unit 1 hospital nursing.pptx

Introduction to Nurse,
Nursing and Hospital
Nursing
Presented by
Ms. Rina Karki

Contents
• Nurse, nursing, hospital nursing and nursing profession.
• Historical perspective of nursing in the world and in Nepal
• Qualities of a good nurse
• Roles and responsibilities of the nurse
• Nursing as a profession
• Ethics
• Legal responsibilities and legal safeguards of the nurse
• Bills of right
• National and international regulatory bodies
• Hospital
• Admission, transfer and discharge procedure of a client
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6/13/2023

Definition of nurse (ICN)
completed a program of
basic nursing
education
qualified and authorized
by the appropriate
regulatory authority
to practice nursing in
his/her country
to provide responsible
and competent
professional services
for the promotion of
health, prevention of
illness, care of the sick
and rehabilitation of the
disabled.
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Definition of Nursing (WHO)
Nursing
encompasses autonomous and collaborative
care of individuals of all ages, families, groups
and communities, sick or well and in all settings
It includes the promotion of health, the prevention
of illness, and the care of ill, disabled and dying
people.
Advocacy, promotion of safe environment, research
and participation in shaping health policy and in
patient and health system management and education
are also key nursing roles.
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Definition of Hospital Nurse
• A hospital nurse is a registered nurse (RN) that
works in a hospital setting. They work directly with
patients who are injured, ill, and disabled working in
various department of the hospital. (Goodwin
University).
• This nursing practice in hospital by licensed nurse is
hospital nursing.
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Definition of Professional Nurse
• A professional nurse is a person who has completed
a basic nursing education program and is licensed in
his/her country to practice professional nursing.
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Historical Perspective of Nursing in the World
Florence Nightingale era
Began in June 15, 1860 :Florence Nightingale Period School
of Nursing opened at St Thomas Hospital in London England.
Upgraded the practice of Nursing
Taking care of the wounded and sick soldiers during the
Crimean War.
Designated as Superintendent of the English general hospital
in Turkey during Crimean War.
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Historical …
Florence Nightingale era
The development of nursing college degrees, specialized schools
and training programs for nurses, and professional associations
dedicated to the advancement of the field.
Twentieth century, a movement toward developing a scientific
research based defines body of nursing knowledge and practice
was evolving.
Nurses began to assume expanded and practice role.
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Historical Perspective of Nursing in the
Nepal
History before
1972
care was provided by women in the
family.
Gubhaju, Dhamighakri, Priest,
Sudeni,
In 1896 AD (1947 BS), the Bir Hospital
no nurses to care patient during
the period of 1947-1987 BS.
four Nepalese girls were sent to India for 18
months midwifery course. They were posted
in Bir Hospital after completing the course
in 1987 BS.
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Historical …
History before 1972 …
• They were:Ms Radha Devi, Ms. Bidhyadevi, Ms. Dharma
Devi, Ms. Bishnu Devi
• 2002 BS : Nine Ladies were sent in India for midwifery
training
• 2009 BS: Ms. Uma Devi and Ms. Rukmini Charan Shrestha
were sent in India to study registered Nurse with WHO
scholarship.
• 2010 BS: eight other women were sent for midwifery
diploma training in India and they worked in Prashuti Griha
at Thapathali later. 10
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6/13/2023

