Responsible for administration of particular unit, Maintains the standard of patient care, kindly share to the others. only for study purposes.

1. By
Mr. Abhijit Bhoyar
lecturer
WARD MANAGEMENT

2. INTRODUCTION
 Systematic planning and organizing nursing
intervention is the essence of good ward
management as far as the direct patient care
concerned ward management is one of the
prerequisite for good nursing care

3. The ward management
includes
I. Management
of client
care/patient
II. Management
of personnel
III. Management
of equipment
and supplies
IV. Management
of unit
environment

4. 1. MANAGEMENT OF CLIENT CARE
• Admission and
orientation of the
client
A
• Assessment of the
patient needs and
planning for the
care.
B
• progressive patient
care
C

5. A. admission and orientation of the client
 - to client
 - to relatives
B. Assessment of the patient needs and planning for
the care.
- Nurse should assess the needs of the patient based
on Maslow’s hierarchy of needs.
- It will guide for giving priority to these needs.
- Collect all necessary information
- It helps to provide continuity of care.

6. C. progressive patient care
 Progressive patient care is defined as
the organization of hospital facilities,
services and staff as per the medical
and the nursing needs of the patient.
 The concept of progressive patient care
is quiet old and started in military
hospital and by florence nightingle
in1800 AD.

7. Elements of PPC
Intensive care
Immediate
care
Self care or
convalescent care
Long term care
Home care
/ambulatory or OPD
care

8. Intensive care
 Based on patient condition
 Who are unable to communicate the needs.
 Who required extensive nursing care.
 Who required constant observation and
supervision.
 Who required ventilating support
 Skilled facilities

9. Immediate care
 Moderate amount of nursing care
 Patients are conscious and able to
express their feelings
 Constant observation not needed
 Segregation of patients helps to provide
good care.

10. Self care or convalescent care
 They are physically self sufficient
 Require least nursing and observation
 Patient are allowed a home type
environment
 Services are purely educational and
supervisory

11. Long term care
 Post operative case with infections
 They require skills and services.
 Nursing care is mandatory not repeated
, only regular periodic assessment is
needed.

12. Home care
 The hospital services extend to home
(outreach services)
 Less intensive diseases such as leprosy,
fractures, etc.

13. Ambulatory or opd care
 Post operative follow up
 Promotive, preventive and rehabilatative
services

14. BENEFITS OF PPC
 FOR DOCTOR’S
- Assure good care
- Better nursing
- Immediate therapy
- Mechanical support
 FOR HOSPITAL
- Effective use of hospital
bed
- Better utilization of skilled
man power
- Improve image
- Participation in community
care

15. BENEFITS OF PPC
 FOR NURSE
- Effective use of skill
- Better time utilization
- Scheduling of care
- Close contact with patient
- Nursing care as per
needs.
 FOR PATIENT
- Specialized attention as
per need
- Assist in getting adjusted
to hospital community and
home

16. d. Priority Nursing Care
 It helps to improve the quality of care.
 The nurse has to assess and planned the priority
nursing care
Example:- If the patient comes to the hospital with
failure of breathing, severe bleeding, injury on the
head, etc. in order to save the life of client. The
nurse give priority to the breathing problems then
to the bleeding and injury.

17. e. ASSIGNMENT OF THE PERSONNEL FOR THE
CLIENT CARE
 Once the planning of the care completed the manager needs
right person for the implementation of his plan.
 The assignment of personnel done in following ways
Team nursing
- Team nursing was assigned to accommodate several categories
of personnel in meeting the comprehensive nursing need of a
group of client.
- It helps to give the best quality of care by utilizing the ability of
every member.

18. Primary nursing
- The one nurse assign the responsibility for the care of each
patient form admission till discharge.
- The primary nurse has the responsibility for planning of client
care for one or more patient on other shift on the day or off day
of the primary nurse.
Case method
- In this the nurse is expect to provide complete nursing care to
the patient including general nursing care, treatment,
administering medication and other miscellaneous activities.
Functional method
- In this specification of function is allotted as a responsibility for
specific client.

19. f. Planning the time schedule &
work schedule
 It helps to provide adequate nursing care
 It helps to promote job satisfaction for each staff
 It provide best possible professional experience for each
personnel
 It helps to promote good relationship among the personnel

20. g. Ward rounds
 The ward incharge has to take rounds with
physician and her staff separately.
 The purpose of ward rounds are
- Observation of physical and mental condi9tion of
patient
- Observation of work
- Observation of effects and treatment
- Ensure the safety measures
- To observe the cleanliness of the wrd.

