Indoor Services

1. Indoor Services S. VivekAdhish Sanjay Arya

2. Indoor Services • Largest component of hospital. • Account for approx. 35-50% of whole hospital complex. • High Capital & operational cost

3. Ward or nursing unit ward include : • Nursing Station • Beds it serves & • Necessary services, work, storage & public areas needed to carry out the patients nursing care.

4. Functions of ward • To substitute for the home for regular eating, bathing, sleeping, etc; • To allow examination, treatment and cure of patients; and • To prepare patients to return to domestic life. • Learning centre

5. Types of Ward Accommodation • Primary • Auxiliary • Sanitary • Ancillary

6. Ward Accommodation… • Primary • Bed accommodation • Nursing station • Treatment Room

7. Ward Accommodation… • Auxiliary • Drs’ room • Nurses room • Stores • Clean Utility

8. Stores • For keeping linen & other supplies like cleaning materials. • Adjoining to the stores (but separately), a space may be provided for patients lockers for keeping their personal belongings.

9. Clean Utility Room • This room (100-200 sq. ft.) is used for clean storage e.g. IV sets & crystalloids, CSSD articles. • Used for packing dressing drums, setting up a treatment trolley etc. • This is sometimes combined with the treatment room.

10. Ward Accommodation… • Sanitary • Toilet block • Dirty Utility • Janitors’ room

11. Bathrooms & Toilets* • WC - 1 for 8 beds • 1 Bathroom - 1 for 12 beds • 1 Wash basin - 1 for 10 beds • Urinal - 1 for 16 beds. *These scales for toilets etc. are exclusive of WC, bath & washbasins provided for single/double room & staff toilets.

12. Bathrooms & Toilets • Toilet for an individual room (single or two-bedded) in a ward unit shall be 3.5 sq m comprising a bath, wash basin and WC. • A toilet common to two such rooms shall be 5.25 sq m comprising a bath, WC in a separate cubicle and a wash basin.

13. Dirty Utility Room/Sluice Room • For cleaning bed pans, urinals, sputum mugs & storage of stool & urine specimens. • It should be fitted with bed pan washer and sink. • A large stainless board is provided for storing specimens.

14. Janitor’s room • A janitor’s room is required in each ward for keeping mops, brooms, cleaning materials & buckets. • It should have a large sink for cleaning buckets and other equipment with adequate supply of hot and cold water.

15. Ward Accommodation… • Ancillary • Ward Pantry • Day room • Conference room • Trolley Bay • Locker Room etc.

16. Pantry • For temporary storage & distribution of meals and preparation of beverages. • It should be equipped with facilities for hot water, refrigerator, hot case & facilities for storage. • It should also have a large sink with drain for washing.

17. Other Areas • Wheel chair/trolley bay • Side lab • Staff rooms • Attendant room • Lockers • Seminar room

18. design of inpatientunits- Factors Nursing unit characteristics and configuration • Work flow • Visibility of patient rooms • Walking distance for staff

19. design of inpatientunits- Factors • Proximity of supplies & equipment. • Adequate storage space • Space requirements • Relationship with other departments

20. THE FIRST WARD

21. NIGHTIGLE WARD • Modified by Florence Nightingale in 1871 • Self contained ward • Patients beds in two rows at right angles to the longitudinal walls • Accommodated 32 patients

22. Sanitary Area NS Nightingale Ward Plan Beds

23. RIGS PATTERN OF WARD • First made in Rigs hospital in 1910 in Copenhagen. • Small cubicles of three to four beds and single bed room. • Beds arranged parallel to the longitudinal wall.

24. Riggs Ward

25. ADVANTAGES • Relative Privacy for patients • Possibility of isolation of infectious patients • Containment of hospital acquired infections • Enhanced flexibility as both sexes can be accommodated in the same ward

26. DISADVANTAGES • Patients are deprived of direct observation by the nurse • Difficulty of communication between the nurse and the patient • Wards become larger so the nurse has to walk more. • More number of nurses are required • Costly to build and maintain

27. Single vs Multi-bed rooms

28. Physical Planning • Floor space for bed in multiple bed room: 7.0 m2 per bed • Single bed room: 14 m2 per bed • 2 bed room: 21.00 m2 • The area per bed in the ICU is 12-14 m2 per bed.

