PREPARE A VISION AND MISSION STATEMENT

HOSPITAL

INTRODUCTION
A hospital is a health care institution providing treatment to patients with specialized staff and
equipment. The word “hospital “derived from the Latin word hospitals which in turn derived from
French word “hopes” that means “ a host or a guest”
A hospital is a health care institution providing treatment to patients with specialized staff and
equipment.

DEFINITION
Hospital is an integral part of a social and medical organization ,the functions of which is to
provide for the population complete health care both curative and preventive , and whose outpatients
services reach out to the family and its home environment . The hospital is also a centre for the
training of health worker and for bio social researches.

FUNCTIONS OF THE HOSPITAL

• Prevention of disease and promotion of health.
• Medical and nursing research
• Medical education and training
• Outpatient services
• Diagnosis and treatment of disease
• Patient care

CLASSIFICATION OF HOSPITALS
They classified according to ,
• Length of stay of the patient
• Clinical basis
• Ownership /control basis
• Objectives
• Size
• Management
• System of medicine

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FUNCTION OF THE HOSPITAL
1) Preventive function
2) Curative function
3) Training function
4) Research function

1) Preventive function: it is an emerging secondary function for the hospital and concerned with
health promotion o It is geared toward providing the preventive services through a community health
center o It takes an active role to improve the health of the population

2) Curative function: o it is the primary function of the hospital and concerned with providing patient
care. It refers to any type of care given to the patients by the health team members e.g. physicians,
nurses, dietitian. Also includes health education to patients

3) Training function: It is a secondary function and concerned with providing training and
educational courses for the professional and technical personnel who provides health services (e.g.
physicians, nurses, dentists, therapist

4) Research function: o It is a secondary function and concerned with conducting the health related
researches that focus on the improvement of the health and/or prevention of diseases.

DEPARTMENTS OF HOSPITAL
OUT PATIENT DEPARTMENT (OPD)
IN PATIENT DEPARTMENT (IPD)
OUT PATIENT DEPARTMENT
In OPD investigative and curative work can be done without admitting the client.
SCOPE
Consultation, investigation, procedures, speciality services •
Preventive and promotive health care
Rehabilitation .
Health education
Counselling

INPATIENT DEPARTMENT
“Inpatient" means that the procedure requires the patient to be admitted to the hospital, primarily so
that he or she can be closely monitored during the procedure and afterwards, during recovery.

OTHER DEPARTMENTS
MEDICAL DEPARTMENT:
Medical superintendent is a doctor who has control over all the medical department. It includes
medicine, paediatrics, orthopaedics, skin, cardiology, psychiatry etc.

NURSING DEPARTMENT:
The nursing department consist of nursing services and nursing education. The primary aim is
to provide comprehensive, safe and well organized nursing care through the personnel of the
department.

OPERATION THEATRE:
This consists of one or more OT and other facilities. There should be four zones- outer zone,
clean zone, sterile zone, disposal zone.

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 PHARMACY DEPARTMENT:
The pharmacy department has the responsibility for purchasing, compounding, storing
dispensing all the drugs.

REHABLIATION UNIT:
This department deals with clients who have functional disabilities resulting from disease
condition/injuries.

RADIOLOGY DEPARTMENT:
The department must be located in a place where is easy accessibility of IP and OP clients.
This department has following services: a) X-ray b) Ultrasonography c) MRI and ECG d) C.T
scan and echo cardiogram

PARAMEDICAL DEPARTMENT:
It include the laboratory services and blood bank facilities.

DIETARY DEPARTMENT:
It has the responsibility for the food service to the client according to their needs and doctor’s
prescription.

CENTRAL STERILE SUPPLY DEPARTMENT:

This department supply sterile articles throughout the hospital.

Vision, Mission and Values

After extensive consultations with our front line staff, executives and Board members, the
Hospital Authority has adopted three basic corporate statements - our Vision, Mission and
Values. Known collectively as "VMV", they serve to guide the planning, development and
delivery of our services.
We also constantly bear in mind that we are a "people-first" Organization. That means we
regard people - including our patients and their families, staff members and other stakeholders
in the community - as the focus of our work, and we always strive to treat them fairly, with
respect and as our equals.

Our Purpose, Vision & Value

• Our Purpose
To provide care that people trust.
• Our Vision
To be a trusted, people-centric, integrated healthcare system as a model for global health.
• Our Values
➢ Honesty & Integrity: The practice of honesty fortifies character. Integrity means doing right
at all times and willingness to live by the standards and beliefs of the organization.
➢ Teamwork: A collaborative work ecosystem, where the collective efficiencies are harnessed
for delivering the best possible care.
➢ Empathy & Compassion: The ability to understand the feelings of patients as well as
employees, so that the services delivered are humane and in a supportive work environment.
➢ Education: Continuous learning for the creation of a sustainable healthcare system, where
employees and the organization can grow together.
➢ Citizenship: Good governance and appropriate working relationship with all stake- holders,
based on compliance to laws and ethical practices.
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➢ Equity: Mutual trust based on fair and impartial consideration of all professional matters so
that it fosters positive contribution towards the institutional purpose.
➢ Dignity & Respect: Treat all with utmost regard and esteem so that it enhances respect and, in
turn, a sense of belonging.

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COMMUNICATION

DEFINITION OF COMMUNICATION:

• Communication is transfer of information from the sender to the receiver so that it is

understood in its right context
• Communication is the means of making the transfer of information productive and
goal oriented
• Communication is a two-way process of sharing thoughts, ideas, opinions, message
and feelings.

CLASSIFICATION OF COMMUNICATION:

➢ FORMAL COMMUNICATION:

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This line of communication is meant for the transmission of official messages within or
outside the organization. the formal communication flow in three direction-downward,
upward and lateral (horizontal) between the departments.

Characteristics of formal communication: -

The chief characteristics of the formal communication are as follow: -

• Written or oral – formal communication can both be written &oral. daily works are
handled through oral communication, while the policy matters require written
communication
• Formal relations- this communication is adopted among those employees where
formal relations have been established by the organizations.Thesender and the
receiver havesome sort of organizational relations.
• Prescribed path- the communication has to pass through a definite channel while
moving from one person to another. For example, to convey the feelings of a worker
to the manager, the foreman’s help has to be sought.
• Organizational manager- this channel is concerned with the authorized
organizational messages only and the personal messages are out of its jurisdiction.

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Advantages of formal communication: -

The following advantages of formal communication are as follow-

• Maintenance of authority and officers- formal communication maintains constant

relations among the superiors and the subordinates as a result of whom the dignity of
the line superiors is maintained. consequently, it is convenient to control the
subordinates and fix their responsibility which is absolutely needed for effective and
successful control.
• Clear and effective communication- in formal communication, there is a direct
contact among the mangers and the subordinates. both understand the capability,
habits, feelings, etc. of one another. managers know as to when and under which
conditions their subordinates need information. in this way, this communication is
capable of making available timely information. hence, it is clear and effective.
• Orderly flow of information- the information has to pass through a definite route
from one person to another. hence, the flow of information is systematic.
• Easy knowledge of source of information- in this type of communication, the
source of each information can be easily located.

Limitations of formal communication: -

The following limitations of formal communication are as follow-

• Overload of work- in a modern business organization much information, many

messages and other things have to be communicated. under formal communication,
they are routed through a definite channel and this consumes much of the time of the
superiors and thus some other important works are left unattended.
• Distortion of information- this method can be a hindrance in the flow of
information. sometimes the distance between the sender and the receiver is so big
that the information has to pass through high many hands and by the time it reaches
the receiver it is distorted. thus it fails to serve its purpose.
• Indifferent officers- the officers do not pay much attention to the suggestion and
complaints of the subordinates. in such a case a subordinates may come lose his faith
in the effectiveness of communication

➢ INFORMAL COMMUNICATION:

Informal communication is the method by which people carry on social, non-

programme activities within the formal boundaries of the organization. Each person

conveying the message, may add, subtract or change the original message,therefore, the
word rumor is used as synonym for the whole informal communication.
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Characteristics of informal communication:

• Formation through social relations-this communication is born out of social

relations who mean that it is beyond the restrictions of the organizations. No
superior subordinate relationship figures there in. a more sociable superior can
gather much information through this channel.
• Two types of information- through this communication, information about the
work and the individual can be collected.
• Uncertain path- since it is beyond the restrictions of the organization, it follows no
definite channel like a grapevine, it moves in a zigzag manner.
• Possibility of rumor and distortion- responsibility for the true or false nature of
communication does not lie on any individual and, therefore, not much attention is
paid to its meeting while communicating. Consequently, the rumors keep floating.

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• Quick relay- informal communication make news spread like wildfire. Not only
this, people start adding something of their own which sometimes changes the real
meaning of the communication.

Advantages of informal communication-

The advantages of informal communication are as follow-

• Fast and effective communication- under this communicating, the message moves
first and their effect is equally great on the people.
• Free environment – informal communication is done in a free environment.free
environment means that there is no pressure of any office – big or small. The
reactions of the employee can easily be collected.
• Better human relations- informal communication saves the employees from
tension. Freedom from tension helps the establishment of better human relations this
is also affects the formal communication.
• Easy solution of the difficult problems- there are many problems which cannot be
solved with the help of formal communication. There is more freedom in informal
communication which helps the solution of difficult problems.
• Satisfying the social needs of the workers- everybody wants good relations with
the high officers at the place of his work. such relations give satisfaction to the
employees and they feel proud. But this can be possible only with the help of the
informal communication.

Limitations of informal communication:

The limitation of the informal communication is as follow-

Unsystematic communication- this communication is absolutely unsystematic and it is

not necessary that information reaches the person concerned.

Unreliable information-most of the information received through this communication

is undependable and no important decision can be taken on its basis.

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➢ VERBAL COMMUNICATION:

When messages or information is exchanged or communicated through words is called

verbal communication. Verbal communication may be two types- written or oral
communication. verbal communication takes place through face-to-face conversations,
group discussions, counselling, interview, radio, television, calls, memos, letters,
reports, notes, email etc. some definitions of verbal communications are as follow-

According to Bovee- “verbal communication is the expression of information through

language which is composed of words and grammar”.

According to Penrose- “verbal communication consists of sharing thoughts the

meaning of words”.

It conveys factual information accurately and effectively.

Importance of verbal communication:

The importance of verbal communication is as follow-

• Keeping each other informed- we can use verbal communication to disseminate

useful and important information
• Asking for help and support- communicating verbally about our problems is the
first step to solving them.
• Making friends- communicating with others can be the start of a good friendship
• Expressing ourselves creatively-verbal communication can be the means for
expressing our imagination.
• Sharing emotions- we can share emotions as well as factual information with our
verbal communication skill.

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Types of verbal communication:

• Speaking face to face-here, our words are combined with our gestures, facial
expressions and tone of voice to give a full communication package.
• Speaking on the phone- communicating verbally on the phone is an excellent way
to reach people far away.
• Video –chat services-the wonders of the internet have enabled us to communicate
verbally with people everywhere and to stay in touch with our loved ones across the
globe.
• Writing a letter- old fashioned letter writing is an art that will never die.
• Giving a lecture- this is a key example of the utility of verbal communication in an
academic context.

➢ NON – VERBAL COMMUNICATION:

When messages or information is exchanged or communicated without using or spoken

or written word is known as nonverbal communication. Non-verbal communication is
usually understood as the process of communication through sending and receiving
wordless messages.

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Non-verbal communication is powerful arsenal in the face-to-face communication
encounters, expressed consciously in the presence of others and perceived either
consciously or unconsciously. Much of non-verbal communication is unintentional
people are not even aware that they are sending messages. Non-verbal communication
takes place though gestures, facial expressions, eye contact, physical proximity,
touching etc. some important definitions of non-verbal communication are as follow-

According to L.C Bovee – non –verbal communication is communication that takes

place through non-verbal cues; through such form of non-verbal communication as
gesture, eye contact, facial expression, clothing and space; and through the non –verbal
vocal communication knows as para language.

Characteristics of non-verbal communication:

Nonverbal communication is any information that is communicated without using

words. The important characteristics of non-verbal communication are as follow-

• No use of words: - nonverbal communication is a communication without words or

language like oral or written communication. it uses gestures,facial expressions, eye
contact, physical proximity, touching etc. for communicating with others.
• Culturally determined: - nonverbal communication is learnt in childhood, passed
on to you by your parents and others with whom you associate. through this process
of growing up in a particularly society, you adopt the taints and mannerisms of your
cultural group.
• Different meaning: - non-verbal symbols can have many meanings. cross culture
aspects give various meanings to same expression in respect of non-verbal
communication.

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• Vague and imprecise: -non-verbal communication is quite vague and
imprecise.since in this communication there is no use of words or language which
expresses clear meaning to the receiver.
• May conflict with verbal messages: - non-verbal communication is so deeply
rooted, so unconscious, that you can express a verbal message and then directly
contradict it with a nonverbal message.
• Shows feelings and attitudes: - facial expression, gestures, body movements, the
way you use your eyes – all communicate your feelings and emotions to others.

➢ DOWNWARD COMMUNICATION:

Downward communication occurs when information and messages flow down through
an organization’s formal chain of command or hierarchical structure. in other words,
messages and orders start at the upper levels of the organizational hierarchy and move
down toward the bottom levels. Responses to downward communications move up
along the same path.

Advantages: Downward communication provides certain advantages to an

organization:

• Organizational discipline: - downward communication follows the organization’s

hierarchy, meaning that organizational discipline and member compliance is much
easier to maintain.
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• Efficiency: - downward communication offers efficiencies because instructions and
information come from the sources in power that are able to coordinate activities
from the top of the organization. Employees receive feedback from the supervisors
who manage them.
• Effective communication of goals: - upper management can easily communicate
goals and assign responsibilities regarding achieving those goals.
Ease of delegation: - delegation is much easier if the delegation comes directly from
the vertical communication structure representing the chain of command.

Disadvantages:

Downward communication is not without disadvantages, including the following:

• Distortion: - ever played the grapevine game? Downward communication can

become distorted as it proceeds through multiple levels of the organizations
• Slow feedback: - it takes time for messages to go down the organization and then up
the organization and then back down again.
• This means that feedback can be slow, resulting in problems, especially in dynamic
environment.
• Interpretative problems: -downward communication pretend interpretation
problems because of the distortion effect and the slow feedback for message
clarification.
➢ UPWARD COMMUNICATION:

Upward communication flows from the bottom to the top, i.e. from the subordinate to
superiors in the form of suggestion, complaints, reports, etc. this also can be oral or

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written problems relating to work. Upward communication is the flow of information
from front lines employees to manager’s supervisors, & directors.

Advantages of upward communication:

• Development of plan: the information received from subordinate plays important

role to help development of planning of the organization.
• Providing suggestions and opinions: by upward communication system,
subordinate takes necessary suggestions and opinions from superiors about the work
related issues of the organization.
• Motivating to employees: upward communication system allows lower level staff
to express their attitude or opinion to upper level staff. as a result, sub-ordinate is
influenced to work more towards fulfilment to target.
• Providing constructive suggestion: all employees are supplied with constructive
and important messages that can help to implement the goals or objectives.
• Good labor –management relationship: it participative in nature. Here, information
is invited from lower level executives and employees and on the basis of this
information top executive makes a decision. so, a good relation between
subordinates and bosses should create for the betterment of the organization.
• Providing feedback- the subordinates reaction is returned to the superior in this
communication system. So, top level management can decide what to do and what
not do clearly understand and followed.
• Creating favorable environment- upward communication helps to develop a
favorable working situation in an organization by creating a good relation among all
employees.
• Promote harmony- upward communication creates friendly environment in the
organization which lead to peaceful and harmonious relationship among the
subordinates and superiors.
• Decision making- top level executives or superiors needed much information before
taking decision on a particular issue. Subordinates supply this information through
the help of upward communication.
• Developing creative and innovative ideas- upward communication facilitates easy
excess of the employees or subordinates to the superiors in providing necessary
constructive suggestions and opinion about the work related issues of the
organization.
• Facilitating collective decision- since upward communication is Participative in
nature. It communication allows the subordinates to convey their feelings,
constructive suggestions and opinions and the work related in the decision making
process.

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Disadvantages of upward communication:

In spite of having many advantages upward communication it is not free from

limitations of disadvantages. the main disadvantages of upward communication are as
follows-

• Changes of information- in upward communication subordinates may change their

accurate information.so, top executive cannot take accurate decision.
• Unwillingness- sometimes subordinates don’t send the information to their superior
willingly. so, communication system may be disrupted.
• Fear of inefficiency- the main problem of the upward communication is fair to
superiors.generally, superiors make a question about the employees work position
and efficiency. many employees fear to communicate and share their ideas,
constructive suggestions and opinions with the superiors.
• Indiscipline- sometimes employees communicate directly to superior by avoiding
proper channel or chain of command. here disciplines are not properly maintained.
• Bypassing- in the process of upward communication, sometimes workers directly
approach the top most authority with their suggestions or by passing their immediate
boss. This is harmful to any organization.
• Flattery-in order to convince the superior bosses, subordinates can take the help of
flattery and for this reason subordinates may conceal the true and provide
incomplete information to top level.
• Lake of initiative-generally subordinates is reluctant to take the initiative to upward
communication for different reason.
• Risk of distortion of messages- in upward communication, subordinates willingly
distort the message because they fear if they tell the original fact to their bosses, they
may face some problems.
• Delay- it is a limitation of upward communication is the long and slow movement of
information to the higher authority.
• Supervisor’s negligence- sometimes top level executives discourage the upward
flow of information and neglect the constructive suggestions and opinions about the
work related issues of the organization

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➢ HORIZONTAL COMMUNICATION:

It is the transmission of information between people, divisions, departments or units

within the same level of organizational hierarchy.

you can distinguish it from vertical communication, which is the transmission of

information between different levels of the organizational hierarchy. Horizontal
communication is often referred to as lateral communication.

Advantages of horizontal communication:

• Reducing misunderstanding- misunderstanding and conflict among the managers

and staffs are very common in organizational life. Horizontal communication helps
to reduce possible misunderstanding and conflict though meeting, discussion, face to
face conversation etc.
• Strengthening group efforts- group efforts and teamwork are essential
prerequisites for organizational success. Horizontal communication helps in
reducing conflicts, controversies, and difference in opinions and thus establishes
consensus among the managers and workers concerned. this consensus strengthens
group efforts and team spirit in the organization.
• Performing interdepartmental communication- horizontal communication occurs
between people at the same level in various departments therefore, interdepartmental
communication occurs smoothly.

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• Gaining benefits of informal communication- though horizontal communication is
formal in nature, it enjoys some degree of informality in exchanging information as
the senders and the receivers hold same position, status and honor.

Disadvantages of horizontal communication:

• Rivalling attitude- horizontal communication occurs between the people at the

same rank and position. If there exists any hostility or rivalry between them, they
will not exchange information spontaneously. moreover, they will conceal their
information intentionally to deprive someone from the real news.
• Interdepartmental conflict- the success of horizontal communication depends on
good relationship between sender and receiver. if there is any conflict, distrust or
suspicion between them, horizontal communication will be ineffective.
• Discouraging attitude of top management- in some cases, top managers
discourage horizontal communication thinking that workers may become friendly
with one another and may create threat for the management.
• Ignoring vertical communication- more concentration on horizontal
communication may work as substitute of upward and downward communication. in
that case upward and downward communications are ignoring.

ELEMENTS IN COMMUNICATION: -

Elements-

• Sender the person or device intending to transmit the information

• Message the information in the form of an idea, thought, attitude, feeling, opinion,
etc.
• Receiver the person willing to share the message with the sender
• Feedback the reactions and responses of receiver to the sender after receiving the
message
• Noise the barriers to the message resulting in the distortion or blackout of
communication

The communication is a two-way process between the sender and the receiver of the
message which can be illustrated by a flow chart.

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THEORY OF COMMUNICATION:

The communication is likely to be conveyed and understood correctly if it is proceeds

in the following steps-

• The sender has an idea, thought, feeling, attitude, opinion with the intention to share
it with others.
• The receiver is willing to receive the communication.
• The sender chooses appropriate words, gesture, visual symbols for correct
transmission of are communication to the receiver.
• The receiver understands the communication.

COMMUNITY

INTRODUCTION
✓ The word "community" is derived from Latin and has been used in the English
language since the 14th century. The word community is derived from the Latin
communities (meaning the same), which is in turn derived from communist,
which means "common, public, shared by all or many" (encyclopedia).

DEFINITION
✓ Community is a group of people living in a same place or having particular
characteristics in common
✓ Community is a social setting.
✓ Community is a social structure.

