Introduction to Hospital nursing

Introduction of Hospital

A hospital is a place of healthcare that offers patients specialized medical and nursing staff, as well as medical supplies. It is a location where those who are ill, hurt, or wounded are cared for by offering the best service in accordance with their specific needs; it also offers customers and the community preventative measures.

The word "hospital" is derived from the Latin word "hospice" which means "host" or "guest" or "an establishment where a guest is received and cared". A patient is a guest and the most important person in the hospital. Historically, hospitals were often founded and funded by religious orders or charitable individuals and leaders; work was usually performed by the founding religious leaders or by volunteers. Today hospital means an institution in which sick or injured persons are treated and healthy persons are helped to promote and maintain an optimum level of well-being. A modern hospital is an institution that possesses adequate accommodation and well qualified and experienced personnel to provide services of curative, restorative, preventive and promotive characteristics of the highest quality possible to all people, regardless of race, colour, creed, or economic status. Hospitals are largely staffed by professional physicians, surgeons, and nurses. Professionally and technically skilled people apply their knowledge and skill with the help of complicated equipment and appliances-to provide quality care for the patient. It is a business as well as a caring, people-oriented institution and it has a similar structure and hierarchy of authority as any large business. The hospitals which are involved in education or the educational organizations provide appropriate education to different professionals and technical students, such as medical and nursing students as well as the other technical students like lab, x-ray, etc. Research is another major activity of the hospital today.

Definition of Hospital

Hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care; both curative and preventive, and whose outpatient services reach out to the family and its home environment. The hospital is also a center for the training of health workers and for bio-social research. -WHO

Hospital is an institution of the care, cure and treatment of the sick, and wounded; for study of diseases and for the training of doctors and nurses. Stedman's Medical Dictionary

Purposes of Hospital

• To provide health care to the sick, and injured people.
• To diagnose and treatment of diseases to both inpatients and outpatients.
• To provide health service in community people. To provide preventive and promotive services like family planning, immunization and
• growth monitoring, antenatal, natal and post natal service.
• To provide training for professionals i.e. doctor, nurses and others who are involving in health care services.
• To provide in-service/continuing education in all disciplines professional/technical professional involving health care for updating the knowledge and skills.
• To participate/conduct research that will benefit patient care, improve the CHN health status, the management of hospital services and the education of individual who perform the required services.
• To provide facilities for the education of doctors, nurses and other health professional.
• To maintain a high standard of nursing care and medical practice through proper qualification of workers committed to promoting the health of the community.

Functions of Hospital

• The main function of a hospital is to provide the population with complete health care; it also functions as the center for the training of health workers. A hospital is generally a vital part of a social and medical organization.
• Therapeutic services: Hospital provides curative health service to those who are sick, injured and well people.
• Diagnostic services: Hospital provides investigation, diagnosis services for the early and prompt diagnosis of illness.
• Emergency care: Hospital provides emergency care to the patient for acute illnesses.
• Critical care: Hospitals provide the advance tertiary care for the patients suffering from the life threating illnesses.
• Rehabilitation: Hospitals also provide the facilities for physical therapy and rehabilitation.
• Preventive services: Hospitals provide the preventive services such as antenatal care, immunization, communicable disease etc.
• Health promotion: Hospitals also actively participate in health promotion activities such as health education and family welfare clinics.
• Research: Hospitals are places, where research is carried out to expand body of knowledge in the field of health sciences
• Teaching and training: Hospital also provide platform to in-service training and education for medical, nursing and other disciplines.
• Employment: Provides employment in different sectors.
• Inside hospital: Health professionals, other health care workers
• Outside hospital: Suppliers, Transport services
• Patient Support: It relates directly to patient care and includes nursing, dietary diagnostic, therapy, pharmacy and laboratory services.

Administrative:

• Concerns the execution of policies and directions of the hospital. Provide service related to accounting, billing, budget, cashiering, housekeeping, laundry, personnel, property and supply, security, transport, engineering and maintenance.
• Render support services to hospital care providers, clients, other government, private agencies, and professional groups.
• Professional Development: Hospitals provides opportunity to develop professional efficiency. it helps to standardize the nursing care.
• Referral: It works as referral center.

