1. Chitwan School of Medical Sciences
School of Nursing
Affiliated by Tribhuvan University
Bharatpur, Chitwan
Field Experience Report
2066
Submitted to - Madam Gayatri Rana
Community Lecturer
Chitwan School of Medical Sciences
School Of Nursing
Bharatpur, Chitwan
Submitted by - Pragati Khanal and Kamala Khadka
Community Major Group
BN 2nd Year
Chitwan School of Medical Sciences
School Of Nursing
Bharatpur, Chitwan
Submitted on: 2066/05/30

2. Introduction of Management:
Management is the technique by means of which the purpose and objectives of a particular
human group are determined, clearified and effectuated.
Management is the complex of the continuous coordinated activities by means of which any
undertaking or any administration or other services, public or private is considered.
Objectives of Management Practicum:
Course description:
Management course offers the students opportunity to apply management concepts and
principles in practice.
Course Objectives:
At the end of the management practicum, the students will be able to:
1. Participate in the administration of the District Public Health Office, utilizing
concepts and principles of management.
2. Demonstrate knowledge and skills of administering the health services at the PHC
level.
3. Demonstrate understanding of the administration of the nursing campus by working
closely with the campus chief and others in their daily activities.
Specific Objectives:
At the end of the community management practicum, the students will be able to:
1. Demonstrate the knowledge of different aspects of the management process of the
regional and district services.
2. Communicate with the members of the community to identify needs.
3. Work in cooperation with professional and traditional health workers, community
leaders and other intersectoral workers.
4. Analyze the management services of the PHCC to identify problems by using clinical
thinking process.
5. Plan and implement daily activities of DPHO under supervision.
6. Demonstrate ability to manage resources such as equipment, drugs, money, time and
space.
7. Analyze the different roles and functions of nursing personnel in the DPHO and
PHCC according to job description.
8. Develop the nursing procedure related to her work.
9. Demonstrate her knowledge of community resources by sending referrals to the
appropriate agencies or by contacting the senior health team member for consultation
or follow up care.
10. Develop a tool to assess the performance of one category of staff.
11. Develop recording forms for documenting patient’s condition and progress and other
essential information.
12. Give formal and informal classes for various categories of staffs.
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3. Objective of DPHO and PHCC Management:
General Objective:
1. To participate in the administrative and management activities of the DPHO and
PHCC by utilizing concepts and principles of management.
Specific Objectives:
In the DPHO, Chitwan:
1. To identify the function of DPHO.
2. To identify the management process of DPHO.
3. To identify the strengths and limitations of DPHO.
4. To analyze the management process of DPHO.
5. To involve in the daily activities of DPHO.
In the PHCC, Shivanagar:
1. To identify the objectives of PHCC.
2. To identify the functions of PHCC.
3. To identify the management process of PHCC.
4. To identify and analyze the role and functions of staffs at PHCC according to job
description.
5. To identify the strengths and limitations of PHCC.
6. To identify administrative policies of the PHCC i.e. leave, staff promotion, staff
evaluation etc.
7. To plan and implement daily activities of PHCC under the supervision of PHCC in
charge.
8. To establish interpersonal relationship with FCHVs and community leaders and
mobilize them.
9. To mobilize the local resources effectively.
10. To identify the PHCC problems and carryout necessary changes.
11. To conduct meeting with PHCC staffs and maintain minute of the discussion and
decision.
Main objective of DPHO:
To obtain an optimal health of public by providing preventive, promotive and curative health
services to maximum people through multi-sectoral involvement with full community
participation and decentralization approach and under the national health policy.
Main objectives of PHCC:
1. To provide preventive, promotive, curative and rehabilitative health services.
2. To control epidemic disease.
3. To provide maximum care by minimum expenditure.
Main Functions of DPHO:
1. Family Health
• Safe motherhood
• Family Planning
• FCHV program
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4. • Outreach program
2. Integrated Management of Childhood Illness
• Control of Diarrhoeal Disease
• Acute Respiratory Infection
3. Child health Program
• Expanded Program on Immunization
4. Nutrition
5. TB (DOTs)
6. Leprosy Control
7. Vector control
• Malaria
• Filariasis
8. HIV/ AIDS and STD control
9. Training Program
10. Health education, information and communication program
Main functions of PHCC:
• Provision of preventive, promotive and curative services to the community.