21. h. Records and reports
 Reports are the information passed on regarding
the client particular unit.
 Reports can be written or oral
 Records is defined as the record of event
pertaining to patients maintained by the
personnel.
 It is the responsibility of the ward incharge to
maintained the records correctly

22. i. Management of emergencies
 The nursing personnel should be ready for the
any type of medical emergency at any time. The
staff should follow the standing orders of the
policies of the hospital to meet emergency
situation.
j. Client teaching

23. II. Management of
personnel
 The nursing care fully depends upon the number and
quality of nursing personnel on duty all the time of the
day and night.
 The following points are helpful for the management
of personnel
a) Orientation of the new personnel
b) Supervision of the personnel and delegation of
authority.
c) Establishment of IPR
d) Evaluation of personnel.
e) Staff conference
f) Staff development program
g) Safety and welfare of personnel.

24. a) Orientation of the New
Personnel :
 The initial orientation of the new personnel should
be done by the nursing administration.
 The new personnel to be given orientation to the
entire hospital and the facilities provided.
 She is introduced to every department and its
personnel.
 She should be explained about the line of the
authority, channels of communication, the policies

25.  Next, she is introduced to the department where she
will be functioning.
 She is oriented to major activities of the unit, facilities
available, the location of the equipment, other
personnel working in the unit, the daily routines etc.
 When new staff is posted in one unit, first few days
allow her to spend in the department without any
assignment.
 During the period she can observe the routines of the
ward

26.  Next few days allow her to assist for other
personnel.
 Then after some time she is allowed to caring the
clients with uncomplicated diseases.
 As she becomes familiar with ward routines she is
given greater responsibilities.
 The orientation should continue until the
individual feel secure in what she is doing.

27.  A nurse who is returning after a long holiday, or
who is transferred from one unit to another also
need orientation, because the procedures and
routines differ from place to place and time to
time

28. b) Supervision of the Personnel
and Delegation of Authority :
 Supervision is an essential aspect of
administration.
 Supervision means guiding and directing effort of
employee and other resources to accomplish
stated work aspects.
 High degree of supervision improves the quality
of work.
 Poor supervision leads to poor work.

29. When assigning the responsibility, the ward
incharge should keep the following points in mind.
 Make sure that staff nurse how to do the work
assigned to her.
 Assign the responsibility with no over lapping
 Delegate responsibility with authority

30.  Specify clearly the duties, responsibilities and
relationship of each job.
 Consider each worker as an individual and make
the assignments based on her professional
experience, previous experience, technical
competence etc.
 Consider the supervision available for each
person. A new person require more supervision
than the person who is in the ward for long time.

31.  Good supervision is facilitative because,
superiors inspects the work in progress and can
correct inadequate performance before serious
consequences develop

32. c) Establishment of
Interpersonal Relationship :
 The ward incharge is responsible for the
establishment of good interpersonal relationship
among the personnel in her unit.
 This will also involve communication system
existing between and within the hospital
departments.

33. The following points to be remember to
establish good interpersonal relationship among
personnel.
 Give personal recognition to everyone by giving
promise and showing concern whenever they
deserve
 Any grievance should be dealt with promptly and
appropriately
 Plan, organize and coordinate the activities of the
team
 Try to create "we feeling" in subordinates

34.  Give each person, time and opportunity to plan
her work and make sure that everyone
understand the working assigned to her/ him
 Avoid interrupting the personnel while they are at
work, unless in case of emergency
 Do not do anything that will lower the status of the
team members Plan for frequent staff
conferences.

35. d) Evaluation of Personnel :
 Evaluation of performance of nursing personnel is
necessary for consideration of giving promotions,
incentives, transfer etc.
 It helps to improve the quality of services. If any
personnel is inadequate performance they can be
given for special training programmes to improve
then performance.

36. The qualities frequently assessed are :
 Quality of performance
 Personal qualities
 Capacity to further development
 Mental qualities
 Supervisory qualities etc

37. e) Staff Conferences :
 Frequent staff conferences or staff meetings are
necessary for good personnel management.
 Select proper time and place that does not affect
with the work of other personnel.
 Encourage all the team members to participate in
the conference.
 Always prepare an agenda that is to be discussed
in the conference.

