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Introduction to Hospital Nursing: Admission, Discharge

The document provides an introduction to hospital nursing, including definitions of a hospital and its purposes. It describes the various functions, types, and departments of hospitals. It discusses the admission process including criteria, documentation, and types of admission. It also covers the discharge process including its aims, principles, types, assessments required, and nursing procedures involved. The document serves as an overview of key concepts related to hospital structure and patient care processes.

Health & Medicine◦
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Unit 2: Introduction to Hospital Nursing Nabina Paneru
Definition of Hospital - A hospital is a residential establishment - providing short term and long term medical care observational, diagnostic, therapeutic and rehabilitative services - for persons suffering or suspected to be suffering from a disease or injury and for parturient. WHO, 1963
Purposes of Hospital • To provide promotive, preventive, curative and rehabilitative services • To facilitate educational activities for doctors, nurses, dentists and other health personnel • To carry out induction training, in-service education and different training to update knowledge and skill • To provide health service to community people
Contd. • To provide opportunity to do research to upgrade the health services provided by the hospital • To maintain a high standard of nursing care and medical practice through proper qualification of workers committed to promoting the health of the community
Functions of hospital • Patient care • Run outpatient, emergency services, outreach services and medical camps • Health Personnel education • Prevention of disease and health promotion • Health related research
Contd. • Education and trainings • Rehabilitative services • Diagnosis and treatment of disease • Vaccination program • Community health services
Contd. • Detect police case and provide report • Isolation of infected cases • Referral
Types of hospital • Based on objectives  Generic hospitals Special hospitals Teaching and Research hospital • Based on administration, ownership, control or finance  Government or public hospitals Non – governmental or private hospitals Semi government hospitals Voluntary agency hospitals
Contd. • Based on length of stay  Short term or short stay hospitals Long term or long stay hospitals • Based on type of medical staff  Closed – staff hospitals Open – staff hospitals
Contd. • Based on bed capacity  Small hospital (up to 100 beds) Medium hospital (>100 and <300 beds) Large hospitals (>300 beds) • Based on type of care  Primary care: basic health care (Health post, PHCC etc)  Secondary care ( 5 to 10 specialties; 200 – 800 beds: provincial, regional or general hospitals) Tertiary care: highly specialized (300 to 1,500 beds: National hospital, Central hospital, Academic or teaching or university hospital)
Contd. • Based on teaching affiliation  Teaching hospital Non-teaching hospital • Based on system of medicine  Allopathic hospital Ayurvedic hospital Homeopathic hospital Unani hospital Hospitals for other system of medicine
Contd. • Based on region  Regional District Community clinics
Departments of hospital 1. Medical and surgical department (Medicine, surgery, gynecology, obstetrics, pediatrics, eye, ENT, dental, orthopedics, neurology, urology, cardiology, psychiatry, skin – plastic surgery, nuclear medicine etc.)  Medical Director as a head. 2. Nursing department
Contd. 3. Paramedical department Laboratory departments - Pathology - Bacteriology - Biochemistry - Hematology - Parasitology - Serology - Blood bank - Histopathology
Contd. 3) Paramedical department Contd.. Pharmacy department Physical medicine and rehabilitation department (Physiotherapy) Radiology Dietary department
Contd. 4. Outpatient Department 5. Emergency department Operation Theatre (OT)
Non professional Health Services departments • Admitting department • Personnel department (Recruitment, Interviewing, Promotion or transfer, Termination, In – service training, Safety, Health programs, Recreation, Remunerations and Incentives) • Purchasing department • Medical records • Housekeeping departments
Contd. • Laundry department • Mechanical department • Maintenance department • Central Sterile Supply Department (C.S.S.D)
Admission and discharge of the patient Admission is defined as permitting patient to stay in hospital for observation, investigation, treatment and prevention of the complication of disease.
