Chapter 03

PLANNING
NURSING
SERVICES

Author
Prof. Dr. Rohini T
 Learning Objectives
After studying this chapter students will be able to

• explain planning nursing services

• discuss the vision, mission and philosophy of planning
• describe the objectives of planning
• explain nursing service policies, procedures and manuals
• discuss functional, strategic and operational planning
• narrate program planning - gantt chart, milestone chart
• explain the concepts, principles and types of budgeting
• discuss budget proposal
• describe cost benefit analysis
• explain planning hospital and patient care unit (ward)
• narrate planning for emergency and disaster
 Chapter Outline
• Planning nursing services
• Vision, mission and philosophy of planning
• Objectives of planning
• Nursing service policies, procedures and manuals
• Functional, strategic and operational planning
• Program planning - gantt chart, milestone chart
• Concepts, principles and types of budgeting
• Budget proposal
• Cost benefit analysis
• Planning hospital and patient care unit (ward)
• Planning for emergency and disaster
 Definitions of Nursing Services
WHO expert committee on nursing defines the nursing services as the
part of the total health organization which aims to satisfy major objective
of the nursing services: to provide prevention of disease and promotion of
health.
 Planning nursing services - Steps
1) Analysis and understanding of the situation. It involves collection, assessment and
interpretation of information.
2) Formulation of objectives and goals.
3) Assessment of current organization capabilities- In terms of resources.
4) Designing alternative course of action and selection.
5) Preparation of implementation plan i.e. detailed action plan.
6) Control and Monitoring
7) Evaluation.
 Vision
• The idealised future image of the organisation is reflected in vision
statements.
• The majority of vision statements are time-bound, with projections for
a maximum of five to ten years, and they serve as a focus point for
strategic planning.
• The organization's mission and core principles are expressed in the
vision statement.
 Developing a vision statement
1. Possible quickly and according to cultural norms; participants can employ techniques that
range from very analytical and logical to extremely creative and divergent, such as
concentrated conversations, divergent experiences with imagining, sharing stories, etc.
2. Creating the vision is often the most enjoyable aspect of planning, but it's also the one
where time flies.
3. It is important to note that the vision was initially a highly attractive description that the
organisation aimed to achieve - evolved in recent years into more of a motivational tool,
frequently containing extremely idealistic language and goals that the organisation is unable
to achieve in practice.
 Mission of planning in an organization
To render quality health care through effective team work.

To train health professionals to become competent, humane and ethical health care
providers, educators and leaders.
To discover the need for change and undertake relevant health system research

To develop a system of referral network and serve as center for complex health care
problem.
To ensure effective and efficient control of resources leading to quality patient care with
cost effectiveness
To be the role model for health care delivery in the country
 Developing a Mission statement
• Take into account the enterprise's values, markets, goods, and services when writing the mission
statement. One should also think about the organization's public image and any actions that are
essential to its existence.
• Take into account whether the mission statement has to be reworded in light of any new
strategies that were proposed during a recent strategic planning exercise.
• Make sure the mission statement is worded so management and staff can determine a priority
list for the delivery of services.
• To recognise the shift in the mission statement's scope and evaluate the concisely it is written, it
can be helpful to add or remove a word from the mission while it is being refined.
• To reflect if the mission statement provide enough context to make sense
 Philosophy

• An explanation of the belief systems that determine how a mission or purpose

is to be accomplished is what is known as a philosophy statement.
• An organization's philosophy describes its values, concepts, and guiding
principles.
 Philosophy of Nursing Services

• A declaration of views that stems from and is consistent with the institution's
philosophy is the nursing service philosophy.
• The nursing philosophy's belief system should be supported by others and
represent the thoughts and aspirations of nursing division members.
 Components of Nursing Service Philosophy

1.Nursing/Nursing Practice
• Practice, education, and research are the key elements of a second set of
values pertaining to nursing and nursing practice.
• The role of nursing in the whole organisation is the final topic area pertaining
to nursing and nursing practice.

2.Patient/Client
• The patient is the main reason for the institution’s existence, examine
patient’s rights.
• Beliefs concerning patient's rights will be influenced in part by institutional
policies and practices .
 Components of Nursing Service Philosophy

3.Nurses
• The daily operations of the hospital organisation depend heavily on nurses.
• They are the ones who perform the nursing acts that lead to high-quality care.
• In order to maintain the organization's smooth operation, values and beliefs
towards nurses must be addressed.
 Philosophy of Planning

Planning is essential

Planning must be done by hierarchical order

Planning should be simple, realistic and must act as

a guide to attend the goal

Planning should be flexible to accommodate

expected and unexpected events
 Objectives

• Objectives are the ends toward which activity is aimed-they are the end results
to ward which activity is aimed.
• According to McFarland, Objectives are goals, aims or purposes that
organizations wish over varying periods of time.
 Objectives of Planning

