clinical guideliness for new comer of nursing profession students

1. DR.ANJALATCHI MUTHUKUMARAN PH.D(N) MD(AM)MBA(HA)MA(SOC)
PROFESSOR CUM VICE PRINCIPAL AND NURSING SUPERINTENDENT
ELMCH, ERA COLLEGE OF NURSING , ERA UNIVERSITY
LUCKNOW 226003

2. Welcomes for all batch of nursing
students at Era Family Members and
nursing profession

3. Introduction
 Clinical practice is defined as a model of practice that
involves those activities with and on behalf of clients,
especially those activities completed in the client's
presence and with the client's collaboration. These
activities are informed by an ecologically based
biopsychosocial assessment.
 General clinical practice guidelines:
 The standard definition of Clinical Practice Guidelines
(CPGs) is "systematically developed statements to assist
practitioners and patient decisions about appropriate
health care for specific circumstances".

4. Meaning
 “Clinical practice guidelines are systematically developed
statements to assist practitioner and patient decisions about
appropriate health care for specific clinical
circumstances.”(Institute of Medicine, 1990)
 Clinical Practice Guidelines are statements that include
recommendations intended to optimize patient care.
 These statements are informed by a systematic review of
evidence and an assessment of the benefits and costs of
alternative care options.
 Guidelines should be evidence-based, incorporate patient input,
as well as explicit criteria to ensure internal validity.

6. Era Educational Trust,Era Lucknow
Medical College and Hospital
 Era Educational Trust (EET) was started in
2001 by the approval of the Medical Council of
India (MCI), Ministry of Health and Family
Welfare and the Government of India, and
received recognition in 2006.
 With an aim to remodel education from being a
cluster of well-understood subjects to becoming
well-adapted aspects and principles of life, the
Era Educational Trust conceptualized Era's
Lucknow Medical College and Hospital.
 EET aspires to inculcate traits of honesty,
compassion, courage, persistence and
responsibility among students, so as to enable
them to become competent doctors with good
clinical knowledge as well as instill in them
ethics and values by which they can treat their
patients with a human touch.

7. Vision, mission and goal of ELMCH
 Vision
To be a centre of excellence in teaching, training,
research, innovation and medical care facilities
by attracting best talents, brains and manpower
for the benefit of the society as a whole.
 Mission
Our mission is to curate, create and disseminate
knowledge and academic excellence so as to
produce graduates and postgraduates who are
fully prepared to achieve highest level of personal
and professional distinction. Furthermore, we
work to provide health care facilities to all classes
of masses, including poorest of the poor and
downtrodden and offer medical care which is
Accessible, Available and Affordable.

8. ELMCH-Teaching Hospital
 ELMC&H is a leading teaching hospital for undergraduate medical
training as well as postgraduate and advanced training of specialist
doctors, nurses and allied health professionals. It has been
recognized as one of the best in the country.
 Among more than 500 government and private medical colleges of
India, ELMC has been ranked 10th, 26th and 32nd by Outlook, The
Week and India Today, respectively in 2022.
 It is affiliated with Era University, one of the most sought-after
institue, located in Lucknow.
 It is also recognized by Government of India and Medical Council
of India, New Delhi and listed with the World Directories of Medical
Schools, WHO/ AVICENNA and IMED/FAIMER directories.

9. Continued
 The college has been functioning as a "Centre of Excellence" in
medical education, healthcare, training and research for almost two
decades. Besides 150 undergraduate (MBBS) seats it also offers
postgraduate degree in 19 subjects (100 seats)
 which include General Medicine, General Surgery, Obstetrics &
Gynaecology, Orthopaedics, Radiology, Paediatrics, Dermatology,
Venerology & Leprosy, Anaesthesiology, Psychiatry, Tuberculosis &
Respiratory Medicine, Oto-Rhino-Laryngology, Ophthalmology,
Pharmacology, Microbiology, Community Medicine, Bio Chemistry,
Pathology, Anatomy and Physiology.
 Recently Fellowship / Post Doctoral Certificate Courses (PDCC) of 1
year duration were also started in various departments in order to
elevate the shortage of skilled and competent man power that will
benefit of the society at large.