Types of Hospital and Departments

General Hospital: The best-known type of hospital is the general hospital, which is set up to deal with many kinds of diseases and injury, and normally has an emergency department to deal with immediate and urgent threats to health. It is an institution that provides complete medical and surgical care to the sick and injured as well as healthy people. These hospitals provide treatment for common diseases. The objective of these hospitals is to provide health service to the people while teaching and research is secondary and incidental e.g. Bir Hospital, Model hospital, etc. Common features of general hospital are organized organogram, standard laboratory, x-ray facilities, and separate different departments.

Specialized Hospital: These hospitals are providing health services and care primarily for only one discipline or a specific condition of one system. Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth.

Teaching Hospital: A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school, nursing school or university. The main objective of these hospitals is teaching based on research and the provision of health care is secondary e.g. T.U., BP Koirala Institute of Health Sciences, Nepal Medical Collage, KMC etc. patients receive treatment from highly qualified physicians with access to the most advanced technology and equipment.

Contagious Disease/Isolation Hospital: This is a hospital in which the persons suffering from infections, communicable diseases requiring isolation of the patients are treated e.g. Sukraraj Tropical Hospital, Teku.

Public Hospital: Public hospitals or government hospitals are run by the central or state government or municipal bodies with a service motive and receives government funding. These hospitals may be general hospitals or specialized hospitals.

Private Hospital: Private hospitals are generally owned by an individual or a group of individuals which are generally self-funded and run for commercial purpose.

Convalescent Hospital: convalescent hospital is an institution which provides medical and nursing service for persons afflicted with a chronic illness or chronic disability resulting from injury and illness.

Charitable Hospital: These hospitals are established under society's registration act and run by for service motive. These are generally funded by donations, grants, and aids from philanthropic organizations.

Corporate Hospital: These hospitals are established by registered companies and generally run by for the commercial purposes.

Day Care Hospital: These hospitals offer care only during daytime. Patients are admitted on the same day; procedure is performed, and then discharged on the same day e.g. eye care hospitals, for chemotherapy, and blood transfusion.

Long Term Hospitals: These hospitals provide care to the people who require the long term services for chronic diseases such as Alzheimer disease.

Short Term Hospitals: These hospitals provide care to the people with short acute illness.

Departments or Wards

Out-patient Department: This is a department in which the patients who don't need hospitalization are treated. It is the point of contact between hospital and community. This department covers all the services provided by the inpatient department including family planning services, well baby clinic, x-ray unit, Lab, antenatal clinic, etc. All the patients suffering from diseases of miner, serious, acute, chronic nature are first examined in this department.

In Patient Department: This is a department in which the patients who need hospitalization are treated. It includes following units: emergency/observation, medical/surgical/maternity ward, CU/CCU, OT/Post op, Orthopedic, plastic unit, burn ward, psychiatric ward, EYE/ENT, etc.

Hospitals consist of departments, traditionally called wards, especially when they have beds for inpatients, when they are sometimes also called inpatient wards. Hospitals may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as the following:

• Emergency,
• Medical,
• Surgical,
• Operation theater,
• Post-operative,
• Cardio-thoracic,
• Intensive care.
  • Paediatric intensive care unit
  • Peonatal intensive care unit
  • Cardiovascular intensive care unit
• Neurology,
• Oncology,
• Obstetrics and gynaecology,
• Geriatric,
• Pediatric,
• Psychiatric,
• Eye, ENT, dental.

Some hospitals have outpatient departments and some have chronic treatment units such as behavioral health services, dentistry, dermatology, rehabilitation services, and physical therapy. In addition, there is the department of nursing, often headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Common support units include laboratory, physiotherapy, radiology, pharmacy, pathology, and radiology. On the non- medical side, there often are: housekeeping, medical records departments, information management, clinical engineering, maintenance, dietary services, and security departments.

