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organization and functions of nursing services presentation

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organization and functions of nursing services presentation

  1. 1. KRISHNA INSTITUTE OF NURSING SCIENCES KARAD SUBJECT:- NURSING MANAGEMENT AND SERVICES TOPIC:- ORGANIZATION AND NURSING SERVICES PRESENTED BY:- MS.POOJA MHALATKAR 2ND YEAR MSC(N) KINS KARAD
  2. 2. GENERAL OBJECTIVES At the end of the class the student will able to understand the organization and functions of nursing services.
  3. 3. SPECIFIC OBJECTIVES At the end of the class students will be able to:- 1) Define the hospital. 2) List down the aims of hospital planning. 3) Understand the organization of hospital services. 4) understand about the space requirement in hospital organization. 5) Explain about the staffing pattern of hospital. 6) Describe the policies and procedures. 7) Define the primary health center.
  4. 4. 8) Explain about the principles,elements,standards,objectives, functions, major role of nurse, Staffing pattern and minimum requirements in PHC. 9) Define community health centre, its elements, principles and standard. 10) Elaborate the functions of nursing services.
  5. 5. DEFINITION OF HOSPITAL • The word hospital is derived from the latin word hospitalis’, which comes from hospis, meaning a host. • “The hospital is an integral part of social and medical organization, the function of which is to provide for the population complete health care, both ‘ curative and ‘preventive’ and whose outpatient services reach out to the family and its environment, the hospital is also a centre for the training of health workers and biosocial research” (WHO expert committee on organization of medical care, 1957).
  6. 6. AIMS OF HOSPITAL PLANNING • To enlarge the existing hospital by introducing new facilities • To increase utilization of hospital facilities • To increase population coverage • To increase productivity of hospital • Modernization of the already existing facilities • To reduce the cost of operations and maximize efficiency of services.
  7. 7. GOVERNING BODY CHIEF EXECUTIVE OFFICER DIRECTOR OF NURSING/CHIEF NURSING OFFICER DEPUTY NURSING OFFICER/ASSISTANT DIRECTOR DEPUTY NURSING OFFICER/ASSISTANT DIRECTOR ASST.NURSING OFFICER/SUPERVISOR/DEP ARTMENTAL SISTERS ASST.NURSING OFFICER/SUPERVISOR/DEPAT MENTAL SISTERS ASST.NURSING OFFICER/SUPERVISOR/DEPARTEMTAL SISTERS ASST.NURSING OFFICER/SUPERVISOR/DEPART MENTAL SISTERS HEAD NURSE/WARD SISTERS HEAD NURSE/WARD SISTERS HEAD NURSE/WARD SISTERS HEAD NURSE/WARD SISTERS STAFF NURSES ANMs WARD CLERKS WARD BOYS/AYAHS STAFF NURSES ANMs WARD CLERKS WARD BOYS/AYAHS STAFF NURSES ANMs WARD CLERKS WARD BOYS/AYAHS STAFF NURSES ANMs WARD CLERKS WARD BOYS/AYAHS
  8. 8. ORGANIZATION Have a hospitals nursing service is organized is determined by many factors the size and kind of hospital, education and skill of the nursing staff, type of medical staff organization, relationship between the nursing staff and other departments and the extent to which personnel in various departments comes in contact with the nursing department.  Although positions in the nursing service hierarchy vary from hospital to hospital, one can usually see the following nursing positions in most hospitals.
  9. 9. Listed in descending order of responsibility are director of nursing ( or nursing superintendent), assistant director of nursing ( assisting nursing superintendent), supervisor( department sister), charge nurse (ward sister, head nurse), senior staff nurse and staff nurse. The director of nursing may have one or more assistant directors and several supervisors to cover all areas of the hospitals ans shifts since the nursing services works and is staffed round the clock.
  10. 10. there may be specialist supervisory staff or departmental sisters for paediatrics, maternity, psychiatry, operating rooms,CCU and ICUs the head nurse or ward sister who is next in the hierarchy is in charge of the ward or unit and is responsible for nursing in her respective unit or ward. There is generally a night supervisor and in large hospitals,a supervisor or assistant director incharge of in service education.