10. Scope of services (Patient Care)
 The hospital provides care for patients, training for doctors and other
healthcare professionals, and conducts research to bring better care to its
patients.
 ELMC has a fully functional 850 bed hospital facility, equipped with
sophisticated, world class diagnostic and therapeutic equipment and supported
by a highly qualified and dedicated faculty.
 Its super specialty departments of Cardiology, Neuro-Surgery, Urology,
Paediatric-Surgery, Nephrology, Gastroenterology, Endocrinology and
Oncology etc. provide expert advice and treatment.
 Empanelled under the Ayushman Bharat Scheme, the hospital provides free
OPD and IPD services with subsidized charges for tests and treatments.
Trauma and Emergency services are available round the clock.
 There are dozen operation theatres (OT) accessible to this section, with adept
medical officers assisted by a team of doctors and other ancillary staff
managing this section.
 NABH accreditation hospital 2023 onwards , NABL accredited 2021 onwards ,

11. 24 hours services
 Maternity services
 Blood bank services
 Emergency services
 Operation theatres
services
 Pharmacy services
 Ambulance services
 Pediatric emergency
services
 Radio-diagnostic services
etc
24×7
Emergency & Trauma Service Unit
with a fleet of ambulances available
Diagnostics Department which
provides comprehensive pathology
and radiology services
Pharmacy well stocked with medicines
& products
Blood Bank operating round the clock

12. Critical care services
 Intensive critical care services unit (ICU)
 Neonatal Intensive critical care unit
(NICU)
 Pediatric Intensive critical care unit (PICU)
 Cardio thoraxic vascular surgery unit
(CTVS)
 Surgical intensive critical care Unit (SICU)
 Highly dependency Unit (HDU)
 Respiratory Intensive care Unit(RICU)
 Renal Intensive care Unit (RICU)
 Intensive Coronary Care Unit (ICCU)

13. Middle level- critical care services
 Labor room (LR)
 Pre-operatives services
 Post Operatives services
 Emergency services
 Burn Unit
 Pain clinic services
 Minor OT services
 Cath Lab services
 Endoscopy services

14. List of floor in ELMCH
 There are seven floor building consisting of 850 bedded , 126
bedded critical care unit, other supportive services like dietary
, linen, CSSD , maintenance services, PRO services,
physiotherapy, occupational services, speech therapy etc.
 Floor wise distribution are
 Ground floor
 Emergency, medicine OPD, pharmacy, PRO office, cardio
dept, diagnostic services , radio diagnostic service, laboratory
services, gyn/OBG OPD services , Ortho OPD, Physiotherapy
dept, HA office, urology OPD, Surgery OPD, dressing Room,
Injection OPD, maitenance office, registration , cash counter
office, etc.

16. First floor to fourth floor
 First floor- pre-op, post-op,OT, MOW, FOW,
dialysis , pain Clinic, Eye OPD, Pedia OPD,
Immunization OPD, adolescent Clinic, ENT OPD
etc
 Second floor – LR, GYN OT, skin OPD, chest
medicine OPD , CTVS, OPD, SICU, PICU, NICU,
HDU, CCU, ICU pharmacy , endoscopy, SR
Room etc
 Third Floor – PVT ward, chest medicine ward ,
HDU-II , GYN.Ward, Blood bank, pedia ward I, II,
III, Picu Extention , Burn unit.
 Fourth floor- MMW I &II, FMW I &II, OBS.Ward ,
Obs department , medicine department etc.