• Provision of safe motherhood, FP and MCH services.
• Provision of basic laboratory service. Blood for TC, DC, HB%, ESR, VDRL ,Blood
grouping ,Urine R/E and M/E, sputum for AFB, stool R/E and M/E, malarial parasites.
• Provision of immunization service through mobile clinic and static center.
• Provision of DOTS service, leprosy control and malaria control.
• Provision of essential drugs to the community.
• Conduction of nutrition Program like Vit-A distribution and growth monitoring.
• Conduction of IMCI Program.
• Provision of referral services.
• Prevention and control of epidemic diseases.
• Conduction of school health Program.
• Regular conduction of monthly review meeting and meeting with FCHVs.
• Co-ordination with different local clubs, CBOs, NGO's and INGOs.
• Conduction of national health Programme i.e. VIT-A, Programme and celebration of
special health days.
• Accurate maintenance of recording and reporting (HMIS and LMIS).
• Supervision of all SHP staffs under this PHC.
Health problems existing in DPHO:
Major health problems existing in DPHO, chitwan are:
1. Skin problems
2. Upper Respiratory Tract Infection
3. Pyrexia with Unknown Origin
4. Fall/Injuries
5. Acute Peptic Disease
6. Lower Respiratory Tract Infections
7. Eye problems
8. Dental problems
9. Diarrhoeal disease
10. Abdominal pain
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5. Administartive and management problems existing in DPHO, chitwan:
1. DPHO is run by acting DPH Officer.
2. Lack of proper arrangements of materials and equipments in Store.
3. Lack of cleanliness in toilet.
Health problems existing in PHCC:
Top ten major health problems existing in the PHCC are mentioned below:
1. Fall/ injuries
2. Skin diseases
3. Upper Respiratory Tract Infections
4. Acute Peptic disease
5. Pyrexia with unknown origin
6. Acute Respiratory Infection (Lower Respiratory Tract Infection)
7. Dental carries
8. Acute Supporative Otitis Media
9. Abdominal pain
10. Conjunctivitis
Problems identified during service delivery in PHCC:
1. Poor cleanliness of PHCC.
2. Improper management of dressing service.
3. Inadequate and not properly displayed IEC materials.
4. Poor management and lack of labelling of medicines cupboard in dispensary section.
5. Improper placement of sterile equipment sets in cupboard without labelling.
6. Inadequate amount of dressing, suture and delivery sets.
7. Old and tore wrappers of dressing, delivery, IUD, CAC sets and perineal sheets.
8. Lack of cervical repair set.
9. Lack of inventory in every section.
10. Improper management of suggestion box.
11. Inadequate supply of dustbins in every section.
12. Improper set up of ANC room, lab and examination room.
13. Lack of medicine box in inpatient departments.
14. Lack of curtains in labour room.
15. Improper management of wheel chair.
16. Improper management of syringes needed for immunization.
17. Improper management of register of previous fiscal years.
18. Lack of regular staff meeting in the PHCC.
19. Improper management of old newspapers.
Health actions taken to solve the identified problems in DPHO:
1. BN students encouraged store keeper for the management of the store section of
DPHO, chitwan.
2. Encouraged Office Assistants to maintain the cleanliness in the latrine.
BN students could not solve all the identified problems so that discussion was made
with DPH Officer for the effective management and implementation for change.
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6. Health actions taken to solve the identified problems in PHCC:
Different actions were taken to solve the problems while delivering services which are
mentioned below:
1. BN 2nd
year students initiated for the cleanliness of PHCC thoroughly using 0.5%
chlorine solution twice a day.