Economy of Improve Empower

Guidance
resources confidence organization

Predict Forecast
Directions future future
events threats
 POLICIES

Policies are rules, guidelines and principles that communicate an

organisation’s culture, values and philosophies
-Kenyon
• Employee entitlement and what they can expect from the organization
• What the organization expects from the employees
• What consumers and community can expect from the organization
 PROCEDURES

Procedures provide step-by-step instructions for routine tasks. They

should also allocate people to be responsible for certain tasks.
• Handling complaints
• Documentation and handling health records
• Managing patient aggression
 POLICIES AND PROCEDURES - Characteristics

• Policies and procedures should be widely accessible and cover all

activities carried out by the organisation
• All policies should be laid out in the same format and should be
written in common language that all staff members can comprehend
• Policies and procedures must be constantly reviewed and updated.
• They should be reviewed annually each time a new law or regulation
is put in place or updated
 POLICIES AND PROCEDURES - Importance

• To know how to take care for patients and how to carry out tasks with
confidence
• To foster consistency in practices, decrease mistakes and keep both
patients and staff safe
• Protects the nurse from confusion and harm
• An incident is easier to investigate
• To identify what went wrong and prevent them from re-occuring
 POLICIES AND PROCEDURES
Policies and procedures in an oncology Standard infusion, vascular access device and
dressing protocols; midline and peripherally
unit
inserted Central catheter dressing change; removal
of peripherally inserted Central catheter;
management of anaphylaxis; chemotherapy
administration and blood checks; management of
chemotherapy extravasation; patient and caregiver
controlled analgesia in the home care setting; safe
handling of chemotherapy agents etc.
 Implementation of policies
Train all
Consistency in
employees in
Consultation policy
policies and
implementation
procedures

Review of
Publicize the
policies and
Tailor the policy policies and
procedures,
procedures
enforcement

Make the policy

Be specific
realistic
Nursing Procedure Manual

• A detailed description of each procedure which are carried out in

nursing can be written, finalized, and compiled.
 Important Considerations in Manual
Compiling

• It is essential that the contents of the procedure manual should be

finalized after a group discussion.
• It is highly important that manual should be kept up to date and old
procedures should be removed when new materials are used.
 GANTT CHART (ACTIVITY PLAN)

Gantt chart is a bar chart that provides a visual view of tasks scheduled
over time
A Gantt chart is a type of bar chart that illustrates a project schedule and
shows the dependency relationships between activities and current
schedule status
-Wikipedia
 GANTT CHART - Importance

Plan and schedule projects in management

Simplify Complex projects into an easy to follow plan and track the
status of task as work progresses

Keep track of project deadlines, milestones and hours worked

Address delays before they wreak problems on project

 GANTT CHART – Information available

The start date of the project

The project tasks
Who is working on each task
When tasks start and finish
Duration of each task
How tasks group together, overlap and link with each other
The finish date of the project
GANTT CHART – Vertical and Horizontal axis

Vertical axis of a Gantt chart Horizontal axis

shows the tasks that need to be

represents time
completed
GANTT CHART – Elements
 GANTT CHART – Steps to create

Step 1
Identify the task involved in completing a project. The list of tasks must
be thorough and complete to be effective.
Step 2
Calculate the expected time required to complete each task. It is possible
and even likely that some tasks will be performed at the same time but by
different team members.
Step 3
Organize the sequence of each of the activities identified. Determine
which tasks are dependent on one another.
 GANTT CHART – Steps to create

Steps 4
Draw a horizontal time axis along the top or bottom of the page. Mark it in an
appropriate scale for the length of task (days/ weeks)
Step 5
On the left side of the page, write each task and milestones of the project in
order.
For the activities that occur over a period of time draw a bar that represents
appropriate items on the timeline.
Align the left end of the bar with the time when the activity begins and align
the right end with the time when the activity concludes. Decide who will be
responsible for each task and delegate to the team.
 GANTT CHART – Advantages

It provides easy graphical representation of progression of activities

Creates a sense of accountability

It helps to visualize how the task are connected

Ensures clean communication and team cohesion among all those involved in the project