Classification of Hospital

Each hospital is distinct in its characteristics as it differs in structure, functions, performance and the community it serves. However, we can classify the hospitals into different types depending upon different criteria.

Based on clinical specialties

• General hospital,
• Specialized hospital,
• Isolation hospital.

Based on ownership of hospital

• Public/Government hospitals - Bir Hospital, Kanti Hospital,
• Semi-Government hospitals - Patan Hospital,
• Charitable hospitals,
• Voluntary Agencies hospitals or hospitals run by NGO Kathmandu Model Hospital,  Tilganga Kidney Center,
• Private hospital - OM Hospital, B&B, Grandy,
• Corporate hospitals.

Based on system of medicine

• Allopathic hospitals,
• Ayurvedic hospitals,
• Homoeopathic hospitals,
• Unani hospitals,
•  Hospitals of other systems of medicine.

Based on diversity in aim of hospitals

•  Teaching hospitals,
• Non-teaching hospitals.

Admission Procedure

Admission of a patient means to hospitalize the patient for observation, investigation, diagnosis, treatment and care for the disease suffering from.

Types of Admission

Routine or planned admission: Routine admissions are those that are scheduled in advance. It refers to schedule in-hospital stay, after patient and physician decides that he/ she needs hospital-based treatment. Direct admitted patients are sent to the hospital directly by their physician or primary care provider when their health condition requires it.

Emergency Admission: Emergency admissions are those for which there is no prior planning. Emergency admission occurs when life-threatening illness or injury requires an immediate admission for hospital care.

Purposes

• To provide immediate care to the patient in acute condition.
• To welcome and establish a positive initial relationship with patient and care taker.
• To assess the condition of the patient.
• To orient patient to hospital environment and available services.
• To provide rest to the patient physically and mentally, not available at home.
• To observe and evaluate the patient's general condition.
• To provide care and treatment according to the need of the patient.
• To undertake different laboratory and x-ray procedures.
•  To help to gather necessary information from the patients regarding their illness.
•  To make the patient comfortable for treatment procedure.
• To help the doctor for final diagnosis
• To collaborate with the patient in planning and providing comprehensive care.

Principles

• Sudden change of environment produces fear and anxiety in the patient.
• Entering the hospital is a threat to once personal identity.
• People have different habits and modes of behaviors.
• Patient develops certain behavioral pattern called mental mechanisms during their illness.

Articles

• Complete set of admission form.
• TPR sheet, medicine chart, I/O chart, Nurses record, progress record chard, Additional chart as needed.
• Vital sign tray.
• Equipment for physical examination e.g. measuring tape, vital signs tray, torch light hammer, scale, weight machine, height chart, tuning fork, tongue spatula.
• Bath tray including hospital dress.
• Specimen container.
• Prepared bed.
• Bedpan, urinal.