Historical …
• 2013 (1956 A.D): the first school of Nursing was established in
Lalitpur, Nepal.
• Later it was shifted in Chhetrapati and Mahaboudha,
• currently it is located in Maharajgunj, Kathmandu with the name of
Maharajgunj Nursing Campus, a mother institute of nursing education
of the country.
• Jaunita Fleming RN, a nurse missionary, convinced the late King H.
M. Mahendra Bir Bikram Shah Dev for the Nursing School
establishment.
• It offered 3 ½ years training
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Historical …
Late Ms. LamuAmatya was the first in- charge .
2016 (1959 A.D): another school of nurses was established under the United Mission to
Nepal(UMN) named as Shanta Bhawan School of Nursing; currently the Patan Academy
of Health Sciences.
1961: Nursing Association was established. It was named was Trained Nurses Association
of Nepal (TNAN) at beginning.
1964: Nursing council came into existence. But it was dysfunctional for many years. It
was reestablished in 1996 and became effective from 1997.
2023 (1966): ANM training Center was established in Biratnagar, upgraded in PCL
Nursing in 2044 BS.
2026 (1969): ANM training Center was established in Nepalgunj, upgraded in PCL
Nursing in 2044 BS.
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Historical …
• In 1972, all academically running schools were placed under TU
Institute of Medicine.
• In 1973 (2030 BS), Princess Prekshya joined nursing training
which brought great change in nursing.
• After 1972 the calendar of operation of nursing programme
like any other university programme was switched.
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Historical …
History after 1972
1977 (2033): Bachelor of
Nursing in midwifery was
introduced, further
community (1980), adult
(1983) were gradually
introduced.
1987 (2041 BS): PCL
Nursing Programme was
started in Pokhara and
introduced BN programme
in 2062 (2005).
1987 (2043 BS): PCL
Nursing programme was
started in Birgunj, upgraded
from CMA programme.
1987 AD/ 2044 BS: ANM
Training Center upgraded
to Biratnagar Nursing
Campus.
15
Ms. Rina Karki
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Historical …
History after 1972…
NEC report, 2049: to move all PCL programmes out from the university by
the year 2057 B.C and bring them under vocational training (CTEVT).
In 2008, MSc started in BPKIHS.
In 2010, Started MN in Lalitpur Nursing Campus
In 2011, started MN in Pokhara Nursing Campus
In 2012-2013Ph D Nursing was started in Maharajgunj Nursing Campus
with course duration of 3 years
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Qualities of a good nurse
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Qualities …
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Has basic knowledge, skills and
attitudes
Honesty
Emotional stability
Tactful
Attentiveness
Creative
Communication skills
Courageos
Clean and pleasant appearance
Discipline
Dedicated
Friendly and helpful
Healthy
Intelligent
Poise
Patience
Patient responsiveness
Good personality
Sympathy
Respect for human
dignity
Self sacrifice

Roles and responsibilities of the nurse
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1. Teacher/Educator: for
patient(health and health
care procedure), unlicensed
assistive personnel,
community
2. Manager: organize man,
money, material; coordinates
other activities in the team
(PHN and CHN)
3. Motivator
4. Researcher
5. Supervisor
6. Change agent
7. Coordinator
8. Facilitator
9. Decision maker
10. Patient advocate: protecting
patient’s right
11. Evaluator
12. Problem solver
13. Communicator
14. Leader
15. Counselor : adjustment
16. Advisor : for individuals and
families
17. Administrator
18. Entrepreneur
19. Case manager
20. Care giver

Nursing as a profession
Well defined body of knowledge:autonomous,
self-governing profession
Strong service orientation
Recognized authority by professional group
standards & Code of ethics
6/13/2023 Ms. Rina Karki 22

Ethical issues
• Withdrawal of life
sustaining treatment
• Physician-Assisted Suicide
• Ethical principles
• Ethical decision making
Legal issues
• Malpractice,Negligence
• Battery; informed consent
• Patient confidentiality
• Medico-legal cases (MLC)
• Legal responsibilities and legal
safeguards
• Law firms(based on ethical
principles)

Ethics
• The word Ethics is derived from Greek word “Ethos”
which means customs or guiding beliefs (character).
• Need for Nursing Ethics???

Ethics …
Need for
Nursing
Ethics
• practice ethically
• identify the ethical
issues in work place
• Protecting patients
right and dignity
• Ethical reasoning
helps the nurse to
respond to ethical
conflicts
• Helps to differentiate
right /wrong
behavior
• Guide for a
professional behavior
• Prevent below
standard practice.

