this slides deal with nursing management, nosocomial infection, patient care unit, its elements, progressive patient care, internal and external disaster, its management.

1. NURSING MANAGEMENT
Management of Nursing
services in Hospital

2. Hospital Infection Control Planning
INTRODUCTION-
Hospital infection are also called ‘nosocomial
infection’ , affect both patient and hospital . The
term nosocomial is derived from the greek word
“Nosokomeion” meaning “health care facility”.

3. DEFINITION-
“ Nosocomial infection or Hospital acquired infection
[HAI] is the infection that develops in patients after
more than 48 hours of hospitalization. Bacterial
infection which appears within 48 hours of admission.
Clients in the health care sittings can easily acquire
infections because they are in high risk group.
Nosocomial infection results from delivery of health
services in a health care facility.”
Nosocomial infections not only extend hospital care
for the patient but increase care for both patient and
hospital .

4. PATIENT CARE UNITS
The hospital differ in size and complexity. It
has many departments which are designed
to serve patients. The services should be
directed towards improved patient care and
utilization of personnel at all levels. Efforts
should be made in several areas such as
food service, medication, and supply etc.

5. PRINCIPLES OF PATIENT CARE UNIT
• Efficient administrative department – it is
required to direct and coordinate the activities
of various departments .
• Diagnostic facilities – fulfill the need of
hospital for carrying out the investigations such
as x-ray , blood tests etc.
• Dietary department – fulfill the dietary need
of patient .

6. • Central service department – this is organized
to provide the services such as :-
Pharmacy
House keeping
Laundry
Central stores with distribution

7. Elements of planning the patient care unit
• Size of patient care unit – information regarding
the factors such as type of patient, rate of
turnover, variety of health problems of patients,
number of doctors, number of personnel working
under her supervision should be borne in mind
while planning the design or size of patient care
unit.
• Shape of unit – the choice of shape of unit
should be decided after careful study of the site ,
number of beds per floor, orientation and
distribution intended.

8. • Patient’s room – it should be large enough
enough to accommodate doctor, nurse and
student nurses during rounds. Each room should
have locker large enough to accommodate the
articles of patient. The doors should be fire safe
and measures 3 feet 10 inches to accommodate
wheel chairs , stretchers and bed.
• Lighting – the patient care unit should have
lighting levels ranging from a fraction of foot-
candle for night lighting upto 100 foot candles
or more for examination and treatment.

9. • Noise – noise which can be disturbing to patient
on many patient care units should be either
reduced or eliminated .
• Ventilation – the patient’s room should be so
designed that air is not circulated to other
patient’s rooms, in case of a known or unknown
infections case or an odorous case.
• Isolation and security room – the patient’s care
unit should have isolation and security room .
When an infectious disease require isolation , can
be kept over there for prevention of spread of
disease.

10. • Treatment room – the treatment room should
be readily cleanable and procedures for infection
control must be established and followed. It
should be 3 feet 10 inches wide to accommodate
wheel chairs , stretchers , bed etc.
• Nurses station – it is the communication,
administration and charting center of the patient
care unit . Counters should be open underneath,
where possible, with drawers placed only where
required. Each patient care unit should have its
own nurses station and supporting services .

11. • Medication room – the patient care unit should
have medication room for storage and
preparation of medication . The pharmacy should
be responsible for stocking . It should have :-
Shelves for individual patient medication
A double locked narcotic safe
Drawers for storage of syringes
Refrigerator
Sink for washing hand
Paper towel dispenser , soap dispenser
A waste receptacle
A bulletin board

12. • Conference room and offices – in patient care
unit, one conference room should be provided for
the use of head nurse and for conferences
between head nurse and other staff members. A
conference room should have bulletin board,
blackboards and provision of a.v. aids . It can be
utilized for team conference , in-service programs
and conferences with patients or family .
• Day room – if visitors are making use of day
room, it should be designed and located so that
noise is not disturbing the patients.
• Supply room – it is the central storage and
distribution point for all sterile and non-sterile
supplies used on unit .