Procedure

• Ascertain the admission of patients, type of illness and type of care needed.
• Prepare the room before the patient arrives. Check the bed is ready to keep the patient.
• Arrange room furniture for easy access from bed.
• Wash hands. Prepare all required equipment.
• Assemble special equipment such as suction equipment, oxygen supplies, I.V. stand, etc. and make sure they are in working condition.
• Receive the patient and family to assign bed. Identify the patient with the admission slip. Greet the patient and his relatives in a pleasant manner and introduce you, staff members and another patients and visitors to them. Make him/her comfortable and assist him/her about according to needs.
• Check the details such as advance payment, unit and room assigned.
• Prepare the patients record with all the necessary information like name, hospital number, grin unit, room and bed number in each record.
• Check for admission consent whether it is duly signed by patient and relatives.
• Observe the general condition of patient, if patient is very ill, place on the examination table or bed and inform to the doctor immediately, perform immediate care.
• Check vital signs and report to the ward sister or on duty doctor for any abnormality.
• Obtain initial patient history and physical examination. Observe general conditions of patient.
• Assess immediate need; see the chart and immediate order. And follow the immediate instruction.
• Initiate care which is required immediately but don't require physical's order such as cold compress, oxygen inhalation and suctioning.
• Give admission bath if needed. Help the patient to change his/her clothing and maintained personal hygiene such as nail care, hair care, bath, etc.
• Help the patient to change hospital's gown. Handover the patient's valuable things to the family.
• Orient the patient and family with ward, ward routines, supportive hospitals facilities and hospitals policies.
• Explain about the facilities available such as canteen, telephone, pharmacy, safety rules.
• Ask the patient and relative to bring daily use equipment e.g. towel, oil, comb, soap, toothpaste, and brush.
• Explain the hospital policies regarding visitor hours, gate pass, attendants staying with patient, and restrictions in the ward.
• Explain the daily routine of the ward including meal time, medication time, and morning wake up and doctors round.
• Obtain detail nursing history and physical examination.
• Complete the admission chart. Obtain specimen such as urine, blood or any other for test if not already obtain
• Inform patient about procedures or treatments scheduled for the next shift or day.
• Wash hands.
• Report/inform to unit in charge and duty doctors about admission of patient. Record the patients detailed in admission book and census form according to hospital policy.
• Write a complete admission report in the patient's chart including date, time of arrival to the ward, patient's condition, and vital sign, any abnormalities and interventions.

Orientation of the patient to the ward:

The following points are to be taken care of when a nurse orients a patient to the ward:

• Introduce the patient to the hospital staff and other patient.
• Show the location of nurse's station, treatment room, visitor room, toilet, and bath room available to the client and visitors.
• Show where to store clothing and personal items.
• Demonstrate how to adjust the hospital bed.
• Explain adjustment of room light and ventilation.
• Orient about where and when lab and diagnostic test are performed
•  Inform meal timing, visiting time and doctor's round and ward routing.
• Show the communication system and keep the bed alarm..
• Valuable are listed and handed over to the relatives after taking signature.

Points to be Rememberd:

• Make proper observations of the patient's condition, record and report.
• In admissions of sick patients or emergency situations, steps of the procedure may be altered, considering the priority of needs.
• Isolate the patient if suffering from communicable diseases.
• Orient the patient and his relatives to hospital and ward policies.
• Avoid physical and psychological trauma.
• Be courteous and kind to the patient and his relatives.
• If the patient is very ill, inform to the doctor or ward in charge immediately.
• Be sure that the call light is within reach, bed in lowered position and side rails are raised.
• Take written informed consent from the patient and visitor for admission, treatment and special procedure.
•  Follow the policies dealing with medico legal cases and inform the duty police in case of police case such as road traffic accident, poisoning, physical assaults, rape and unknown cases.
• Encourage patient to send the valuables home. If the patient prefers to keep them, list the items on a paper and have the patient or family member sign it and handover to the family.

Discharge Procedure

Discharge is the preparation of the patient for departure from the hospital with approval of the doctors. Discharge planning prepares a client to move from one level of care to another within or outside the current health care facility.

Discharge planning is a centralized, coordinated, multidisciplinary process that ensures the patient has a plan or continuing care after leaving the hospital. obrn

Purposes

• To reduce the number of days stay at the hospital.
• To ensure continuity of care to the patient after discharge.
• To develop the necessary knowledge and skills of patient and family to meet the patient's needs at home.
• To advice the patient and their family about medicine to be taken, follow up visit, and education on diet, exercise and rest needed to the patient.
• To make the patient comfortable in a healthy atmosphere.
• To co-ordinate referrals to appropriate hospital or rehabilitation center.

Types of Discharge

• Cured and discharge,
• Discharge against medical advice,
• Discharge at request,
• Transfer to other hospital,
• Death,
• Absconded.

Articles

• Patient's all records.
• Discharge letter (paper).
• 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 nursing history, care plan and ongoing assessment of physical abilities and cognitive function from time of admission.
• Assess the patient's and family's need for health teaching related to home therapies, restrictions resulting from health alterations and possible complications.