Simple to create

It allows planning, monitoring and control

Helps in better time management

 GANTT CHART – Disadvantages

Some consider Gantt chart as too complicated to prepare, comprehend

and update
It does not explain the reason behind the duration of each activity
It does not indicate the relationship between separate activities
Milestone chart
• A milestone chart is a graphical chart that provides an easy-to-read
representation of a project’s milestones or key events.
• A milestone chart is used to monitor a project's progress. It can
inform stakeholders of important project milestones. It is presented
as a graphic depiction of the key moments of a project.
 ADVANTAGES DESCRIPTION
Clear project overview A milestone chart gives an overall overview of the project in a clear and concise manner.
It presents important dates and accomplishments in an understandable manner.
Track Progress Progress is tracked with the use of a milestone chart, which enables the team to keep an
eye on things and spot any problems or delays that could affect the schedule. Then,
actions can be taken beforehand.
Controls expectations A milestone chart controls expectations for team members and stakeholders. Everyone
will understand exactly what has to be done and how much work still needs to be done.
Encourages cooperation A milestone chart's concise and straightforward design makes it easy for consumers,
and communication employees, and stakeholders to understand the status of a project. By establishing a
common knowledge of objectives, deadlines, and expectations, it also facilitates
collaboration.

Enhances Decision- A milestone chart can assist project managers in choosing how to allocate resources,
Making prioritise their work, and take calculated risks.

Encourages responsibility It fosters a sense of accountability when milestones are connected to pertinent team
members on the chart. Every member receives a comprehensive overview of their duties
and due dates.
 Steps in creating a milestone chart

Identify key
Objective To do list Timeline
areas

Distribute Launch
Modifications
chart inititative
Example of a milestone chart
 Difference Between a Gantt Chart and a
Milestone Chart
• Gantt charts show the schedule for each task in a project in graphic
form. Since the tasks on the timeline are not precisely in order, they
may overlap.
• On the other hand, in a milestone chart, every activity has its own
timeframe and each milestone must be completed before moving on
to the next.
 Concept of Budget
Budget is a means of checking the progress made in keeping expense and
cost in compliance with an organization's financial plans and allowances.
In a budget, expenses are classified as
Fixed or variable
Controllable or non-controllable
 Classification of expenses
Controllable Non controllable
Fixed Expenses Variable expenses
expenses expenses

It cannot be
This does not Can be controlled
This vary with controlled or
vary with the or varied by a
the volume varied by a
volume manager
manager

Example: salary Example:

Example: salary number of Example : number
of hourly wage
of a manager personnel and type of
employee
working in a supplies needed by
certain shift, patients, overtime
staffing mix that occurs in
response to an
emergency
 Meaning of Budget

Earlier French word

Now it means
‘Bougette’ meant
- papers containing
- Leather bag or
financial proposals
wallet
 Definition of Budget
Budget is a plan that uses numerical data to predict the activities of an
organisation over a period of time and it provides a mechanism for
planning each unit's needs and contributions
- Carruth and Noto, 2000
 BUDGETING PRINCIPLES
• Management Support
• Employees Involvement
• Statement of Organizational Goal
• Responsibility Accounting
• Organizational Structure
• Flexibility
• Communication of Results
• Sound Accounting System
 Howard SK delineated the principles of budgeting as follows

Annularity: According to this principle, money is spent to the various departments and
executives for one year. Any amount left unspent during the budget year, the approval
stands lapsed and it cannot be spent until it is further approved for the next budget year.
Comprehensiveness: It should include all the departments in the organisation
Unity: It should contain both long term and short term expense items (annual operating
funds)
Exclusiveness: Budgeting must be concerned with money and not with issues
Specificity: Budget should be allocated to identifiable objects
Accountability: Money must be spent as indicated in the budget plan
 Purposes of Budgeting
General purpose
Effective use of scarce financial and non-financial resources
 Purposes of Budgeting
Specific purposes
• Assess the financial requirement of an organisation and to enhance
budget planning
• Provides a detailed plan to reduce uncertainty
• Indicates the direction in which the money received will be spent
• Acts as a guide to spend money allocated for various schemes
• Control expenses by efficient and economical manner and thereby
conserves resources by regulation
 Purposes of Budgeting
Specific purposes
• Coordinates effort among organizational departments
• Provides a criterion to measure the work effort on a timely basis
• Facilitates comparison of actual performance with the target and
thereby assist in controlling function
• Helps to evaluate managerial performance
 Nursing budget
A nursing budget is a systematic plan that is informed best estimate by
nurse administrators of nursing revenues and expenses. It projects how
revenues will meet expenses and projects a return on equity or profit
 Purposes of Nursing budgeting

To plan the objectives,

To motivate nurse managers
programs and activities of
and nursing workers through
nursing services and the fiscal
analysis of actual experiences.
resources to accomplish them.