2. Technical person is assigned to dressing section for the service delivery.
3. All the IEC materials were collected from store and different sections and were
displayed properly in the IEC corner.
4. Medicine keeping cabinets of the medicine cupboard were labeled properly and
managed the medicines in the cupboard.
5. Cupboard of dressing sets and delivery sets were managed with proper labeling.
6. Dressing, suture and delivery sets were increased for the effective delivery of the
service.
7. New wrappers were prepared for dressing; suture, delivery sets, IUD and CAC sets as
well as new perineal sheets were made.
8. Cervical repair set was prepared.
9. Inventory was prepared of each section and displayed in the wall.
10. Suggestion box was managed and kept in proper place for the collection of suggestion
of community for the purpose of providing effective service with the community
participation.
11. New dustbins were issued for each sections of the PHCC.
12. Set up of ANC room, lab and examination room for the effective service delivery.
13. Medicine box were prepared and located in the wards and labour room.
14. Curtains were prepared for labour room.
15. Wheel chair is placed in labour room.
16. All the syringes were placed properly which are needed for the immunization.
17. All old registers were kept in cupboard properly.
18. BN 2nd
year students initiated to start regular staff meeting in monthly basis in the
PHCC.
19. All old newspapers were arranged and kept properly.
Management activities taken to solve identified problems at the DPHO:
1. BN students developed good interpersonal relationship with each and every staffs of
DPHO.
2. They clearly explained about their objectives to each section of DPHO.
3. Good communication and coordination was maintained through out the duty time for
the change.
Management activities taken to solve identified problems at the PHCC:
1. BN students coordinated with PHCC in charge as well as staffs while implementing
change process.
2. BN students always implemented change process in the PHCC after getting approval
from PHCC in charge.
3. BN students conducted meeting with PHCC staffs for the management of different
issues and problems which were raised during the service delivery to the community
in an effective way.
4. BN students completely participated for the implementation of change process in the
meeting.
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7. 5. BN students completely participated in the service delivery to community people.
6. BN students used available local resources as much as possible while implementing
change process.
7. BN students completely involved while changing the set up of different sections.
Response of the health workers towards those health actions in DPHO:
BN students discussed with the staffs of DPHO after assessment of the problems in DPHO
and initiated for the change. All the staffs were positive regarding the positive suggestion for
the DPHO. Office Assistant cooperated and implemented the change effectively.
Response of the community and health workers towards those health
actions in PHCC:
BN students discussed with the PHCC in charge as well as staffs of the PHCC after
assessment of problems in the PHCC. They expressed positive attitude towards the problem
solving approach and appreciated for he group work. They all co-operated BN students very
well and supported during management practicum for fulfilling the objectives. They showed
their interest to solve problems and change process. They also realized their responsibility.
Different problems of the PHCC were solved and managed with the co-operation of the
PHCC staffs.
In conclusion, the staffs of the PHCC were impressed by management activities of BN 2nd
year. Management activities could not be effective without enough support and co-operation
from the PHCC staffs. Students of BN 2nd
are very grateful to them for their adequate support
and cooperation through out the period of management.
Community people are also very excited after the implementation of change process in the
PHCC. It is seen that clients arriving to PHCC for the health service are engaged in IEC
corner in different posters and leaflets which is increasing gradually. Clients are happy by
getting the dressing service quickly by technical person.
Strengths of health service management of DPHO:
1. Implemented health programs are effective as the program is integrated.
2. Recording tools are updated.
3. Provision and supply of adequate resources for the health care service delivery.
4. Program has the principal of “No Commodities No Program”.
5. Regular monitoring and supervision activities.
6. These health programs have the supported in epidemic control.
7. The formulation of rapid response team for disaster.
8. Co- ordination with other agencies NGOs/ INOGs is appreciated.
9. Specific focal person for supervision of PHC, HP and SHP.
10. Regular conduction of review meeting with PHC, HP and SHP.
11. The focal persons of programme are responsible and accountable for evaluation of
health services in the district.