17. PICU,SICU/CTVS/ICU

18. Fifth floor to seventh floor
 Fifth floor- MSW I & II, III, FSW I & II, Psychiastric ward
, physiotherapy department , ortho department etc
 Sixth floor- account office, HR office, CSSD office, ADA
office, IT office, Director Office, ENT ward, EYE ward,
community medicine dept, happiness ward etc.
 Seventh floor – skin ward , emergency ward extension ,
linen department , MRD , foreignsic department ,

19. Hospital Highlights
 One of the best Radiology Centre in the whole of North India with state-of-the-art
MRI machine, spiral CT scanner, mammography machine, High-Resolution Colour
Doppler, the latest Ultrasound machine, Mobile and Fixed X-Ray machines with IITV
 ICU is equipped with a central monitoring system, ventilators, defibrillator, blood gas
analyzer, piped oxygen, suction and compressed air. For critical neonates requiring
extra care, the hospital has hi-tech fully equipped specialized NICU
 Neurosurgery and Trauma cases, Laparoscope Surgeries and Endoscopy
performed on a routine basis.
 It received the prestigious SKOCH award for implementing and seamlessly
executing the Ayushmann Bharat Scheme of the Govt of India.
 Immediate attention to medico-legal cases
 In-house biomedical waste disposal facilities including an incinerator
 Doctors residential quarters are available in the campus to facilitate immediate
patient care.
 Electricity generating plant which provides round the clock power supply.

20. Patient-Directed Research
 ELMC&H seeks to bring to its patients new and better care and therapies through
research.
 It is the first medical institute in the country to establish the Department of
Personalized and Molecular Medicine and is a registered 'National Referral
Centre for Lead Poisoning in India'.
 Research is an integral part of our institutional practice. ELMC has the honor of
being amongst the top 4.3% medical institutes of India (most active in the field of
medical research), with more than 1300 published research articles in National
and International and peer-reviewed journals.
 The university bi-annually publishes a multidisciplinary scientific journal titled
Era's Journal of Medical Research (EJMR) which is indexed and peer reviewed.
The university's national and international research collaborations provide a
platform for exchange of knowledge.
 Healthcare delivery in India has witnessed an extraordinary paradigm shift and we
at Era promise to deliver the best and updated practices of healthcare through
comprehensive integrated clinical practice, medical innovation and lifelong learning.

21. Cath lab services at ELMCH

22. INC guidelines
 The following Establishments / Organizations are eligible to Establish /
Open a General Nursing and Midwifery School of Nursing (GNM
School).
 a) Central Government/State Government/Local body;
 b) Registered Private or Public Trust;
 c) Organisations Registered under Societies Registration Act including
Missionary Organisations;
 d) Companies incorporated under section 8 of Company’s Act;
 2. The eligible Organizations / Establishments should have their own
100 bedded Parent Hospital.
 1:3 ratio for student and patient ratio
 Minimum 30 meter distance of clinical area
 100 % clinical area expose and completion of requirements

23. Why it need for nursing services
 Etiquette Rules of behavior among members of
a profession or class of society
 It is necessary to have certain rules of behavior
laid down in the service
 This will ensure that every member knows what
is expected of him/her
 It also helps to ensure the welfare and safety of
our patients/clients
 Etiquette is a code of good manners that a
nurse should follow.
 The nurse is an important member of the health
team that must work in co-operation and
harmony for the care of the sick.
 For a smooth functioning and a good
interpersonal relationship.

24. Aim of clinical practice
 The goal of clinical practice guidelines is to improve the
quality and cost-efficiency of health care.
 If this is to occur, then monitoring of patient care (i.e.,
gathering data) is a must.
 Patient safety and good quality of standard

25. Good Clinical Guidelines
 Good Clinical Practice (GCP) is a set of internationally recognised
ethical and scientific quality requirements that must be followed
when designing, conducting, recording and reporting clinical
trials that involve people.

26. Guidelines important in clinical practice
 Clinical guidelines
are evidence-informed
recommendations
intended to optimize
patient care.
 A valid guideline has the
potential to influence care
outcomes, but for that it
needs to be effectively
disseminated and
implemented so it can
inform care processes
future generation .

27. Purpose of guidelines
 A guideline aims to
streamline particular
processes according to a
set routine or sound
practice.
 Guidelines may be issued
by self and used by any
organization
(governmental or private)
to make the actions of its
employees or divisions more
predictable, and presumably
of higher quality.