To evaluate the performance

of nurse administrators and
managers and increase the
awareness of costs.
 Functions of Budget in Nursing
• Articulates and documents unit's needs effectively to higher
administrative level
• Provide opportunities for subordinates to participate in relevant fiscal
planning
• Identify and develop short and long range fiscal plans which reflects
unit's needs
• Assess the internal and external environment of the organisation in
forecasting by identifying the driving forces and the barriers of fiscal
planning
• Coordinates unit level fiscal planning to be congruent with the
organisational goals and objectives
 Types of Budget
Personnel Operating
Capital budget
budget budget

Incremental
Cash Budget Roll over budget
budget

Fixed ceiling Open ended

Flexible budget
budget budget

Performance Historical
Program budget
budget budget

Trended budget
Long and short term component in Capital budgeting

Long-term major Short-term

component component
- outlines future replacement and
-includes equipment purchases
organizational expansion that will
within the annual budget cycle
exceed one year

Examples: Renovation of a major

wing in a hospital, acquisition of a
Example: Hospital bed, crash cart
Single Photon Emission Computed
Tomography (SPECT) scanner
 Classification of Budget

1.Coverage of 2. Nature and 3. Period of 4. Range of

function activity covered Budget Flexibility

Master Capital Long term Fixed

budget budget budget budget

Functional Revenue Short term Flexible

budget budget budget budget
 4 most common Budgeting methods

Incremental budgeting (flat percentage increase budgeting)

Zero based budgeting
Flexible budgeting
New performance budgeting
 Key words in budgeting methods

Incremental Zero based Flexible Performance

budgeting budgeting budgeting budgeting

Previous year Starts afresh the Changing census Outcomes and

expense forms budgeting and needs forms results forms the
the base process the basis basis
 Budget proposal

A Budget proposal is a formal document that is used to clearly provide

the financial budget plan for the organization.
 Budget proposal - Importance

The accounting department will be able to identify how much is needed

by the organization to continue the services.
 Budget proposal - Elements

Step 1: Cover page and letter for the budget proposal

Step 2: Purpose and justification of the proposed budget
Step 3: Breakdown of the Costs per Item
Step 4: Cost Summary or Financial Summary
Step 5: Delivery or Timeline
 Direct and indirect cost/expenses

Cost/Expenses Description

Direct costs or expenses This includes the following items: materials and
equipment, labor, activities, food and the like.

Indirect expenses This includes the following costs: utility, salaries and
professional fees for staff and consultations,
incentives etc.
Sample budget proposal
 Name of the organisation
FY 2021-2022 budget proposal
Title of the department: Nursing Service Contact person:
Email address: Phone number:
Fax number:
Nature of Expenditure Quantity cost Total amount in rupees

A. Direct cost

Personnel

1. Staff nurses

1. Nursing aides

1. …………………………
1. ……………………………….
Personnel subtotal
A. Equipment

List of equipments

Subtotal equipments
A. Materials and supplies

List materials and supplies

Subtotal materials and supplies

TOTAL AMOUNT PROPOSED

Date:

Signature
 Cost benefit analysis

Cost-benefit analysis is a practical way of assessing the desirability of

projects, where it is important to take a long view (looking at the action
in the future as well as in the near future and a wide view in the sense of
allowing side effects of many decisions) i.e. it implies the enumeration
and evaluation of all the relevant cost and benefits.
—Prest and Terkey
Cost-benefit analysis

Negative Positive
consequences consequences

COST BENEFITS
 Classification of Benefits
Direct benefit Indirect benefits Intangible benefits

Values of desirable health Averted cost and savings Values of positive

and non-health outcomes resulting from the outcomes which cannot be
directly related to the interventions but not estimated from market
implementation of related directly to them. data (reduction in
proposed interventions suffering, pain etc.)
Estimated by using market
based data
Purposes of cost-benefit analysis

Economic
efficiency

Decision to
implement specific
program

Select among
competing
alternative options
Steps in cost-benefit analysis
1. Defining the
problem

6. Defining the 2. Identifying

discount rate interventions

5. Defining time
3. Defining the
frame and analytic
audience
horizon

4. Defining the
perspective
 Types of outcomes

Non-Healthcare
Health Intangible
non-health
outcomes outcomes
outcomes

reduction in time lost

decreased mortality,
from work, reduction in pain,
decreased morbidity,
improved access to suffering, health risk
increased life
health services in the etc.
expectancy etc.
area etc.
Advantages of cost-benefit illness

It helps to compare It studies in-depth

different programs having regarding the full
different health outcomes economic impact of all
or health programs to non- potential outcomes of an
health programs intervention

It permits the analyst to

It helps to allocate scarce
examine its distributional
resources to programs that
aspects; who will receive
maximize societal
these benefits and who
economic benefit
will bear the costs
 Limitations of cost-benefit illness

It measures the cost and the outcomes in monetary terms and not disease
specific
There is difficulty in assigning monetary value to all permanent
outcomes including changes in the quality of human life
The result of cost benefit analysis is only as good as the assumptions and
valuations on which they are based.
 Nursing service
Nursing Service is the part of the total Health Organisation which aims at
satisfying the nursing needs of the patient or community. The major
objective of nursing service is to provide prevention of disease and
promotion of health.
-WHO expert committee on nursing
 Nursing service – Objectives
Management of nursing care and services
Education training and staff development programs
Nursing research
Community Health programs
Factors to be considered in planning Hospital
Nursing service