12. It applies and follows the principal of PHC.
13. It follows the national health policy.
Strengths of health service management of PHCC:
1. All sanctioned posts are fulfilled.
2. All the programs of the PHCC are running effectively.
3. Provision of 24 hour emergency services and delivery services.
4. PHCC has been providing good referral services.
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8. 5. Regularity of doctors’ service.
6. Most of essential drugs are available in the PHCC.
7. Clients’ flow is increasing daily.
8. PHCC has its own physical structure and adequate area.
9. Availability of ambulance service.
10. Good recording and reporting system of PHCC activities.
11. Good communication, cooperation and co ordination among staffs.
12. Good commitment of PHCC staffs to strengthen the PHCC services.
13. Provision of ECG and X-ray service in near future.
Limitations of health service management of DPHO:
1. Need for change in working trend.
2. Still lacking of 100% coverage.
3. Need for more than 90% coverage.
Limitations of health service management of PHCC:
1. Only two sanctioned post of office assistants.
2. Inadequate space in store room to store equipments and medicines.
3. Lack of separate DOTs room.
4. Lack of mental health service provision.
5. Lack of schedule for supervision of field activities and performance of sub health
posts functioning under the PHCC, Shivanagar.
Analysis of Field experience:
During the 2 weeks period of DPHO management, BN students got knowledge about latest
updates regarding health related matters adopted by Nepal government. They were able to
grasp new and latest information. They implemented their theoretical knowledge in the
practical site. All the staffs of DPHO supported them for the implementation of their
objectives and activities. BN students are grateful to all the staffs of DPHO for their adequate
cooperation and support through out the period of management. Students are even grateful to
Madam Mamata Sharma for her keen guidance, supervision and support for the DPHO
management.
During the 6 weeks period of PHCC management BN students got new managerial
experience. This period was the golden opportunity to learn knowledge and skill for
management activities being an in-charge learned about planning, organizing, budgeting,
supervision and evaluation of the staff which are the important points in the management
activities. Knowledge about rules and regulations and governmental policies were gained
from PHCC management. BN students developed self confidence to manage PHCC activities
after conducting management practicum. BN 2nd
year students are glad to PHCC family as
they are provided staffs’ well managed quarter for the lodging. Communication, cooperation
and coordination of staffs working in the PHCC played vital role in the achievement of
planned activities, implementation and evaluation.
Management practicum could not be completed effectively without proper guidance and
supervision from respected teachers. Therefore students are heartly pleasure to respected
teachers: Madam Gayatri Rana and Madam Mamata Sharma for their keen guidance and
supervision during the management practicum even in field activities.
In conclusion it can be said that the students had fruit full learning experience during the
period of six weeks management practicum.
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9. Recommendation for further improvement of health services provided by
DPHO:
1. It would be better if job description could be provided to all staffs.
2. It would be better if regular staff meeting should be conducted at least once a month.
3. It would be better to provide key information about organizational structure, function,
achievement and target through chart, graph and tables.
4. It would be better to expand laboratory services in the peripheral health institution
working under this DPHO.
Recommendation for the further improvement of health services provided
by PHCC:
1. It would be better if one office assistant can be recruited and managed from PHCC
management committee for the effective service delivery.
2. It would be better if another room can also be managed for the store.
3. It would be better if the separate room can be allocated for the DOTs room.
4. It would be better if mental health service could also be provided.
5. It would be better if a schedule for supervision of sub-health post could be prepared.
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10. References
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Publishing Company Limited. New Delhi.
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6. Tuladhar, K. Rai, B. Leadership and Management for Nurses. Educational Resources
for Health. Kathmandu.
7. McMohan, R. Barton, E. Piot, M. (2007). On being In charge. (2nd
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Geneva. A.I.T.B.S. Publishers. New Delhi.
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9. Thapa, B. (2008). Community Health Nursing. (2nd
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Publishers (P) ltd India.
10. HLMC, Community Health Nursing.
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