Unit II: Nursing U nit M anagement

Unit II: Nursing Unit Management Mrs.Indumathi Lecturer YNC

INTRODUCTION • Nursing unit is an area in the hospital or other health care delivery setting where patients with similar needs are grouped to facilitate the delivery of care by health care professional trained in that specialty.

QUALITY PATIENT CARE The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

NURSING SERVICE • Nurses are one of the few blessings of being ill. • Nursing services employees are responsible for carrying out the treatment plan developed by the physician. • Nursing services, also called patient care services, is the largest component of the hospital.

Issues to be addressed to improve patient care are • Access. Accessibility and availability of both the hospital and the physician • Waiting. Waiting times for all services should be minimized • Information. Patient information and instruction about all procedures, both medical and administrative, should be made very clear

Administration. Check-in and check-out procedures should be ‘patient friendly’ • Communication. Communicating with the patient and the family about possible delays is a factor that can avoid a lot of frustration and anxiety. • Ancillary Services. Other services such as communication, food, etc. should be accessible both to patients and to attending families

Physical Layout of nursing unit

Factors affecting the quality of nursing care 1.Environmental Factors • Age • Economic cutbacks: staffing levels, early discharge policy 2. Organization factors 3.Type of Hospital • Private Hospital • Public Hospital

4.Coordination and communication • Patient care assignment 5.Patient information 6.Consistency of caregivers • Primary nurse giving care to one patient

7.Nurse patient relationship 8.Personal attributes • Personality, technical skills • Caring :Empathy and Compassion

Maintenance of therapeutic environment • A therapeutic nurse-patient relationship is defined as a helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of patient's physical, emotional, and spiritual needs through your knowledge and skill.

Contd.. • This caring relationship develops when you and your patient come together in the moment, which results in harmony and healing. Effective verbal and nonverbal communication is an important part of the nurse-patient interaction, as well as providing care in a manner that enables your patient to be an equal partner in achieving wellness.2

Goal • The goal of creating a healing environment is to reduce stress, and thereby reduce associated problems such as medical error, inability to concentrate, and physical symptoms of stress that can affect logical thought process

Physical setting • eliminates environmental stressors such as noise, glare, lack of privacy and poor air quality; • connects patients to nature with views to the outdoors, interior gardens, aquariums, water elements, etc.; • offers options and choices to enhance feelings of being in control - these may include privacy versus socialization, lighting levels, type of music, seating options, quiet versus 'active' waiting areas;

Contd… • provides opportunities for social support - seating arrangements that provide privacy for family groupings, accommodation for family members or friends in treatment setting • provides positive distractions such as interactive art, fireplaces, aquariums, Internet connection, music, access to special video programmes with soothing images of nature accompanied by music developed specifically for the healthcare setting • engenders feelings of peace, hope, reflection and spiritual connection and provides opportunities for relaxation, education, humour and whimsy.

Maintenance of a therapeutic environment • Introduce to your patient and use her name while talking with her. A handshake at your initial meeting is often a good way to quickly establish trust and respect. • Make sure your patient has privacy when you provide care. Be sure that her basic needs are met, including relieving pain or other sources of discomfort. • Actively listen to your patient. Make sure you understand her concerns by restating what she has verbalized.

Contd… • Maintain eye contact. Remember, too much eye contact can be intimidating. Smile at intervals and nod your head as you and your patient engage in conversation. Speak calmly and slowly in terms that she can understand. • Maintain professional boundaries. Some patients need more therapeutic touch, such as hand-holding and hugging, than others and some patients prefer no touching. Always respect differences in cultures.

Administration of the unit 1.Linear Corridor Unit Designs: • The linear corridor unit designs also called “race track” design occur as a single corridor or double corridor layout . • Most existing original floor plans typically have one nursing station on each unit. • Most corridor floor plans are organized around the central station where charts, orders, medications and supplies are concentrated.

Contd… • The nursing station functions as the heart of patient care activities and allows responsive access to all patient rooms and good visibility to the patient rooms in close vicinity to the nursing station. • Negative aspects include long walking distances for nurses and restricted visual control over patient rooms further away from the nursing station

Contd… 2.Cluster Designs: • In the cluster designs, patient rooms are organized around the nursing station dedicating one station as a main nursing location or entry reception station. • Compact clustered unit designs were not only aimed to reduce walking distances but also to eliminate centrally located nursing stations, to place the provision of drugs closer to patients and to take full advantage of visibility. • Patient support services were decentralized with each pod consisting of six to twelve beds and one decentralized nursing station with amenities for charting data, preparing medication, etc.