Number and type of Number of beds and

Services required
patient type of ward

Procedures or Number and type of

techniques necessary personnel needed to Physical facilities
for care perform effective care

Provision of supplies
and equipments
 Role of a Nurse administrator in nursing service

Nurse Administrator

Planning Directing Controlling Coordinating Evaluating

 Role of head nurse and staff nurse in nursing Service
Department
DESIGNATION ROLE

Head nurse • The functions of a head nurse are primarily concerned with activities that ensure good
patient care and make the ward run smoothly
• Their responsibilities include planning of patient care, maintenance of clear orders,
maintaining well-organized reports etc
• Delegating the duties and responsibilities according to the qualification and the competence
of the nursing personnel is also another important administrative function
Staff nurse • Planning individualized care to the assigned patients
• Supervising the patient care assigned to her nursing team
• Promote the development of team members
• Appropriate utilization of supplies and equipments
• Maintain effective communication among the team members
• Participating in the appraisal of the effectiveness of administration of nursing service
Hospital – Definition
A hospital is a health care institution providing
patient treatment with specialized medical and
nursing staff and medical equipment.

- Wikipedia
Hospital is an integral part of social and medical
organisation, the function of which is to provide
complete health care to people both curative and
preventive and outpatient services to reach out to the
family and its home environment. Hospital is also a
Centre for the training of health workers and bio
social research.
- World Health Organisation expert committee
Hospital – Functions

Functions of Hospital
• Medical care
• Patient support
• Administrative
• Teaching
• Research
• Employment
 Hospital – Administrative Functions
Function Description

Finance • Planning, directing, controlling (providing fund estimates, managing receipt

and disbursement of cash or collections) and coordinating functions

Personnel • Establishing personnel development programs, policies and Standards,

enforcement and administration of laws, rules and regulations

Material • Procuring, storing, inventory control, condemnation of materials

General services • Functions related to housekeeping, laundry, security and Transport

 Hospital – Classification
1. Based on Objective 5. Based on type of care
a. General hospitals a. Primary Care: e.g. Primary health centres
b. Special hospitals b. Secondary Care: General hospital
c. Teaching cum Research Hospital c. Tertiary Care: Medical college hospital
2. Based on Ownership, control or financial income 6. By teaching affiliation
a. Governmental or public a. Teaching hospital
• Central Govt. Hospital b. Non-teaching hospital
• State Govt. Hospital 7. Based on system of medicine
• Corporation/local bodies a. Allopathic hospital
b. Non-Governmental or private b. Ayurveda hospital
c. Semi Govt. Hospital c. Homeopathic hospital
d. Voluntary Agency Hospitals d. Unani hospital
e. Charitable hospitals e. Hospitals of other system of medicine
3. Based on Length of Stay 8. As per WHO Classification
a. Short-term or short-stay hospitals (stay less than 30 days) a. Regional Hospital
b. Long-term or long-stay hospitals (stay more than 30 b. Intermediate/ District Hospital
days) c. Rural Hospital
4. Based on bed capacity
a. Small hospital (up to 100 beds)
b. Medium hospital (more than 100 to less than 300 beds)
c. Large hospital (more than 300 beds)
 Hospital – Services rendered

Essential Supportive Utility

services services services

Administrative Biomedical Educative

Services research function
HOSPITAL PLANNING
 Aims of Hospital Planning

Provide high quality patient care services which include preventive,

promotive, curative and rehabilitative services
To maintain the standards of care and promote patient satisfaction
Effective utilisation of hospital facilities
To increase the productivity of the hospital
Provide quality training and education to the healthcare professionals
(doctors, nurses, paramedical education technician etc.)
To encourage professionals in all disciplines to conduct research
activities in order to uplift patient care
Principles of planning Hospital and patient care units
Protection from unwanted and unnecessary
disturbances in order to help speedy recovery.
Infants and children should be protected from
theft and infection etc.
Separation of dissimilar activities
Control: Nurses’ station should be positioned
strategically to enable proper monitoring of
visitors entering and leaving the ward.
Circulation where all the departments of the
hospital must be properly integrated
Important considerations: Guiding Principles in Hospital
Planning
High quality patient care
Adequate community orientation
Economic viability
Orderly planning
Sound architectural plan
 Hospital Planning process

Conceptualization Site dimensions Stage of actual

stage finalization stage building

Stage of
Stage of financial
Stage of survey equipment
planning
planning

Building
commissioning,
Pre planning work Stage of team
shakedown period,
schedule stage planning
initiate Hospital
functioning
 Elements of feasibility study