Ethics …
Ethical principles
1. Autonomy
2. Beneficence
3. Non-Maleficence
4. Justice
5. Fidelity

Ethics …
ICN code of ethics (1953)
– Fundamental guidance of nursing
– Guide for carrying out nursing responsibility
– code
 Nurses and people: nursing care; safer environment; confidentiality
 Nurses and practice: accountability and responsibility for care; standard
of care
 Nurses and the profession: ethical organizational environment;
sustaining professional values
 Nurses and co-workers: guide co-worker; respectful relationship

MEDICO LEGAL CASE
• A case of injury or ailment in which investigations by
the law-enforcing agencies are essential to fix the
responsibility regarding tha causation of the said
injury.

Informed consent
Informed consent is a process of communication
between patient and health care provider that often
leads to agreement or permission for care,
treatment, or services. Types include:
1. Express consent: express consent is typically
done in writing (verbal written).
2. Implied consent. While implied consent is
typically conveyed through a patient’s actions
or conduct.

Types of informed consent…
Eg:when you show up to your doctor’s office for
your seasonal flu shot and roll up your sleeve, you
are essentially implying that you consent to
receiving a flu vaccination.
The same applies if you go to a lab to have your
blood drawn or if you showed up for a routine
physical exam. By showing up for the exam, you
are essentially consenting to the exam.

Points to be considered
• Voluntary
• Given by person of sound mind and above 18yrs of
age.
• Requires disclosure of information for decision
making.
• free from pain,depression
• If patient is not mentally capable (critical patients)

When consent is invalid?
• Consent obtained from a minor.
• Consent given under fear, fraud or misinterpretation.
• Person under sedation, intoxication or
semiconsciousness
• Consent obtained without providing adequate
information on the possible risks .

Legal responsibilities of the nurse
• Common Sense precaution
• Be competent in Practice
• Ask for assistance
• Document well
• Do not give legal advice to clients
• Do not accept gifts

Legal safeguards for nurses
• Licensure
• Institutional policies
• Patient’s bill of rights
• Competence practice
• Executing physician orders
• Professional liability insurance
• Documentation
• Reporting

National and International regulatory
body and professional organization
• NNC
• NAN
• MIDSON
• ICN

Nepal Nursing Council
• Establishing uniform and high standards of
nursing education in nepal.
• Licensing examination started since 2012

Nepal Nursing Council…
Power, Function an duties
– formulate policy to operate the nursing profession
– recognition to a teaching institution
– evaluate and review the curriculum
– determine the work limit of nursing professionals
– formulate professional code of conduct(???)

Nursing Association of Nepal
• Founded in 1962 AD, june(Magh,2018) with
the name of Trained Nurses Association of
Nepal .
• ICN member at 1969
• First president was Ms. Lamu Amatya

Nursing Association of Nepal…
Activities
• Promote economy and general welfare of nurses
• Establish and maintain code of ethics
• Official representative of Nepalese nurses in the
ICN.
• Celebration of NAN day
• Launching health programmes
• Giving opportunity to meet and discuss the matters
relating their profession.

Midwifery Society of Nepal
• Established on febraury, 2010
• Objectives
– To develop, promote and safeguard the professional rights
of midwives to promote the health of women, children and
families.
– To strive for the professional recognition nationally and
internationally and strengthening high standard of
midwifery service and profession.
– To work for ensuring availability, accessibility and
utilisation of effective and quality reproductive health
services.

??????/

Patient’s bill of rights
• consultation with the physician(s) of their choice
• To contract with their physician(s) on mutually agreeable
terms;
• To be treated confidentially, with access to their records
limited to those involved in their care or designated by the
patient;
• To use their own resources to purchase the care of their choice;
• To refuse medical treatment even if it is recommended by their
physician(s);
• To be informed about their medical condition, the risks and
benefits of treatment and appropriate alternatives;
• To refuse third-party interference in their medical care, and to
be confident that their actions in seeking or declining medical
care will not result in third-party-imposed penalties for
patients or physicians.