38. Purposes of staff conference :
 It helps to build up the group morale and Inter
Personal Relationship (IPR) in the personnel
 It acts as a means of communication among the
members of the working team.
 It helps to update the knowledge of the team
members
 It helps in decision - making and problem solving
 Any problem that is encountered during care of
patients can be discussed in the conferences and
problems are solved

39. f) Staff Development
Programme :
 Inservice education and continuing education are
necessary for staff to update their knowledge and
skills and to meet the technical competence day
to day.
 The training needs of the individual is assessed
through performance appraisal and if necessary
inservice education programmes provided by the
organization.
 Some of the training needs may be necessary to
send the personnel for training courses eg.
Seminar and workshops outside the institution etc

40. g) Safety and Welfare of the
Personnel
The establishment of positive health and safety
programmes for the personnel include:
 Pre - employment physical examination
 Periodical examination of the health of the each
staff member
 Educating the employees to develop healthy
habits of living and working

41.  Good working environment is provided such as good
lighting and ventilation, etc.
 The measures to be taken to reduce risk of infection
and other occupational hazards at working area
 Provision for the welfare services such as social and
recreational facilities, employee counselling,
benevolent funds, retirement plans, Health insurance,
provision of rest rooms, canteen and living facilities
etc

42. III. Management of equipment
and supplies
 The utilization of equipment and supplies in the
wards / units is managed by the ward incharge.
 The effective management and control of
equipment and supplies, the ward incharge
should follow the principles of material
management.
 She may have to deal with many problems while
managing the ward supplies and equipment.

43. The problems that are faced by the
personnel regarding equipment and
supplies are:
A. INADEQUATE SUPPLY OF MATERIALS :
 The clients comfort, welfare and safety are
greatly influenced by the adequacy of supplies
and equipment.
 eg: lack of oxygen's supply endanger the life of
critically ill patients
 Treatment may be delayed if the sterilized trays
or equipment is not there when necessary
 Insufficient supply syringes and needles delays
the treatment.

44. B. EQUIPMENT MAY BE OUT OF
ORDER :
 If the rechecking of the equipment is not done.
 It will cause an embarrassing situation to
doctors, nurses and clients when they come
prepared for a procedures

45. C) SUPPLIES AND EQUIPMENT
MAY BE INACCESSIBLE :
 To prevent misuse and theft of the articles, some
of them are kept under lock and key
 If the person having key is not available in time or
she goes out of unit, delays the treatment of the
patient.
 Eg: Equipment from a central supply room
becomes inaccessible, if it is allowed to
accumulate in one or two departments, as it
become; inaccessible in other departments

46. D) EQUIPMENT IS
INCONVENIENTLY LOCATED
 It is waste of time and energy to take something
from the cup - board or store - rooms that are in
constant use for clients. Constantly moving the
place for keeping articles causes confusion and
wasting of time.
 There will be wastage of time and energy, if the
articles are scattered in several rooms.


47. For proper maintenance of supplies and
equipment the following points to be
remembered
 Keep an adequate supply of materials at hand at
all times.
 They are to be in good working condition Keep all
the articles ready for use.
 Articles should be easily available and as near as
possible to the place where it will be used
 To minimize obsolescence to be stolen and lost
easily should be place under lock and key. The
key must be available
 For usage of items follow FIFO (First in First out)
rule.

48.  Delegate someone with the responsibility for
handling supplies and the equipment's.
 The person who is given responsibility should see
that articles are kept in order, periodic checking is
to be done and report breakage and theft of these
articles which cause a deficiency in the ward.

49.  Educate the personnel in the economic use of
materials
 As far as possible avoid using the substitutes
 Use the articles in the proper way in which it is
designed to use.
 All necessary equipment and supplies necessary
for a particular treatment should be kept in one
unit

50.  Equipment should be located in the same place in
order to prevent loss of time. Observe the
personnel to prevent and misuse of materials.
 Follow the hospital policies regarding the
purchase and maintenance of equipment and
supplies

51. Aids in keeping an adequate
supply at hand :
1. Set a standard for quantity of each item to be
kept in the ward :
 Standards are established quantities which are
required to meet the needs of a particular
division.
 Eg: A unit should leave a standard of 4 manual B.
P. apparatus, which is the number the ward
incharge should keep at hand at all times.

52.  There are many factors that serve as guidelines
in setting the standards. They are:
a. The number of the beds in the unit :
 Certain articles need to be equal to the number of
bed. Eg. Mattresses, bed side lockers, etc ...
 Urinals and bed pans may be one for every 4
beds.
b. The type of service :
 A surgical unit will need certain items which are
not required in medical unit Eg: Orthopaedic,
gynecological; paediatric wards need different
items.

53. C. The age of the clients :
 Children need different items than adults, elderly
patients need different items
D. The sex of the clients :
 There are differences in requirements in a men
and women's unit.
E. The severity and type of illness :
 An intensive care unit will need emergency
equipment and supplies which is not needed for a
general ward.

54. F. Cost of items :
 The number of costly items are to be kept at a
minimum under the control of top level
management.
G. Durability of articles :
 Articles that are easily broken will have to be kept
in large stock than those are unbreakable

55. 2. Have a Satisfactory System for
Replacing Broken or Worn-out
Equipment :
 Most hospitals maintain an exchange system for
the replacement of equipment in order to prevent
overstocking or lowering the standards of
equipment.
 Eg: Broken thermometer is returned to the stores
before a new article is issued. This prevents an
increase beyond the standard.