Demographic pattern
Need assessment
Prioritisation of need
Environmental study
Electricity and water supply
Transport and communication
 Pre-planning work schedule stage

Need assessment for bed planning is calculated using the following

formula
Bed planning:
Population = A x S x 100
365 x PO
A - Number of patient admission per 1000 population per year
S - Average length of stay
PO - Percentage Occupancy
Areas in financial planning

Constructing,
equipping
Financial and
assistance furnishing the
hospital

Operating fund
Space requirement - Basic department in construction plan

Area Sq.ft/bed
Nursing unit 250-280

Nursery 12-18
Delivery suite 15-20

Operation theatre 30-50

Physical medicine 12-18
Radiology 25-35

Laboratory 25-35

Pharmacy 4-6

CSSD 8-25

Dietary 25-35
Medical record 8-15
Housekeeping 4-5
Space requirement - Basic department in construction plan
Area Sq.ft/bed
Laundry 12-18

Mechanical installation 50-75

Maintenance workshop 4-6

Store 25-35

Public area 8-10

Staff facilities 10-15

Administration 40-50

Total 567-751

Circulation 115-751

Total net area 682-891

 Types of equipments in the hospital
Non depreciable
Built-in equipment Depreciable equipment
equipments
• Counters, cabinets, • Equipment that has a • Includes all the small
incinerators, life of 5 or more items with low unit
elevators, fixed years. cost and the life span
sterilizing equipment • It is usually not of less than 5 years.
etc. purchased through • Examples: kitchen
construction utensils, surgical
contracts. instruments, linen etc.
• Examples: diagnostic
equipments,
laboratory
instruments, office
furniture etc.
 Steps in hospital planning
Request for
Need assessment Feasibility report Architects brief
proposal

Allocation of Notice inviting Detailed project Appointment of

work tender report consultant

Construction of
Purchase and Stage of
building, services
manpower commissioning
including Review process
selection and (Shakedown
facilities and
recruitment period)
equipment
 Patient care units in hospital

Inpatient Outpatient Emergency Intensive Care

department department department Unit

Obstetrical unit Newborn unit Paediatric unit Psychiatric unit

Radiology and Central sterile

Pharmacy Hospital Store
laboratory services supply department

Medical
Hospital dietary maintenance and Medical records
Laundry services
services emergency department
department
 Basic requirements in ICU
Basic Descriptions
requirements

visualisation • It should be designed in such a way that complete control and visualisation of all the beds by
nursing and medical staff is possible

surveillance of • There should be provision for surveillance of physiological monitoring

monitoring

Procedures and • Efficient use of routine and emergency diagnostic procedures and interventions must be
interventions guaranteed

Proper record • There should be efficient recording and maintenance of patient information

Monitoring • Various monitoring equipments to record the cardiovascular and respiratory status, mechanical
equipments ventilators, dialysis equipment, radiological equipment, laboratory equipment etc. should be
available in sufficient number and good working condition
 Components of ward/unit

Ancillary services Auxiliary Sanitary facilities

facilities
Patient's bed or
Nurses station • Dietary services, • Toilet,
room physiotherapy • Housekeeping, bathroom, sluice
area, utility lecture hall, room, washing
room, store, resting room area etc.
ward pantry (doctors, nurses)
visitor's room,
ward lab etc.
 Components of Ward Management

Management Interpretation
Management Management
Personnel of supplies of policies
of patient of the
Management and and
care Environment
equipments procedures
 Responsibilities of the ward sister or the head nurse

Patient care
Supervise the nursing care being rendered to all patients and give attention
to patient’s comfort and safety
To create a safe and comfortable environment for patients
Evaluate the efficiency of patient care services, identify nursing care
problems and assist in finding out the solutions
Guide and provide nursing care to patients
 Responsibilities of the ward sister or the head nurse

Ward staff
To plan the duty roster specific to the ward (assign duties to nurses and
other ancillary nursing personnel) and implement patient classification
system
Conduct meetings with the subordinate staff and provide guidance or
teaching to improve their nursing care
Evaluate the job performance of nursing and ancillary staff (performance
appraisal)
 Responsibilities of the ward sister or the head nurse
Ward Environment
Take active steps in procurement, storage, inventory, distribution and
disposition of hospital supplies and equipment
Ensure that the supplies and equipments are adequate and in good working
condition
Safe custody of dangerous drugs and records of their administration
Maintenance of stock registers and inventory
Ensure that infection control practices are properly followed
Evaluate and make recommendations or suggestions regarding ward
facilities
 Factors influencing ward management