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COMMUNITIES
✓ To identify the health status of a community
✓ To provide a baseline to evaluate planned and potential intervention To identify
community resources
✓ To identify factors that may be influencing health status (both positive and
negative)
✓ To solicit the opinion of community members
✓ To engage community members in thinking about the health of their community
✓ To assess the community we will use community-as-partner model to guide
practice.
✓ The community-as-partner model provides us with both the map and the
boundaries and is used to describe the nursing process applied to the community
as a whole.
✓ The community-as-partner-model was developed by Anderson & McFarlane
(2008) to illustrate the definition of community health nursing as the synthesis of
public health and nursing.

COMPLETE COMMUNITY DIAGNOSIS HAS FOUR COMPONENTS

✓ Statement of the problem or issue
✓ Identification of the aggregate/population/community affected.
✓ Identification of the factors that are casually linked to the problem or strength
(etiology)
✓ Identification of the evidence that support the diagnosis (manifestation).

LEVEL OF PLANNING INVOLVES ESTABLISHING:

✓ Goals (based on issue contained in community diagnosis).
✓ Target population (based on focus contained in community diagnosis).
✓ Objectives (based on etiology contained in community diagnosis).
✓ Indicators of success (based on manifestation contained in community diagnosis).

Evaluating the interventions

3 types of evaluations:
1. Formative (process)
2. Impact (summative)
3. Outcome:

Formative evaluation:
✓ Asses the program implementation as soon as it begins.
✓ Enable improvement in the plan during the implementation phase.

Impact evaluation
✓ Asses the immediate effects of the program on: Knowledge Attitudes
✓ Skills Perceptions
✓ Beliefs Access to resources Social support
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Outcome evaluation:
✓ Asses’ population level impact of program
✓ Measure change in incidence and prevalence of risk factors
Our Mission, Vision & Values
Mission
To improve the health of our community through the provision of
comprehensive, high quality, compassionate health care to all, regardless of
ability to pay.
Vision
A health care home of choice reflecting community needs, empowering
individuals toward lifelong wellness.
Values
• Accessibility
• Quality
• Teamwork, Integrity, Respect
• Consumer Voice
• Inclusion and Equality
• Integration of programs and services
• Transparency
• Innovation
• Sustainability

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EDUCATIONAL INSTITUTION
EDUCATION
Education in its general sense is a form of learning in which knowledge, skills, and habits of a
group of people are transferred from one generation to the next through teaching, training, research.

STRUCTURE OF EDUCATIONAL INSTITUTION:

Primary education lasts for nine years divided into two stages of five and four years
respectively. It leads to Secondary education comprise three main types of schools: secondary general
schools (gymnasium), secondary technical schools and secondary vocational schools. Gymnasiums
prepare for study at higher education institutions and for professions. The secondary technical schools
and 4-year courses or three-year follow-up courses at secondary vocational schools prepare students
for a wide range of professions, as well as for studies at higher education institutions. The 2-year and
3-year courses at the vocational schools prepare students for professional activities.

HIGHER EDUCATION:
Higher education institutions can be of university and non-university type. The non-university
higher education institutions usually offer Bachelor study programmes and, if accredited, master study
programmes. They are not allowed to provide doctoral study programmes. University-type higher
education institutions offer Bachelor, Master and in most case also Doctoral study programmes.
Higher education institutions offer courses in the Humanities, Social Sciences, Natural Sciences,
Engineering, Medicine and Pharmacy, and Theology, as well as in Economics, Veterinary Medicine,
and Agriculture, Teacher Training and Arts. They are public, state or private institutions. Public
institutions are financed by the state budget through the Ministry of Education, Youth and Sports. The
private institutions can be partially financed by the State. All higher education institutions provide
accredited study programmes which are assessed by the Accreditation Commission.

TYPES OF EDUCATION
1) Formal Education
2) Informal Education

Formal Education
Definition
Formal education is any education provided by a recognized institution teaching courses or
even at home, following a planned course of study.
Formal education refers to the structured educational system provided by the state for children.
Any process of teaching which involves supervision, instruction, set plan, definite aims and
principles amounts to formal education.

Main Points:
Planned with a particular end in view.
Limited to a specific period.
Well-defined and systematic curriculum
Given by specially qualified teachers.
Includes activities outside the classroom
Observes strict discipline.

1) Planned with a particular end in view

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Formal education is planned with a particular end in view. It is given in school, college and similar
other institutions which are established with the purpose. In this way it is direct schooling, instruction
and tuition.

2) Limited to a specific period

Formal education is limited to a specific period or stage. It is provided according to certain set rule
and regulations. It is in the form of systematic, planned and guided instruction.

3) Limited to a specific period

Formal education is limited to a specific period or stage. It is provided according to certain set rule and
regulations. It is in the form of systematic, planned and guided instruction.

4) Given by specially qualified teacher’s

Formal education given by specially qualified teachers they are supposed to be efficient in the art of
instruction.

5) Includes activities outside the class-room

In modern progressive schools, the process of education is not merely restricted the four walls of the
class-room. There are more activities outside the class-room than inside it.

6) Observes strict discipline Formal education observes strict discipline. The pupil and the teacher are
both aware of the fact an engage themselves in the process of education.

Informal Education:

Informal Education is "the process, by which a person imbibes attitudes, develops skills,
cultivates values and acquires knowledge, without there being any organization or system
about it.
Informal Education refers to learning that takes place while at work or at play and during
travels-as well as spontaneous learning through films, radio and television."

Main Points:
Incidental and spontaneous
Not-pre-planned.
Not imparted by any specialized agency.
No prescribed time-table or curriculum.
May be negative also

1) Incidental and spontaneous:

Informal education is incidents and spontaneous. There is no conscious effort involved in it. Education
learn in a market place or in a hotel or in one's sitting room amount to informal education.

2) Not preplanned nor deliberate:

Informal education is an educative activity which is neither pre-planned nor deliberate. The child
learns many habits, manners and patterns while living with others or moving in different spheres like
home, society, groups etc.
3) Not imparted by any specialized agency:
Unlike formal education, informal education is not imparted by any specialized agency such as school
or college.

4) No prescribed time-table or curriculum:

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Informal education is not given according to any fixed time-table or through formal means of
education. There is no set curriculum required. Informal education consists in experiences and actual
living in the family or community.

6) May be negative education also:

Informal education may take to negative direction also. Instances are not rare when one learns
stealing, or some other forms of misbehavior from the experiences which the child may casually have
in the street, in the market, in the cinema hall or in some other such place.

FUNCTIONS OF EDUCATIONAL INSTITUTION

Functions of educational institution consist of teaching basic skills such as functional literacy,
teaching knowledge and skills for specific jobs ,transmitting the culture of the society in other words
,they transmit the beliefs ,norms and values of the society, Developing skills in critical thinking
Preparing the individual to live in society ,the total development of the individual.

Types:
1) Manifest Functions
2) Latent Functions

Manifest Functions:
The consequences for the operation of society as a whole.

Types:
Socialization:
college schools teach students the student-roles, specific academic subjects, and political
socialization for example the importance of the democratic process
Transmission of culture:
Schools transmit cultural norms and values to each new generation. It plays, as well, an
important process in the assimilation of new immigrants. Immigrants learn the dominant
cultural values, attitudes, and behaviors so that they can be productive members in their new
society.
Social Control:
Schools are responsible for teaching discipline, respect, obedience, punctuality, and
perseverance. They teach conformity by teaching young people to be good students,
conscientious future workers, and law abiders.

Social Placement:
Schools are responsible for identifying the most qualified people to fill advanced positions in
society. Schools often channel students into programs based on their ability and academic
achievement. Graduates receive appropriate credentials for entering the paid work force.

Change and Innovation:

Schools are sources of change and innovation. To meet student needs at a given time, new
programs for example AIDS education, computer education, and multicultural education are
created. College and university faculty are expected to conduct research and publish new
knowledge that benefits the overall society. A major goal of education is to reduce social
problems

Latent Functions
1) The consequences that is largely untended and unrecognized.
2) Latent functions are the not-so-obvious functions associated with education

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Types:

Cultural Capital:
Cultural capital is social assets such as values, beliefs, attitudes, and competencies in language
and culture that they learn at home, but which are reinforced in school.

Hidden Curriculum:
The hidden curriculum is the way certain cultural values and attitudes, such as conformity and
obedience to authority, are transmitted through implied demands in the everyday rules and
routines of schools.

College of Nursing Philosophy

The College of Nursing Board of Trustees has adopted statements of vision, mission, values,
goals, and philosophy to guide the operation of the institution.

Vision
The vision College of Nursing is to prepare excellent health care providers and leaders to
transform the lives of persons and communities through innovative education and health care.

Mission
College of Nursing is a private institution of higher education dedicated exclusively to
educating students for the diverse opportunities offered by careers in nursing and other health care
fields.

Purpose
College of Nursing serves students, the nursing profession, health care organizations, clients
receiving care, and the increasing needs of society for qualified nurses by offering programs for
students who seek careers in nursing and other medical fields.

College of Nursing devotes its resources to maintaining quality nursing programs in an

environment that focuses on clinical competence across all scopes of practice, and that help develop
the technical and thinking skills needed to foster successful careers and a lifetime of continued
professional learning. The programs build on foundations of general education common to nursing
education, and all programs meet or exceed common standards for nursing education programs in
Colorado.

The nursing programs explore a differentiated practice model that teaches students to
maximize their own role development, to seek the opportunity to learn and collaborate effectively with
other nurses of differing educational preparations.

The programs integrate holistic health care values with traditional health care values so
students can explore the understanding of “whole body wellness” in client care.

Programs are offered to adult students from the economically and ethnically diverse regional
community served.

Philosophy
The philosophy College of Nursing flows from the mission of the school and supports the
concepts of clinical competence, excellence in education, holistic care, professionalism, evidence-
based practice, and lifelong learning.
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 The philosophy incorporates the conceptual framework that was developed by faculty to
provide direction for the selection and organization of learning experiences to achieve program
outcomes. The conceptual framework serves to unite these four constructs:

Nursing
Nursing is an art and science that identifies, mobilizes, and develops strengths of the client
through acquired skill, professionalism, knowledge, and competence supported by evidence-based
practice.

Person
Person is a unique, physical, psychosocial, spiritual, cultural, and holistic being or community
with value, dignity, and worth possessing the capacity for growth, change, and choices for which they
bear responsibility.

Environment
Environment is the dynamic subtotal of internal and external elements that impact an
individual’s perception of and adaptation to the community in which they exist.

Wellness
Wellness is defined as the individual’s perception of his/her quality of life throughout the
lifespan and his/her ability to adapt to restrictions of environment, disease, or disability.

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 PREPARE AND ORGANIZATION CHART OF ORGANIZATION
CHART OF NURSING SERVICE
Definition
Organization is a form of every human association for the attainment of common purpose and
the process of relating specific duties or function in a whole
-J D Mooney

Organization consists of the relationship of individual to individuals and groups to groups

which are related as to bring about an orderly division of labor.
- Pfiffiner.

Nature of organization Four P‖s are required to form the bases for organization,
• P- Purposes
• P- Process
• P- Person target group
• P- Place setting

Importance of organization
• It increases managerial efficiency .
• It ensures an optimum use of human efforts through specialization and also make use of all
resources , determines needs for innovative and new technologies in terms of cost effectiveness
and accomplish objectives.
• It places a proportionate and balanced emphasis on various activities.
• It facilitates coordination in the enterprises.
• It provides scope for training and developing managers.
• It helps to consolidate growth and expansion of the institution/enterprise.
• It invites creative and innovative ideas.
• It prevents the growth of laggards, wire pullers or other forms of corrupters

Principles of organization
According to Ms. T.K.Adranvala
• Division of labor
• Hierarchy of authority
• System for co-ordination and control
• Span of control – it depends on ,
➢ Unity of objectives
➢ Division of work &specialization
➢ Job description
➢ Unity of command
➢ Principle of adequate authority
➢ Span of supervision

According to BT Basavanthappa
There are six principles of organization as follows:
• Hierarchy
• Span of control
• Integration vs. disintegration
• Centralization vs. decentralization
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 • Unity of command
• Delegation
According to Russell C. Swansburg & Richard J. Swansburg
• Principle of chain of command
• Principle of unity of command
• Principle of span of control
• Principle of specialization

TYPES OF ORGANIZATIONAL STRUCTURE

1) Tall or Centralized Structure.
2) Flat or Decentralized Structure.
3) Matrix Structure.
4) Adhocracy Structure. 5) Shared Governance.

Tall or Centralized Structure

• A Tall organization is named so because a chart of its relationship appears tall and narrow.

• It is also called Centralized, because most of the decision making authority and power is held
by few persons in central positions. e.g. In an acute care hospital, the nursing position would
be that of the chief nursing officer, with 2 or 3 assistants.

Flat or Decentralized Structure

• The chart of relationships shows few levels and a broad span of control.
• Decision making is commonly spread out among many people and those closest to the
situation are given wide latitude in determining appropriate actions.

Matrix Structure
• These structures are most often found in very large, multifaceted organizations.
• Many organizations try to apply principles of business to health care.
• This resulted in the organization of areas around product lines (which focuses on end product
of health care) and service line (represents the tasks required to accomplish the delivery of the
product)

Adhocracy Structure
• This type of structure uses teams of specialists who are organized to complete a particular
project or task.
• These groups are referred to as project team or task force.
• It is composed of highly specialized professionals, the work is delegated by a director to
members of the project team who provide particular expertise.

Shared Governance
• It represents a professional practice model in which the nursing staff and nursing management
are both involved in making decisions as opposed to having the decisions made at an
administrative level only.
• It requires the staff nurses participate in professional development designed to increase the
nurse‘s understanding of decision making, team building, group dynamics, leadership and
budgeting.
• Disadvantages:
• Time involved in shared governance is costly to organizations.
• Its cost effectiveness in terms of patient outcomes is questioned sometimes.

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ORGANIZATIONAL EFFECTIVENESS
• The product or output of an organization is termed organizational effectiveness (O.E).
• There should be a relationship between organizational effectiveness and performance (O.P).
• Nurse Managers define the goals and provide the resources for both the organizational
effectiveness and organizational performance.
• For e.g- The dimensions include: Patient satisfaction with care Family satisfaction with care
Staff satisfaction with work
• Staff satisfaction with rewards , intrinsic and extrinsic
• Staff satisfaction with professional development – career, personal and educational
• Staff satisfaction with organization
• Management satisfaction with staff.
• Community relationships.
• Organizational

Role of Nurse Managers In Organizational Climate

• Nurse Managers should emphasize management tasks or activities that stimulate motivation in
nursing employees.

• Nurse Managers should establish a management strategy to support new nurses and involve
them in decision making.

• Nurse Managers should establish a climate in which discipline is applied fairly and uniformly.

• Nurse manager will work to establish an organizational climate that provides

➢ Incentives for clinical nurses,
➢ Places them on committees,
➢ Is creative and equitable in all staffing matters;
➢ Emphasizes pride,
➢ Promotes participation,
➢ Rewards seniority and achievements,
➢ Reduces boredom and frustrations.

Activities to promote positive organizational climate

• Developing the organization's mission, philosophy, vision , goals and objectives statements
with input from practicing nurses , including their personal goals.
• Establishing trust and openness through communication that includes prompt and frequent
feedback and stimulates motivation.
• Providing opportunities for growth and development, including career development and
continuing education programs.
• Promoting team work.
• Asking practicing nurses to state their satisfactions and dissatisfactions during meetings and
conferences and through surveys.
• Marketing the nursing organization to the practicing nurses, other employees and the public.
• Analyzing the compensation system for the entire organization and structuring it to reward
competence, productivity and longevity.
• Promoting self esteem, autonomy, and self fulfillment for practicing nurses including feelings
that their work experiences are of high quality.
• Emphasizing programs to recognize practicing nurses contributions to the organization.
• Assessing needed threats and punishments and eliminating them.

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• Providing job security with an environment that enables free expression of ideas and exchange
of opinions.
• Being inclusive in all relationships with practicing nurses.
• Helping practicing nurses to overcome their short comings and to develop their strengths.
• Encouraging and supporting loyalty, friendliness, and civic consciousness.
• Developing strategic plans that include decentralization of decision –making and participation
by practicing nurses.
• Being a role model of performance desired of practicing nurses.

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 ORGANIZING NURSING SERVICES AND PATIENT CARE

INTRODUCTION
A hospital may be soundly organized, beautifully situated and well equipped, but if the nursing
care is not of high quality the hospital will fail in its responsibility.‖

ORGANIZING NURSING SERVICES

Meaning of nursing service and nursing service administration

Nursing Service
Nursing service is the part of the total health organization which aims at satisfying the nursing
needs of the patients/community. In nursing services, the nurse works with the members of allied
disciples such as dietetics, medical social service, pharmacy etc. in supplying a comprehensive
program of patient care in the hospital.

Nursing service administration

Nursing service administration is a complex of elements in interaction and is organized to
achieve the excellence in nursing care services. It results in output of clients whose health is
unavoidably deteriorating, maintained or improved through input of personnel and material resources
used in a process of nursing services.

DEFINITION OF NURSING SERVICE

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 is to provide prevention of
disease and promotion of health.

OBJECTIVES OF NURSING SERVICE

The first component of nursing service administration is the planning and it should be based on
clearly defined objectives. The objectives of nursing service department are as follows:

Objectives in relation to Patient care

The primary emphasis is on total patient care that is:
• To give highest possible quality care in terms of total patients need which include
physical, psychological, social, educational and spiritual needs by collaborating with
other health tem members.
• To assist the physician in providing medical care to the patients.
• To provide preventive and rehabilitative services.
• To provide round the clock nursing care to all the patients.
• To render timely and appropriate nursing service to emergency patients.
• To provide cost effective quality care as per the needs of patients.

Objectives in relation to Education

• Planning of education and training programme for nurses are must for professional growth and
development needs through in-service education and research support.
• To provide regular staff development, in-service education and guidance services for all
members of nursing staff.
• To conduct regular orientation programme for new entrants and for those have been on the job
for a long time.

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 • To conduct training for operating procedure of latest gadgets and on handling sophisticated
bio-medical equipment.

Objectives in relation to Administration and Organization

• To make regular supervision through rounds.
• To ensure that the essential equipment is provided in functional status for nursing care
services.
• To provide regular flow of essential supplies to render quality nursingcare.
• To have a proper system of rotation of staff, provision for annual leave and days off for the
nursing staff without hampering patient care.
• Establish a communication system for nursing personnel, other health worker, patients, health
authorities, government authorities and public.
• Ensure that each nurse identifies her job responsibilities and accountability.
• Counseling for health personnel, patients and the public.
• The formulation of policies, standards, goals of nursing service, education and practice.
• Maintaining proper documentation of the personnel employed in nursing service.

Objectives in relation to Research

• Establish a system for collection of essential information, research and studies concerning all
aspects of nursing.
• To contribute in research programme conducted by hospitals and by other health personnel.
• To encourage and support the nurse to conduct research projects/ activities.

Objectives in relation to Performance appraisal

• Appraise the performance of nursing service personnel regularly against set standards and
performance indicators objectively with a view to maintain quality-nursing services.

PRINCIPLES OF NURSING SERVICE

➢ Initiate a set of human relationships at all levels of nursing personnel to accomplish their job and
responsibilities through systematic management process by establishing flexible organizational
design
➢ Establish adequate staffing pattern for rendering efficient nursing service to clients and its
management
➢ Develop and implement proper communication system for communicating policies, procedures and
updating advance knowledge.
➢ Develop and initiate proper evaluation and periodic monitoring system for proper utilization of
personnel
➢ Develop or revise proper job description for nursing personnel at all the levels and all units for
proper delivery of nursing care.
➢ Share nursing information system with other discipline functionaries in the hospital.
➢ Assist the hospital authorities for preparation of budget by involvement.
➢ Participate in interdepartmental programs and other programs conducted by other disciplinaries for
improvement of hospital services.
➢ Develop and initiate orientation and training programs for new employees in cooperative with
authorities and other health disciplines
➢ Create an atmosphere that conductive to give proper required learning experience for the students

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 ➢ Assist in the development of a sound, constructive program of leadership in nursing to assure
intellectual administration and management to safeguard, conserve and preserve nursing resources
of the hospitals.
➢ Participate in the application of data and research
➢ Participate in community health programs, associated with hospital.

FUNCTIONS OF NURSING SERVICE

• To assist the individual patient in performance of those activities contributing to his health or
recovery that he would otherwise perform unaided has had the strength, will or knowledge.
• To help and encourage the patient to carry out the therapeutic plan initiated by the physician.
• To assist other members of the team to plan and carry out the total programme of care.

The organization of nursing care constitutes a subsystem for achieving the hospital‘s overall objective.
Nursing care of patients generally takes forms:
➢ Technical
➢ Educational
➢ Trusting relationship

PREPARATION AND ORGANIZATION CHART OF NURSING SERVICE

CHART

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NURSING EDUCATION OR COLLEGE CHART

NURSING UNIT CHART

35
 DEVELOPING BUDGET PROPOSAL

DEFINITION
Budget is a concrete precise picture of the total operation of an enterprise in monetary
terms .
(HM Donovan)

Budget is an operation plan, for a definite period usually a year- Expressed in financial
term and based an expected income and expenditure.

