives Aims
Target Standards
Motivating
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Communicating
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and Decision
Planning and Organising
Making Reviewing
Means
Results and
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Staff Plan
Monitoring and controlling
to keep on target or
The nurse manager has to apply llie whole management process while managing the
ward/unit and to follow these main four steps mentioned above for an effective
management of herlhis ward. These steps are to be followed in a cycling way as they are
related to each other. In every step the monitoring, controlling, and the reviewing must
be done to get an effective result and to avoid/minimise the errors which may be cost
effective as well as time effective also. Special care sllould be taken in the step of
planning which is a crucial and most important step of whole management process.
1) What are thc types of orgausations7
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I.........,.*..~.m.,.,.....,,...,.,..,..#.......,.*..............,...,.....,,...,...,,....,..,
2) Skcich/draw tlle organisation set up of nursing service in any one of a gencral
hospital.
What are the skills that a manager should apply while managing thc waraunit? Ward Management and Nursing CPR
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Management of Nursing Personnel
The nursing care of patient in hospital fully depends upon the number and the quality of
nursing personnel on duty at all times of the day and night.
The following factors should be considered before planning the nursing manpower.
Number of beds in a hospital.
1)
The type of hospital and the available services.
2)
The design and the lay-out of the hospital.
3)
Availablelpattern of arrangement of nurses.
4)
The type and number of emergency cases coming to the hospital per day.
5)
Staffing Norms
For planning 01n ursing manpower wc have to follow some norms.
The nursing norms are recommended by various committees, such as; the Nursing Man
Power Commitlee, the High-power Committee, Dr. Bajaj Committee, and tlle Staff
Inspection Committee, Trained Nurses Association of India, and Indian Nursing Council
(1985). (For details See Unit 2 of this Block.)
All the above committees and the staff inspection unit recommended the norms for
optimum nurse-patient ratio. Such as 1:3 for Non Teaching Hospital and 1:5 for the
Teaching Hospital. The Staff Inspection Unit (S.I.U.) is the Unit which has
recommended the nursing norms in the year 1991-92. As per this S.I.U. norms the
present nurse-patient ratio is based and practiced in all central government hospitals.
Most of the hospital today is following the S.I.U. norms. In this the post of the Nursing
Sisters and the StaB Nurses have been clubbed together and the work of the ward sister
is remained same as staff nurse even after promotion. The Assistant Nursing
Superintendent and the Deputy Nursing Superintendent have to do the duty of one
category below of their rank. There will be:
a One nursing sister for 3.6 staff nurses (30% nursing sister) has been fixed by the
Government in settlement with the Delhi Nurses Union @NU) in 1990.
0 One ANS (Assistant Nursing Superintendent) for every 4.5 Nursing Sisters.
o The ANS will perform duty in shifl as done by the present Nursing sisters.
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a OneDNSfor7.5ANS.
a The DNS will perform the duty of the Assistant Nursing Superintendent.
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a One Nursing Superintendent for 200 beds in the Hospital.
One Cluef Nursing Officer for 50Q to 750 beds.
There should be 45% posts added for the area of 365 days working including 10% leave
reserve (maternity leave, earned leave, and days off as nurses are entitled for 8 days off
per month and 3 National Holidays per year when doing 3 shift duties).
The Nurse-patient Ratio as per the S.LTJ. Norms
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General Ward 1:6
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Special Ward 1 :4
Nursery 1:2
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Labour Room 1:l per table
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I.C.U. 1 :1 ( Nothing mentioned about the shifts)
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O.T. Major 1 :2 per table
O.T. Minor - 1:l per table
Casualh, 1:35
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Burn 1:2
O.P.D. - 1:40
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~ c pselrvi ces-II The Nurse-patient Ratio as per the norms of TNAI (Trained Nurses Association of
India) and INC (The Indian Nursing Council, 1985)
The norms are based on Hospital Beds.
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1) Chief Nursing Officer 1 per 500 beds
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"$1
; 2) Nursing Superintendent 1 per 400 beds or above
3) D.NS. 1 per 300 beds and 1 additional for evcry 200 beds
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; 1, 4) A.N.S. 1 for 100-150 beds or 3-4 wards
!I: i '8; 5) Ward Sister 1 for 25-30 beds or one ward. 30% leave reserve
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6) Staff Nurse 1 for 3 beds in Teaching Hospital in general war&
j and 1 for 5 beds in Non-teaching Hospital +30%
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'l Leave reserve
7) Extra Nursing Staff to be provided for departmental research function.
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8) For OPD and Emergency 1 staff nurse for 100 patients (1 :1 00 ) + 30% leave
reserve
9) For Intensive Care Unit (I.C.U.) 1:l or (1:3 for each shift ) +30% leave reserve.
10) It is suggested that for 250 beded hospital there should be One Infection Control
Nurse (ICN).
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II For specialised depertments, such as Operation Theatre, Labour Room, etc. 1:25 +30%
leave reserve.
