This document discusses nursing rounds and standing orders. Nursing rounds are conducted by head nurses or nurse teachers to understand patient conditions and the effects of nursing care. They allow observation of patients and staff work. Standing orders provide emergency treatment instructions for nurses and health workers when doctors are unavailable. They are intended to be used temporarily and cautiously. Standing orders aim to improve access to healthcare, especially in rural areas. Nurses play an important role in implementing standing orders appropriately through skills like physical exams, identifying issues, providing care, and making referrals.

1. Nursing
Rounds/Visits

2. Introduction
 There are several methods that can be used
effectively in clinical teaching. Nursing rounds
are conducted by the head nurse or nurse
teacher with the members of her staff or
students for a clear understanding of the
disease and the effect of nursing care for
each patient.

3. Types of nursing rounds
1.rounds with doctors.
2. rounds with discuss psychological problem of
patient.
3.social service rounds
4.medical round for nurses.
5.round with the physical therapist.
6.nursing rounds

4. Purpose of nursing rounds
 To observe the physical and mental condition
of the patient and the progress made from
day to day.
 To observe work of staff.
 To specific observation of the patient and give
report to doctor regarding., for example-
wounds,drainage,bleeding.
 To introduce patient to personnel and vice
versa.

5. Cont..
 To carry out plan made for care of patient.
 to evaluate result of treatment and patient
satisfaction.
 To ensure that safety measures are employed
for patient and personnel.
 To orient the nurse /student in taking charge
of the patient’s treatment and status of the
patient.

6. Cont..
 To teach nursing students or hospital staff regarding
specific condition.
 To check any preventable condition in patient such as
bedsore, foot drops etc.
 To check emergency equipment near the patient for
safety and working order.
 To compare C/F of disease in a patient so that the
students gains better insight.
 To prescribe any modification in nursing action.

7. Ways of conducting rounds
 When ward rounds are conducted , the
teacher goes to the patient’s room with the
group of nurses.
 Outside of the door, out of his hearing ,they
discuss the objectives , after which they go in
to see the patient and talk for a few moments
with him.
 They than move on to the next patient.

8. Cont..
 The discussion must necessarily by brief
including only the outstanding points if the
purpose is to visit all the patient in the ward.
 Nursing rounds are done in a reporting style
regarding the patient’s condition , nursing
care, medical care and prognosis.

9. Advantage of nursing rounds
 This method is a mean of testing the
knowledge of students and their acquaintance
with all the patient on the floor.
 The students, who are informed prior to
rounds, benefit the maximum in a real life
teaching method.
 No other type of round is subtitute for nursing
rounds.

10. Cont..
 It is very valuable for the head nurses to go
on regular nursing rounds with a clinical
instructor.
 An intelligent nurse with creative abilities may
find many other ways of successfully assisting
students nurses to develop nursing skills.
 Round helps in orienting a new nurse /
student to the patient.

11. Cont..
 Rounds are interesting strategies involving
the students, teacher and the patient.
 They offers a real life learning situation.
 Through rounds , evaluation of nursing activity
hurdles faced by nurse in nursing care can be
appraised.

12. Disadvantage of nursing rounds
 The confidentiality of the patient is hampered.
 The patient may overhear the discussion and may
not like the thought that he is being talked about.
 If group is large the teacher may not able to speak
loudly enough to be heard in which case the
attention of individuals who are on the fringes is
lost.
 Distractions are present in the ward.

13. Cont..
 An unprepared nursing round has little
teaching learning value.
 The value of nursing rounds depends on the
quality and presentation of the nurse teacher
head nurse.

14. Nursing Manuals

15.  It is a good practice to compile all the rules/guidelines
concerning the management and procedure in a manual
that can be made available for reference. These
directives generally fall under the following 3 headings.
1. Procedure issued by the administrative office and
referring mainly to regulations. This is essential for
maintaining discipline.
2. Procedure manuals, e.g.lab procedure manuals,
nursing procedure manuals.
3. Unit procedure outline the procedure to be used in unit.

16.  The contents of the manual , particularly in relation to the
specific procedure, will be more acceptable if compiled
following a group discussion. It is important that manual
should be keep up to date and old procedure should be
removed when new materials is issued.

17. Standing Orders/Nursing Protocols

18.  Standing orders are specific instruction regarding
treatment for condition that nurses and other health
workers may encounter in home, school and industries
where a doctor is not readily available. The standing
order are intended to provide treatment only in
emergencies and temporarily in the absence of a doctor,
they should be limited.

19. Purpose of standing order
 To meet emergency situation in rural area.
 To deliver care at home, school, community.
 To provide temporary treatment in the
absence of a doctor.
 To promote health services in community.

20. General standing order
instruction
 Standing order instructions should be issued
jointly by an authorized medical office and a
nurse or a committee with a nurse
representative.
 The community health nurse working in rural
areas may be only qualified professional
person readily available to the family , so
standing instruction must be used with caution
and discretion.

21.  Standing orders are these to promote health services in
the community.
 The medical officer is legally responsible for issuing
standing orders, and he should have faith in the sound
judgment of his staff.
 They reduce danger in acute condition.
 They create the feeling of responsibility among the
members of the health team.
 Every health service should issue standing instruction to
meet the health need of the areas.

22. Role of the nurse in standing
order
 The community health nurse should be skillful
in recording the history and in physical
examination in order to detect abnormality.
 The community health nurse should be
prompt in detecting appropriate action for
particular situation.
 The nurse should maintain a record of vitals
and other care given to the patient.

23. Cont..
 The nurse should have thorough knowledge to identify
the actual problem of the patient and to plan appropriate
nursing intervention.
 The nurse should intervene with services according to
the given community standing orders.
 The nurse should develop a good therapeutic
relationship with the individual and family.
 The nurse should use referral system if it is possible.

24. Cont..
 The nurse should inform the health officer immediately if
there is a communicable disease.
 He/she should keep the medication safe and ready to
follow standing orders.
 He/she should ensure a safe and healthy environment
for patient.
 Recording and reporting is a essential part of community
health services.

25. Types of standing order
1.Institutional standing orders:-
 They are meant keeping in mind available
resources ,staff position and the objectives of
a medical institution or hospital
 Ex-standing order of PHC can be differat from
those of district hospital.

26. Cont..
2.Specific standing order:-
 These orders are meant for trained medical personnel,
mainly the nurses , technical knowledge and specific
skills are require to implement these orders.
 Ex-giving care at home ,injections , oxygen therapy.

27. Cont..
3.General standing orders:-
 Owning to a large population , vast
geographical area and the shortage of
resources , some standing order are used to
propagate health care messages to the
masses.
 Ex-preventive measures against AIDS.

28. Advantages of standing order
 Community standing orders provides timely treatment
during emergencies.
 They enhances the quality and activity of health
services.
 They provide a feeling of confidence and responsibility in
the nursing staff and other health workers.
 They help to decentralize the health responsibilities.
 They help to strenthn the primary services in the
community.

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