Knowledge of Effective Standards and Starting the

the ward planning policies work on time

Establishment Adequate Maintenance

Orientation of
of ward supplies and of records and
new staff
routines equipments reports

Good Method of
working Delegation patient
relationship assignment
 Role of a head nurse in in ward management

Responsible to assure quality patient care while managing, leading,

coordinating, and overseeing nursing practice.
Responsible for the management of a ward or department effectively
motivating, leading and supervising staff to ensure that the resources and
the time are managed through effective teamwork.
Takes the delegated responsibility for a part of budgeting
Contributes and influences the total patient experience through
collaborative working and effective communication with the
multidisciplinary team
Assist in formulation and review of clinical policies and procedures
 Role of a head nurse in in ward management

Overall responsibility for maintaining the high standards of cleanliness,

tidiness and decor in the ward
Lead, support, supervise and instruct the team through the process of
change demonstrating professional integrity and balance
Helps in resolving the concerns of patients and their families as quickly
as possible
Prepare duty roster on weekly basis and circulate the same to the
respective personnel
Monitor all the records for its accuracy and completion
Document and supervise all the use of supplies and equipments
Regular monitoring of crash cart in terms of drug availability, expiry
date and consumption
 Meaning of disaster

Disaster is a serious disruption of the functioning of the society, causing

wide spread human, material, or environmental losses which exceed the
ability of the affected society to cope using its own resources.
 Definition of disaster
A disaster is a sudden, calamitous event that seriously disrupts the
functioning of a community or society and causes human, material, and
economic or environmental losses that exceed the community's or society's
ability to cope using its own resources. Though often caused by nature,
disasters can have human origins.
-The United Nations International
Strategy for Disaster Reduction (UNISDR)
 Classification of disaster

Natural Man-made
Cause disasters disasters

Speed Rapid onset Slow onset

disaster disaster
of onset
 Disaster Management
Disaster management is the organisation, planning and application of
measures preparing for responding to an initial recovery from disaster.
Disaster management focuses on creating and implementing preparedness
to reduce the impact of disaster.
-UNISDR
 Objectives of Disaster Management
Plan and organise standard operating procedures for emergency response
and relief during disaster
Identify the individuals and department during disaster and specify their
roles and responsibilities
Organise activities to reduce the impact of disaster
 Principles of Disaster Management

Plan

Team

Control and communication

Triage

Facilities
Activities involved in Disaster Management

Prevention

Rehabilitation Mitigation

Recovery Preparedness

Response
 Phases of Disaster Management
Pre – Disaster phase Disaster phase Post Disaster phase

This phase occurs before a This phase occurs as a response This phase occurs after a disaster
disaster immediately after a disaster

To reduce the potential for The goal of the disaster phase is It aims to achieve rapid and
human, material or to ensure that the needs and durable recovery which does not
environmental losses caused by provisions of victims are met to reproduce the original
hazards and to ensure that these alleviate and minimize suffering. vulnerable conditions
losses are minimized when the
disaster actually strikes.
 Pre-Disaster phase

Disaster
mitigation Disaster
preparedness
 Types of mitigation

Structural mitigation Non-structural mitigation

The protection from disaster or hazards The activities include formulation of policies
includes activities of modifying physical and practices, land use planning laws and
construction of a building. their enforcement, insurance schemes,
Examples: construction of disaster resistant conducting awareness and health education
infrastructure, ocean wave barriers, regarding local hazard etc.
earthquake resistant construction of building
and evacuation Shelters etc.
 Activities of Disaster preparedness

2. Response 3.
1. Hazard risk 4. Information
mechanism Preparedness
identification management
and strategies planning

7. Public 6. 5. Early
education and Mobilisation warning
training of funds systems
 During disaster phase
Disaster Response
Disaster response refers to the first stage response to any calamity.
It includes any actions taken during or immediately following an
emergency, including efforts to save lives and to prevent further property
damage.
The emergency relief activities include immediate relief, rescue, and the
damage needs assessment and debris clearance.
 Post disaster phase
Disaster recovery
Disaster recovery happens after damages have been assessed.
This involves actions with an aim to return the affected community to its
pre-disaster state and to make it less vulnerable to future risk.
Components of disaster recovery

Reconstruction

Rehabilitation Development

Disaster
Recovery
 Aim of Hospital emergency plan

Sufficient number
Proportional
Survival and of healthcare Appropriate Integrate the
distribution of
recuperation of as personnel to meet services according services with
patients to other
many patients as the emergency to the needs of the other departments
Healthcare
possible needs of the patients of the hospital
facilities
patients
Strategies included in Hospital emergency plan

Treat the patients based on the

Enhance the capacities of rules of individual management,
admission and treatment. despite there being a greater
number of patients

Ensure proper ongoing treatment Smooth handling of all

for all patients who were already additional tasks caused by such
present in the hospital. an incident.

