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Nursing services organisation

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Nursing services organisation

  1. 1. ORGANISATION AND FUNCTION OF NURSING SERVICES- HOSPITAL AND COMMUNITY By Sandhya C M.Sc Nursing Final Year RAKCON 1
  2. 2. ORIGIN OF WORD HOSPITAL • The word hospital is derived from the Latin word hospitalis,which comes from ‘hospes’ meaning a host. • Today hospital means an institution in which sick or injured persons are treated as well as healthy persons are helped to prevent, promote and maintain an optimum level of well being. 2
  3. 3. HOSPITAL • The hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive and whose out patient services reach out to the family and its environment, the hospital is also a centre for the training of health workers . -WHO expert committee 3
  4. 4. Functions of a Hospital • The primary function of a hospital is the provision of medical care to a community • To be a centre for education of all types of health professionals • To be a centre for research 4
  5. 5. 5
  6. 6. Nursing Service:- Is the part of the total health care organization which aims to satisfy the nursing needs of the community ,major objective of the nursing services is to provide prevention of disease and promotion of health. -WHO Expert Committee 6
  7. 7. Organization of patient care in hospital • Of all services provided in a hospital, the nursing service closest to the patients. • Management and supervision of nursing personnel is therefore a vital factor in establishing and maintaining an acceptable standard of nursing care for patients. 7
  8. 8. Major functions of hospital nursing services Education, training and staff development programme Personal and working relationships Maintaining an appropriate environment for patient care Personnel management Planning organising directing and coordinating individualised patient care. 8
  9. 9. Management of nursing care and services Establish adequate staffing pattern Develop and implement proper communication system. Develop and initiate proper evaluation and periodic monitoring system. Proper job description for nursing personnel. Assist hospital authorities for effective personnel management Share nursing information system with other discipline Formulate and interpret nursing service policies Assist hospital authorities for preparation of budget. Participate in inter departmental programs and other programs 9
  10. 10. Education,training and staff development programme Develop and initiate orientation and training programs. Create an atmosphere that conducive to give proper learning experiences for students. Assist in the development of a sound, constructive program of leadership in nursing. Initiate programs to improve the practice of nursing in keeping with advances in the relative areas and disciplines affecting the quality of nursing. 10
  11. 11. Nursing research Participate in identifying the areas of research Participate in the application of data and research. Produce conducive environment for research. 11
  12. 12. Nursing care • Nursing care is a direct service which includes one or both of the following components needed to maintain or restore an individuals optimum health Implementation of the physicians plan of care Planning,organising providing and evaluating facilities and care in terms of a patients need. 12
  13. 13. 13
  14. 14. Essential characteristics of a nursing service Written statement of Purpose and Objectives of Nursing service Plan of Organization Policy and Administrative Manuals Nursing Practice Manuals Nursing Service Budget Master Staffing Pattern Plan for Appraisal of Nursing Care Nursing Service Administrative Meetings Adequate Facilities, Supplies and Equipment Written Job Descriptions and Job Specifications Personnel Records Personnel Policies. Health Service and Welfare Facilities. Inservice Education of Nursing Personnel Programmes 14
  15. 15. Factors to Consider in Organising Patient Care in a Hospital Ward Administrative Policies pertaining to Patient Care and to Nursing Service in a Ward Need: for Care of Patients (Individually and as a Group in a Ward) Facilities, Supplies and Equipment for Safe and Effective Patient Care Personnel (Nursing and non-Nursing) Available to Provide Care 15
  16. 16. Administrative decisions and policies which may affect nursing care in a ward • Is the ward sister financially responsible for loss of equipment and linen and breakage in the ward? • What research is being done in the ward that may affect the morale of the nursing staff,indirectly this can affect the nursinh care? 16
  17. 17. Needs for care of patients • The Nursing care plan is based upon the Nurse’s observation of the patient and her Nursing knowledge and skills. • Her appraisal of the patient’s needs for Nursing care is a continuing process and is accomplished by such methods as observation, Nursing rounds, ward conferences, knowledge of patient’s record and medical orders. • To the extent possible, Nursing care plans are patient centred. 17
  18. 18. • Let us take a Male Medical Ward with 60 sanctioned beds and 65 patients (5 are “floor” patients). The 60 beds are assigned to five physicians. The day staff includes one Ward Sister, one Staff Nurse, two Student Nurses (one in the first year of Nursing and one in the second year), one Ayah and one Sweeper. Some of the patients are seriously ill, some moderately and some are able to care for themselves, for the most part. The diagnosis include: diabetes, cardiac insufficiency, hypertension, nephritis, typhoid fever, pneumonia, fever of unknown origin, gastric ulcer, hepatitis, general debility, diarrhoea and undiagnosed admitted for observation. • To organise Nursing care for these patients takes skill. The need of the patient’s individually and in relation to the group, as a whole will have to be assessed and planned for. What about a plan for progressive patient care within the ward? This would include grouping the patients according to their self-care abilities. 18