  11. 11. The head nurse is a key member of the nursing staff. within the organized nursing care unit,she is responsible for the administration and coordination of patient care and other activities including preparing nursing care plans, instructing nurses and supervising personnel in the unit. she is responsible for the ward 24 hours of the day in the senses that personnel of evening and night shifts report to her she assigns duties to them. the head nurse must exercise good judgement, adhere to the policies, rules and regulations of the institutions and make sound decisions that results in good care of patients.
  12. 12. The night supervisors supervises and coordinated the activities of the nursing personnel during the night so that continuing care is maintained round the clock. She visits nursing units to oversee nursing care and ascertain the condition of patients, and gives advice to nurses regarding treatment, medication and on any problem they may have. When she goes off duty, she informs supervisors of the subsequent shift of the patients condition, and other matters of importance Education, training, experience and other qualifications required for various nursing service positions vary from institutions to institutions, but there are some similarities.
  13. 13. For example, the director of nursing may require an Msc degree in nursing and 8 to 10 years of experience, 5 to 6 of which is at least in progressively responsible management positions. Similarly , the assistant director should preferably have an Msc degree and 6 to 8 years of experience. The supervisor and head nurse must at least be graduates in nursing (Bsc in nursing) with adequate experience, and the staff nurses in charge of special units must have in additional special training in their specialties, like operating room techniques, psychiatric nursing, CCU and ICU nursing care, CSSD etc.
  14. 14. the registered staff nurse has a diploma/ certificate in nursing which is currently a 3 year course or a Bsc degree in nursing a four year course from in a recognized college or school of nursing and is registered under the Nursing Council.
  15. 15. There are other categories of personnel in the nursing service:- Auxiliary Nurse Midwife( ANM) is a staff member who has received 2 year training in some aspects of nursing amd has a certificate awarded by the nursing council.some hospitals use them to relieve the staff nurses of some of the routine work. Unit manager is a professional manager with a college degree who supervises the administrative functions of the nursing unit. Ward boy/Orderly,nurse aid and helper are non professional staff members who assist the nursing staff in various activities of the ward. Ward secretary and ward clerk are staff members who assist in routine clerical and paperwork.
  16. 16. ORGANIZATION OF NURSING SERVICES AT HOSPITAL DIRECTOR OF NURSING Records and reports Nursing services must function under a senior competent nursing administrator variously called as director of nursing, nursing superintendent, matron, or matron in chief. She is responsible to the hospital administrator for overall programme and activities of nursing care of all patients in the hospital.
  17. 17. Nursing programme is administered by her through appropriate planning, of services, determining nursing policies in collaboration with nursing staff, giving general supervision, delegation of responsibility, coordination of interdepartmental nursing activities, and counseling the hospital administration on nursing problems.  She has a dual role:- the first one is the administrative responsibility towards hospital adminstration, and the second one is the coordinating of all professional activities of nursing staff with those of medical staff. The role of the nursing superintendent starts in a new hospital from helping to establish the overall goals, policies and organization and facilities to accomplish these goals in the most effective and efficient manner.
  18. 18. The functional elements of the role of nursing superintendent includes the following:-  Formation of the aims. Objectives and policies of nursing services as an integral part of hospital service.  Staffing based on nursing requirements in relation to accepted standard of medical care.  Planning and directing nursing services.  Maintaining supplies and equipments.  Budgeting.
  19. 19.  NURSING SUPERVISOR Each department or clinical division e.g ,Medical, surgical, Obstetrical, operation theatres, outpatient department, nurseries etc should have a supervisor. As they may be more than one nursing unit in each division or department, supervisors have a general administrative and coordinating function within their respective division. However, supervisors will also have limited clinical functions.
  20. 20. HEAD NURSE A head nurse is assigned to a nursing unit, or ward, or a section of department. She works under the general direction of the supervisor of the division. STAFF NURSE Staff nurses are employed at the ‘floor’ level for carrying out skilled bedside nursing. This is the real work force of the hospital upon whose competency, state of training and dedication depends the success of the nursing department.