Criteria for admission • The person’s condition requires clinical management and/ or facilities not available in their usual residential environment. • The person requires observation in order to be assessed or diagnosed. • The person requires at least daily assessment of their medication needs. • The person requires a procedure/s that cannot be performed in a stand – alone facility, such as a doctor’s room, without specialized support facilities and / or expertise available • There is a legal requirement for admission
Hospital rules related to clients admission • Informed consent should be taken. • Doctor should fill the admission form. • Money should be deposited in the hospital by the patient at the time of admission and should take their inpatient number. • Visitor should stay with the patient during hospital stay.
Contd. • Smoking and alcohol are strictly restricted and should not be taken inside hospital premises • Inform to the patient and visitors to keep the valuable items, personal belongings such as money, jewelry carefully. Inform them that it is their responsibility and hospital will not be responsible if anything is lost.
Contd. • Peaceful environment should be maintained. • Visitors are not allowed to stay in ward during procedure hours, cleaning of the ward. • Visitors should be limited every time. • Patient should not go out of ward without informing the ward staffs. • Violence against medical, paramedical, other staff and damage to hospital property are punishable offences.
Contd. • Take consideration of client’s right.  Right to make informed choice about the treatment. Right to refuse a treatment. Right to make decision about the care.
Assessment of admission • Assess the admission payment bill and admission document and consent. • Assess the bed. • Observe the general condition of patient. • Assess vital signs and height and weight.
Purpose of assessment • To prepare patient both physically and mentally for his stay in the hospital. • To help the patient to be comfortable and t provide him with a clear and safe environment for preventing infection. • To give a good impression of the hospital and its service so that the patient will fully co-operate with the treatment and nursing care.
Types of admission • Emergency admission (admission that Is not planned and which results from trauma or acute illness which cannot be treated on an outpatient basis.) • Routine admission (admission is panned and gets admitted in the hospital on routine basis for treatment, diagnostic test and recovery.)
Articles required
Documentation • The time and date of admission • Where the client came from e.g. A&E, OPD, Clinic, another ward or hospital • How did the client arrive on the ward i.e. on a trolley, wheelchair, walking, being held in mother’s arms, whether mother was ambulant or sitting in a wheelchair. • The reason for admission
Contd. • Past medical and surgical history • Brief system assessment • Whether doctor’s orders were carried out • The condition of your client at the end of the admission process
Discharge • Is a process which involves the development and implementation of a plan to facilitate the transfer of an individual from hospital to an alternative setting where appropriate.
Aims • To teach the patient and his family about his illness and its effect on his lifestyle • To reduce the number of days of stay at the hospital • To ensure the continuity of care to the patient after discharge • To provide instructions for home care • To assist the patient in discharge process
Aims • To communicate dietary or activity instructions • To explain the purpose, adverse effects, and scheduling of drug treatment • To co-ordinate with out patient or home health care services • To answer all queries that the patient and the patient’s family have
Principles • Patient and family understands the diagnosis, anticipated level of functioning, discharge medications and medical follow – up. • Specialized instruction is provided to the patient and family to ensure that proper care after discharge will be provided to the patient. • Relocation of the patient and coordination of support system or transfer to another health care facility are performed.
Types of discharge • Cured and discharged: When the patient is discharged after the patient is full cured and doctors advice or order to leave the hospital. • DAMA (Discharged against medical advice) or LAMA (Leave against medical advice): When patient leaves a hospital against the advice of doctor or without doctor order for discharge. (Client signs the form that release the physician and health care institution from any legal responsibility for his/her health status and client is informed of any possible risks).
Contd. • Discharge on request: When patient request the doctor or staff members for discharge. (Patient or relatives signs a statement the they are taking the patient on their own will and responsibility) • Absconded: When patient escapes from hospital without knowledge of the hospital staffs and without signing the statement. • Transfer / Refer • Death
Articles required • Wheelchair, unless the patient leaves by ambulance • Patient’s chart • Patient instruction sheet • Discharge summary sheet • Plastic bag or patient’s suitcase for personal belongings
Assessment for discharge • Observe the doctor’s written order for discharge paper • Inform patient and family or relative about discharge • Check document and complete discharge information • Assess to make sure all the fees are paid
Nursing Procedure