  19. 19. Personnel nursing and non nursing • In a hospital ward those involved in providing Nursing care to patients may include: Ward Sister, Staff Nurse, Student (Nursing and/or A.N.M.), Ayah, Orderly, Sweeper, and relatives of patients. The qualified Nurses can perform the more complex care and make the professional judgments. The Auxiliary Nurse Midwives, and these are not many in hospitals, can perform less complex care. Students should function at the level of their preparation. • A sweeper may give bed pan to selected patients, but a patient with recently fractured pelvis may need the skill of a nurse to help with elimination. 19
  20. 20. Facilities, Supplies and Equipment for Safe and Effective Patient Care • Environmental factors are important in providing safe and effective patient care. “Good administration aims at seeing that a ward is so arranged and equipped that good Nursing is possible, economy of effort and maintenance familiated, and the time and energy of personnel conserved • Availability of clean water and sanitation,the adequacy of supplies and drugs for clinical work,safe storage and use of drugs and chemicals and supplies for safe handling of blood and excreta 20
  21. 21. Organogram of Hospital nursing Chief nursing officer Nursing superintendent Deputy Nursing superintendent Assistant Nursing Superintendent Ward sister-Clinical Supervisor Staff Nurse Student Nurse 21
  22. 22. Job responsibilities Read out from the handout 22
  23. 23. COMMUNITY • A social group determined by geographic boundaries • A group of individuals with common values and interests. • A group of individuals living in the same place or having a particular characteristic in common. • Its members know and interact with one another. It functions within a particular social structure and exhibits and creates norms, values, and social institutions 23
  24. 24. community health : Community health is a field of public health that focuses on studying, protecting, or improving health within a community. It does not focus on a group of people with the same shared characteristics, like age or diagnosis, but on all people within a geographical location or involved in specific activity. community health nursing :- According to WHO “Public Health Nursing is a special field of Nursing that combines the skills of Nursing, public health and' some phases of social assistance and functions as part of the total public health programme for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation and prevention of illnesses and disability ...... ” 24
  25. 25. CONCEPTUAL LEVELS OF ORGANISATION FOR COMMUNITY HEALTH NURSING ADMINISTRATION IN INDIA 25
  26. 26. • StaffingPattern • Community Health Services are delivered in the rural area through a team of workers, at the block level Primary Health Centre,Sub centre and at the village level. 26
  27. 27. At the PHC: • Staff Nurse (GNM) • Female & Male Health Worker (FHW 85 MHW) • Health Assistant Female or LHV Health Assistant Male Pharmacist • Block Extension Educator • Upper Division Clerk • Lower Division Clerk • Laboratory Technician Statistician / Computer • Driver • Class IV Staff 27
  28. 28. At Sub Centre • Health Worker Female / AN M • Health Worker Male • Voluntary Workers (TD, CHV etc) 28
  29. 29. job responsibilities TO help the worker to develop a clear understanding of his / her expected job responsibilities. To avoid overlapping activities among different categories of workers. To provide a written document for legal purposes. To help as a tool for supervision v) To help in development of better understanding among the different categories of workers 29
  30. 30. The Nursing members in the team for health care delivery in the community consists of: • Community Health Nurse /PHN • Health Supervisor-Male &Female • Health Worker Male & Female 30
  31. 31. COMMUNITY HEALTH NURSE ROLE PREVIOUS ROLES Care provider Counselor Health educator Co coordinator Change agent trainer supervisor PRESENT ROLES Team leader manager supervisor Evaluator of programmes Liaison between staff advocate 31
  32. 32. Examples of Public Health Nursing Activities Evaluating health trends and risk factors of population groups and helping to determine priorities for targeted interventions. Working with communities or specific population groups within the community to develop public policy and targeted health promotion and disease prevention activities. Providing essential input to interdisciplinary programs that monitor, anticipate, and respond to public health problems in population groups. 32
  33. 33. DPHNO District public health nursing officer • The district public health nurse officer is attached o the district health office. And is directly responsible to the district health officer (DHO) and has responsibility for all nursing personnel in the District Public health field (i.e. in primary health centers and sub centre, family welfare programme tuberculosis and other programmes). Her area of work is the entire district. In technical matters, she is guided by the Deputy/assistant Director of health services. 33
  34. 34. FUNCTIONS General Administrative Supervisory functions Educational: 34
  35. 35. Director nursing services:(state) • Usually one or two nurses are posted with varying designations for example in tamilnadu, there is one Assistant Director, Nursing who is responsible to director, medical services and director medical education • In Maharashtra two nurses work one in each in the office of director medical education is responsible for all matters of nursing service and nursing education. • The nurse in the office of the director, health services is responsible for community health nursing services, nursing education. 35
  36. 36. Nursing Adviser • This is the post in the medical division of directorate general of health services.The nursing adviser is directly responsible to the deputy director general (medical) • The nursing adviser is assisted by nursing officer and support staff for all her/his work. • Functions: • Advices the DGHS,the ministry health family welfare as well as other ministries, departments e.g. railways,labour,delhi administration/municipal corporation delhi,etc. on all matters of nursing services, nursing education and research. 36
  37. 37. Deputy nursing adviser • This post is in the training division of department of FW. • Here the nurse deals with training of ANMs,dais,health supervisor. • There is no direct linkage between the nursing adviser and deputy nursing adviser as both are independent posts. 37
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