13. • House keeping – the main function is the
removal of soil and dust from all surface to
prevent cross infection.
• Nourishment facilities – food should ne served in
a closed container from hospital dietary
department to patient care unit and to be served
to patients the trays used for distributing should
be returned to dishwashing room.
• Stretcher and wheel chairs – one stretcher and
two wheel chairs are required as a minimum for
each 30 to 35 bed medical or surgical .

14. • Central supply of Oxygen and suction – each
patient unit should have central supply of
oxygen and suction in patients cubicle or room
for proper care during emergency.
• Communication system – such as telephones ,
radio system with central broad casting etc.
should be in the patient care unit . Even
registers are mean of communication such as
report register , in and out register etc.

15. PROGRASSIVE PATIENT CARE
In 1957 , under the sponsorship of the US Public
health services division of hospital and medical
facilities , the exenestary Memorial Hospital began a
project known as “Progressive Patient Care” , to
determine methodology , for classifying patient
based on as evaluation of many factors , to make a
determination of the best kind of unit to which the
patients should be assigned .
Today’s progressive patient care concept is a more
sophisticated , implementation of patients
classification that began many years ago.

16. DEFINITION
• FAVE ABDULLAH – The organisation of
facilities, services and staff around the medical
and nursing needs of the patient .
• MANUAL OF INTENSIVE CARE – Progressive
patient care is talloring of hospital services to
meet the patients needs . The right patient in
right bed with right service at the right time .

17. Major objectives of progressive patient care
 Providing high quality of therapeutic comprehensive
care for each patient to meet his immediate needs .
 To provide adequate equipment's and facilities ,
professionals and trained personnel at a lower cost than
traditional .
 To provide a difficult level of medical and nursing care in
the various units to meet the patients needs .
 Shorten the average length of patients hospitalizing
period .

18.  To provide effective hospital services
under the supervision of efficient
manager .
 Initiate suitable hospital admissions
procedure so that patient can be
assigned to appropriate units .
 To provide community service in and
outside hospital in an organized way as
per family and patients needs .

19. Elements of Progressive Patient Care
Intensive care – Where the patients who are very
serious are given constant care. In the out ICU, the
critically ill patient are concentrated upon regardless
of diagnosis.
Constant care – it is new element of the PPC system
for the accurately ill patient who require less
continuous nursing service than patient classified in
the ICU category.
Intermediate care – it include , those patients
requiring moderate amount of nursing care , but
whose intensity level of care is less than those in
specialty units.

20. Long term care – this care is closely associated
with health needs of elder patients and others
who need prolonged medical, nursing and other
supportive services. The patient who requires
continues physical care are assigned to be as
long term patient.
Self care – it is organized for patient who are
ambulatory and self sufficient but require
therapeutic or diagnostic services, pre-
operative services, specific treatment or
instructions prior to discharge are the patients
under this category.

21. Home care – it is a hospital community service
that assists patient in preparation for resuming to
their own home and family.
Out patient services – these services are offered
to ambulatory person who requires periodic,
diagnostic, curative, preventive or rehabilitative
services.
Emergency care – the hospital emergency service
provides for the assessment of the ill or injured
persons who is either treated or transferred to as
appropriate facility in the hospital or another
institution that offers service required by the
patient.

22. Advantage of progressive patient care
• Effective use is made of personal and equipment.
• Patients are in the best place to receive the care they require.
• Use of nursing skills are maximized due to different staffing
patterns, in each unit.
• Extra privacy is appreciated by the patient.
• Centralized of costly equipment's both diagnostic and
therapeutic instead of having them in different wards.
• Reducing the hospital cross infection.
• Patients feel confident and encouraged.
• Centralizing of acutely ill patients which affects maximum
care for each case and eliminate the disturbance to other
conclusive patients.

23. Disadvantage of progressive patient care
• There may be discomfort to the patients who are
mourned often.
• Continuity of care is difficult.
• Long term nurse patient relationship is difficult to
arrange.
• Heavy emphasis is placed on comprehensive written
care plans.
• Meeting administrative needs of the organisation
staffing are many times difficult.
• Low morale if patients has to go back form
intermediate ward to ICU.