  21. 21. STUDENT NURSE Students nurse cannot be employed on nursing duties expect under supervision of fully qualified staff nurses.
  22. 22. SPACE REQUIREMENT • In the nursing service administration unit, provision should be made for the following:- • Nursing director’s office • Assistant director (s) and supervisors offices • Reception control area with waiting areas for visitors • Secretarial and clerical work area • Conference room. • Toilet facilities • Storage for personnel files, administrative files ansd office supplies.
  23. 23. STAFFING PATTERN • The complement of nurses required for a hospital, generally referred to in terms of nurse bed ratio, is a much debated and misunderstood subject. The indian Nursing council stipulations are so high that not many hospitals adhere to them.be that as it may, it is good to keep those stipulations in mind so that managements do not keep theirs hospitals grossly understaffed. • For a 150-bed hospital: • Nursing Superintendent -1 (for minimum of 150 beds) • Deputy Nursing Superintendent-1 • Assistant Nursing Superintendent-2 • For every additional 50 beds one more assistant nursing superintendent.)
  24. 24. In addition with regard to staffing pattern the Nursing Council recommends 30% leave reserve posts because a nurse is entitled to 30 days of earned leave, 10- 12 days of casual leave and a certain number of days of sick leave and maternity leave, and in some hospitals, 24 days off duty in a year in addition to one or one and a half days a weekly off.it is observed that on any working day, 25% of the nursing staff is off duty on casual leave, earned leave, etc. a a nurse, therefore works for about 240 days in a year whereas the hospital requires nursing round the clock on 365 days of the year,which means that 30% more nurses are required on the rolls.
  25. 25. The classification is aslo used to determine the category for personnel – registered nurse, ANM, or nurse aide who should provide the required care. CATEGORY 1:- A patient who requires only minimal amount of nursing care an average of 2.8 of nursing per 24 hours. CATEGORY 2:- A patient who requires an average amount of nursing care-an average of 4.3 hours of nursing per 24 hours. CATEGORY 3:- A patient who requires about average nursing care- an average of 5.8 hours of nursing per 24 hours. CATEGORY 4:- A patient who requires maximum nursing care- an average of 8.6 hours of nursing per 24 hours.
  26. 26. Examples of what the patient can do himself (herself) and what is required only minimal amount of nursing care( an average of 2.8 hours per 24 hours) is given below:- A patient who is mildy ill. A patient who required little treatment and observation and or/ instruction. A patient who is up and about, takes his own bath. A patient who does not exhibit any unusual behavior patterns. A patient without intravenous therapy or many medications.
  27. 27. WARDS AND SPECIAL UNITS STAFF NURSE SISTER EACH SHIFT DEPARTMENTAL SISTER /ASSISTANT SUPERINTENDENT MEDICAL WARD 1:3 1:25 1 FOR 3-4 WEEKS SURGICAL WARD 1:3 1:25 1 FOR 3-4 WEEKS ORTHOPEDIC WARD 1:3 1:25 1 FOR 3-4 WEEKS PAEDIATRIC WARD 1:3 1:25 1 FOR 3-4 WEEKS GYNECOLOGY WARD 1:3 1:25 1 FOR 3-4 WEEKS MATERNITY WARD( INCLUDING NEWBORNS) 1:3 1:25 1 FOR 3-4 WEEKS INTENSIVE CARE UNIT 1:1 (24 HOURS) 1