PURPOSE
Budget supplies the mechanism for translating fiscal year objectives into
projected monthly spending pattern.
Budget enhances fiscal planning and decision making.
Budget clearly recognizes controllable and uncontrollable cost areas.
Budget offers a useful format for communicating fiscal objectives.
Budget allows feedback of utilization of budget.
Budget provides means for measuring and recording financial success with the
objectives of the institution
Budget helps to identify problem areas and facilities for effective solution.

FEATURES OF BUDGET
It should synthesis at past, present and future.
It should be flexible
It should be product joint venture, co- operation of executives /department heads
at different levels of management.
It should be in the form of statistical standard laid down in the specific numerical
terms.
It should have a support at top management throughout the period of its planning
and implementation.

PRINCIPLE OF BUDGET
Budget should provide sound financial management by focusing on requirement
of the organization.
Budget should focus on objectives and policies of the organization. It must flow
from objectives and give realistic expression to the way of realistic such
objective.
Budget should ensure the most effective use of scarce financial and non-
financial resources.
Budget requires that programme
Budgetary process requires consistent delegation for which fixed duties and
responsibilities are required to be allocated to managers at different level for
framing and executing budget.

36
 Budget should include co-coordinating efforts of various departments
establishing a frame of reference for managerial decision and providing certain
criteria for evaluating managerial performance.
Selling budget target requires an adequate checks and balance against the
adoption of too high or too low estimate, almost care is a must for fixing targets.
Budget period must be appropriate to the nature of business or service and to type
of budget.
Budget is prepared under the direction on the supervision of the administration or
financial officer.
Budget are to be prepared and interpreted consistently throughout the
organization in the communication in the planning process

IMPORTANCE OF BUDGET

Budget is needed for planning for future course of action and to have a control
over all activities in the organization.
Budget facilitates coordinating of various departmental and selection for realizing
organizational objectives
Budget serves as a guide for action in the organization.
Budget helps one to weigh the values and to make decision when necessary on
whether on e is of greater values in the programmes than

TYPES OG BUDGET

OPERATING BUDGET(Revenues and Expenses): -

Provides an overview of agency function by projecting the planned operation for
upcoming year. Deals with salaries, medical-surgical supplies, office supplies,
laundry services, books periodicals, recreation and contractual services.

CAPITAL EXPENDITURE BUDGET: - Related to long range planning.

Includes physical changes (replacement and expansion of plant, major
equipments and inventories).They are major investment and reduces flexibility in
budgeting.

CASH BUDGET: Planned to make adequate funds available and to use extra
funds profitably. Should not have too much cash on hand during budgetary
period.

LABOR OR PERSONNEL BUDGET: - Estimate cost of direct labor

necessary to meet agency objectives. Determine the recruitment, hiring,
assignment, layoff, discharge of personnel. Nurse manager has to decide number
of aids, orderlies required during a shift months and areas.

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FLEXIBLE BUDGET: Some costs are fixed ,others changes with volume of
business. Some expenses are unpredictable and can be determined only after
change has begun. Periodic reviews required to compensate for changes.
STRATEGIC PLANNING BUDGET: Long range budget for long range
planning. Projected for 3-5 years. Programmed budget is a part of this budget.

INCREMENTAL: Based on estimated changes in present operation plus a

percentage increase for inflation, all of which is added to previous year budget.

OPEN ENDED :-A financial plan in which each operating manager present a
single cost estimate for what is considered optimal activity level.

FIXED CEILING BUDGET: The uppermost spending limit is set by top

executive before the unit and divisional manager develop budget proposal for the
areas of responsibility.

FLEXIBLE BUDGET: Several financial plans each for different programmed

activity.

ROLL OVER BUDGET: Forecast programme,revenues and expenses for a

period greater than a year, to accommodate programmed larger than annual
budget cycle.

PERFORMANCE BUDGET: Allocates functions not divisions (direct nursing

care ,in service education, nursing research, quality improvement).

PROGRAM BUDGET: Where cost are computed for a total program(group

total cost for each service program). Eg. MCH,FP,UIP.

ZERO BASE BUDGET: Requires nurse manager to examine ,justify each cost
of every program both old and new in every annual budget preparation.

SUNSET BUDGET: Designed to “self destruct” within a prescribed time period

to ensure the cessation of spend in by a predetermine date.

SALES BUDGET: Is starting in budget program, since sales are basic activities
which gives shapes to other activities. Compiled in terms of quantity and value.

PRODUCTION BUDGET: Aims at securing the economical manufacture of

production and maximizing the utilization of production facilities.

REVENUE AND EXPENSE BUDGET: Expressed in financial terms and take

the nature of Performa income statement for future. Shows the item of profits and
loss.

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 CASH BUDGET: Prepared by way of projecting the possible cash receipts and
payments over budget period.

BUDGET PROCESS

STEP 1: Establishment of operational goals and objectives and policies.

STEP 2: Goals must be translated into quantifiable management objectives for
organizational units. Departmental goals are made.
STEP 3: Formal plan for budget preparation and review including assignment of
responsibilities and timetable is prepared.
STEP 4: Departmental budget are revised and master budget is prepared.
STEP5: Financial feasibility of master budget is tested and final document is
approved and distributed to all parties involved.
STEP 6: Every head of the office required to prepare budget estimate in respect
of salaries of establishment, contingent expenditure and others.eg. Telephone,
office expenses, rent of building etc.

ADVANTAGES

Fixes accountability, assignment of responsibility and authority.

Encourages managers to make careful analysis of operation.
Weakness is revealed, corrective measures taken.
Financial matters can be handled in orderly fashion. Activities are balanced.

DISADVANTAGES

Converts all aspects of organizational performance in monetary values. Only easy

aspects can be considered and equally important facts such as organizational
development may be ignored.
May become an end in itself instead of means to end. Budgetary goals may
superzede agency goals.
Skills and experiences are required for successful budgetary control.
Time consuming and expensive
To properly negotiate budgets for research studies it is important to assess
protocol feasibility and identify the costs to conduct the study. A study should
not be pursued if it does not cover the costs to conduct it, unless there are
additional financial resources identified.

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BUDGETING FOR NURSING COLLEGE

40
 DESIGN LAYOUT PLAN FOR SPECIALTY UNITS
HOSPITAL
Background
ICU is highly specified and sophisticated area of a hospital which is specifically designed,
staffed, located, furnished and equipped, dedicated to management of critically sick patient, injuries or
complications. It is a department with dedicated medical, nursing and allied staff. It operates with
defined policies; protocols and procedures should have its own quality control, education, training and
research programmes. It is emerging as a separate specialty and can no longer be regarded purely as
part of anaesthesia, Medicine, surgery or any other speciality. It has to have its own separate team in
terms of doctors, nursing personnel and other staff who are tuned to the requirement of the speciality
In India the scenario of ICU development is fast catching up and after initiatives, promotion,
education and training programmes of ISCCM during last 15 yrs, there has been stupendous growth
in this area but much needs to be done in area of infrastructure, human resource development,
protocol, guidelines formation and research which are relevant to Indian circumstances. An
acceptable and logistically feasible no compromise can be made on quality and health care delivery
to critically sick, yet an acceptable guidelines can be adopted for making ICU designing guidelines
which may be good for both rural and urban areas as also for smaller and tertiary centres which may
include teaching and non teaching institutes .

Location/entry/exit points of ICU in Hospital

• Safe, easy, fast transport of a critically sick patient should be priority in planning its location,
therefore, ICU should be located in close proximity of ER, Operating rooms, trauma ward.
• Corridors, lifts & ramps should be spacious enough to provide easy movement of bed/
trolley of a critically sick patient.
• Close/easy proximity is also desirable to diagnostic facilities, blood bank, pharmacy etc.
• No thoroughfare can be provided through ICU.
• There should be single entry/exit point to ICU, which should be manned.
• However, it is required to have emergency exit points in case of emergencies and disasters.

ICU Bed Designing and Space Issues

• Space per bed has been recommended from 125 to 150 sq ft area per bed in the patient
care area or the room of the patient. Some recommendation has placed it even higher up to
250 sq ft per bed. In addition there should be 100 to 150% extra space to accommodate
nursing station, storage, patient movement area, equipment area, doctors and nurses rooms
and toilet.
• However in Indian circumstances after reviewing and feed back from various ICUs in our
country it may be satisfactory to suggest an area of 100 to 125 sq ft be provided in patient
care area for comfortable working with a critically sick patient where all the paraphernalia
including monitoring systems, Ventilators & other machines like bedside X-ray will have
to be placed around the patient. Bedside procedures like Central lines, Intubation,
Tracheostomy, ICD insertion and RRT are common.
• It may be prudent to make one or two bigger rooms or area which may be utilised for
patients who may undergo big bedside procedures like ECMO, RRT etc and has large
number Gadgets attached to them.
• 10 % (one to two) rooms may be designated isolation rooms where immuno-
compromised patients may be kept, these rooms may have 20% extra space than other
rooms.

41
 • The planners may think about, if they are thinking of introducing newer technologies in
their ICU like ECMO, Nitric Oxide and Xenon clearance etc. Do they need Lamellar flow
for specific patient population in their ICUs. This will be highly specific for High end up
ICUs and is not recommended in routine Provisions may be kept open for such options in
future.

Partition between two room and maintaining privacy of patients

• It is recommended that there should be a partition/separation between rooms when patient
privacy is desired which is not unusual.
• Standard curtains soften the look and can be placed between two patients which is very
common in most Indian ICUs, however they are displaced and become unclean easily and
patients privacy is disturbed
• Therefore, two rooms may be separated by unbreakable fixed or removable partisans,
which may be aluminium, wood or fibre. However permanent partitions takes away the
flexibility of increasing floor space temporarily (In Special circumstances) for a particular
patient even when the adjoining bed/room may not be in use.
Pendant vs Head End Panel
One of the most important decisions is to how to plan bedside design
Two approaches are usually practised
1 Head wall Panel
2 Free standing systems (power columns) usually from the ceiling Each can be fixed or
moveable and flexible can be on one or both sides of the patient.
▪ Flexibility is usually desirable,
▪ Panels on head wall systems allow for free movements
Adaptable power columns can move side to side or
rotate, Mounts on power columns are also usually
adjustable,
▪ Flexible systems are expensive and counterproductive if the staff never move
or adjust them,
▪ Head wall systems can be oriented to one side of the patient or to both
sides, Some units use two power columns, one on each side of the patient,
▪ Other units use a power column on one side in combination with some fixed
side wall options on the opposite side,
▪ Ceiling mounted moveable rotary systems may reduce clutter on the floor and
make a lot of working space available, However, this may not be possible if
the weight cannot be structurally supported
▪ Power columns may not be possible in smaller rooms or units.
▪ Each room should be designed to accommodate portable bedside x-ray,
Ultrasound and other equipment such as ventilators and IA Balloon pumps; in
addition, the patient's window view (If available) to the outside should be
preserved.

Height of Monitoring System

Excessive height may be a drawback to the way monitoring screens are typically well above
eye level and display more parameters. Doctors and nurses may have chronic head tilting leading
to cervical neck discomfort and disorders, Therefore, the levels of monitors should be at
comfortable height for doctors and nurses

Keep Bed 2 ft away from Head Wall

• A usual problem observed in ICU is getting access to the head of the bed in times of
emergency and weaving through various tangled lines. And at the same time patient also
42
 should not feel enclosed and surrounded by equipment and induced uncalled for fear
• About 6 inches high and 2 ft deep step(Made of wood) usually temporary/removable (which
would otherwise would stay there only) is placed between the headwall and the bed lt will
keep the bed away from the wall and automatically gives caregivers a place to stand in
emergencies without too much of problems.
• Lines may be routed through a fixed band of lines tied together.

Provision for RRT

Two beds should be specially designated for RRT (HD/CRRT) where outlets should be available
for RO/de-iodinated water supply for HD machines. Self-contained HD machines are also
available (Cost may be high)

Isolation Rooms
10% of beds ( 1 or 2 ) rooms may be used exclusively as isolation cases like for burns , serious
contagious infected patients .

Alarms . music . phone etc

Each group should decide if they want to provide the patient access to music (audio), telephone
etc.
However an alarm bell which has both indicators by sound and light must be provided to each
patient and he be taught about it, how to use it when needed

Oxygen/Vacuum/ Compressed air outlets and No of Electric Plugs For tertiary

center
Summary of key Recommendation for Minimal standards in ICU

Standards AIA/AAH (1) IEEE SCCM (2)

O2 outlets 2 to 3 2 2 to 3
Vacuum outlets 2 to 4 3 2 to 3
Compressed air outlets 1 to 3 1 1 to 2
Electric outlets 7 8 11 to 12
Room size (sq ft) 132 - 150 to 250
Isolation room 150 - 250
Anteroom 20 - 20
Unit size - - 12 beds

Adopted from Don Axon DCA FAIA Losangeles

Recommendations for Indian ICUs

We recommend following for Level I and Level II Indian ICUs Unit size 6 to 12 beds
Bed space- minimum 100 sq ft (Desirable) >125.
Additional space for the ICU (Storage/Nursing stn/doctors/circulation etc) 100 % extra of
the bed space (Keep the future requirement in mind)
Oxygen outlets 2
Vacuum outlets 2
Compressed air outlets 1
Electric outlets 12 of which 4 may be near the floor 2 on each side of the patient. Electric
43
 outlets/Inlets should be common5/15 amp pins. Should have pins to accommodate all
standard International Electric Pins/Sockets. Adapters should be discouraged since they
tend to become loose.
Environmental Requirements
Heating, Ventilation and Air-conditioning (HVAC) system of ICU
• The ICU should be fully air-conditioned which allows control of temperature, humidity and
air change. If this not be possible then one should have windows which can be opened (‘Tilt
and turn' windows are a useful design.).
• Suitable and safe air quality must be maintained at all times. Air movement should always
be from clean to dirty areas. It is recommended to have a minimum of six total air changes
per room per hour, with two air changes per hour composed of outside air. Where air-
conditioning is not universal, cubicles should have fifteen air changes per hour and other
patient areas at least three per hour.
• The dirty utility, sluice and laboratory need five changes per hour, but two per hour are
sufficient for other staff areas.
• Central air-conditioning systems and re-circulated air must pass through appropriate filters.
• It is recommended that all air should be filtered to 99% efficiency down to 5 microns.
• Smoking should not be allowed in the ICU complex.
• Heating should be provided with an emphasis on the comfort of the patients and the ICU
personnel.
• For critical care units having enclosed patient modules, the temperature should be adjustable
within each module to allow a choice of temperatures from 16 to 25 degrees Celsius.
• A few cubicles may have a choice of positive or negative operating pressures (relative to the
open area). Cubicles usually act as isolation facilities, and their lobby areas must be
appropriately ventilated in line with the function of an isolation area (i.e. pressure must lie
between that in the multi-bed area and the side ward).
• Power back up in ICU is a serious issue. The ICU should have its own power back, which
should start automatically in the event of a power failure. This power should be sufficient to
maintain temperature and run the ICU equipment (even though most of the essential ICU
equipment has a battery backup). Voltage stabilization is also mandatory. An Uninterrupted
Power Supply (UPS) system is preferred for the ICU

Negative pressure isolation rooms

(Isolation of patients infected/suspected to be)
Infected with organisms spread via airborne droplet nuclei <5 µm in diameter) In these rooms the
windows do not open. They have greater exhaust than supply air volume. Pressure differential of 2.5
Pa. Clean to dirty airflow i.e. direction of the air flow is from the out side adjacent space (i.e..
corridor, anteroom) into the room. Air from room preferably exhausted to the outside, but may be
re-circulated provided is through HEPA filter NB: re-circulating air taken from areas intended to
isolate a patient with TB is a risk not worth taking and is not recommended

Positive pressure isolation rooms

(To provide protective environment for patients at Highest risk of infection e.g. Neutopenia, post
transplant)
These rooms should have greater supply than exhaust air. Pressure differential of 2.5 – 8 Pa,
preferably 8 Pa. Positive air flow relative to the corridor (i.e. air flows from the room to the outside
adjacent space) . HEPA filtration is required if air is returned.

44
LIGHTING
Light in room

• Natural Light – Access to outside natural light is recommended by regulatory authorities in

USA,
• This may improve the Staff Morale and Patient outcome,
• Data suggests that synthetic artificial daylight use in work environment may deliver better
results for night time workers
• It may be helpful in maintaining the circadian rhythm
• Natural lighting in the unit can decrease power consumption and the electrical bill which is
so relevant to Indian circumstances.
• Access to natural light also means one may have access to viewing external environment
which may be developed into green and soothing.

Light for Procedures

High illumination and spot lighting is needed for procedures, like putting Central lines etc.
They can descend from the ceiling, extend from the wall/ Panel, or be carried into the room.
Recommended Spot lighting should be shadow free l50 foot candles (fc) strength.

Light required for general patient care-

• It should be bright enough to ensure adequate vision without eyestrain.
Overhead lighting should be at least 20-foot candles (fc)
• Higher frequency fluorescent lights and coated phosphorus lamps may be
good for assessing skin colour and tone
• Patients may need rest and quiet surroundings during the day, Blackout curtains or blinds or
Individual eye may be used, These may be helpful when the staff requires a high level of
lighting at the bedside while the patient is resting.
• Lights that come on automatically when cupboard doors or drawers are opened are useful.
• Floor lighting may be important for safety at the bedside and in the hallways at night and
should be about l0fc.
• Glare created by reflected light should be diffused
• Light switches should be strategically located to allow some patient control and adequate
staff convenience.
• A second remote control can be turned on/off by the nurses/doctors to observe patients
intermittently at night without entering the room and disturbing the patient.
• Hall lights controls should subdivided into smaller independent areas and dimmer switches
may be desirable

The Illuminating Engineering Society of North America published useful guidelines on this subject.

Noise Control in ICU

The international Noise Council recommends that the noise level in an ICU be under 45
dBA in the daytime, 40 dBA in the evening. and 20 dBA at night (dBA is a scale that filters out
low frequency sounds and is more like the human hearing range than plain dB)
• A watch ticks at about 20 dBA,
• A normal conversation is at about 55
dBA. A vacuum cleaner produces -about
70 dBA A garbage disposal-- about 80
dBA.
• Noise level monitors are commercially available.

45
 • lf the unit noise exceeds that level, a light comes on or flashes to remind the staff to decrease
the noise level.

FURNITURE AND FURNISHINGS

• The counters and furniture should be tough to withstand a lot of heavy use. Easy
to clean and maintain,
• Connections should be made of metal—to—metal fasteners Cabinet-
quality wood construction should also be tough and strong
• Surfaces for counters should be solid, non-porous and stain resistant,
• Fabrics should be durable, colourfast and flame and static resistant if possible
• Bedside clocks, calendars and bulletin boards help the conscious patient well oriented and in
better moods
• Providing the patient with a place to keep a few small personal items of their own make the
environment more familiar and personalized.
• Some finishing touches like some art work/décor/ sculpture may change the ICU atmosphere a
great deal and has been recommended by the SCCM.

Chairs number and types –

• Individual units should decide about the number, usually enough number to accommodate
the care giving staff/doctors and Nurses and additional chairs may be stored and used
whenever needed.
• Individual Units should decide whether they want to allow the relative to sit by the side
(Short or long time) of the patient in the ICU.
• However, a chair/sofa type chair on wheels with safety belt or vault is recommended for
mobilising the patient. and making him sit during recovery
• Provisions must be made to accommodate an obese patient

FLOOR, WALL AND CEILING COVERINGS

Floor –

• The ideal floor should be easy to clean, non slippery, able to withstand abuse and absorb
sound while enhancing the overall look and feel of the environment,
• Carts and beds equipped with large wheels should roll easily over it.
• In Indian context Vitrified non-slippery tiles seem to be the best option which can be fitted
into reasonable budgets, easy to clean and move on and may be stain proof
• Vinyl sheeting is another viable option, It can be non-porous, strong and easy to clean,
However, the life of Vinyl flooring is not long and a small damage in one corner may trigger
damage of entire flooring and make it accident prone. It may require frequent replacement
making it to be inconvenient choice.