28. How to understand attitude bring good clinical
practices
 Good Clinical Practice is a set of guidelines for biomedical
studies which encompasses the design, conduct,
termination, audit, analysis, reporting and documentation
of the studies involving human subjects.

29. 4 pillars of Clinical Practice
 ACPs are deployed
across all healthcare
settings and work at a
level of advanced clinical
practice that pulls together
the four ACP pillars of
 Clinical Practice,
 Leadership and
Management,
 Education and
innovation
 Research.

30. 3 MAIN GCP PRINCIPLES
 Three basic ethical
principles of equal
importance,
 Namely respect for
persons,
 Beneficence,
 and Justice, permeate all
other GCP principles.

31. You as a nurse should follow certain essential good
manners:
 Etiquette For Nursing
Professionals Respect and pay
courtesy to older people or
ones superior rank You should
greet your seniors, co-workers,
your patients etc .with
appropriate words and according
to the time of the day.
 You should be courteous to all.
 Be gentle and polite in your
talk.

32. Continue for work professional etiquette
 When entering a room or ward
senior members must be
allowed first and doors
opened for them Open the
door for the seniors and stand
aside for them to pass.
 Know the other classes of
healthcare professionals who
care for your patients and be
familiarized with their
procedures and cooperate
with them
• Do not give information which
will make the public fearful of
hospitalization
• Do not stress the fact that you
are better prepared than others
when working with them
• We should know the people in
our care and address them
according to their rank
• Address them properly-
address the seniors with proper
title eg Sir, Madam, Sister,
Mister, Miss etc.

33.  Visitors coming to the ward or health facility should be
properly attended to and warmly welcome Information
about our patients should be given to the right people.
 Keep eye contact and sit face to face when listening to
someone. Never let others secret go out of you. Do not
cover the mouth while talking to others. Excuse
yourself before you interfere with others engaged in
talking or doing some work.
 Say "Thank you" when some one is doing a favour for
you. Do not delay your answers to the questions. give
the answers immediately and appropriately. Be
punctual.

34.  Maintain silence wherever and
whenever necessary.
 Keep your dress neat and tidy.
 While on duty never use any form
of jewellery that may interfere with
work.
 Stand up when people of higher
rank enter your room.
 Stand up when answering
questions in the class room.
 Excuse yourself when overtaking a
senior person.
 Obey seniors without arguing.
 Help the seniors to carry a heavy
load if you find them on the way.

35. How do you monitor clinical practice
guidelines?
 Strategies for continuous
monitoring and updating of CPGs
The strategy included four steps:
 continuous and exhaustive
searching;
 reviewing the new evidence;
 revising recommendations;
 and announcing new evidence
and modified recommendations.

36. Why are nursing need guidelines
important in clinical practices
 They provide an evaluation tool for yourself and your
colleagues to ensure clinical proficiency and safety.
Professional nursing standards are also used to provide a
framework for developing clinical competency checklists or
proficiency evaluations for a specific clinical unit or employer.
WORK PLACE ETIQUETTES
 Dress Appropriately:
 No sharp colours.
 No strong perfumes.
 Not too much jewelery.

37. WORK PLACE ETIQUETTES
 MIND YOUR LANGUAGE:
 Your point wont come across any better if you use
rude, derogatory or obscene language, no matter
whom you are addressing.
 Talk like a professional.

38. WORK PLACE ETIQUETTES
IMPORTANT RULES:
 SHOW RESPECT: We all want respect no matter what
job function we do, what age we are or what position
we hold.
 WORK PLACE ETIQUETTES Manners that replace
crudeness, rudeness and coarseness with gentle
behaviour and finesse. It is a duty and should be a part
of every formal training
 WORK PLACE ETIQUETTES Your hard and technical
skills can get you a job…. But what keeps you climbing
the ladder of success are your soft skills and etiquettes.