  28. 28. STAFF NURSE SISTER (EACH SHIFT) DEPARTMENTAL SISTER/ASSISTANT NURSING SUPERITENDENT CORONARY CARE UNIT 1:1 ( 24 HOURS) 1 NEPHROLOGY 1:1 ( 24 HOURS) 1 1 DEPARTMENTAL SISTER/ASSISTANT NURSING SUPERITENDENT FOR 3-4 UNITS CLUBBED TOGETHER NEUROLOGY AND NEUROSURGERY 1:1 ( 24 HOURS) 1 SPECIAL WARDS- EYE,ENT,ETC 1:1 ( 24 HOURS) 1 OPERATION THEATRE 3 FOR 24 HOURS PER TABLE 1 1 DEPARTMENTAL SISTER/ASSISTANT NURSING SUPERITENDENT FOR 4-5 OPERATING ROOM CASUALTY AND EMERGENCY UNIT 2-3 STAFF NURSES DEPENDING ON THE NUMBER OF BEDS 1 1 DEPARTMENTAL SISTER/ASSISTANT NURSING SUPERITENTEND FOR EMERGENCY, CAUSUALTY
  29. 29. POLICIES AND PROCEDURES In order that a good standard of nursing care be maintained, the nursing superintendent should develop written policies and procedures to serve as a guides for nurses of the various units of the hospitals. Important topics that should be incorporated are as follows:-  Organization  Status and relationship  Responsibilities  Staffing pattern  Departmental functions
  30. 30.  Requistioning of supplies  Utilization, care and maintenance of equipment  Nursing procedures, coordination with domestic services  Handling of the patients clothing and valuables  Isolation technique
  31. 31. AT COMMUNITY- PRIMARY HEALTH CENTRES INTRODUCTION The PHC is the first contact point between the village community any the medical officer. There are established and maintained by the state government under minimum needs/basic minimum services programme. It acts as a referral unit for six sun centre and has 4-6 beds. A PH C covers population of 30000 in plain area and 20000 in hilly remote and tribal area. The activities of PHCs involve curative, preventive and family welfare services. There were 23,391 PHCs functioning as on March 2009 in the country.
  32. 32. DEFINITION Primary health centre is the basic structural and functional unit of public health care in peripheral areas.
  33. 33. ELEMENTS OF PHC  E- Ensure safe water supply.  L- Locally endemic diseases control.  E- Education/ expanded programme on immunization.  M- Maternal and child health.  E- Environmental sanitation.  N- Nutritional services.  T- Treatment of minor aliments.  S- School health services.
  34. 34. PRINCIPLES OF PHC  Equitable distribution  Intersectoral co-ordination Appropriate technology  Community participation  Focus on prevention
  35. 35. STANDARD OF PHC  The PHC has been prepared keeping in view the resources available with respect to functional requirement for PHCs with minimum standards such as- Building Man power Instrument Drugs Other facilities
  36. 36. The standards prescribed are a PHC covering 20000 to 30000 population wit six beds on well the block level PHC are ultimately going to be upgraded as CHC with 30 beds of providing specialized services.
  37. 37. OBJECTIVES  To provide comprehensive primary health care to the community through the PHC.  To achieve and maintain an acceptable standards of quality of care.  To make the services more responsible and sensitive to the needs of the community.
  38. 38. MINIMUM REQUIREMENTS ARE The assured services cover all the essentials of preventive, promotive, curative and rehabilitative primary health care. This implies a wider range of services that includes:- 1) Medical care. 2) Maternal and child health care. 3) Full range family planning services including counseling and appropriate referral for couples have infertility . 4) MTP services 5) Health education for prevention and management of malnutrition, anemia and vitamin A deficiency and coordinates with ICDS.
  39. 39. 6) School health services. 7) Adolescent health care. 8) Diseases survelliance and control of epidemics. 9) Collection and reporting of vital events. 10) Promotion of sanitation . 11) Testing water quality . 12) Nutritional health programme. 13) Training health workers. 14) Training of ASHA.