Contd… • By the 1990’s, bedside computerization enabled nurses to enter patient care data into a terminal at the patient’s bedside. • Health care services were now literally brought to the patient. • Decentralized nursing stations were complemented with an information station located outside each patient room. Information flow revolved around the patient bed and around the decentralized nursing station

Contd… 3.Radial Nursing Unit Designs: • The radial nursing unit designs maximize visualization, patient rooms are organized around nursing sub-stations within each unit. • Nurses have an unobstructed view of each patient room from each decentralized nursing station. • This design also accommodates fewer nurses on staff during night shift. • Radial units are space consuming and tend to be smaller in bed numbers which increases construction and staffing costs.

Duties and responsibilities in relation to patient care • To organize and make plan of all nursing activities of her unit for patient care according to hospital policy and rules. • To establish and reinforce the prepared standard protocol for patient care. • To take the report of her unit from the on duty staff nurse and will read and sign the report book. • To make bed to bed round of the department with Staff & Students. • To supervise direct patient care of the unit and provide direct care to seriously ill patients as and when situation arises.

Contd… • To assign staff nurses, student nurses for nursing care, specially for acute ill, dangerously ill patient and post operative cases. • To co-ordinate with other department for patient care and for smooth running of the unit. • To supervise dietary arrangement, serving of diet and feeding of the helpless patient. • To supervise, guide and direct the staff Nurses and students to carry out treatment of the patients as prescribed by the physician/surgeon of the unit. • To check all the records of the patient related to diagnosis, condition and treatment and ensure proper maintenance of records.

Duties In relation to ward management and supervision • To maintain cleanliness of the ward with the help of Assistant Superintendent and Ward master. • To ensure safety and comfort of the patient of the unit. • She will make duty roster of the staff nurses, student nurses and work assignment. • She will check the attendance of all nurses posted in her unit and report to the office of Nursing Superintendent.

Contd • She will indent and procure the ward supplies, equipment and drugs. • She will check the inventory regularly and keep the stock register up to date. • She will maintain the records of non-serviceable articles and make arrangement for condemnation. • She will maintain stock register and it will be countersigned by Nursing Superintendent.

contd • She will face the audit (Internal & External) periodically. • She will establish and reinforce the standard of nursing procedure as prescribed. • She will ensure the maintenance of waste management and infection control of the ward. • She will ensure prevention of wastage and misuse of supplies and drugs. • She will act as a liaison officer between ward and administration. • She will maintain good public relation in her unit.

contd • She will maintain ward statistics and submit to concern authority regularly. • She will deal with adverse situation and report to the concerned authority. • She will report any theft or loss to the higher authority through Nursing Superintendent. • She will report any medico legal cases in the ward to the concern authority. • She will write and submit performance report of the staff and send to the office of the Nursing Superintendent.

contd • She will make arrangement for keeping the patients belongings in safe custody as per laid down policy of the hospital. • She will maintain daily patient’s census of the unit and report about the critically ill patients to the Nursing Superintendent. • She will perform any other duty allotted to her by the Nursing Superintendent/ Dy. Nursing Superintendent in the interest of the public and when necessary. • She will perform morning, evening and night duty in the interest of the Hospital.

Duties In relation to nursing education • To organize and oversee the orientation programme of staff and student. • To encourage and participate in staff development programme in her unit. • To implement the practical part of the Nursing Educational Programme. • To guide the student for formulation of nursing care pan, nursing care studies for the patient. • To evaluate the students performance in the ward & report accordingly. • To assist and supervise the student for incidental teaching, health education programme (formal and informal) for the patients and their relatives. • To help in Medical and Nursing Research.

CONCLUSION • Panning is the process of determining the objectives of administrative effort and devising the means calculated to achieve them • Nursing unit is an area in a hospital where patients with similar needs are grouped to facilitate the delivery of care by health care professionals.

EVALUATION • Short Essay 1.Factors affecting the quality of care 2.How to maintain therapeutic environment

REFERENCES • B T Basavanthappa; nursing administration,(2ndedn)Jaypeepublication • M.Suneetha;Management Nursing Services and Education,Frontline publication. • JogindraVati;Principles and practice of Nursing Management and administaration,Jaypee publication.

Unit II: Nursing U nit M anagement