Nurses bill of rights

Hospital(WHO)
An integral part of a social and medical organization
complete health care; both curative and preventive
outpatient services reachout to the family and its home
environment.
centre for the training of health workers and for bio-
social research.

Functions of hospital
• Therapeutic services
• Diagnostic
• Emergency care
• Critical care
• Rehabilitation
• Preventive services
• Health promotion
• Research
• Teaching and training
• Employment
• Administrative
• Refferal service

Classifications of hospital
Based on clinical specialities
• General: Bir hospital
• Specialized
Based on ownership
• Government
• Semi-government
• private

Classifications of hospital…
Base on system of medicine
• Allopathic
• Ayurvedic
• Homoepathic
• Unani
Based on level
• Electoral constituencies Primary Health Centre
• District hospital
• Zonal hospital
• Regional

Classifications of hospital…
Based on diversity in aim of hospitals
• Teaching
• Non-teaching

Admission Procedure
• Admission is defined as allowing a patient to
stay in hospital for observation, investigation,
treatment and care.

Admission Procedure…
Purposes of admission
• To undergo evaluation & treatment
• To know what is really happening in his/her body
• To provide emotional security to the newly admitted
patient and his family

Principles of admission
• Sudden change or strangeness in the environment
produces fear and anxiety
• Entering the hospital is threat to one’s personal
identity.
• People have diversity of habits and modes of
behavior.
• Illness can be novel experience for the client and
bring stress on his physical and mental health

Types of admission
Emergency admission
• In this, patients are admitted in acute conditions
requiring immediate treatment.
Routine admission
• In this, patients are admitted for investigation,
diagnostic and medical or surgical treatment.

Articles required
• Complete set of admission form
• TPR sheet, medicine chart, I/O chart, Nurses record,
progress record, additional char as needed.
• Vital sign tray
• Equipment for physical examination
• Hospital dress
• Specimen container
• Prepared bed,bedpan urinal

• Ascertain the admission of patient.
• Room preparation and wash hands.
• Equipment setup; special equipment: suction,oxygen,IV
stand.
• Receive patient and family to assigned bed; greet them,
self introduction, make comfortable and assist as per
need.
• Preparation of patient record, consent for admission,
check admission payment.

• Obtain initial patient history, observe general
condition, perform physical examination and if very
ill, inform the duty doctor immediately.
• Check vital signs.
• Assess immediate need and immediate instructions.
• Orientation about ward routines(morning wakeup,
medication time,hospital meal), rules and regulations,
facilities, policies(visiting hour,gate pass, store, 24
hours visitor stay)

• Ask the family to bring daily use equipments.
• Give admission bath if needed. Maintain personal
hygiene.
• Initiate care which is required immediately.
• Obtain detail nursing history and physical
examination.
• Complete the admission chart. Obtain specimen such
as urine, stool, blood .

• Inform patient about procedures or treatments
scheduled for the next shift or day.
• Wash hands
• Report to unit in charge and duty doctors about
admission of patient.
• Write complete admission report.

Discharge procedure
• The hospital Discharge Procedure is the preparation
of the patient and discharge records to leave the
hospital.

Discharge procedure…
Purposes
• To reduce number of days at the hospital
• To ensure continuity of care to the patient after
discharge.
• To make the patient comfortable in a healthy
atmoshphere.
• To coordinate referrals to appropriate hospital or
rehabilitation centre.

Purposes
• To reduce number of days at the hospital
• To ensure continuity of care to the patient after
discharge.
• To make the patient comfortable in a healthy
atmoshphere. To coordinate referrals to appropriate
hospital or rehabilitation centre.

Types of discharge
1. cured and discharged.
2. Discharged against medical advice (DAMA/LAMA).
3. Discharged on request.
4. Absconded.
5. Transferred to other hospital.
6. Death.