Walls – Should meet following criteria:

• Durability, ability to clean and maintain, flame retardance, mildew resistance, sound
absorption and visual appeal.
• It has been very useful to have a height up to 4to5 ft finished with similar tiles as of floor
for similar reasons.
• For rest of the wall soothing paint with glass panels on the head end at the top may be good
choice.
• Wooden panelling has also found favour with some architects but costs may go high.
• Doorstoppers and handrails should be placed well to reduce abuse and noise to minimum; it
helps patient movement and ambulation.
46
Ceiling
• lt is the ceiling surface patients see most often, sometimes for hours on end, Over several
days or weeks, In addition, bright spotlights or fluorescent lights can cause eye strain,
• Ceiling should be Soiling and break proof due to leaks and condensation.
• Tiles may not the most appealing or soothing surface, but for all practical purposes it is
easier to remove individual or few tiles for repairs over ceiling in times of need. Ceiling
design may be enhanced by varying the ceiling height, softening the contours, griddled
lighting surfaces, painting it with a medley of soft colours rather than a plain back ground
colour, or decorating it with mobiles, patterns or murals, to make it more patient and staff
friendly.
• It is recommended that no lines or wires be kept or run over ceiling or underground because
damages do occur once in a while and therefore, it should be easy to do repairs if the lines
and pipes are easily explorable without hindering patient care

Waste Disposal and Pollution Control

• This is mandatory and a huge safety issue both for the patient and staff/doctors of the
hospital and society at large
• It is important that all govt regulations (State Pollution control Board in this particular
case) should strictly be complied with.
• It is mandatory to have four covered pans (Yellow, blue, Red, Black) provided for each
patient or may be one set between two patients two save space and funds. This is needed
to dispose off different grades of wastes.

Hand Hygiene and Prevention of Infection

• Every bed should have attached alcohol based anti-microbial instant hand wash solution
source, which is used before caregiver (doctor/Nurse/relative/Paramedical) handles the
patient.
• Water basin at all bedside has not proven popular and successful because of poor
compliance by one and all and also for reasons of space constraints and maintenance
issues.
• An operation room style sink with Elbow or foot operated water supply system with
running hot and cold water supply with antiseptic soap solution source should be there at a
point easily accessible and unavoidable point, where two people can wash hands at a time.
• This sink should have an immaculate drainage system, which usually may become a point
of great irritation and nuisance in later yrs or months.
• All entrants (Irrespective of Doctors or nurses should don mask and cap in ICU and
ideally an apron which should be replaced daily)
• No dirty/soiled linen/material should be allowed to stay in ICU for long times for fear of
spread of bad odour, infection and should be disposed off as fast as possible. Dirty linen
should be replace regularly at fixed intervals.
• All surroundings of ICU should be kept absolutely clean and green if possible for obvious
reasons
Disaster Preparedness
• All ICUs should be designed to handle disasters both within ICU and outside the ICU.
Outside the ICU may include inside the hospital and in the city or state.
• Within ICU may be fire, accidents and Infection or unforeseen incidents.
• Similarly outside the ICU there may be major or minor disasters like fire, accidents,
Terrorist acts etc.

47
 • There must be an emergency exit in ICU to rescue pts in times of internal disaster. There
should be provision for some contingency room within hospital where critically sick
patients may be shifted temporarily.
• HDU may be the best place if beds are vacant.
• There should be adequate fire fighting equipment in side ICU and protection from
Electrical defaults and accidents.
• ICU is location for Infection epidemics, therefore, it is imperative that all protocols and
recommendation practises about infection control and prevention are observed and if there
is a break out then adequate steps taken to control this and disinfect the ICU if indicated.

MEETING THE NEEDS OF FAMILIES AND VISITORS

It is very important to value family members and take care of their needs.
Many features that ease the stress of facing threat of death because of critical illness may not be
necessarily expensive. Identifying these needs by acting as a visitor of a patient in ICU may be
useful. Some of these may be as follows:

Signage Clearly marked and multilinguistic including English and Hindi + Local Language
guiding them to correct desired location, Once they reach the unit, it should be easy for them to
learn how to gain entry into the unit.

Waiting and seating space

• Many guidelines suggest that l-l/2 to 2 seats per patient bed be provided in the waiting area,
Despite using this ratio, many admit that their waiting area is still too small.
• In rural and semi-urban India, there are large and extended families, This should be reflected
in the size of waiting rooms of institutions that commonly serve such populations,
• Designers can establish several small areas within a larger space with a variety of seating
and lighting options, Large open rooms may be easier to achieve, but they are often noisy
and lack the capability to provide areas for privacy, intimacy and rest,
• Minimally, a separate small room for grieving or private conferences should be provided
near the unit with soothing decor and comfortable seating, This may be used for counselling
the family members in times of need.
• One large TV should be provided for them
• Family members often go through periods when they spend several long hours in the waiting
room, ln such cases, recliners or even hideaway beds are greatly appreciated, Enough
number of restrooms should be provided.
• Some institutions have their own hotels, motels, or guesthouses /Dharmshalas.
• Lockers be provided to families, that can allow them to bring things they need without
having to drag them all with them whenever they come and go.
• Written information about dining facilities inside and outside the hospital should be
available.
• Ideally, a café or tea counter with refrigerator, microwave, sink and/or vending machines can
be provided in or near the waiting area,
• An information shelf having booklets or videos on diseases relevant to critical care are
helpful.
• Pamphlets for the consumer on critical care and on advanced directives may be very useful.
• Trained volunteer or social workers can help families cope and to reduce their anxiety, keep
them updated with compassion about condition, progress, procedures, expenses about the
patient.
• SCCM has also recently published a manual in this regard

48
Summary
• ICU is a highly specialized part of a hospital or Nursing home where very sick patients are
treated.
• It should be located near ER and OT and easily accessible to clinical Lab. Imaging and
Operating rooms.
• Thorough fare can be allowed trough it
• Ideal Bed strength should be 8 to 14. More than 14 beds may put stress on ICU staff and
may also have a negative bearing on patient outcome. <6 Bed strength will be neither viable
or provide enough training to the staff of ICU
• Each patient should have a room size of >100 sq ft , However a space of 125 to 150 sq ft per
pt will be desirable .
• Additional space equivalent to 100 % of patient room area should be allocated to
accommodate nursing stn, storage etc.
• 10% beds should be reserved for patients requiring isolation.
• Two rooms may be made larger to accommodate more equipment for patients undergoing
multiple procedures like Ventilation, RRT Imaging and other procedures. There should be at
least two barriers to the entry of ICU
• There should be only one entry and exit to ICU to allow free access to heavy duty machines
like mobile x-ray, -bed and trolleys on wheels and some time other repairing machines.
• At the same time it is essential to have an emergency exit for rescue removal of patients in
emergency and disaster situations.
• Proper fire fighting /extinguishing machines should be there.
• It is desirable to have access to natural light as much as possible to each patient.

DESIGN LAYOUT PLAN FOR ICU UNIT

49
COMMUNITY
Introduction
Health care delivery in India has been envisaged at three levels namely primary, secondary and
tertiary. The secondary level of health care essentially includes Community Health Centres (CHCs),
constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The CHCs
were designed to provide referral health care for cases from the Primary Health Centres level and for
cases in need of specialist care approaching the centre directly. 4 PHCs are included under each CHC
thus catering to approximately 80,000 populations in tribal/hilly/desert areas and 1,20,000 population
for plain areas. CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and
Gynecology, Surgery, Paediatrics, Dental and AYUSH. There are 4535 CHCs functioning in the
country as on March 2010 as per Rural Health Statistics Bullvetin 2010. These centres are however
fulfilling the tasks entrusted to them only to a limited extent. The launch of the National Rural Health
Mission (NRHM) gives us the opportunity to have a fresh look at their functioning.

Objectives of Indian Public Health Standards (IPHS) for CHCs

• To provide optimal expert care to the community.
• To achieve and maintain an acceptable standard of quality of care.
• To ensure that services at CHC are commensurate with universal best practices and are
responsive and sensitive to the client needs/expectations.

Service Delivery in CHCs

• OPD Services and IPD Services: General, Medicine, Surgery, Obstetrics & Gynaecology,
Paediatrics, Dental and AYUSH services.
• Eye Specialist services (at one for every 5 CHCs).
• Emergency Services
• Laboratory Services
• National Health Programmes

Physical Infrastructure
The CHC should have 30 indoor beds with one Operation theatre, labour room, X-ray, ECG and
laboratory facility. In order to provide these facilities, following are the guidelines.

Location of the centre: All the guidelines as below under this sub-head may be applicable only to centres
that are to be newly established and priority is to be given to operational the existing CHCs.
• To the extent possible, the centre should be located at the centre of the block headquarter in order to
improve access to the patients.
• The area chosen should have the facility for electricity, all weather road communication, adequate
water supply, telephone etc. It should be well planned with the entire necessary infrastructure.
• It should be well lit and ventilated with as much use of natural light and ventilation as possible.
• CHC should be away from garbage collection, cattle shed, water logging area, etc.

Disaster Prevention Measures: (For all new upcoming facilities in seismic zone 5 or other disaster
prone areas).

Building structure and the internal structure should be made disaster proof especially earthquake
proof, flood proof and equipped with fire protection measures.

Earthquake proof measures: Structural and nonstructural elements should be built in to withstand
quake as per geographical/state govt. guidelines. Nonstructural features like fastening the shelves,
almirahs, equipment etc are even more essential than structural changes in the buildings. Since it is

50
likely to increase the cost substantially, these measures may especially be taken on priority in known
earthquake prone areas.

CHC should not be located in low lying area to prevent flooding.

CHC should have dedicated, intact boundary wall with a gate. Name of the CHC in local language
should be prominently displayed at the entrance which is readable in night too.

Fire fighting equipment: Fire extinguishers, sand buckets, etc. should be available and maintained to
be readily available when needed. Staff should be trained in using fire fighting equipment. Each CHC
should develop a fire fighting and fire exit plan with the help of Fire Department. Regular mock drills
should be conducted.

All CHCs should have a Disaster Management Plan in line with the District Disaster management
Plan. All health staff should be trained and well conversant with disaster prevention and management
aspects Surprise mock drills should be conducted at regular intervals. After each drill the efficacy of
the Disaster Plan, preparedness of the CHC, and the competence of the staff should be evaluated
followed by necessary changes in the Plan and training of the staff.

The CHC should be, as far as possible, environment friendly and energy efficient. Rain-Water
harvesting, solar energy use and use of energy-efficient CFL bulbs/equipment should be encouraged.
Provision should be made for horticulture services including herbal garden.

Entrance Zone
Signage
• Prominent display boards in local language providing information regarding the services
available and the timings of the institute.
• Directional and layout signages for all the departments and utilities (toilets, drinking water
etc.) shall be appropriately displayed for easy access. All the signages shall be bilingual and
pictorial.
• Citizen charter shall be displayed at OPD and Entrance in local language including patient’s
rights and responsibilities.
• On-the-way signages of the CHC & location should be displayed on all the approach roads.
• Safety, hazards and caution signs shall be displayed prominently at relevant places, e.g.
radiation hazards for pregnant woman in X-Ray.
• Fluroscent Fire-Exit signages at strategic locations.
• Barrier free access environment for easy access to non-ambulant (wheel-chair stretcher), semi-
ambulant, visually disabled and elderly persons as per “Guidelines and Space Standards for
barrier-free built environment for Disabled and Elderly Persons” of Government of India.
• Ramp as per specification, Hand-railing, proper lightning etc must be provided in all health
facilities and retrofitted in older one which lack the same.
• Registration cum Inquiry counters.
• Pharmacy for drug dispensing and storage.
• Clean Public utilities separate for males and females.
• Suggestion/complaint boxes for the patients/ visitors and also information regarding the person
responsible for redressal of complaints.

Outpatient Department
The facility shall be planned keeping in mind the maximum peak hour load and shall have
scope for future expansion.

51
 Name of Department and doctor, timings and user fees/ charges shall be displayed.

Layout of the Out Patient Department shall follow the functional flow of the patients: e.g.
Enquiry→ Registration→ Waiting→ SubWating→ Clinic→ Dressing room/Injection Room→
Billing→ Diagnostics (lab/X-ray)→ pharmacy→ Exit

Clinics for Various Medical Disciplines : These clinics include general medicine, general surgery,
dental, obstetric and gynaecology, paediatrics and family welfare. Separate cubicles for general
medicine and surgery with separate area for internal examination (privacy) can be provided if there are
no separate rooms for each. The cubicles for consultation and examination in all clinics should provide
for doctor’s table, chair, patient’s stool, follower’s seat, wash basin with hand washing facilities,
examination couch and equipment for examination.
• Room shall have, for the admission of light and air, one or more apertures, such as windows
and fan lights, opening directly to the external air or into an open verandah. The windows
should be in two opposite walls.
• Family Welfare Clinic : The clinic should provide educative, preventive, diagnostic and
curative facilities for maternal, child health, school health and health education. Importance of
health education is being increasingly recognized as an effective tool of preventive treatment.
People visiting hospital should be informed of personal and environmental hygiene, clean
habits, need for taking preventive measures against epidemics, family planning, non-
communicable diseases etc. Treatment room in this clinic should act as operating room for
IUCD insertion and investigation, etc. It should be in close proximity to Obstetric &
Gynaecology. Family Welfare counselling room should be provided.
• Waiting room for patients.
• The Pharmacy should be located in an area conveniently accessible from all clinics. The
dispensary and compounding room should have two dispensing windows, compounding
counters and shelves. The pattern of arranging the counters and shelves shall depend on the
size of the room. The medicines which require cold storage and blood required for operations
and emergencies may be kept in refrigerators.
• Emergency Room/Casualty: At the moment, the emergency cases are being attended in OPD
during OPD hours and in inpatient units afterwards. It is recommended to have a separate
earmarked emergency area to be located near the entrance of hospital preferalbly having 4
rooms (one for doctor, one for minor OT, one for plaster/dressing) and one for patient
observation (At least 4 beds).

Treatment Room
• Minor OT
• Injection Room and Dressing Room
• Observation Room

Wards:
Separate for Males and Females
• Nursing Station : The nursing station shall be centered such that it serves all the clinics from
that place. The nursing station should be spacious enough to accommodate a medicine chest/a
work counter (for preparing dressings, medicines), hand washing facilities, sinks, dressing
tables with screen in between and colour coded bins (as per IMEP guidelines for community
health centres). It should have provision for Hub cutters and needle destroyers.
• Examination and dressing table.
• Patient Area
52
 ➢ Enough space between beds.
➢ Toilets; separate for males and females.
➢ Separate space/room for patients needing isolation.

• Ancillary rooms
➢ Nurses rest room.
➢ There should be an area separating OPD and Indoor facility.

• Operation theatre/Labour room

➢ Patient waiting Area.
➢ Pre-operative and Post-operative (recovery) room.
➢ Staff area.
➢ Changing room separate for males and females.
➢ Storage area for sterile supplies.
➢ Operating room/Labour room.
➢ Scrub area.
➢ Instrument sterilization area.
➢ Disposal area.
➢ Newborn care Corner

Public utilities:
Separate for males and female; for patient as well as for paramedical & Medical staff. Disabled
friendly, WC with wash basins as specified under Guidelines for disabled friendly environment should
be provided.

Physical Infrastructure for Support Services

• Central Steritization Supply Department (CSSD): Sterilization and Sterile storage.

• Laundry: Storage should be separate for dirty linen and clean linen. Outsourcing is
recommended after appropriate training of washer man regarding segregation and separate
treatment for infected and non-infected linen.
• Engineering Services: Electricity/telephones /water/civil Engineering may be outsourced.
Maintenance of proper sanitation in toilets and other public utilities should be given utmost
attention. Sufficient funding for this purpose must be kept and the services may be outsourced.
• Water Supply : Arrangements shall be made to supply 10,000 litres of potable water per day
to meet all the requirements (including laundry) except fire fighting. Storage capacity for 2
days requirements should be on the basis of the above consumption. Round the clock water
supply shall be made available to all wards and departments of the hospital. Separate reserve
emergency overhead tank shall be provided for operation theatre. Necessary water storage
overhead tanks with pumping/boosting arrangement shall be made. The laying and distribution
of the water supply system shall be according to the provisions of IS: 2065-1983 (a BIS
standard). Cold and hot water supply piping should be run in concealed form embedded into
wall with full precautions to avoid any seepage. Geyser in O.T./L.R. and one in ward also
should be provided. Wherever feasible solar installations should be promoted.
• Emergency Lighting : Emergency portable/ fixed light units should also be provided in the
wards and departments to serve as alternative source of light in case of power failure.
Generator back-up should be available in all facilities. Generator should be of good capacity.
Solar energy wherever feasible may be used.
• Generator : 5 KVA with POL for Immunization Cold Chain maintenance.
• Telephone: minimum two direct lines with intercom facility should be available.
• Administrative zone Separate rooms should be available for:
53
 ➢ Office
➢ Stores
• Residential Zone
➢ Minimum 8 quarters for Doctors.
➢ Minimum 8 quarters for staff nurses/ paramedical staff.
➢ Minimum 2 quarters for ward boys.
➢ Minimum 1 quarter for driver.
If the accommodation can not be provided due to any reason, then the staff may be paid house
rent allowance, but in that case they should be staying in near vicinity of CHC so that they are
available for 24 x 7 in case of need.

DESIGN LAYOUT PLAN FOR COMMUNITY

54
EDUCATIONAL INSTITUTIONS
DESIGN LAYOUT PLAN FOR NURSING COLLEGE
PHYSICAL FACILITIES
Building: The College of Nursing should have a separate building. The college of Nursing should be
near to its parent hospital having space for expansion in an institutional area. For a College with an
annual admission capacity of 40-60 students, the constructed area of the college should be 23720
square feet. Adequate hostel/residential accommodation for students and staff should be available in
addition to the above mentioned built up area of the Nursing College respectively. The details of the
constructed area is given below for admission capacity of 40-60 students:
Teaching block :

S.No. Teaching block Area (Figure in Sq feet)

1. Lecture Hall A @ 1080 = 4320
2. (i) Nursing foundation lab 1500
(ii) CHN 900
(iii) Nutrition 900
(iv) OBG and Paediatrics lab 900
(v) Pre – clinical science lab 900
(vi) Computer lab 1500
3. Multipurpose Hall 3000
4. Common Room ( Male and Female) 1100
5. Staff Room 1000
6. Principal Room 300
7. Vice Principal Room 200
8. Library 2400
9. A. V. Aids Room 600
10. One Room for each Head of Department 800
11. Faculty Room 2400
12. Provisions for Toilets 1000
Total 32720 Sqr. Ft.

Note: -
1. Nursing Educational institution should be in Institutional area only and not in residential area.
2. If the institute has non-nursing programme in the same building, Nursing programme should have
separate teaching block.
3. Shift-wise management with other educational institutions will not be accepted.
4. Separate teaching block shall be available if it is in hospital premises.
5. Proportionately the size of the built-up area will increase according to the number of students
admitted.
6. School and College of nursing can share laboratories, if they are in same campus under same name
and under same trust, that is the institution is one but offering different nursing programmes. However
they should have equipments and articles proportionate to the strength of admission. And the class
rooms should be available as per the requirement stipulated by Indian Nursing Council of each
programme.

1. Class rooms
There should be at least four classrooms with the capacity of accommodating the number of
students admitted in each class. The rooms should be well ventilated with proper lighting system.
55
There should be built in Black/Green/White Boards. Also there should be a desk/ dais/a big table and a
chair for the teacher and racks/cupboards for keeping teaching aids or any other equipment needed for
the conduct of classes also should be there.

Departments: College should have following departments

1. Fundamentals of Nursing including Nutrition
2. Medical Surgical Nursing
3. Community Health Nursing
4. Obstetric and Gynecological Nursing
5. Child Health Nursing
6. Psychiatry and Mental Health Nursing

2. Laboratories
There should be at least Seven laboratories as listed below:
Nursing Foundations and Medical Surgical
Community Health Nursing
OBG and Peadiatracs
Nutrition
Computer with 10 computers
Pre Clinical Science Lab. (Biochemistry, Microbiology, Biophysics, Anatomy &
Physiology)

3. Auditorium
Auditorium should be spacious enough to accommodate at least double the sanctioned/actual
strength of students, so that it can be utilised for hosting functions of the college, educational
conferences/ workshops, examinations etc. It should have proper stage with green room facilities. It
should be well – ventilated and have proper lighting system. There should be arrangements for the use
of all kinds of basic and advanced audio-visual aids.
4. Multipurpose Hall
College of Nursing should have multipurpose hall, if there is no auditorium.
5. Library
There should be a separate library for the college. The size of the Library should be of
minimum 2400 sqr. ft. It should be easily accessible to the teaching faculty and the students. Library
should have seating arrangements for at least 60 students for reading and having good lighting and
ventilation and space for stocking and displaying of books and journals. The library should have at
least 3000 books. In a new College of Nursing the total number of books should be proportionately
divided on yearly basis in four years. At least 10 sets of books in each subject to facilitate for the
students to refer the books. The number of journals should 15 out of which one- third shall be foreign
journals and subscribed on continuous basis. There should be sufficient number of cupboards, book
shelves and racks with glass doors for proper and safe storage of books, magazines, journals,
newspapers and other literature.
In the library there should be provision for: -
• Staff reading room for 10 persons.
• Rooms for librarian and other staff with intercom phone facility
• Video and cassette / CD room (desirable)
• Internet facility.