Provide medications, medical

consultation, infusions, dressing
material and any other necessary
medical equipments.
 Principles of hospital disaster plan
PRINCIPLES DESCRIPTION
Predictable Hospital disaster plan should have a predictable chain of management.

Simple Plan should be simple and operationally functional.

Flexible Plan should have organizational charts

The plan should be executable for various forms and dimensions of
different disasters.
Concise Clear definition of authority
The plan should specify various roles, responsibilities, work
relationships of administrative and technical groups.
 Principles of hospital disaster plan
PRINCIPLES DESCRIPTION
Comprehensive: (Compatible It should be comprehensive enough to look at the network of various other
with various hospitals) health care facilities along with formulation of an inter-hospital transfer policy
in the event of a disaster.
Adaptable Although the disaster plan is intended to provide standard procedures which
may be followed with little thought, it is not complete if there is no space for
adaptability.
Anticipatory All hospital plans should be made considering the worst case scenarios.

Part of a Regional Health Hospital cannot be alone entity making its plans in isolation.
Plan in Disasters The hospital plans have to be integrated with the regional (district/taluk/block)
plan for proper implementation
Components of a hospital emergency plan during the pre-disaster
phase

Planning
• The hospital plans mostly are formulated during the pre-disaster phase
and is discussed in a suitable forum for approval.

The disaster manual

• The hospital disaster plan should be prepared in a document form and
copies of the same should be available in all the areas of the hospital.

Staff education and training

• The staff should know about and get trained in using the hospital
disaster/emergency manual.
• Regular staff training by suitable drills should be undertaken in this
phase.
 Disaster Nursing
Disaster preparedness, including risk assessment and multi-disciplinary
management strategies at all system levels, is critical to the delivery of
effective responses to the short, medium, and long- term health needs of
a disaster-stricken population.
-International Council of Nurses (2006)
 Qualities of a nurse working in Disaster
Management
Nurses should have confidence, good communication skill, leadership,
coordination, responsibility and readiness to work with accountability
and ability to provide first aid and resuscitation to the disaster victims
 Goal of a nurse working in Disaster Management
To provide the best possible nursing service to promote the physical and
emotional well-being of victims and community affected by disasters
 Role of a nurse administrator in disaster nursing
Pre-disaster phase
Planning and participating in disaster preparedness and mitigation
Should have emergency and disaster plan in the respective nursing
department/in the ward where she is working
Knowledgeable regarding the disaster prone areas and about the potential
impact
Awareness regarding the disaster management policies and protocols
issued by the various management agencies (example: issued by the
disaster management health authority, Government of India)
Participate in organising disaster for mock drills
Enhance public awareness through mass media Communications
 Role of a nurse administrator in disaster nursing
During disaster
Initiate, participate and encourage her subordinates in life saving
measures, first aid, triaging the victims, care of injured, transporting
victims to higher level Health Care facility etc.
Active participation in providing first aid, resuscitation, triaging and
providing comprehensive nursing care
Address physical needs of the survivors; approach them in a calm and
quiet manner.
Participate in providing food, water, shelter, clothing and reducing their
physical problems.
 Role of a nurse administrator in disaster nursing
Post disaster
Initiate interventions such as evacuation of victims
Participate in arranging shelter areas for the management of affected
people
Ensure adequate supply of safe drinking water, food, medicine, clothing
etc.
Give special attention to the special population: Mentally challenged,
elderly, under-five children etc. as they need special care and attention
Participating in important activities during the rehabilitation phase such
as epidemiologic surveillance, prevention and control of communicable
diseases, environmental hygiene etc.
 Role of a nurse administrator in disaster nursing
Post disaster
Effective public education regarding the importance of healthy lifestyle
and hygiene
Training, counselling and educating individuals in the affected area in
order to help them to attain the highest possible level of functional ability
Mental health support: Encourage the victims to share their feelings and
counsel them to prevent post-traumatic stress.
Used therapeutic approach to address the needs of the individual or
family
Refer victims to a psychologist or social worker if necessary
Proper documentation of the disaster management activities, challenges
faced and the lessons learnt
 Role of a nurse in disaster management

Disaster mitigation
Risk assessment
Risk management
Coping strategies
Persons to contact
Community awareness
 Role of a nurse in disaster management

Disaster preparedness
Personal preparedness (capacity building, knowledge)
Professional preparedness (disaster plan, supplies, equipments, team)
community preparedness (community education and awareness)
 Role of a nurse in disaster management

Disaster impact and response

Determining magnitude and needs, field care,
outreach programmes
 Role of a nurse in disaster management

Recovery
Surveillance and prevention of outbreak activities
Textbook of Nursing Management and Leadership