  40. 40. MAJOR ROLE OF NURSE IN PHC  Facilitative role  Developmental role  Clinical role  Supportive role
  41. 41. FUNCTION OF PHC 1 Medical care 2 Maternal and child health 3 Control of communicable diseases 4 Collection and reporting of vital statistics 5 Immunization services 6 Improvement in environmental sanitation 7 School health programmes
  42. 42. STAFFING PATTERN STAFF EXISTING RECOMMENDED MEDICAL OFFICER 1 4 ( AT LEAST ONE FEMALE) AYUSH PRACTITIONER - 1 ACCOUNTANT MANAGER - 2 PHARMACIST 1 7 NURSE MIDWIFE(STAFF)NURSE 1 1 HEALTH WORKER 1 1 HEALTH EDUCATOR 2 2 HEALTH ASSISTANT 2 2 CLERKS 1 2 LABORATORY TECHNICIAN 1 OPTIONAL/VEHICAL MAY BE FROM OUTSIDE DRIVER 1 4
  43. 43. COMMUNITY HEALTH CENTRES INTRODUCTION The community health centres are established and maintained by state government under MNP/BMS ( Minimum Need programme/Basic Minimum services) programme. It has 30 indoor beds with x-ray labour room, operation theatre and laboratory facilities. It is managed by four medical specialists i.e surgeon, physician, gynecologist and pediatrician. On 31st march 2003, 3076 CHC were established each covering a population of 80000 to 1.20 lakh.
  44. 44. DEFINITION Community health centres ate the nonprofit community governed health organizations that provide primary health care, health promotion and community development services, using them inter disciplinary terms of health providers
  45. 45. PRINCIPLES A) EXCELLENCE B) INNOVATIONS C) ACCOUNTABILITY D) COLLABORATION E) ACCESSIBILITY F) INTEGRITY G) ENVIRONMENT
  46. 46. ELEMENTS I) PRIMARY CARE II) ILLNESS PREVENTION III) HEALTH PROMOTION IV) COMMUNITY CAPACITY BUILDING V ) SERVICE INTEGRATION
  47. 47. STANDARD OF CHC In order to provide quality care in CHCs IPHS are being prescribed to provide optimal expert care to the community and achieve and maintain an acceptable standards of quality of care. These standards would help to monitor and improve the functioning of CHCs CHCs has to provide the following services like:- A) Care of routine and emergency cases in surgery. B) Care of routine and emergency cases in medicine. C) 24 hour delivery services.
  48. 48. D) Essentials of emergency obstetric care. E) Full range of family planning services including laproscopic services. F) Safe abortion services. G) New born care. H) Routine and emergency care of sick children . I) Other management of medical and accidental conditions . J) All national health programmes should be delivered through CHCs.
  49. 49. FUNCTIONS OF NURSING SERVICES As a basic function, to assist the individual patient in performance of those activities contributing to his health or recovery that he would otherwise perform unaided has had the strength will, or knowledge.] As an extension of the above basic function, to help and encourage the patients to carry out the therapeutic plan initiated by the physician. As a member of health team, to assist others members of the team to plan and carryout the total programme of care.
  50. 50. Formulating nursing service policies and procedures, and for keeping them up to date. Putting into effort and interpreting the administrative policies established by the governing board. Maintaining stable staffing pattern. Selecting and assigning nursing personnel. Planning and directing orientation and in service training programs for professionals and non- professional nursing staff.
  51. 51. Constantly evaluating and improving nursing care of patients and establishing nursing standard. Maintaining proper nursing records for clinical and administrative purposes. Assisting in the preparation of and administering the budget for the department.
  52. 52. Coordination of activities of various activities nursing units. Promoting and maintaining effective and harmonious relationships among nursing personnel, and between the nursing service department and medical staff, patient and public. Participating in community health and health education programs.
  53. 53. CONCLUSION Administration is a combination of purpose and means of achievement of that purpose. Nursing service administration results in out put of patient whose health is unavoidably detorioating, maintained or improved through input of personnel and material resources used in an orderly process of nursing service. Management is the process of getting work done through others. the nurse managers/ supervisors task is to plan, organize, direct and control available financial, material and human resources In order to provide effective, economic care to groups of patients.
  54. 54. REFERENCES 1) DEEPAK. K textbook of nursing management published by Emmess Medical publishers page no 22-33. 2) SUKHBIR KAUR JAGJIT KAUR textbook of nursing management and services jaypee brothers Medical publishers; 2007, page no. 73-75.

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