Preparation before the day of discharge

• Suggest way to change physical arrangement of home to meet patients' needs if required e.g. if the patient with COPD needs continuous oxygen therapy and nebulazion at home.
•  Provide patient and family with information about community health care resources.

Day of Discharge

• Prepare and check the patient's entire document.
• Collect the written discharge letter. Arrange chart such as charge sheet and admission sheet solo are kept upper most along with discharge slip.
• Check physician's discharge orders for prescription and change in treatments.
• Send chart with the discharge ticket to billing section with relevant information.
• After clearance of the bill, give instruction according to the discharge ticket.
• Provide discharge instruction about diet, rest, sleep and exercise, medication including dose, time, duration, complication of diseases, home care, follow up visits, care of wounds based on mental, social and spiritual.
• Provide information about home care facilities available.
• Gather equipment supplies and prescription that the patient has taken.
• Handover the patient's belonging and any valuable which have been kept safely to the patient's relatives under proper receipt.
• Assist the patient in dressing and packing items to go home.
• If the patient is ambulatory, instruct relatives to assist him.
• Obtain wheel chair for patient who is unable to ambulate.
• Complete documentation of patient discharge in nurse's note.
• After the patient has gone, the bed should be made clean and tidy and keep ready for next use.
• Send the chart to medical record department.

Points to Remember

• If the patient leaves the hospital against medical advice, inform the physician and nursing in-charge and complete the LAMA form as per hospital policy. The procedure is the same as the patient's discharge process except a discharge ticket is not given to the patient. In such cases, the patient or the relative is asked to sign a statement that he/she is going or taking the patient on his or her own will and responsibility. This is a sort of protection to the hospital authorities, who can be sued in court of law, if the patient is convened that he/ she was maltreated.
• If the patient is a police case, the nurse on duty should inform the police before the patient leaves the hospital.
• When the patient escapes from hospital without knowledge of the hospital staff and without signing the said statement, he or she is treated as absconded.
• If the patient is transferred to another hospital for further treatment, the relatives / should be informed or provided transfer letter.
• Patients who may need detailed instructions and follow up visit after discharge include:
  • Newly diagnosed chronic disease like DM.
  • Patient after major and radical surgery.
  • Patient who are socially isolated.
  • Patients with emotional or mental instability.
  • Patients who are terminally ill.

Transfer of a Patient from Unit to Unit and Hospital to Hospital

Transfer of a patient is defined as shifting a patient from one department to another department in the same hospital or between hospitals. Transferring a patient from one department to another department within the hospital is done for facilitating more specialized care in an acute and life threatening illness or continuity of routine care in a stable condition of patient. Inter hospital transfer is needed when the diagnostic and therapeutic facilities required for a patient are not available at the given hospital. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency condition.

Purposes

• To transfer patient in a unit that is most suitable to provide specialize nursing care.
• To provide different services such as diagnostic tests, treatment and nursing care to the patient available in another department or hospital.
• To have care continued closer to home.
• To have care continued when financial resources prohibit receiving care in the current facility.
• To provide for more skilled care and closed observation in specialized units.

Articles 

• Wheel chair/stretcher,
• O2 cylinder with tube
• IV stand,
• Requisition forms,
• Records and Recording charts.

Procedure

• Check written transfer order and assess reason for transfer the patient.
• Inform to senior, patient and his relatives about the purpose of transfer.
• Complete the patient chart and make it up to date.
• Assess the patient's physical condition and determine the mode of transportation.
• Check the belongings of the patients and keep ready for shifting.
• Prepare referral slip including 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 necessary nursing therapies.
• Perform final assessment of patient's physical stability.
• Assist in transferring patient to stretcher or wheel chair.
• Gather equipment supplies and prescription that the patient has taken.
• Accompany the patient to receiving unit or hospital.
• Hand over all document of the patient to the receiving person.
• After the patient has gone, the bed should be made clean and tidy and keep ready for next use.
• Complete the needed documentation after transfer according to agency policies.