56. 3. Make regular Inventories of all
items
 An inventory is a detailed list of all articles, their
specifications and standard number of quantity.
The specifications make it possible to identify the
articles, by size, number or description, some
times the cost of items are included.
 When inventory is taken, the count is checked
against, the standard and corrections are made
as necessary, separate the articles into groups for
listing eg: linen, furniture, metal ware etc.

57.  Some articles are counted on daily basis, some
are weekly, and some are monthly basis.
 The regular checking of articles helps to keep
equipment in its proper place to return borrowed
articles, to find damaged articles and to remove
unnecessary equipment.

58. 4. An intelligent ordering is necessary to keep
adequate amount of supplies and equipment at
hand:
 Requisition is written order for supplies and
equipment or for their repair.
 Requisition may be written by the ward incharge
or by someone who is specifically given
responsibility of handling equipment and supplies.

59.  Before writing requisition a systematic check to
be done to determine the numbers which are at
hand.
 Then she considers the expected needs and
determines the amount needed and writes the
requisition.
 She allows a small margin for emergencies.
Improper orders cause oversupply of articles
which may result in wastage.

60. IV. Management of
Environment :
 Provision of a safe and comfortable environment
for the patients and the personnel is the
responsibility
 of the ward incharge.
 It includes
 Regulation of atmosphere, temperature, humidity
and ventilation.
 Adequate lighting
 Prevention of noise
 Elimination of unpleasant odours.

61.  Dust control and safe disposal of excreta and
wastes
 Safe and adequate water supply
 Freedom from insects, vitamins and animal parts
 Protection from mechanical, thermal, chemical
injuries
 Fire prevention
 Provision of adequate privacy
 Prevention of cross infection
 Control of visitors
 Cleanliness and orderliness
 Aesthetic factors

62. Preplanning of Nursing Care
Activities
 Preplanning of nursing care activities essential for
good ward management to achieve long range
goals.
 eg:. Time schedule for staff.

63. Establishment of Routine
Organization of Work :
 Coordination and cooperation is essential for good
administration of frequently performed activities.
Therefore, establishment of routine for day to day
work by providing guidelines to the staff is essential.
 It helps in saving time for handling unusual incidences
in the ward. The ward incharge and other Nursing
personnel should disregard the policies and
procedures of hospital to enforce their routine in the
ward.

64. Organization of Work :
 It is essential to provide a care to the patient
according to the priority even for simple activity.
 The staff members should be aware of the priorities of
nursing care.
 Proper planning, organization and setting of priorities
for even the simple task for providing patient care
reduces feeling of frustration, conflict and stress
among the staff in the ward.

65. Decision Making
Responsibility :
 Every person working in the unit/ ward should
know her/ his responsibility.
 It is a responsibility of the ward incharge to
delegate the activities in order to provide patient
care in her unit with responsibility and
accountability.
 Delegation of responsibility of nursing care and its
accountability provide greater satisfaction to the
nursing staff concerned.
 But the overall responsibility is vested with the
ward incharge

66. Communication System :
 Communication system in patient care unit is
essential in order exchange of ideas and
information.
 Day to day patient care demands planned
communication in the form of written reports and
records.
 It is an important activity of the ward incharge
which is carried out by nurses to ensure
communication in a documented format.

67. Coordination and Cooperation
:
 Coordination and cooperation is essential in order
to provide good patient care. It facilitates
 Organization of work
 Establishment ward routines for performance of
nursing care
 Pre-planning of nursing care activities
 Effective supervision, evaluation by feedback
from time to time and plan staff development
programmes
 Maintenance of good communication.

68. Supervision and Rounds :
 Supervision means guiding and directing the effort of
employees to accomplish stated work aspects.
 The effectiveness of staff depends largely on the
supervision they receive.
 Good supervision is facilitative because ward
incharge inspects the work in progress and can
correct inadequate performance before the
consequence develop.
 Ward rounds also equally essential for planning
nursing care in the ward. Ward rounds can be made
along with the physician or self-independent rounds
by ward incharge in order to observe the clients,
follow the orders, to give prescribed treatment etc.

69. Records and Reports :
 There are different records and reports
maintained in the ward.
 They provide accurate and detailed information
about medical treatment and nursing care given
to the patients.
 Records and reports shall be written, clearly,
accurately, legibly and appropriately. Reports may
be oral or written.
 Eg: reports between nursing staff.
 The records are case sheet, drug register etc.
Confidentially of the records and reports are
maintained