29. Physical Planning • Ceiling height: 3.0 m • Width of corridors: 2.4 m • Windows: 20%of floor area • Doors: 1.2 m • Dado: 1.2 m

30. Physical Planning • The size of a hospital bed is 6’6” x 3’3” (2.2 m x 1.1 m) • Space at the head-end 0.25 m. • The space between two rows of beds is 5 ft. • The distance between two beds should be 3.5 to 4 ft.

31. Physical Planning • Water & electricity supplies • 300-500 liters for per bed. • Alternate source of light supply • One industrial switch for portable x-ray • At least two switches each of 15 amp. & 5 amp. in each cubicle.

32. Nursing Station • Central with critical patients close by • Built in cupboard for storage of drugs , dressings & instruments • Closet for narcotics & dangerous drugs • Electric panel for nurses call station visible

33. Treatment room • A treatment room is required for physical examination, dressings & certain procedures. • Should be equipped with examination table, spot light, cabinets and a dressing trolley. • Should have hand washing facilities.

34. Duty room for doctors • There should be a doctor’s duty room where doctors can work during day & take rest during night. • It should be equipped with a bed, chair, table & attached toilet.

35. Space for different areas • Sister’s duty room – 14 Sq M (Toilet 3.5 M2) • Clean Utility – 10 to 14 Sq M • Ward Store – 10-15 Sq M • Ward Pantry – 10.5 Sq M • Dirty Utility – 7 Sq M • MO’s duty room – 14 Sq M

36. Norms for Nursing Staff • Chief Nursing Off: 1 per 500 beds • Nursing Supt: 1 per hospital • Dy. Nursing Supt: 1 up to 400 beds & 200 addl. Beds • Asst. Nursing Supt: 1 for 100-150 beds or 3-4 wards

37. Norms for Nursing Staff • Ward Sisters: 25-30 beds/ Ward • Teaching Hospital: 1 nurse for 3 beds * • Non-teaching : 1 nurse for 5 beds * * For 24 hr.

38. Norms for Nursing Staff • For ICU / CCU: 1 nurse for 1 bed • Extra nursing staff to be provided for Depts. & research functions. • For each 250 beds: 1 infection control nurse.

39. Nursing Methods • Case Method • Functional method • Team method.

40. Case Method • A nurse is assigned to the care of a number of patients. • She is responsible to give complete nursing care.

41. Advantages • It provides more individualised care to the patients • Patients feel sense of belongingness to nurse. • It provides more incentives to personnel to improve the quality of their care. • Professionally most satisfying

42. Functional method • Nurses are assigned to specific functions for all the patients in the ward

43. Advantages • One person becomes expert in one particular job, which enables to do the same in less time • Less equipment is required • Better maintenance of the equipment as handed by a particular person.

44. Disadvantages • Care of the patient becomes mechanical as the nurse knows little of the overall care of the patient. • The patient feels insecure as care is provided by many people and the nurse-patient relationship disappears. • Least satisfying to nurse as well as patients.

45. Team method • Several staff members of all categories under leadership of a professional nurse are assigned to a group of patients. • The team leader is responsible for assigning, supervising and instructing her team members.

46. Team method • This is very good & desirable method of assignments but requires good team building & supervision. • Useful, where we plan to use auxiliary nurses along with staff nurse.

47. Progressive Patient Care • The basis for PPC system is orienting wards on the basis of nursing needs of patients. • Nursing Care required is linked to criticality & degree of dependence of the patients on nurse because of underlying disease. • Wards are manned & equipped accordingly.

48. Progressive Patient Care • Intensive Care • Intermediate care • Self care • Long term care

49. Intensive care • Critically ill patients • Totally dependant on nurse & are even unable to communicate needs • Requires continuous observation & intensive nursing care.

50. Intermediate care • Moderately ill patients. • Require moderate amount of nursing care.