39. WORK PLACE ETIQUETTES
 What does etiquettes mean? The forms and practices
prescribed by social convention or by authority.
(Websters II new college dictionary) The code of a
polite behaviour in a society.(Oxford Reference
Dictionary)
 WORK PLACE ETIQUETTES Also means behaving in
an ACCEPTABLE manner and being CONSIDERATE
of others…. Do not impose on others what you yourself
do not desire

40. WORK PLACE ETIQUETTES
 USE OF COURTESY WORDS: Say thank you and
please whenever required.
 It makes people understand you appreciate what they
can do or have done for you.
 BREAK BARRIERS: The best way to do this is to
introduce people to others whenever the opportunity
present itself
 USE OF FORMAL NAME: Address people by their
formal name when meeting them for the first time, until
you are more friendlier to them.

41. WORK PLACE ETIQUETTES
INTEGRITY
 When you make a promise, you need to follow through on
it
 REFRAIN FROM POLITICS: Indulging in office politics is
against the accepted norms of etiquettes…
 RESPECT EVERYONES PRIVACY: Do not eavesdrop on
anyone. It is very rude.
 LOOSE LIPS, SINK SHIPS: Keep gossip or hurtful
information to yourself. Do not spread rumors or encourage
them
 STOP BULLYING: Help your juniors and sub-ordinates.
Dont bully them or allow your peers to do so.

42. WORK PLACE ETIQUETTES
 BE PUNCTUAL:
 Appreciate the value of time … yours and others.
 BE KIND: Every living thing responds to kindness. Use
this skill for good results in handling people
 KNOCK PLEASE: Never walk in unannounced or
uninvited in some ones office.
 Make sure the person is not busy when you talk to
him/her.

43. WORK PLACE ETIQUETTES
 CHOOSE YOUR COMPANY CAREFULLY:
 Be careful which crowd you associate with.
 It should not leave a bad impression on others
 NEVER INTERRUPT: Remember it is always rude to
interrupt.
 USE OF COURTESY WORDS: Say thank you and
please whenever required. It makes people understand
you appreciate what they can do or have done for you.

44. WORK PLACE ETIQUETTES
 LEAVE GENDER OUT OF THE EQUATION:
 Coworkers are peers regardless of their gender.
 It is there to make your work more easier… use it
judiciously.
 Care for it as you would for anything that you owned.
 Avoid using them for personal use.
 DONT GRAB ALL THE PERKS:
 Sharing is good for you.

45. WORK PLACE ETIQUETTES
 NO LOUD CELL PHONES RINGTONES: Cell phones
should be kept mute or with decent ringtones.
 TAKE PERMISSION: Do not use any ones stationary,
computer or any other belonging without permission
from anybody in hospital premises
 TAKE CARE OF PERSONAL HYGIENE: Dont irritate
others with your bad habits. Chewing gums or popping
bubble gums Itching Clipping nails


46. WORK PLACE ETIQUETTES
A true professional
treats others with
respect and expects
the same from them.

47. Dos in clinical practices
 Use over coat/apron while your in clinical area
 Wear/Put up uniform as per course and institutional
rules .
 Use only black color ¾ cover shoe with shocks in
clinical area
 Use simple writs watch for time management
 Use water bottle for drink water
 Have pocket articles /stationary items while on duty

49. Don’t practices certain behavior in clinical
setting
 Never stand in corrider area , on the way, entrance,on front
area, road side etc
 Don’t discuss any official information way, corrider, stair
case, outside etc
 Don’t sit in bench, table, out of mannerism area
 Don’t sit any hospital waiting area , patient OPD area with
duty hours and uniform
 Don’t spit here and there
 Don’t smoke in hospital premises
 Don’t eat pan masala, hooka etc.