24. PLANNING – Emergency and Disaster Management
It is difficult to prevent the chaos during first
minutes of disaster. During the first phase of
disaster more admission and treatment capacities
are required in hospital, so special preparedness
planning has to be in effect. Even there is
possibility that hospital itself could be afflicted by a
major accident. All this require the need to have
special and well working disaster plan .
Disaster are if 2 types – External Disasters and
Internal disasters.

25. Purpose of emergency disaster plan
For external disasters :-
 To handle large number of patients by enhancing
the capacities of admission and treatment
effectively and efficiently.
 To provide on going continuous treatment those
who are already in hospital area. To support the
damage are by means of material required such as
infusions, dressing material and equipment etc. and
manpower to meet the existing needs of disaster .
 To protects the patients, employees and rescue
personnel form any damage .
 To ensure an effective co-ordination of available
resources .

26. For internal disaster :-
 To protect the men, material and environment by
the putting the prepared plan measures into
action .
 To prepare the staff in advance so that know
their task and give appropriate instructions.
 To reestablish as quickly as possible an orderly
situation ensuring to normal work conditions.

27. DISASTER PLAN
In case of disaster the need for immediate action
arises and decisions have to be taken. The principles of
disaster plan / emergency plan are:-
Mobilization of manpower within short notice.
Predefined and prepared site with required
infrastructure.
Delegation of competencies to achieve immediate
execution within short time period.
Ensuring remaining routine hospital work in
continuous.
Availability of resources on the existing base.

28. External Disaster Plan Include
ALARM – it has to be quick , otherwise time is lost
during early phase and will not be compensated.
MOBALISATION – the staff should be mobilized
immediately on alarm alert as delayed
mobilization is irreparable. The staff should know
where to go and what to do.
COMPETENT STAFF – they should be trained
enough in handling the disasters and creating
non-stressful environment. The should be aware
of :-

29. a) Discharge of uncomplicated, simple medical
problem patients which can be treated at home
from hospitals.
b) Transfer of patient .
c) Protective measures for self and others i.e.
patient and visitors .
d) Release of beds and operation rooms.
e) Postponing uncomplicated scheduled
admissions and operations.
f) Right and duties to inform towards the patients.

30. ADMISSION AND REGISTRATION OF PATIENTS – these
procedure will not be possible at the time of
disaster . So a simple and ready-for-use system , a
reliable identification system of personal property
of patients and an adequate handling methods
which enables relatives to find patients in hospital
in required for use.
PREDEFINED TRANSPORTATION ROUTES – a proper
guiding system with respective floor marking
should be used to avoid chaos .
SORTING AT EMERGENCY ENTERANCE –it is required
to have start of sorting at the emergency entrance ,
for which physician should be there , who is having
adequate training.

31. COMMUNICATION – wire and radio contacts as
well as messengers have to be integrated into
communication concept. Ensure that the
communication should not fail.
PROTECTIVE MEASURES – it is important to
protect the personnel and patients from any
type of damage or infection.
PREPARED OTHER DEPARTMENTS – the other
department such as radiology, blood bank,
laboratories have to be prepared for more
extensive performance.

32. • TRAINING – all the personnel involved in disaster
relief should be trained enough. They should not
only have theoretical education but also have
periodical exercise. Mock disaster have to be well
prepared and executed to make the disaster team
skillful in handling the disaster .

33. INTERNAL DISASTER
It includes all the elements as of external
disaster including some modifications and
additional measures such as :-
Availability of rescue material such as escape
masks, fire fighting equipment's and fire
blankets.
Exit possibilities include elements and an
evacuation plan. Evacuation plan should be
adequate.

34. Every hospital should create one disaster plan
to manage disaster conditions. A lot of money
can be saved by timely preparation, which
otherwise can put an additional cost on the
hospital as well as on clients.