6. Offices Requirements

56
(a) Principal’s Office
There should be a separate office for the Principal with attached toilet and provision for
visitor’s room. Independent telephone facility is a must for the Principal’s office with intercom facility
connected/linked to the hospital and hostel and a computer with internet facility. The size of the office
should be 300 sqr. ft.
(b) Office for Vice-Principal
There should be a separate office for the Vice-Principal with attached toilet and provision for
visitor’s room. Independent telephone facility is a must for Viceprincipal’s office with intercom
facility connected/linked to the hospital and hostel and a computer with internet facility. The size of
the office should be 200 sqr. ft.
(c) Office for Faculty Members
There should be adequate number of office rooms in proportion to the number of teaching
faculty. One office room should accommodate 2 teachers only. Separate toilet facility should be
provided for the teaching faculty with hand washing facility. There should be a separate toilet for male
teachers. The size of the room should be 200 sqr. ft. Separate chambers for heads of the department
should be there.

(d) One separate office room for the office staff should be provided with adequate toilet facility. This
office should be spacious enough to accommodate the entire office staff with separate cabin for each
official. Each office room should be adequately furnished with items like tables, chairs, cupboards,
built –in racks and shelves, filing cabinets and book cases. Also there should be provision for
typewriters, computers and telephone.

7. Common Rooms
A minimum of 3 common rooms should be provided. One for the teaching faculty, one for the
student and one for the office staff. Sufficient space with adequate seating arrangements, cupboards,
lockers, cabinets, built-in-shelves and racks should be provided in all the common rooms. Toilet and
hand washing facilities should be made available in each room.

8. Record Room
There should be a separate record room with steel racks, built-in shelves and racks, cupboards
and filing cabinets for proper storage of records and other important papers/ documents belonging to
the college.

9. Store room
A separate store room should be provided to accommodate the equipments and other inventory
articles which are required in the laboratories of the college. This room should have the facilities for
proper and safe storage of these articles and equipments like cupboards, built-in-shelves, racks,
cabinets, furniture items like tables and chairs. This room should be properly lighted and well-
ventilated.

10. Room for Audio-Visual Aids

This room should be provided for the proper and safe storage of size 600 sq. ft. for all the
Audio- Visual Aids.

11. Other Facilities Students’ welfare hall of size 400 sqr. ft. Indoor games hall of size 4000 ft. Safe
drinking water and adequate sanitary/toilet facilities should be available for both men and women
separately in the college in each floor common toilets for teachers (separate for male and female) i.e 4
toilets with Wash basins. Common toilets for students (separate for male and female) 12 with Wash
Basins for 60 students.

12. Garage

57
 Garage should accommodate a 60 seater vehicle.

13. Fire Extinguisher

Adequate provision for extinguishing fire should be available as per the local bye-laws.

14. Playground
Playground should be spacious for outdoor sports like Volleyball, football, badminton and for
Athletics.

Hostel Block (60 Students):

S.NO. Hostel Block Area (Figures in Sq feet)
1. Single Room 24000
Double Room
2. Sanitary One latrine and one bath room (for 5 students) - 500
3. Visitor Room 500
4. Reading Room 250
5. Store 500
6. Recreation Room 500
7. Dining Hall 3000
8. Kitchen and Store 1500
Total 30750 Sqr. Ft.
Grand Total : 23720 + 30750 = 54470 Sqr. Ft.

Note:
Proportionately the size of the built-up area will increase according to the number of students
admitted. Hostel Facilities: There should be a separate hostel for the male and female students. It
should have the following facilities.
1. Hostel Room :It should be ideal for 2 students with the minimum 100 sq. ft. carpet area. The
furniture provided should include a cot, a table, a chair, a book rack, a cupboard and a cloth
rack for each student.

2. Toilet and Bathroom :Toilet and bathroom facilities should be provided on each floor of the
students hostel at the rate of one toilet and one bathroom for 2-6 students. Geysers in bathroom
and wash basins should also be provided.

3. Recreation:There should be facilities for indoor and outdoor games. There should be provision
for T.V., radio and video cassette player.

4. Visitor’s Room :There should be a visitor room in the hostel with comfortable seating,
lighting and toilet facilities.

5. Kitchen & Dining Hall :There should be a hygienic kitchen and dining hall to seat at least
80% of the total students strength at one time with adequate tables, chairs, water coolers,
refrigerators and heating facilities. Hand washing facilities must be provided.

6. Pantry :One pantry on each floor should be provided. It should have water cooler and heating
arrangements.

58
 7. Washing & Ironing Room: Facility for drying and ironing clothes should be provided in each
floor.

8. Sick Room: A sick room should have a comfortable bed, linen, furniture and attached toilet.
Minimum of 5 beds should be provided.

9. Room for Night Duty Nurses: Should be in a quiet area.

10. Guest Room: A guest room should be made available.

11. Warden’s Room: Warden should be provided with a separate office room besides her
residential accommodation.

12. Canteen: There should be provision for a canteen for the students, their guests, and all other
staff members.

13. Transport : College should have separate transport facility under the control of the Principal.
50-seater bus is preferable.

DESIGN LAYOUT PLAN FOR NURSING COLLEGE

59
 PLANNING SUPPLIES AND EQUIPMENTS DURING
EMERGENCIES AND DISASTER
Introduction
Emergency preparedness planning requires a wide variety of supplies, equipment and
resources, including personal protective equipment (PPE), decontamination equipment, and training.
Planning should include collaborating with local emergency planning committees, local/state public
health departments, and area hospitals to determine the supplies, equipment, and resources each
healthcare facility needs to handle a disaster.
Products and contracted suppliers
Many products generally available and routinely used in healthcare facilities may also be used
in emergency preparedness/safety planning. Other specialized items – for example, Level C equipment
like powered respirators – are used primarily in emergency preparedness. The Safety Institute's
emergency preparedness products file, lists products and equipment that may be considered when
developing an emergency preparedness supply inventory. This file is intended to serve only as an
example and may not include all items and contracted suppliers that should be considered.
Products and equipment for emergency preparedness
Healthcare facilities purchase many of the supplies and materials needed for safety and
emergency preparedness on a regular basis from a variety of companies. Some of these routine
supplies may also be designated for a disaster supply inventory. In addition, emergency preparedness
requires specialized equipment and supplies. Many companies with comprehensive emergency-
preparedness, safety-related equipment offers catalogs, some of which are available online.
Product categories
The following table provides some sample categories and subcategories of search terms that
may be useful in locating specific healthcare products, equipment, and training services for emergency
preparedness.
General Considerations in material management during disaster:
a. Supplies and Equipment:
1. Extra supplies will be obtained from purchasing personnel through runners.
2. Outside supplies will be ordered by the Purchasing Director and brought into the hospital via
the loading dock.
3. Be responsible for setting up extra beds in hospital if needed, as well as transporting
storeroom supplies and bringing in extra supplies from other areas.
4. Be willing to help with movement of victims from ambulance to Triage.

b. Materials Management - Purchasing

1. Department Head or designee will call in their own personnel as needed after reporting to
Command Center.
2. Be prepared to supply all departments with needed supplies.
3. Director will designate assistant to supply runners or volunteers to deliver supplies.
4. Have an up-to-date list of suppliers who can quickly supply extra materials.
5. Have Kardex in Storeroom up-to-date.

c. Valuables and Clothing:

1. Large paper or plastic bags are available in the treatment Areas and the storeroom for
patient's clothing and valuables.

d. Housekeeping and Laundry

1. Department head or designee will call in their own personnel as needed after reporting to
Command Center.
2. Be sure all hallways or traffic areas are clear of cleaning carts, equipment and etc.
60
e. Operating Room, CSR, PAR, Anesthesia, & OP
1. Check area for supplies and equipment.
2. Keep minimum list of supplies on hand and be prepared to process additional sterile supplies
quickly.
3. Notify anesthetists who will maintain adequate anesthesia and drug supplies.

f. Hospital Unit - Supervisor will:

1. Prepare for expansion by notifying maintenance of number of extra beds needed and where
to set them up.
2. Send for extra supplies needed from Purchasing, CSR, Laundry, and Dietary.
3. Will make wheelchairs available.
g. Laboratory
1. Have arrangements made to obtain additional blood, equipment and supplies from area
agencies.
i. Pharmacy
1. Report to Command Center, and then remain in department.
2. Have list of drug suppliers that can provide emergency supplies quickly
3. Keep minimum supply of emergency drugs on hand at all times.
4. Pharmacy should remain open and have a runner to deliver needed meds to areas.
j. Respiratory Therapy
1. Keep adequate supply of bubblers, cannula, masks and flow meters available in Respiratory
Therapy Department.
2. Be prepared to obtain additional respirators and equipment as needed.
3. Keep resuscitation equipment in good operating condition and well marked.

PLANNING SUPPLIES AND EQUIPMENTS DURING EMERGENCIES AND

DISASTER

Safety catalog search terms by categories and subcategories

Category Subcategories
Apparel – Personal Eye, face, head, foot, hearing
or protective protection; respiratory protection
clothing
Personal
protective
equipment (PPE)
PPE response Example: first responder level C kit
kits (A, B, C, D)

Clinical diagnostics Clinical diagnostics; sample collection/transportation; swabs, wipes

Decontamination Spill control
Detection; monitoring Detection instruments; personal alarm kits; gas detection instruments
Fire equipment Extinguishers
First aid Blankets, kits
Mail handling products Powder-free gloves, bags
Monitoring
61
PREPARATION OF EQUIPMQNT AND SUPPLIES FOR ICU UNIT
Sr Name of equipment Number Specification
No
1 Bedside Monitors One per Bed Modular -2 Invasive BP, SPO2,NIBP, ECG, RR, Temp Probes
(For ICU) with trays
2 Monitors for HDU Same Same but without Invasive BP but upgradeable
3 Ventilators 6 With paediatric and adult provisions, graphics and Non-
Invasive Modes (Two Ventilators should be with inbuilt
Compressor. each should have a Fisher and Paykel Humidifier
(These can be bought directly from F &P
4 Non invasive 3 With Provision for CPAP and IPAP
Ventilators
5 Infusion Pumps 2 Per bed in ICU Volumetric with all Recent upgraded drug calculations
1 Per Bed in
HDU
6 Syringe Pumps 2 per bed in ICU With recent up gradation
7 Head End Panel 1 Per bed With 2 O2 Outlets, two vacuum, one compressed air and 12
electric outlets , provision for Music, Alarm, trays for two
monitors, Two Drip stands, One Procedure light
8 Defibrillator Two with TCP Adult and paediatric pads with Trascutaneous pacing facility
facility (one
standby )
10 ICU Beds (Shock Proof) One for each bed Electronically Manoeuvred with all positions possible with
(Fibre) mattress. Now beds are available which give lateral positions
also
11 Over Bed Tables One for each ALL SS with 6 to 8 cupboards in each to store Drugs Medicines,
Bed side tray for x-rays, BHT, on wheels
12 ABG Machine One+One facility for ABG and Electrolytes Second one
as stand-bye
13 Crash/ Resuscitation Two for ICU + To hold all resuscitation equipment and Medicines
trolley One for HDU
14 Pulse Oxymeter Two As stand bye units
(Small Units)
15 Freeze One + One for With deep freeze facility
use of staff and
doctors
16 Computers 2 (for ICU), One With laning, Internet facility and printer to be connected with all
for HDU, One departments
for In charge
17 HD Machines 2 User friendly so that even a Nurse can Operate
18 CRRT One High flow /Speed Model
19 CO, SVR, ScvO2 One As Described
Monitor
20 Intermittent Leg Two To prevent DVT
Compressing
Machine
21 Airbeds 6 To Prevent Bed sores
22 Intubating Video One To make difficult Intubations easy
scope
23 Glucometer 2 for ICU, one
for HDU

62
 DEVELOPING STAFFING PATTERN

Staffing pattern refers to the number and types or categories of staff assigned to the particular
wards in a hospital. Staffing patterns that accommodate imbalanced patient to nurse ratios can affect
nursing staff negatively.

DEFINITION:
Staffing is the process of determining and providing the acceptable number of nursing
personnel to produce a desirable level of patient care to meet the patients demand.
To provide each nursing unit with an appropriate and acceptable number of nurses in each category to
perform the nursing tasks required

STAFF SCHEDULING:
Schedule: timetable showing planned work days and shift.
Scheduling: assigning work and off days to nursing personnel to assure adequate patient care.

CRITERIA FOR EFFECTIVE STAFFING:

Coverage: the number of nurses assigned to be on duty should be in relation to the minimum
number of nurses required.
Quality: the total number of patient care should be planned in such a way that trained nurses
are available for patient care of 24 hours a day.
Stability: allocation procedure must be consistent with leave and rotation policy. Each nurse
must know her off, privileged leave etc.
Flexibility: the allocation policy must provide flexibility.
Objectives: there should be fairness in allocation and scheduling shift duties.

NURSING SERVICE
• Nursing superintendent 1 per 300 beds and additional for every 200 beds
• Deputy nursing superintendent 1 Up to 400 beds
• Assistant nursing superintendent 1 for 100-150 beds or 3-4 wards
• Ward sisters 1 for 25-30beds or one ward
• Staff nurse 1 for 3 beds in teaching hospital in general ward and 1 and 5 beds in non-teaching
hospital plus 30% leave reserve extra nursing staff to be provided for departmental
• Teaching hospital 1 fpor 5 beds
• Non teaching hospital 1 nurse for 3 beds
• For ICU/CCU 1 nurse for one bed

STAFFING REQUIREMENT AS PER SHIFT

• Ideally 1:1 ratio during day and 1:2 during night
• Broadly 4-5 nurses per bed including reliever
• One ANS for administration

STAFFING PATTERN OF NURSING EDUCATION

1. Principal cum professor- 15 year experience with M.Sc.(N) out of which year should be
teaching experience with minimum of 5 years experience in college programme PhD is
desirable
2. Vice principal- 12 years experience with M.Sc (N) out of which 10 years should be teaching
experience with minimum of 5 years experience in collegiate programme PhD is desirable

63
 3. Professor- 10 year experience with M.Sc. Out of which 7 years should be teaching experience.
PhD is desirable
4. Associate professor- M.Sc with 8 years including 5 years teaching experience . PhD is
desirable
5. Assistance professor/lecturer- M.Sc (N) with 3 years teaching experience. PhD id desirable
6. Tutor/clinical instructor- M.Sc or Bs.c/post basic Bs.c N with 1 years experience.

STAFFING PATTERN AS PER INC

For Bs.c and P.B.B.SC program:

S. No Designation M.Sc Nursing B.sc Nursing P.B.B.Sc

10-25 students 60-100 Nursing
students 20-60 students
1 Professor cum principal 1 1
2 Professor cum voice 1
principal
3 professor 1
4 Associate professor 1 4
5 Assistant professor 2 6 2
6 tutor 19-28 2-10
Student teacher ratio 1:10

STAFFING PATTERN OF COMMUNITY HEALTH CENTER

STAFF PATTERN

PERSONNEL DESIRABLE
Block medical officer/medical superintendent 1
Public health specialist 1
Public health nurse 6
Physician 1
General surgeon 1
Obstetrician and gynecologist 1
Pediatrician 1
Anesthetist 1
Dental surgeon 1
General duty medical officer 2
Medical officer Ayush 1
pharmacist 1
Lab. technician 1
radiographer 1
dietician 1
OT technician 1
Counselor 1
Administrative staff 6
Group D staff 4
Driver 1
Peon 1

64
 PLAN OF ACTION FOR RECRUITMENT PROCESS
INTRODUCTION
Recruitment forms the first stage in the process, which continues with selection and cease with
placement of the candidate. Recruitment makes it possible to acquire the number and type of people
necessary to ensure the continued operation of the organization.

DEFINITIONS:
In simple terms Recruitment is understood as a process for searching and obtaining applicants
for jobs, from among the available recruits. Recruitment is the process of searching for prospective
employees and stimulating them to apply for jobs in the organizations.
RECRUITMENT VARIABLES:
Successful recruitment of an adequate workforce is dependent upon many variables:
• Resources available for advertisement, and visits to career day programs.
• Number of new and experienced nurses available.
• Competitiveness of the organizations salaries and benefits.
• Attractiveness of the setting to the potential workforce.
• The reputation of the organization regarding past employment practices and quality of patient
care.
PURPOSE OF RECRUITMENT:
• Attract and encourage candidates to apply for the post in the organization
• Determine present and future requirements for the organization
• Create a pool of candidates to enable the selection of best candidate for the organization
• Create a pool of candidates at low cost
• Begin identifying and preparing potential applicants who will be appropriate candidates
STEPS IN THE RECRUITMENT PROCESS:
•Organizational policies regarding recruitment should be reviewed prior to the advertisement of
a job positions.
• All possible sources of potential applicants must be identified.
• The optimum mode of publicizing job vacancies must be determined. 4- the recruitment need
and qualifications required must be stated.
• The response to the recruitment effort should be evaluated and adjusted as needed.
CRITERIA FOR GOOD RECRUITMENT POLICY :
• Complies with government policies
• Provides job security and fair treatment
• Provides employee development opportunities
• Flexible to accommodate changes
• Ensures its employees long-term employment opportunities
• Cost effective for the organization
SOURCES OF RECRUITMENT
1- INTERNAL SOURCES
2- EXTERNAL SOURCES
INTERNAL SOURCES OF RECRUITEMENT
• Promotions: Promotion means to give a higher position, status, salary and responsibility to the
employee. So, the vacancy can be filled by promoting a suitable candidate from the same
organization.
• Transfers : Transfer means a change in the place of employment without any change in the
position, status, salary and responsibility of the employee. So, the vacancy can be filled by
transferring a suitable candidate from the same organization.
65
 • Internal Advertisements : Here, the vacancy is advertised within the organization. The
existing employees are asked to apply for the vacancy. So, recruitment is done from within the
organization.
• Retired Managers: Sometimes, retired managers may be recalled for a short period. This is
done when the organization cannot find a suitable candidate.
• Recall from Long Leave: The organization may recall a manager who has gone on a long
leave. This is done when the organization faces a problem which can only be solved by that
particular manager. After he solves the problem, his leave is extended.

ADVANTAGES OF INTERNAL SOURCES OF RECRUITEMENT :

• It is time saving, economical, simple and reliable.
• There is no need of induction training because the candidate already knows everything about
the organization, the work, the employee, the rules and regulations, etc.
• It motivates the employees of work hard in order to get higher jobs in the same organization.
• It reduce executive turnover.
• It increases the morale of the employees and it improves the relations in the organization.
• It develops loyalty and a sense of responsibility

DISADVANTAGES OF INTERNAL RECRUITMENT :

• Limited Internal Sources: The source of supply of manpower is limited in internal recruitment
method. When an employee is promoted, his/her previous position will be vacant and another
personnel is to be recruited to fill that vacant position.
• Implementation Of Traditional System Internal recruitment requires the implementation of
traditional form, system, process and procedures. And this limits the scope of fresh talent in the
organization.Favourism :There will be tendency of referring friends and family members in the
organization. Then, the organization will be overstaffed with talent- less crowd.
• No Opportunity:
• In internal recruitment, the internal employees are protected from competition by not providing
any opportunity to fresh talents. This also develops a tendency among the employees to take
promotions without any extra knowledge or talent.

EXTERNAL SOURCES:
• The external sources of recruitment refer to reaching out to the external labor market to meet
the labor requirements.
• They are huge, diverse and important for recruitment.
• Tapping these sources calls for careful planning by the organization.