• Articles
• Patient’s all record
• Discharge paper
• Discharge register
• Wheel chair or stretcher.

Procedure
• Check written order for discharge
• Inform the patient and patient’s relatives in time.
• Assess patient’s health care needs at the time of
discharge using nusing care plan, cognitive function
from time of admission.
• Assess the need for health teaching

Preparation before the day of discharge
• Suggest way to change physical arrangement
of home to meet patient’s need .
• Provide patient and family with information
about community health care resources.

Day of discharge
• Prepare and check the patient’s entire document.
• Collect the discharge ticket from the doctor.
• Check physician’s discharge orders for prescription
and change in treatments.
• Send chart with the discharge ticket to billing section
with relevant information.

Day of discharge…
• After clearance of the bill, give instruction according
to the discharge ticket.
• Provide discharge instruction about diet, rest, sleep
and exercise, medication, home care , follow-up.
• Provide information about home care facilities
available.

Day of discharge…
• Handover the patient’s belonging and any valuable
which have been kept safely.
• Assist the patient in dressing and packing items to go
home.
• If the patient is ambulatory, instruct relatives to assist
him.
• Obtain wheel chair if necessary.
• Documentation of discharge on nurse’s note.
• After the paient has gone, the bed should be made clean
and tidy for next use.

Transfer procedure
• Shifting a patient from one department to another
department in the same hospital or between hospitals.

Transfer procedure
Purposes
• To transfer patient in a unit that is most suitable to
provide specialize nursing care, closed observation in
specialized unit.
• To receive different forms of therapy and
management.
• To have care continued closer to home.
• To have care continued when financial resources
prohibit receiving care in the current facility.

Transfer procedure
Articles
• Wheel chair/stretcher
• Oxygen cylinder with tube
• IV stand
• Requisition forms
• Records and recording charts.

Transfer procedure
Procedure
• Assess reason for transfer of the patient.
• Inform to senior about transfer.
• Check the belongings and keep ready for shifting.
• Complete the patient chart and make it up to date.
• Assess the patient’s physical condition and determine
the mode of transportation.

Transfer procedure
Procedure…
• Inform patient and his relatives about the purpose of
transfer.
• Prepare summary of patients’ treatment and
condition. Complete the nurse’s record and transfer
form.
• Anticipate problems patient may develop just before
or during transfer and perform nursing therapies.

Transfer procedure
Procedure…
• Assist in transferring patient to stretcher or wheel
chair.
• Perform final assessment of patient’s physical stability.
• Accompany the patient to receiving unit or hospital.
• Hand over all document of the patient to the receiving
person.
• Complete the needed documentation after transfer
according to agency policies.

References
1. Sharma M, Nursing Concepts & Principles, 1st edition,
Kathmandu, Medhavi publication, 2012
2. Rai L, Nursing Concepts Theories and Principles,4th
edition, Kathmandu, Akshav publication,2019
3. Kozier & Erbs, Fundamental of Nursing, 9th edition,
India, Dorling Kindersley pvt.ltd. 2013
4. Pathak S, A text book of Fundamentals of Nursing,
Kathmandu, Vidyarthi Pustak Bhandar,2019
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6/13/2023

Assignment
• State the professional code of conduct by NNC
• Orientation of the patient to the ward
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Self-assessment
• Short questions
a. Define nurse and nursing.
b. State good qualities of nurse.
• Long questions
a. Discuss about role and responsibilities of nurses.
b. Discuss about code of ethics.

MCQ
1. All schools of nursing were placed under TU in
a. 1972
b. 1973
c. 1960
d. 1958
2. First school of nursing under the HMG was
opened in
a. 1956
b. 1954
c. 1960
d. 1958

MCQ
3. Which of the following ethical principles refers to
the duty not to harm?
a. Beneficence
b. Non-maleficence
c. Fidelity
d. Veracity

unit 1 hospital nursing.pptx

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