50. Don’t do party/celebration

51.  Don’t wear over coat out of patient area /clinical area .
 Don’t go with uniform out side of hospital /till house/home .
Market place, tea stall, canteen etc,
 Don’t use loud voice in hospital premise.
 Don’t throw any waste here and there.
 Don’t roaming out of your allotted clinical area while on duty .
 Don’t bring any value items to clinical area like wallet, laptop,
mobile gold /silver item etc
 Don’t make sound able shoes /sandal/cheppal in clinical area
 Don’t make any crowd /unity in clinical area

52. Principles
 Principle 1: Ethical Conduct
 Principle 2: Research described in a protocol
 Principle 3: Risk Identification
 Principle 4: Benefit-Risk Assessment
 Principle 5: Review by Independent Ethics Committee/
Independent Review Board
 Principle 6: Protocol Compliance
 Principle 7: Informed Consent
 Principle 8: Continuing Review/Ongoing Benefit-Risk Assessment
 Principle 9: Investigator Qualifications
 Principle 10: Staff Qualifications
 Principle 11: Records
 Principle 12: Confidentiality/Privacy
 Principle 13: Good Manufacturing Practice
 Principle 14: Quality Systems

53. The following resources offer Clinical Practice Guidelines
for you to search, browse, download, and use:
 Infection Control Guidelines
 IPHS guidelines for CHC, SC, PHC, District hospital
 ECRI Institute's Guidelines Trust
 National Center for Complementary and Integrative Health
(NCCIH) Clinical Practice Guidelines
 Clinical Practice Guidelines and Evidence-Based Reviews
for Neuroscience Nurses
 Clinical Practice Guidelines Infobase
 National comprehensive Cancer Network (NCCN)
Guidelines
 Veteran's Health Administration (VHA) Guidelines

54.  Registered Nurse's Association of Ontario (RNAO) Best
Practice Guidelines Program
 Emergency Nurses Association (ENA) Clinical Practice
Guidelines
 State nursing council guidelines (SNC)
 Indian Nursing Council guidelines (INC)
 Trainned Nurse Association guidelines(TNAI)
 National Medical Council (NMC)
 Consumer protection act (CPA)
 Right of patients /responsibilities of patient
 Right of employee/responsibilities of employee
 University Grants Commission (UGC) guidelines

55. Compliance with statutory norms
 All statutory acts, rules and regulations must be strictly adhered to. It will be the
duty of senior officials to comply with these and they can delegate roles and
responsibilities to relevant officials. They must also provide regular monitoring
and feedback mechanism that is followed. The following must be included
although it not an exhaustive list:
 No Objection Certificate from the Fire Authority
 Compliance with state by-laws and the National Building Code (NBC) for all
infrastructure
 Gas cylinder rule 1981, ISO 7396-1:2016 and Indian Explosive Acts, 1984
 Authorisation under the revised Biomedical Waste (Management and Handling
Rules) 2018 guideliness
 Seismic safety guidelines 1983
 Registration of Births and Deaths Act 1961
 License for Blood Bank or Authorisation for Blood Storage facilities

56.  Consumer Protection Act 1986
 Drugs and Cosmetics Act 1940 to 1945
 Indian Medical Council Act and the Code of Medical Ethics 1948
 Indian Nursing Council Act 1948
 Pharmacy Act 1948
 Medical Termination of Pregnancy Act 1971
 Persons with Disability Act 1995, 2016
 PC & PNDT Act 1994
 Mental Health Act 1987
 Narcotics and Psychotropic Substances Act 1988
 Authorisation and approval from the Atomic Energy Regulation Board
(AERB) 1962

57.  Boilers Act 1950
 Excise permit to store spirits
 Vehicle Registration Certificates
for Ambulances Form 23 A,23
B
 Clinical Establishment
(Registration and Regulation)
Act 2010
 Right to Information Act 2005

58. Clinical Guidelines are important to
nursing officer because
 They should do :
 Provide quick access to the synthesis of evidence
 Give the clinician direct access to the knowledge-base
of the experts
 Allow one to self-assess their current practice
 Assist with developing direction of future clinical
research

59. BENEFIT OF GCP
 The benefits of clinical practice guidelines include
 Improve clinical outcomes
 Reduce variability in clinical practice
 Increase use of known effective interventions
 Provide greater cost effectiveness
 Increase transparency of evidence to justify
interventions
 Legitimize profession in the eyes of external
stakeholders

60. Thank you so much for listening…….