CLASSIFICATION:
• Recruitment agencies: Transferring the whole or a few parts of the recruitment process to an
external HR consultant rendering recruitment services is called outsourcing recruitment.
• Advertisements: printed advertisements are a preferred mode of external recruitment for
several reasons Reach many people in short period of time, the vacancies can be
communicated to a potential candidate quickly. Classification of external sources.
• Deputation:The employee of one organization Are selected or taken on deputation from other
organization for filling the vacancies for a certain time
• On line recruitment The job candidate sends details of vacancies on screen and asks if he or
she wants to apply on line.
• Telecasting: The practice of telecasting of vacant posts over T.V
SELECTION PROCESS:
• PRELIMINARY INTERVIEW: The purpose of this interview is to scrutinize the applicants,
i.e. elimination of unqualified applications.
66
 • SELECTION TESTS: Different types of selection tests may be administrated, depending on
the job and the organization. Generally tests are used to determine the applicant’s ability,
aptitude(talent), and personality.
• EMPLOYMENT INTERVIEW: The next step in the selection process is employment
interview, an interview is conducted at the beginning, and at the selection process of the
employment interview can be one- to-one interview or panel interview.
• REFERENCE AND BACKGROUND CHECKS: Many employers request names, address,
telephone numbers or references for the purpose to verify information and gaining additional
background information of an applicant.
• SELECTION DECISION: Selection decision is the most critical of all steps in selection
process. The final decision has to be made from the pool of individuals who pass the tests,
interviews and references checks.
• PHYSICAL EXAMINATIONS: After selection decision and before the job offer is made, the
candidate is required to undergo a physical fitness test. A job offer is often; contingent upon
the candidate being declared fit after the physical examinations.
• JOB OFFER: The next step in selection process is job offer. Job offer is made through a letter
of appointment. Such a letter generally contains a date by which the appointee must report on
duty
• CONTRACT OF EMPLOYMENT: Basic information is written in Contract of employment
that varies according to the levels of job. After the offer and acceptance of the job certain
document is the attestation form
• EVALUATION OF SELECTION PROGRAM: The broad test of effectiveness of the
selection process is a systematic evaluation .a periodic audit is conducted in the HR department
that outlines and highlights the areas which need to be evaluated in the selection proc

REQUITMENT ACTION PLAN:

FILLING THE TOP LEVEL FORMULATING CAMPUS

POSITION ON A PRIORITY BASIS STRATEGY TO ATTRACT
TALENTED STUDENTS AND
GROOM THEM TO BE THE
FUTURE MANAGER

CLOSELY WORKING WITH THE WORKING WITH CATEGORY

RESOECTIVE LEADERS TO FILL BUSINESS HR HEADS TO FILL
THE FIRST LEVEL LEVEL KEY POSITIONS THROUGH
POSITIONS THROUGH THE TOP
DOWN APPROACH

67
 PREPARATION OF JOB DESCRIPTION FOR ANY ONE
CATEGORY OF NURSING PERSONNEL

DEFINITION:
A job description is a document that describes the general tasks, or other related duties, and
responsibilities of a position.
A job description template details the specific requirements, responsibilities, job duties, and
skills required to perform a role.

NURSING PERSONNEL:
1) STAFF NURSE
2) SENIOR STAFF NURSE
3) NURSING SUPRITENDENT GRADE –I
4) NURSING SUPRITENDENT GRADE – II
5) NURSING TUTOR /CLINICAL INSTRUCTER
6) LECTURER COLLEGE OF NURSING
7) ASSISTANCE PROFESSOR COLLEGE OF NURSING
8) PROFESSOR COLLEGE OF NURSING
9) PRINCIPAL COLLEGE OF NURSING
10) PUBLIC HEALTH NURSE

STAFF NURSE
EDUCATIONAL QUALIFICATION:
1. General: pre university course
2. Professional: 3 years general Nursing/6 months psychiatric nursing diploma Certificate,
recognized by Indian Nursing Council
3. Registration: registered with INC,MNC,respective state nursing council.

JOB SUMMARY:
Staff nurse is a first level professional nurse who provides direct patient care to one patient or
group of patients assigned to her/him during duty shift and assist in management of
wards/units/special departments. She/he directly responsible to Senior Staff Nurse or ward incharge
nurse.

DUTIES AND RESPONSIBILITY:

1) Direct patient care
2) Ward/unit management
3) operation theater management
4) Management of labour room
5) Management of psychiatric unit
6) Educational function

SENIOR STAFF NURSE

Educational qualifications:
1. General: As prescribed for staff nurse.
2. Professional: As prescribed for staff nurse
3. Registration: Registered with state Nursing Council/Indian Nursing Council.
4. Experience: Should have experience as staff nurse of not less than 5 years.

68
JOB SUMMARY:
Senior staff nurse is a first level nursing supervisor who is accountable for nursing care
management of a ward on unit assigned to her/him. She/he is responsible to the Nursing
Superintendent Gr.II for ward/unit management. She/he takes full charge of the ward and assigns work
for various categories of nursing.

DUTIES AND RESPONSIBILITY:

o Direct patient care
o Supervision and administration
o Educational function.

NURSING SUPERINTENDENT GR.II

EDUCATIONAL QUALIFICATION:
1. General education: As prescribed for staff nurse.
2. Professional: As prescribed for staff nurse.

REGISTRATION: WITH INDIAN NURSING COUNCIL/MNC (STATE NURSING

COUNCIL)
1. Experience: Should have experience as senior staff nurse 5 year

JOB SUMMARY
She/he is responsible for developing and supervising nursing services of a department or a
floor consisting of two or more wards or units managed by the senior staff nurses. These units may be
in patient wards, out- patient department clinics, operation theaters, obstetric units, supply department,
etc. she/he is responsible to nursing superintendent Gr.I

DUTIES AND RESPONSIBILITY • Patient care and ward/unit management • Educational function

NURSING SUPERINTENDENT GR.I

EDUCATIONAL QUALIFICATION:
General education: As prescribed for staff nurse.
Professional: As prescribed for staff nurse.
Registration: with INDIAN Nursing Council/MNC (State Nursing Council)
Experience: Should have experience as
NURSING SUPERINTENDENT GR.II
JOB SUMMARY
Nursing superintendent is responsible to the medical Superintendent, in a hospital having 200
or above bed strength. She is accountable for the safe and efficient running of the various nursing
department in the hospital. She is assisted in carrying out her duties, by the Deputy Nursing
Superintendent/Assistant Nursing Superintendent, ward supervisors and clerical, linen room and
domestic staff.
DUTIES AND RESPONSIBILITY
Various nursing services

NURSING TUTOR / CLINICAL INSTRUCTOR

EDUCATIONAL QUALIFICATION:
• General: As prescribed for staff nurse
• Professional: B.Sc, Nursing (Postgraduate) or Msc Nursing or equivalent examination.
• Registration: Registered with State nursing Council.
• Experience: Should have experience as staff nurse and teaching in school of nursing.

69
 JOB SUMMERY
She/he is teacher in nursing school, responsible to the vice principal nursing school responsible
for planning and implementation of teaching program assists in administration of school of nursing

DUTIES AND RESPONSIBILITY

Academic function
Administration and evaluation

LECTURER COLLEGE OF NURSING

EDUCATIONAL QUALIFICATION:
• General: as prescribed for staff nurse
• Professional: Msc Nursing or equivalent examination.
• Registration: Registered with State nursing Council.
• Experience : Should have experience as staff nurse and teaching in school of nursing. Not less
than 5 year

JOB SUMMERY:
He/she work under the direction of departmental head and assist him in administration instruction and
guidance activity.

DUTIES AND RESPONSIBILITY

1. Instruction
2. 2. Guidance and counseling
3. 3. Research

ASSISTANT PROFFESOR COLLEGE OF NURSING

EDUCATIONAL QUALIFICATION:
General: as prescribed for staff nurse
Professional: Msc Nursing or equivalent examination.
Registration: Registered with State nursing Council.
Experience : Should have experience of teaching in college of nursing. Not less than 5 year

JOB SUMMERY
The assistant professor usually works under the professor /HOD of particular department of specialty
and assist him/her in administration, teaching guidance, counseling and research activity.
DUTIES AND RESPONSIBILITY
Administration
Instruction
Helping to learner

PROFESSOR, COLLEGE OF NURSING

EDUCATIONAL QUALIFICATION
General: as prescribed for staff nurse
Professional: Msc Nursing or equivalent examination or PHd in nursing Registration:
Registered with State nursing Council.(INC,KNC,MNC)
Experience: Should have experience of teaching in college of nursing. Not less than 5 year

JOB SUMMERY:
The professor is overall in charge of the department and there by responsible for administration
teaching activity and guidance do that particular department

70
DUTIES AND RESPONSIBILITY:
Administration
Instruction
PRINCIPAL COLLEGE OF NURSING
EDUCATIONAL QUALIFICATION:
General: as prescribed for staff nurse
Professional: Msc Nursing or equivalent examination or PHd in nursing
Registration: Registered with State nursing Council.(INC,KNC,MNC)\
Experience : Should have experience of professor in college of nursing. Not less than 5 year

JOB SUMMERY
Principal college of nursing is administrative head of college of nursing will be directly
responsible of director of medical education /director of family welfare services and responsible for
implementation and curriculum of various courses and research activity of college of nursing.

DUTIES AND RESPONSIBILITY

Administration
Organizing
Coordination
Controlling Instruction (teaching)

JOINT DIRECTOR OF NURSING / DEPUTY DIRECTOR OF NURSING

EDUCATIONAL QUALIFICATION
• General: as prescribed for staff nurse
• Professional: Msc Nursing or equivalent examination or PhD in nursing
• Registration: Registered with State nursing Council.(INC,KNC,MNC)
• Experience: Should have 10 year experience in nursing service and 5 years in administration and
education.
JOB SUMMARY:
Senior Asst. Director of Nursing is at present rate, head of nursing services. Directorate of
Health and Welfare Services, directly responsible to both the Director of Health and Family Welfare
Servicers and the Director of medical education He/she should responsible all activities concern and
improvements of the nursing services in the State

DUTIES AND RESPONSIBILITY

Leave Transfer of:
1) Nursing personnel
2) Student nurses from one school to another
3) Promotion and postings
4) Review of confidential reports
5) Educational program
6) Proposals to government.
7) Inspections

PUBLIC HEALTH NURSE:

EDUCATIONAL QUALIFICATION
General : Bsc degree in nursing from any university or certificate in public health nursing
Professional: experience of working in rural area

71
JOB SUMMARY:
The public health nurse will assist the district medical officer /district family welfare officer in
planning implementing and evaluating maternal and child health program undertaken in district she
will receive technical guidance from him and administrative control.

72
 PREPARE DUTY ROSTER
PREPARE DUTY ROSTER FOR ICU( HOSPITAL)
NAME 1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3
OF 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1
STAFF

M M M M M O E E N N N N O E E E E E M O E M N N N N O E M M M
HIRU
RAM

M M M M O E E N N N N O E E E E E M O E M N N N N O E M M M M
PUSHP
A

M M M O E E N N N N O E E E E E M O E M N N N N O E M M M M M
SURE
KH
A
SAHU

M M O E E N N N N O E E E E E M O E M N N N N O E M M M M M M
VIYET
A
YADA
W

M O E E N N N N O E E E E E M O E M N N N N O E M M M M M M M
YAMI
NI
SAHU

M – MORNING DUTY
E - EVENING DUTY
N – NIGHT DUTY
O – OFF

73
PREPARE DUTY ROSTER FOR COMMUNITY

NAME OF 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
STAFF

BHAVNA M M M M M O E E N N N N O E E E E E M O E M N N N N O E M M M
KHOMES M M M M O E E N N N N O E E E E E M O E M N N N N O E M M M M
HWARI
KIRAN M M M O E E N N N N O E E E E E M O E M N N N N O E M M M M M
LEENA M M O E E N N N N O E E E E E M O E M N N N N O E M M M M M M
MUKESH M O E E N N N N O E E E E E M O E M N N N N O E M M M M M M M
SUNITA E E N N N N O E E E E E M O E M N N N N O E M M M M M M M O E
TIKESHW E N N N N O E E E E E M O E M N N N N O E M M M M M M M O E E
ARI
TRIVENI N N N N O E E E E E M O E M N N N N O E M M M M M M M O E E E
VARSHA N N N O E E E E E M O E M N N N N O E M M M M M M M O E E N N
VEENA N N O E E E E E M O E M N N N N O E M M M M M M M O E E N N N
M – MORNING DUTY
E - EVENING DUTY
N – NIGHT DUTY
O – OFF

PREPARE DUTY ROSTER FOR EDUCATIONAL INSTITUTION

CLASS 9- 10-11AM 11AM- 12-1PM 1-2PM 2-3PM 3-4PM 4-5PM
10A 12PM
M

M.SC MSN LIBRARY NSG EDU NSG MSN ADVANC MSN

NURSIN RESEARC E NSG
G 1ST H LUNC PRACTICE
YEAR H

M.SC. MSN MANAGEMEN LIBRAR MSN NSG MSN RESEARC

NURSIN T Y NSG MANAGEMEN H WORK
G 2ND T
YEAR

74
 PLAN OF ACTION FOR PERFORMANCE APPRAISAL
INTRODUCTION-
The employee performance appraisal is a specific and important part of the management
process requiring much skill.
When accurate and appropriate appraisal assessment is performed, the outcome can be very positive.
It is a powerful tool to calibrate, refine and reward the performance of the employee. It helps to
analyze his achievement and evaluate his contribution towards the achievement of the overall
organizational goals.

DEFINITION
It is a periodic formal evaluation of how well the employee has performed his/ her duties
during a specific time period.
A basic human tendency to make judgments about these one is working with, as well as about
one self.
Performance appraisal refers to all the formal procedures used in working organization to
evaluate the personalities and contribution of group members.

AIMS OF PERFORMANCEAPPRAISAL
• Give employee feedback.
• Identify employee training need
• Form a basis for personnel decisions: Salary increases, promotions, disciplinary actions,
bonuses, etc
• Provide the opportunity for organizational diagnosis and development
• Facilitate communication between employee and employer.
• Validate selection techniques and human resource policies.
• To improve performance through counseling, coaching and development.
• To determine the job competence e.g. to judge whether employees performing at an acceptable
level.
• To establish standards of job performance.
• To reach an understanding about the objectives of the job/ agency.
• To improve commitment and satisfaction.
• To provide documentation in case an employee sues for wrongful termination.
• To help organizations determine if it is meeting its goals.

PURPOSES OF PERFORMANCE APPRAISAL

• To review the performance of the employees.
• To judge the gap between the actual and the desired performance.•
• To help the management in exercising organizational control.
• To diagnose the training and development needs of the future.
• Provide information to assist in the HR decisions like promotions, transfers etc.
• Provide clarity of the expectations and responsibilities of the functions to be performed by the
employees.
• To judge the effectiveness of the other human resource functions.
• To reduce the grievances of the employees.
• Helps to strengthen the relationship and communication between superior –subordinates and
management – employees.

75
OBJECTIVES OF PERFORMANCE APPRAISAL
Work related objectives-
• To provide a control for work done.
• To improve efficiency.
• To help in assigning work and plan future work assignment.
• To carry out job evaluation.
Career development objectives
• To identify strong and weak points and encourage finding remedies for weak points through
training.
• To determine career potential.
• To plan developmental (promotional or lateral) assignments.
• To plan career goals.
Objectives of communication
• To provide adequate feedback on performance;
• To clearly establish goals, i.e. what is expected of the staff members in terms of performance
and future work assignments
• To provide counseling and job satisfaction through open discussion on performance
• To let employees assess where they stand within the organization in terms of their
performance.
Administrative objectives
• To serve as a basis for promotion or demotion
• To serve as a basis for allocating incentives
• To serve as a basis for determining transfers 2
• To serve as a basis for termination in case of reduction of staff.

ELEMENTS OFPERFORMANCE APPRAISAL

• Setting performance goals and objectives
• Determining key competencies
• Measurement of performance against the goals and objectives
• Measurement of performance against key competencies,
• Feedback of results.
• Amendment to goals and objectives

CHARACTERISTICS OF EFFECTIVEPERFORMANCE APPRAISAL

• The philosophy, purpose, and objectives of the organization are clearly stated so that
performance appraisal tools can be designed to reflect these.
• The purposes of performance appraisal are identified, communicated, and understood.
• Job descriptions are written in such manner that standards of job performance can be identified
for each job.
• The appraisal tool used is suited to the purposes for which it will be utilized and is
accompanied by clear instructions for its use.
• Evaluators are trained in the use of the tool.
• The performance appraisal procedure is delineated, communicated and understood. Plans for
policing the appraisal procedure and evaluating appraisal tools are developed and
implemented.
• Performance appraisal has the full support of top management.
• Performance appraisal is considered to be fair and productive by all who participate in it.

76
FACTORS AFFECTING OF PERFORMANCE APPRAISAL-
1. Performance: Performance of an employee by default affects his appraisal. Every organization
would want to make better profits. If certain employees perform above their caliber to help
company achieve better results, the organization would appreciate their efforts by giving them
a raise in their compensation. It is a motivating factor as well for employees who continue to
contribute efficiently to the organization.
2. Attendance: A very essential part of employment is to be present at the workstation and other
team and company activities. Taking a day off once in a while is okay, but
frequent absenteeism will no doubt weigh down your appraisals. Employees who have lesser
absenteeism and are punctual can expect good appraisals.
3. Being motivated: A manager would love to see his employees work with excitement and
energy. Employees who get to work with motivation, take initiatives and show interest to
perform exceptionally are highly looked upon. Positive employees are retained, respected and
rewarded by the organization.
4. Team work: Organizations like team players. Employees who gel well with the team and help
the team improve will surely be recognized and the efforts will be honored. This would be one
of the reasons why employees with still performance will manage to get a healthier raise in
their appraisals. Employees who spread negativity among the team might have to face a tough
time during their appraisals.
5. Service to the customers: Employees who deal with customers of the organization should
make sure that they fulfill the required complainants. This is essential as ’employee client
relations’ will be responsible for bringing revenue to the organization. Employees who do a
good job here will definitely receive a bonus.
6. Product knowledge: Employees should know in and out about the product or service that they
deal with. Product knowledge or process knowledge is an attribute by which the employee is
measured. Limited knowledge about the product or service restricts customer experience, and
also it is difficult to convince the customers about the benefits of the product/service. This in
turn shows your inefficiency which leads to poor appraisal.

QUALITIES OF A GOOD APPRAISAL-

It is Factual

It is fair

It describes the Whole Period

It describes the Whole Job

It has no Surprises

METHODS OF PERFORMANCE APPRAISAL

TRADITIONAL METHODS OF PERFORMANCE APPRAISAL

Essay appraisal method-
This traditional form of appraisal, also known as "Free Form method" involves a description of
the performance of an employee by his superior.
This description is an evaluation of the performance of any individual based on the facts and often
includes examples and evidences to support the information. A major drawback of the method is the
inseparability of the bias of the evaluator.

77
Straight ranking method
• This is one of the oldest and simplest techniques of performance appraisal.
• In this method, the appraiser ranks the employees from the best to the poorest on the basis of
their overall performance.
• It is quite useful for a comparative evaluation

Paired comparison
A better technique of comparison than the straight ranking method, this method compares each
employee with all others in the group, one at a time.
After all the comparisons on the basis of the overall comparisons, the employees are given the final
rankings.

Checklist method
• In this method of recording whether a behavior is present and absent, or whether an action is
taken or not.
• The advantages of the checklist are the expectations are clearly identified in behavior language
of employee.
• This advantage is that it does not indicate the degree or frequency with which a behavior
occurs, and it is difficult to construct.
• The rate is given a checklist of the descriptions of the behavior of the employees on job.
• The checklist contains a list of statements on the basis of which theater describes the on the job
performance of the employees.

Critical incidents methods

• In this method of Performance appraisal the evaluator rates the employee on the basis of
critical events and how the employee behaved during those incidents.
• It includes both negative and positive points.
• The drawback of this method is that the supervisor has to note down the
• Critical incidents and the employee behavior as and when they occur.

Field review
• In this method, a senior member of the Human Resource department or training officer
discusses and interviews the supervisors to evaluate and rate their respective subordinates.
• A major drawback of this method is that it is a very time consuming method.
• But this method helps to reduce the superiors’ personal bias.

Graphic rating scale

• In this method, an employee’s quality and quantity of work is assessed in a graphic scale
indicating different degrees of a particular trait.
• The factors taken into consideration include both the personal characteristics and
characteristics related to the on the job performance of the employees.
For example a trait like Job Knowledge may be judged on the range of average, above average,
outstanding or unsatisfactory.

Peer review
It is process where monitoring and assessing work performance are carried out by peers rather
than by supervisors.

78
MODERN METHODS OFPERFORMANCE APPRAISAL
Management by Objectives‟ (MBO)
The concept of management by objectives (MBO) was first given by Peter Ducker in 1954. It
can be defined as a process whereby the employee and the superiors come together to identify
common goals, the employee set their goals to be achieved, the standards to be taken as the criteria for
measurement of their performance and contribution and deciding the course of action to be followed.
The essence of MBO is participate goal setting choosing course of actions and decision making. An
environment part of the MBO is the measurement and the comparison of the employee’s actual
performance with the standards set. Ideally, when employees themselves have been involved with the
goal setting and the choosing the course of action to be followed by them, they are more likely to
fulfill their responsibilities.

360-Degree-performance-appraisal method
Degree feedback, also known as multi-rater feedback, is the most comprehensive appraisal
where the feedback about the employees ‘performance comes from all the sources that come in contact
with the employee on his job
360 degree appraisal has four integral components-
1. Self appraisal
2. Superior’s appraisal
3. Subordinate’s appraisal
4. Peer appraisal.

BENEFITS OF PERFORMANCEAPPRAISAL
Benefit for the individual:
✓ Gaining a better understanding of their role
✓ Understanding more clearly how and where they fit in within the wider picture
✓ A better understanding of how performance is assessed and monitored
✓ Getting an insight
✓ Improving understanding of their strengths and weaknesses and developmental needs
✓ Identifying ways in which they can improve performance
✓ Providing an opportunity to discuss and clarify developmental and training needs
✓ Understanding and agreeing their objectives for the next year
✓ An opportunity to discuss career direction and prospects.