~ormasr e not based on Nursing Hours or Patient's Needs here.
2) Match the following: Ward Management and Nursing Can!
S.1.U. reco~ninendatiollo f Nursc-paticnt ratio is:
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i) I.C.U. a) I:]
ii) Gencral Ward b) I:4
iii) Special Ward c) 1:6
iv) O.T. major d) 1:2
V) Casually c) 1:1
vi) O.T. Minor 1) 1:35
3) Indicalc T~vaen d False:
a) For ICU Nurse-patic111r atio is 1:l rccorn~ncndedb y S.I.U. (rEj
b) Tlie S.I.U. Norms were rcco~i~rncildcind the year 1991-92. (TIP)
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c) Thc INC rcconi~~~e~Niducrsdc -paticut ratio in 1985. (TfF)
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d) TIICn orills of thc staff llurscs sliould be 1:s in teacliitlg hospitals. (T/E)
C) For every 200 beds ollc additional DNS to be posted as pcr ?YAI i
and INC norms. ('I-IF) r
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3.6 NURSING CARE METHODS
There are many incthods that may be applied for providing the care to the patient in the
ward, but lnai~ilyt hree n~etllodsw hich should be practiced for an effective ward
management. Tliere are three Nursing Carc ~netllodsu sed for the assigrunent of nursing
work.
The tasks of the ward are carried out ~nainlyb y these three accepted palterns of
Assignmendmetbods which depend on the training, experiences and the rules of a
particular llospitaVinstitution.
1) Functional Method
2) Case Method
i 3) Team Mcthod
Organisation of ward work and assignment of st& need careful. consideration.
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i I) Functional Method
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k 111 this method the tasks are divided ainong the stafI e.g. in a ward one sister (nurse) is
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made responsible for giving injections, anotlier sister takes care of oral medications and
the third sister does all the other works for tllc patients. In this a nurse is assigned to
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specific function in the ward as mentioned above, giving injection, oral medicines,
taking vital signs of the patients, doing any other work of the patient etc. This method
is also called eficiency method.
Following are the advantages of this method:
a) It helps to improve the eficiency of care provider (Nurse).
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b) More work can be accomplished in a given period of time, so it is very useful
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method during evening and night slMs.
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I c) Less intemption and less confusion is there.
d) It helps in developing the skill when the activity is repeated often.
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1 Following are the disadvantages of this method:
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a) There is no satisfaction to the nurses.
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b) Nursing activity becomes monotonous when the same activity is repeated again
and again leading to less interest in the activity,
c) No individualized nursing care is possible, so patients also do not get satisfied and
they do not hiow whom to approach in case of any problem far clarification.
d) More confusion is there in thc patient to attend many people (nurses) in a day.
1 e) Less accopntability of the work by the staff can lead conflict with the supenisor. 3 9
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Clinical Services-II 2) PatientlCase Method
In this assignment a nurse is expected to give complete nursing care to one patient.
Each nurse is assigned to one or two cases and she is fully responsible for total care of
those patients. A nurse is providing general nursing measures, treatment and
medications, taking tempcrature, pulse, respiration, serving nourishment to lier patients
also giving health education. If she goes off for lunch that time she has to hand-over the
patient to another nurse for the time being. She is responsible to giving complete hand-
over to lier next shift partner about her patients before going off from duty.
I The advanlages of this method are:
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II Ij a) More individualized care is possible.
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1/ I b) Opportunity of nursing education is superior.
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1 c) Satisfactions to the nurse are getting increased.
I i d) Satisfaction of the patient is also of a higlier grade and there is less confusion.
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i Disadvarilages of this method are:
a) More workers (Nurscs) are required for the patierit care.
b) Lcss work is done in a given period of time,
c) This method does not improve the elficiency of the workers (Nurses).
d) The method is rlot good for developing the nursing skills,
3) Tlie Tcam Method
It is a new method of assignmenttpatient care. In this melhod the nursing stafs€ are
divided into Tcms, each of which is led by an experienced Nurse. There is one
experienced professional nurse, who is being designated as a team leader. This leader
assigns duties to other nursing s Wm embers of her team for giving care to a group of
patients. The work is done under the direct supervision and guidance of the leader. The
tcaln leader is fully responsible to thc ward sisterlward in-charge (A.N.S.).
I The advantages of this method are:
a) Better patient care is provided to the patients assigned to the team.
b) It helps the leader to assulne the responsibility and to organise the work efficiently
and independently.
c) There is better ward management and better planning of patient care.
d) Job satisfaction is there among the nursing personnel.
e) All themembers learn to work in a team spirit.
Disadvantages of this method are:
a) More nurses are required than the functional method.
b) The t a nc annot function unless there is a stable team leader,
c) It can be successful only if everyone concerned is interested and determined to
make it work efficiently, I
Check Your Progress 4
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1) List the methods of nursing care.