Benefit to the line/manager/supervisor/team leader:

Opportunities to
✓ Hear and exchange views and opinions away from the normal pressure of work
✓ To identify any potential difficulties or weaknesses
✓ An improved understanding of the resources available
✓ To plan for and set objectives for the next period
✓ To think about and clarity their own role
✓ To plan for achieving improved performance
✓ To plan for further delegation and coaching– to motivate members of the team
Benefits to the organization
✓ A structured means of identifying and assessing potential
✓ Up-to-date information regarding the expectations and aspirations of employees
✓ Information on which to base decisions about promotions and motivation
✓ An opportunity to review succession planning
✓ Information about training needs which contact as a basis for developing training plans
✓ Updating of employee records (achievements, new competencies, etc)
✓ Career counseling
✓ Communication of information
79
USES OF PERFORMANCE APPRAISAL
S.NO USES DESCRIPTION
1. Basis for suitable Performance appraisal provides information for
personnel policies personnel decisions such as pay increase, promotions,
demotions, transfer and terminations.

2. For judging the It helps to judge the effectiveness of recruitment,

effectiveness of selection, and placement and orientation system of the
recruitment organization.
3. for analyzing training It is useful in analyzing training and development
and development needs needs. The needs can be assessed because appraisal
reveals people who require further training to remove
their weakness.
4. Assessment of individual Performance appraisal can be used to improve
potentials performance through appropriate feedback, working
and counseling to employees. Its serves as a means of
telling a subordinate how he is doing and suggesting
necessary changes in his knowledge, behavior and
attitude.
5. Basis foe planning Performance appraisal facilitates human resources
planning, carrier planning and succession planning.
6. Boost the morale It promotes positive work environment which
contributes to productivity.
7. Motivates the employees A competitive spirit created and employees are
motivated to improve their performance. Systematic
appraisal provides management an opportunity to
properly size up the employee.

8. Develop confidence Systematic appraisal of performance helps to develop

confidence among employee

ESSENTIAL OF A GOOD APPRAISAL SYSTEM

1. Ease of understanding-
If an appraisal system is too complex or too time consuming it may be grounded by its own
dead weight of complication, which nobody but only the experts understand.
2. Support of line workers-
If the line workers think that the system is too ambitious or unrealistic, or that it has been
imposed on them by ivory towered staff or consultants who have no comprehension of the actual
demands on the time of line workers, they will resent it.
3. Suitability of the operations and structures-
A system may function extremely well at an organization whose activities are compact.
Likewise, where the operations are interdependent are interlinked, performance data of any individual
cannot be regarded as adequately discrete or reliable for appraising his or her performance.
The validity of rating is the degree to which the system truly indicates the intrinsic merit of the
employee. Reliability of rating is the consistency with which the ratings are made, either by several
different raters or by one rater at different times.

80
4. Provision of incentives-
The system should have appropriate built in incentives to be awarded after satisfactory
performance.
5. Periodical evaluation –
There is the danger that subjective criteria may become more salient than the objectives
standards originally established. There is another danger that the system may become rigid in a tangle
of rules and regulations, many of which may be no longer useful.

ROLE OF ADMINISTRATOR IN PERFORMANCE APPRAISAL

✓ Manage and supervise the work of others, directly and through subordinate managers.
✓ Appraise performance.
✓ Counsel and train employees, directly and through subordinate managers.
✓ Monitors smooth functioning of performance appraisal in the department.
✓ Understand, interpret and apply laws, rules, regulations and policies related to Performance
appraisal.
✓ Develop and implement disciplinary actions as necessary.
✓ Collect, interpret and evaluate narrative another data pertaining to Performance appraisal.
✓ Prepare complex reports and other written materials of Performance appraisal.
✓ Analyze and resolve complex problems related to appraisal
✓ Communicate clearly and concisely, both orally and in writing; present findings, of
Performance appraisal to employees.
✓ Provide excellent interpersonal relations with employees.
✓ Maintains performance appraisal records and reports of all employees working under her/him.

81
 PREPARATION AND PRESENTATION
ANECDOTAL RECORDS

INTRODUCTION
An anecdotal record is an observation that is written like a short story. They are descriptions of
incidents or events that are important to the person observing. Anecdotal records are short, objective
and as accurate as possible

DEFINITION
Anecdotal records is a record of some significant item of conduct, a record of an episode in
the life of students, a word picture of the student in action, a word snapshot at the moment of the
incident, any narration of events in which may be significant about his personality. Randall.

MEANING
Informal device used by the teacher to record behavior of students as observed by him from
time to time.
It provides a lasting record of behavior which may be useful later in contributing to a
judgment about a student.

CHARACTERISTICS OF ANECDOTAL RECORDS

Anecdotal records must possess certain characteristics as given below
They should contain factual descriptions of what happened, when it happened, and under what
circumstances the behavior occurred.
The interpretations and recommended action should be noted separately from the description.
Each anecdotal record should contain a record of a single incident.
The incident recorded should be that is considered to be significant to the students growth and
development of example.
Simple reports of behavior
Result of direct observation.
Accurate and specific
Gives context of child's behavior
Records typical or unusual behaviors

PURPOSE
To furnish the multiplicity of evidence needed for good cumulative record.
To substitute for vague generalizations about students specific exact description of behaviour.
To stimulate teachers to look for information i.e pertinent in helping each student realize good
self- adjustment.
To understand individual’s basic personality pattern and his reactions in different situations.
The teacher is able to understand her pupil in a realistic manner.
It provides an opportunity for healthy pupil- teacher relationship.
It can be maintained in the areas of behaviour that cannot be evaluated by other systematic
method.
Helps the students to improve their behavior, as it is a direct feedback of an entire observed
incident, the student can analyze his behaviour better.
Can be used by students for self-appraisal and peer assessment.

82
GUIDELINES FOR MAKING ANECDOTAL RECORD
Keep a notebook handy to make brief notes to remind you of incidents you wish to include in
the record. Also include the name, time and setting in your notes.
Write the record as soon as possible after the event. The longer you leave it to write your
anecdotal record, the more subjective and vague the observation will become.
In your anecdotal record identify the time, child, date and setting
Describe the actions and what was said.
Include the responses of other people if they relate to the action.
Describe the event in the sequence that it occurred.
Record should be complete.
They should be compiled and filed.
They should be emphasized as an educational resource.
The teacher should have practice and training in making observations and writing records.

ITEMS IN ANECDOTAL RECORDS

To relate the incident correctly for drawing inferences the following items to be incorporated.
The first part of an anecdotal record should be factual, simple and clear.
Name of the students
Unit/ ward/ department
Date and time
Brief report of what happened.
The second part of an anecdotal record may include additional comments, analysis and
conclusions based on interpretations and judgments.

DESCRIPTIVE REPORTS
The instructor writes a brief report on student nurses performance over a given period. These
reports are quite useful if instructor highlights student’s strength and weaknesses in a
systematic way.
Instructor decides what to include in a report and she may quite inconsistent unless she is
guided by some kind of a structure. Otherwise these type of reports turn out to be subjective
assessments.

ADVANTAGES OF ANECDOTAL RECORDS

Supplements and validates of other structured instruments.
Provision of insight into total behavioral incidents.
Economical and easy to develop.
Open ended and can catch unexpected events.
Can select behaviors' or events of interest and ignore others, or can sample a wide range of
behaviors' (different times, environments and people).

DISADVANTAGES OF ANECDOTAL RECORDS

If carelessly recorded, the purpose will not be fulfilled.
Only records events of interest to the person doing the observing.
Quality of the record depends on the memory of the person doing the observing.
Incidents can be taken out of context.
Subjectivity.
Lack of standardization.
Difficulty in scoring.
Time consuming.
May miss out on recording specific types of behaviour.
Limited application.
83
USES OF ANECDOTAL RECORDS
Record unusual events, such as accidents.
Record children's behavior, skills and interests for planning purposes.
Record how an individual is progressing in a specific area of development.
It provides a means of communication between the members of the health care team and
facilitates coordinated planning and continuity of care. It acts as a medium for data exchange
between the health care team.
Clear, complete, accurate and factual documentation provides a reliable, permanent record of
patient care.

ANECDOTOL RECORD ON CLINICAL ASSIGNMENT

NAME Case Case Weekly Clinical Health Demonstration

presentation study care plan teaching education

INCIDENT REPORT
INTRODUCTION
Incident:
• It is an unplanned event within the scope of this procedure that causes, or has the potential to
cause, an injury or illness and damage to equipment, buildings, plant or the natural
environment.
• In a health care facility, such as a hospital, nursing home, or assisted living, an incident report
or accident report is a form that is filled out in order to record details of an unusual event that
occurs at the facility, such as an injury to a patient. The purpose of the incident report is to
document the exact details of the occurrence while they are fresh in the minds of those who
witnessed the event. This information may be useful in the future when dealing with liability
issues stemming from the incident.

TYPES OF INCIDENT
There are mainly three types of incidents
Near Miss
Adverse Events
Sentinel Events

NEAR MISS
This is where the incident did not result in harm, loss or damage, but could have; this is
referred to as a ‘Near Miss’. This may be clinical or non-clinical. Near miss reporting is just as
important in highlighting weaknesses in systems, policies/procedures and practices. If near misses are
84
reported and learn from and any necessary corrective action taken, they can help to prevent actual
incidents of harm, loss or damage from occurring. Near miss should be reported within 24hrs of
working days.
ADVERSE EVENTS
Adverse Incident (Clinical) An event or circumstance arising during clinical care of a patient
that could have or did lead to unintended or unexpected harm’. Adverse Incident (Non-Clinical) ‘An
event or circumstance that could have or did cause unexpected or unwanted harm, loss or damage to
any individual(s) involved (including patients but not related to clinical care, staff, visitors etc) or
damage to/loss of property/ premises in the hospital . It should be reported with in 2 hrs
SENTINAL EVENTS
An unexpected incident, related to system or process deficiencies, which leads to death or
major and enduring loss of function for a recipient of healthcare services. It should be reported
immediately.
INCIDENT REPORTING (STAFF)
It is a requirement of all Hospital staff that they report any incident, accident or potential
incident which has caused or has the potential to cause harm, loss or damage to any individual
involved or loss or damage in respect of property premises for which the hospital is responsible.
HOW TO REPORT AN INCIDENT
Obtain the proper forms from your institution.
Each institution has a different protocol in place for dealing with an incident and filing a
report.
Start the report as soon as possible.
Write it the same day as the incident, if possible, because if you wait a day or two your
memory will start to get a little fuzzy. You should write down the basic facts you need to
remember as soon as the incident occurs, and do your report write-up within the first 24 hours
afterward.
Provide the basic facts.
Your form may have blanks for you to fill out with information about the incident. If not, start
the report with a sentence clearly stating the following basic information given in the Incidence
form.
Write a first person narrative telling what happened.
For the meat of your report, write a detailed, chronological narrative of exactly what happened
when you report to the scene. Use the full names of each person who is included in the report,
and start a new paragraph to describe each person's actions separately.
Be thorough.
Write as much as you can remember - the more details, the better. Don't leave room for people
reading the report to interpret something the wrong way. Don't worry about your report being
too long or wordy. The important thing is to report a complete picture of what occurred.
Be accurate.
Do not write something in the report that you aren't sure actually happened. Be clear. Don't
use flowery, confusing language to describe what occurred. Your writing should be clear and
concise. Use short, to-the-point, fact-oriented sentences that don't leave room for interpretation.
Be honest.
Even if you're not proud of how you handled the situation, it's imperative that you write an
honest account. If you write something untrue it may end up surfacing later, putting your job in
jeopardy and causing problems for the people involved in the incident.
Submit your incident report.
Find out the name of the person or department to whom your report must be sent. When
possible, submit an incident report in person and make yourself available to answer further
questions or provide clarification.

85
PERSON RESPONSIBLE FOR THE IMMEDIATE MANAGEMENT OF THE
INCIDENT
The person responsible for the immediate management of the incident (e.g. the nurse in charge
of the ward at the time an incident occurs), should undertake an immediate assessment of the
situation, in order to determine any immediate treatment and/or ongoing care needs of the
affected person, and/or the extent of any loss/damage to property and any other immediate
action required (e.g. removal and isolation of faulty equipment). The situation/scene should be
made safe.
ROOT CAUSE ANALYSIS
Root Cause Analysis’ is a structured investigation process that aims to assist in the
identification or the root or underlying cause of a particular event or problem by determining
the failure occurred and the actions necessary to prevent or minimize the risk of recurrence.
A ‘Root Cause’ is a failure in a process that, if eliminated, would prevent an adverse incident
occurring. Training for the relevant staff on incident grading/investigation and root cause
analysis will be provided as part of the risk management training programmed.
FAIR BLAME CULTURE
In an organization as large and complex as the Hospital, things will sometimes go wrong. The
wrong assessment should not be one of blame and retribution, but of learning, a drive to reduce
risk for future patients and staff. Blame cannot, and should not, be attributed to individual
health care professionals. Identifying and addressing dysfunctional systems is, therefore, the
key to reduce the risk of harm for many patients and staff through incident form.
It is understood that fear of disciplinary action and subsequent sanctions may discourage the
staff from reporting incidents, therefore, continues to be developed within a culture of ‘fair
blame’. The Management approach following incidents will therefore focus on ‘what went
wrong, and not who went wrong’.

86
INCIDENT RECORD

Employee detail
Name
Department
Phone number

DESCRIPTION OF INCIDENT
Location Incident detail
Date
Time
Police notified
YES
NO

Incident causes Follow up recommendation:

REPORTED BY:
Name:
Position:
Department:

87
DAY REPORT

NEONATAL ICU/ PEDIATRIC ICU

New Transfer out Transfer in Total

admission
NICU 1 1 1 3
PICU
Total 3

B/O VEENA SAHU • Patient come labor room at 9.30AM. Check the height, weight,
LSCS head circumference and stomach wash done.
• Patient transfer ward to neonatal ICU
B/O NEHA DUBEY • Checked the vital reordered and reported
NORMAL DELIVERY • Checked bilirubin level
• Assess the patient condition
• Feeding problem

• Patient comes casualty to neonatal ICU

B/O GULAB
• Patient complain of fever, sneezing, coughing and yellowish
eye
• Check the fever, and bilirubin level
• Send the investigation biochemistry
B/O Saroj
• Patient transfer to the ward

88
HANDLING AND TAKING OVER REPORT
This handover template is based on the SABR technique (situation, assessment,
recommendation), which is designed to improve patient safety and wellbeing in healthcare
setting
Patient : NHS no:
Location: Date admitted

Date:

Ward/ Team

Current shift Next shift

Current shift leader Next shift leader

SITUATION

Current condition/ status:

Recent actions

Special notes

Any other info:

BACKGROUND

Relevant medical history:

Relevant personal needs:

Past medication
requirement:

89
ENQUIRY REPORT

1 Customers name
Contact person
Address
Contact {0} {R}
{0} {R} {Mobile no.}
Fax
Inquiry received through Tender
Letter
Personnel references
Phone

2 Last date of submitting location

3 PRODUCT
s.no item size criteria-1 criteria-1 criteria-1 schedule Remark
delivery
date

4. Cost estimation
s.no Description Quantity Estimated cost Sales price /kg
and per kg

90
NURSES REPORT
INTRODUCTION
Reports can be compiled daily, weekly, monthly, quarterly and annually. Report summarizes the
services of the nurse and/ or the agency. Reports may be in the form of an analysis of some aspect of a
service. These are based on records and registers and so it is relevant for the nurses to maintain the
records regarding their daily case load, service load and activities.
IMPORTANCE OF GOOD REPORT
It helps in efficient management of the ward.
Complete reports give a sense of security which comes from knowing all factors in the
situation.
Patients receive better care when reports are thorough and give all pertinent data.
Full reports often save embarrassment due to ignorance of situation.
Good reports save duplication of effort and eliminate the need for investigation to learn the
facts in a situation.
CRITERIA FOR GOOD REPORT
Good oral reports are clearly expressed and presented in an interesting manner. Important
points are emphasized.
No extraneous material is included.
It is clearly stated and well organized for easy understanding.
A good report is clear, complete, and concise.
Reports should be made promptly if they are to serve their purpose well.
If it is written all pertinent, identifying data are include – the date and time, the people
concerned, the situation, the signature of the person making the report.
TYPES OF REPORT
Oral reports : Oral reports are given when the information is for immediate use and not for
permanency. E.g. it is made by the nurse who is assigned to patient care, to another nurse who
is planning to relieve her.
Written reports : Reports are to be written when the information to be used by several
personnel, which is more or less of permanent value, e.g. day and night reports, census,
interdepartmental reports, needed according to situation, events and conditions.
RECORD USE IN HOSPITAL SETTING
Change- of- shift reports or 24 hours report
Provide only essential background information about client (name, age sex, diagnosis and
medical history) but do not review all routine care procedures or task.
Identify clients’ nursing diagnosis or health care problems and other related causes
Describe objective measurements or observations about clients’ condition and response to
health problems. Stress recent change, but do not use critical comment about clients’ behavior
Share significant information about family members, as it relates to clients’ problems
Describe instructions given in teaching plan and clients’ response.Continuously review
ongoing discharge plan. Do not engage in gossip.

91
 SAMPLE OF AN CHAGE OF SHIFT REPORT OR 24 HOURS REPORT

WARD:
NUMBER OF BED:
DATE:
BED NO. NAME DISGNOSIS MORNING EVENING NIGHT
AND AGE SHIFT SHIFT SHIFT

FINAL CENSES:

SIGNATURE:

TRANSFER REPORTS
A transfer reports involve communication of information about clients from the nurse on
sending unit to the nurse on the receiving unit. Nurse should include the following information.
A transfer reports involve communication of information about clients from the nurse on
sending unit to the nurse on the receiving unit. Nurse should include the following information.
Client’s name, age, primary doctor, and medical diagnosis.
Summary of medical progress up to the time of transfer.
Current nursing diagnosis or problems and care plan.Current health status- physical and
psychosocial.
Needs for any special equipments etc. Any critical assessment or interventions to be
completed shortly.
INCIDENT REPORTS
The nurse who witnessed the incident or who found the client at the time of incident should file
the report.
The nurse describes in concise what happened specifically objective terms, etc
The nurse does not interpret or attempt to explain the cause of the incident.
The nurse describes objectively the clients, conditions when the incident was discovered
Any measures taken by the nurse, other nurses, or doctors at the time of the incident are
reported.
92
 The report is submitted as soon as possible.No nurse is blamed in an incident report
No nurse is blamed in an incident report
The report is submitted as soon as possible.
The nurse should never make photocopy of the incident report.

CENSUS REPORT
This is a report compiled daily for the number of patients. Very often it is done at midnight and
the norms are collected by the night supervisor. The report will show the total number of
patients, the number of admissions, discharges, transfers, births and deaths. The nurses should
remember that a single mistake in the census figures made buy one of the nurses make the
census report of the entire institution incorrect.

BIRTH AND DEATH REPORT

The nurses are responsible for sending the birth and death reports to governmental authorities
for registration within the specified time.

ANECDOTAL REPORT
An anecdote is brief account of some incident. Incident reports and reports on accidents,
mistakes and complaints are legal in nature.
A written record concerning some observation about a person or about her work is called an
anecdote note.

NURSING RESPOSIBILITY OF RECORD KEEPING AND REPORTING

The patient has a right to inspect and copy the record after being discharged
Failure to record significant patient information on the medical record makes a nurse guilty of
negligence.
Medical record must be accurate to provide a sound basis for care planning.
Errors in nursing charting must be corrected promptly in a manner that leaves no doubts about
the facts.
In reporting information about criminal acts obtained during patient care, the nurse must reveal
such information only to the police, because it is considered a privileged communication.
FACT
Information about clients and their care must be functional. A record should contain
descriptive, objective information about what a nurse sees, hears, feels and smells.
ACCURACY
A client record must be reliable. Information must be accurate so that health team members
have confidence in it.
COMPLETENESS
The information within a recorded entry or a report should be complete, containing concise and
thorough information about a client care or any event or happening taking place in the
jurisdiction of manger.
CURRENTNESS
Delays in recording or reporting can result in serious omissions and untimely delays for
medical care or action legally, a late entry in a chart may be interpreted on negligence.
ORGANIZATION
The nurse or nurse manager communicates information in a logical format or order. Health
team members understand information better when it is given in the order in which it is
occurred.
CONFIDENTIALITY
Nurses are legally and ethically obligated to keen information about client’s illnesses and
treatments confidential.

93
OFFICIAL LETTER
Sample letter representative or senator
DATE:
NAME:
ADDRESS:
CITY, STATE, PINCODE:
PHONE NO.

The honorable
House of representative or unitated states senate
Office address of representative of senator

Dear Representative/senator
{In your first paragraph include personal information} I am very fortute to have been provided with an
excellent education thet prepared me for the future. I Currently have children in both elementary and
middle school. Recently, I have become very concerned about legilative impact on education. As a
parent yourself, Iam sure that you share many of these concerns.

{Include fact} Research has shown that school with strong school library media programms have
better rate of success.

{State what you are asking for} I ask that you support (insert name of bill here ). In supporting this bill
funding will be provided that will support school library media programms. This is avery small prices
to invest in the futures of our nations children. All children should have the opportunity to achieve and
develop skills necessary for the future. I believed that in supporting this bill you will impact the lives
of countless children.

Sincerely,

94
CURRICULAM VITAC

INTRODUCTION
• CVs are ‘first impression’ in the selection process that could land you on a new career path.
CV is a summary of your career history, and the skills and experience you have gained.
• Put as much effort into your CV as you do into your exam and interview.
• The CV is your opportunity to be in the spotlight.

REASONS FOR WRITING A CV

• Attract attention.
• Create a good impression.
• Show that you have the necessary qualities and qualification to do the job you applying for.

FACTOR AFFECTING CURRICULAM VITAC

The position
The candidates
The scores required to
Knowledge
be accepted
Skills
The skills required to
Abilities
do the job
Attitudes
The abilities to cope
with a changing and to
learn new skills
The attitudes required
to be successful and to
be accept

ELEMENTS OF A CURRICULAM VITAC

• Personal details.
• Qualifications and standardized exams.
• Jobs and Clinical experiences.
• Conferences and symposiums.
• Courses and workshops.
• Lectures and seminars delivered
• . Researches and publication
• Activities and voluntary works.
• Academic interests
• Personal interests
• Personal Details

95
 DEVELOPING STANDARDS FOR PATIENT CARE
STANDARD
The standard of care is a constant
The same standard of care is expected from a generalist and a specialist.
But what amounts to reasonable care with regard to the specialist differs from what amount of
reasonable care is standard for the generalist.

DEFINITION
Predetermined levels of excellence that serves as a guide for practice

Standards are professionally developed expressions of the range of acceptable variations from
a norm or criterion

(Avedis Donabedian)
Criteria are pre-determined elements against which aspects of the quality of medical service
may be compared.

NURSING STANDARD
Are needed to practice safely.
They reflect a desired and achievable level of performance against which actual performance
can be compared. Their main purpose is to promote, guide and direct professional nursing
practice.
Broad statements of quality.
Provide exact criteria with which clients, nurses and employers can evaluate care for
effectiveness and excellence.
Used as a measurement tool and hence should be objective, measurable and achievable.
There is no one set of standards, each organization and profession must set standards and
objectives to guide individual practitioners in performing safe and effective care.

IMPORTANCE OF NURSING STANDARD

Outlines what the profession expects of its members. & respect for the various &
complementary roles
Provides nurses with a framework for developing competencies
Promotes guides and directs professional nursing practice – important for self-assessment and
evaluation of practice by employers, clients and other stakeholders.
Aids in developing a better understanding & respect for the various & complementary roles
Provide a baseline for evaluating quality of nursing care.
96
 Helps supervisors to guide nursing staff to improve performances.
Help Nursing to clearly define different levels of care.
Help to clarify the Nurse’s area of accountability.
It is a device for quality assurance as Quality Help Nursing to clearly define different levels
of care.

STANDARD FOR PATIENT CARE

STANDARD- I ASSESSMENT: Assessment is the initial step in the nursing process. The
nurse assess the physical and psychological aspects of the client and systematically collects
date that are accurate and comprehensive

STANDARD- II DIAGNOSIS: The nurse the assessment data in determining diagnosis

STANDARD- III OUT COME IDENTIFICATION: The staff identifies expected outcomes
individualized to the child and family

STANDARD- IV PLANNING: The nurses develop a plan care that prescribes interventions
to obtain expected outcome

STANDARD- VI IMPLEMENTATION: The nurses implements the intervention identified

in the plan of care

STANDARD- VI EVALUATION: The nurse evaluate the clients progress toward attaintent
of outcomes and reassessment the client.

STANDARD OF PROFESSIONAL PERFORMANCE

STANDARD- I QUALITY OF CARE
The nurse systematically evaluates the quality and effectiveness of nursing practices.
STANDARD- II PERFORMANCE APPRAISAL
The nurse evaluates his or her own nursing practice in relation to professional practice standard
and relevant status and regulations
STANDARD- III EDUCATION
The nurse acquires and maintain current knowledge and compenterncy in the nursing practice.
STANDARD- IV COLLEGIALITY
The nurse interact with and contribution to the professional development of peers colleagues
and other health care providers.
STANDARD- V ETHICS
The nurse assessment action and recommendation on clients and their family are determined in
an ethical manner.
STANDARD- VI COLLABORATION
The nurse collaborates with the client family and other health care providers in the providing
client care.
STANDARD- VII RESEARCH’
The nurse contributes to nursing and health care through the use of research methods and
findings
STANDARD- VIII RESOURCES UTILIZATION
The nurse considered factors relate to safety, effectiveness and cost in planning and delivering
patient care

97
PREPARATION OF AN ASSESSMET TOOL FOR EVALUATING NURSING STANDARDS
IN NURSING SERVICE/ NURSING EDUCATION
SAMPLE ASSESSMENT SCALE FOR NURSING PERSONNEL
HOSPITAL……………………………………………….
WARD…………………………………………………………
NAME OF EMPLOYEE…………………………………………………
1 2 3 4 5
Patient care – dose she:
➢ Perform assignment skillfully
➢ Show a genuine interest in comfort and progress
of patient?
➢ Establish good rapport with patient

Responsibility- dose she:

➢ Report on duty punctually
➢ See work to be done and show initiative in
doing it?
➢ Follow directions intelligently and with
judgment?
➢ Carry out assignments promptly?
Neatness
➢ In uniform- without jewellery hair off collar and
tidy, etc
➢ In work does she return articles to their proper
place and aid in keeping units near?
Health –does she:
➢ Observe good health habits cleanliness, hand
washing, good posture etc.
➢ Appear rested each morning?
➢ Perform her assignments without undue
physical and mental strain?
Adaptability- does she:
➢ Show understanding and courtesy to her
coworkers?
➢ Meet new situations calmly?
➢ Accept suggestions for improvement graciously

Loyalty – does she:

➢ Avoid criticism or comments before patient?
➢ Avoid destructive criticism or ideal gossip?
➢ Observe rules and upload standard?
➢ Preserve her problem to the proper person?

The reserve side of this from should contain for comments by the rarer and the following
Record discussed with nurse………………………………..
Date …………
Signed…………………….
Rank or position…………………………….

98
ASSESSMENT TOOL FOR EVALUATING NURSING STANDARD IN NURSING
EDUCATION
Name ………………….. Date……………..
Audience ………………………… Date……………..
Topic…………….

S.no. Items to be evaluated during Excellent Very Average Poor Very

presentation good poor
1 Introduction
a) Appropriate
b) Interesting
2 Content
a) Relevant and adequate
b) Organization
c) Mastery of the subjects
d) Recent trends
3 Presentation
a) Posture
b) Confidence
c) Voice audible
d) Clarity and language
4 Time management
5 A.V. aids{black board,
models,chart}
6 Preparation of lesson plan
7 Summarization
8 Assignment to students
9 Bibliography
Total

GENERAL COMMENTS……………………………………………………….
……………………………………………………………………………..
……………………………………………….

Signature of the student: Signature of the evaluator:

99
EVALUATION FORMAT OF THE NURSING STAFF
CENTRE
NAME ………………. AGE…………….
DATE OF APPOINTMENT…………….. DESIGNATION……………
NAME OF THE SUPERVISOR……………….. DATE……………….
S.NO CONTENT 1 2 3 4 5
1 Attendance
1. Always prompt on duty
2. Occasionally late on duty
3. Usually late on duty
4. Very often late on duty
2 Appearance
1. Always well groomed neat and tidy in
uniform or suitable dress
2. Mostly well groomed
3. Occasionally unity
4. Always untidy
3 Knowledge and application of nursing
principles
1. Knows and apply knowledge in all
nursing situations
2. Knows but does not apply in all nursing
situations
3. Knows but applies only when directed
4 Initiatives
1. Seeks and set up for new additional tasks
2. Resourceful alert to apportuties for
improvement of work and solution of
problems
3. Routine worker
5 Quality and quantity of work
1. exceptionally of high quality
2. quality is a above average
3. quality is quite satisfactory
4. quality quite not up to standard but not
unsatisfactory
6 Reliability
1. Exceptionally reliable
2. Reliable
3. Fairly reliable
4. Often not reliable
7 Responsibility
1. Hign sence of responsibility meets all of
them with out supervision
2. Take responsibility well
3. Meet responsibility satisfactory
4. Meet responsibility well but needs
supervision
5. Meet little or no responsibility
8 Nursing skills techniques and procedures
1. Practice accurate nursing techniques and
procedure
100
 2. Does not practice accurate nursing
techniques and procedure
9 Planning
1. Adequate and complete {neat
conciselegible, methodical, precise and to
the point }
2. Average {occasionally incomplete,
illegible}
3. Poor {incomplete, illegible}
10 Records
1. Adequate and complete {neat
conciselegible, methodical, precise and to
the point }
2. Average {occasionally incomplete,
illegible}
3. Poor {incomplete, illegible}

11 Teamwork and personal relationship:

1. Cooperative exceptionally well and
maintains good
2. Cooperative good maintains satisfactory
relationship
3. Cooperative at time not effective
4. Often fails to cooperate and maintain
relationship
12 Attitude towards supervisions:
1. Seeks advice and guidance
2. Accept and follows corrections always
3. Accept corrections but does not always
follow them
4. Argumentative and refuses corrections
13 Leadership interest and professional growth
1. Avails opportunities for personnel and
professional growth
2. Does not avail opportunities for
improvement of self
3. Is able to get work done from others

Special remark if any

……………………………………………………………………………………………………………
…………………………………………………………………………………
SIGNATURE OF SUPERVISOR SIGNATURE OF STAFF

101
 ORGANIZATION AND STAFF DEVELOPMENT
PROGRAMME
INTRODUCTION
Staff development is the process directed towards the personal and professional growth of
nurses and other personnel while they are employed by a health care agency. Staff development refers
to all training and education provided by an employee to improve the occupational and personal
knowledge, skills and attitudes of vested employees.

DEFINITION
Staff development refers to the processes, programs and activities through which every
organization develops, enhances and improves the skills, competencies and overall performance of its
employees and workers.

NEED FOR STAFF DEVELOPMENT

• Social change and scientific advancement
• Advancement in the field of science like medical science and technology.
• To provide the opportunity for nurses to continually acquire and implement the knowledge,
skills, attitudes, ideals and valued essentials for the maintenance of high quality of nursing
care: – As part of an individual’s long-term career growth.
➢ To add or improve skills needed in the short term
➢ Being necessary to fill gap in the past performance
➢ To change or correct long-held attitudes of employee
➢ Need to increase the productivity and quality of the work
➢ To motivate employees and to promote employee loyalty
➢ Fast growing organizations.

• Staff Development Activity

Staff development activities are defined by its concepts such as competence, interest needs leaning
and training.

• Competence
Is the state of processing qualities and abilities that are required for a normal role a task (eg) nurse
competence in handling new equipment.

• Interests
Are inclinations that cause an individual to be attracted or repelled by certain objects, events are
persons with the result that the individual seeks experience that favor development. The goal of
staff development program should be stimulate sufficient interest is a topic that the learner will
continue to study the object independently.

• Need
Is a lack, tension, desire condemned that implies a person to specific behavior. An educational
need is a measurable discrepancy between a person’s actual job competence and designed
competence level.
• Learning
Consists of desirable behavioral from a proscribed experience.
• Training
May be defined as an method of ensuring that people have knowledge and skills for a specific
purpose that they acquired the necessary knowledge to perform the duties of the job. It is expected
to acquiring new skills will increases productivity or create a better product.

102
GOALS FOR STAFF DEVELOPMENT
• Assist each employee (nurse) to improve performance in his/her position
• Assist each employee (nurse) to acquire personal and professional abilities that maximize the
possibility of career advancement.
OBJECTIVES FOR STAFF DEVELOPMENT
• To increase employee productivity.
• To ensure safe and effective patient care by nurses.
• To ensure satisfactory job performance by personnel.
• To orient the personnel to care objectives, job duties, personnel policies, and agency
regulations.
• To help employees cope with new practice role
• To help nurses to close the gap between present abilities and the scientific basis for nursing
practice that is broadening through research.
STEPS OF STAFF DEVELOPMENT PROGRAM
• Assess the educational needs of all staff members
• Set priority
• Develop general objectives for the staff development program
• Determine the resources needed to reach the desired objectives
• Develop a master calendar for an entire year
• Develop and maintain staff development record system
• Establish files on major educational topics
• Regularly evaluate the staff development program
RESOURCES
• Public libraries
• Audiovisual program in addition to many books and computers, research activities and
speakers to community groups.
• Schools and universities
• Association Health and inter service agency
• Other nursing homes
• One’s own staff
Staff Development Model for Goal Achievement of the Health Care Agency the
Nurse and the Nursing Profession

103
 • SOCIO ECONOMICS.
i. Manpower planning
➢ Recruitment
➢ Selection
➢ Placement
ii. Counseling
➢ Performance evaluation
➢ Career planning.
➢ Promotion
iii. Employee- employer relation
➢ Personal politics and practices
➢ Health services
➢ Labour relations

• EXPERIENCE
i. Nursing practice
Direct patient care.
➢ Approach of independent patient care assignment or team approach.
Indirect patient care
➢ Supervision, administration, teaching and research.
ii. Other real life experiences
➢ Colleague interaction.
➢ Voluntary activities to health care.
➢ Professional association and participants.
➢ Personal life.

• EDUCATION
i. Continuing education
In service
Orientation
➢ Skills, attitude and knowledge pertinent to nursing practice within health care team.
➢ Extra mural education
➢ Post graduate education Education after graduation or the basic education.

TYPES OF STAFF DEVELOPMENT

➢ Induction Training.
➢ Job Orientation
➢ In service education
➢ Continuing education
➢ Training for special function

INDUCTION TRAINING
Induction is the process of receiving and welcoming an employee when he first joins a company and
giving him the basic information he needs to settle down quickly and start work

104
NEED OF INDUCTION TRAINING
➢ Increased retention of newly hire employees
➢ Improved employee morale and Increased productivity.

STEPS IN INDUCTION
➢ Tour of facilities
➢ Introduction to the other employees, superiors and subordinates.
➢ Description of organizational functions.
➢ Departmental visit
➢ Orientation to philosophy goals and objectives
➢ Administration policies and procedures

JOB ORIENTATION.
The process of creating awareness with an individual of his/her roles, responsibilities and
relationships in the new work situation.
Components
➢ A new employee to his or her job setting so that he / she is aware of his/ her job responsibility
and expectation.
➢ present employee to the job responsibilities of his/ her expanded/ enriched role. The old
employees to the policy changes.
IMPORTANCE OF ORIENTATION PROGRAMME
➢ Acquaints her with personnel services readily with in the institution/community
➢ Help new employee in solving initial problems and adjust the new situation/environment,
➢ Apprehension
➢ Mistakes and confusion
➢ Reduces misinterpretation
➢ Passing of incorrect information by old employees and peers.
➢ Learning by trial and error
➢ Eliminates
➢ Helps the new employee to develop a sense of belonging
➢ Lessen the time for the employee to learn about new situations related to his/her job setting.
➢ Helps employee to gain confidence,
➢ Provides essential, relevant and necessary information
IN SERVICE EDUCATION
Definition
The education which builds a previous education is called continues education. Continuing education
is all the learning activities that occur after an individual has completed his basic education
Concept of in- service education
➢ Closely identified with services Help a person’s to improve performance effectively Planned
education activities Provided in a job setting
Aims of continuing education
➢ It develops interest, job satisfaction and confidence
➢ To keep the nurses with the latest development of technologies
➢ To motivate the staff to seek the latest knowledge
➢ Improvement of professional practice
Purpose of continuing education
➢ Improve the ability to communicate or participate in research work.
105
 ➢ Increase ability in order to solve the problem in a clinical teaching/ administrative area.
➢ Ensure professional development
➢ Provides exposure to new concepts, procedural refinements, innovative product applications,
or acquisition of increased expertise
➢ Enable a worker to move from satisfactory to excellent performance.
Need of continuing education
➢ To acquire specialized skill for professional.
➢ Professional are altered as society changes and as technologies emerge
➢ For career advancement
➢ Development of nurses by updating their knowledge
➢ Changing health care delivery system,
➢ To ensure safe and effective nursing care
TRAINING FOR SPECIFIC FUNCTION
Definition : This is concerned with developing expert technical or manual skills, communication
and helps the personnel to perform their functions effectively.
Objectives
➢ To help the nursing personnel to perform correct methods and procedures with understanding.
➢ Establishing standards and quality of nursing services.
➢ Procedure to skill nurses to skilled nurses.
Need for skill training
➢ A venues of advancement and promotion need to be better development
➢ Good work to be recognized and reward.
➢ Individual nurse needed to have greater freedom to choose the specific field of nursing
in which she would work.
Guidelines for skill training
➢ Set the stage, using equipment similar to that provided for the worker in the work situation
➢ Create in worker a learning attitude
➢ Give reasons why the procedure is carried out in this way in this agency
➢ Break the activities in to logical steps, necessary to carry out the procedure.
➢ Make certain that the person has learnt by requiring a return demonstration
➢ Provide written out lines for references
➢ Arrange for follow up (supervision)
FUNCTIONS OF STAFF DEVELOPMENT PROGRAM
➢ To provide educational activities for all nurses employed by the health care agency directed
towards change behavior related to role expectations.
➢ The staff development program must be concerned with the growth and development of
personal from their critical contact with a health care agency until termination of service.
➢ Staff development can be facilitated within an agency and can be provide a linkage with per
service education, experience and socio economics of the nurse.
SUMMARY
Staff development can be viewed as the activities and programs (formal or informal and on or
off campus) that help staff members learn about responsibilities, develop required skills and
competencies necessary to accomplish institutional and divisional goals and purposes, and grow
personally Staff development refers to all the policies, practices, and procedures used to develop the
knowledge, skills, and competencies of staff to improve the effectiveness and efficiency both of the
individual and the University

106
 PREPARATION OF PROTOTYPE PERSONNEL FILES
Policy: FACULTY PERSONNEL FILES
Effective date: July 1, 2017
Review date: July 1, 2021
Revised:

FACULTY PERSONNEL FILES

Faculty personnel files, which may include both paper and electronic records, are maintained
by the college or department in which the faculty member is employed and the office of Human
Resources. Collectively these documents are referred to in the Policy as “Faculty Personnel Files.”
Material in personnel files should be maintained together as a personnel file. Electronic documents
should be stored together as a personnel file.

MATERIAL IN FACULTY PERSONNEL FILES

a. DEPARTMENT OR COLLEGE PERSONNEL FILES

The department or college faculty personnel file shall contain the following information:
Letters of hire, contracts, and faculty role assignments;
Annual reviews, with performance ratings and any written appeals, by department heads and
college deans;
Official letters of warning, reprimand, or disciplinary suspension;
The department or college file may contain the following information at the discretion of the
unit maintaining the file:

Complaints, negative comments, or other subjective or evaluative material may be placed in

the file only after the faculty member has been provided notice of the material and an
opportunity to respond. After consideration of the faculty member’s response, the supervisor
will notify the faculty member if the material will be placed in the file. Complaints or
criticisms that have not been made known to the faculty member may not be placed in the
personnel file or considered in any personnel decision. The faculty member may submit a
rebuttal, comment, and/or clarification of any unfavorable item in the file which will be
attached to the relevant item in the file.
Laudatory letters, achievements, and other honors or awards may be placed in the file at the
discretion of the unit maintaining the file and should be shared with the faculty member.
Any communications which the faculty member originates concerning terms and conditions of
employment.

b. HUMAN RESOURCES PERSONNEL FILES

The faculty personnel files maintained by Human Resources [HR] may include employment
contracts, payroll and appointment records, sick and annual leave usage records, benefits documents,
hiring documents, home address, phone, and other paper and electronic records related to the terms
and conditions of employment, but will not include evaluative material such as annual reviews,
promotion, tenure and retention reviews, disciplinary records, etc. Human Resources is also
responsible for maintaining the Banner HR system which contains information about university
employees necessary to perform various HR functions.

107
RETENTION, TENURE AND PROMOTION DOSSIERS AND TEACHING EVALUATIONS

The Provost’s Office will maintain a copy of the complete dossier, including letters of peer
reviews, recommendations of reviewers, for each faculty member who applies for retention, tenure, or
promotion. The dossier will be maintained for the duration of the faculty member’s employment with
the university. The department will also maintain a copy of the teaching evaluations for each faculty
member for the duration of the faculty member’s employment. These files are not considered part of
the “personnel files.” A faculty member may request access to the files with the exception of
confidential materials, such as letters of external peer review. See Promotion and Tenure.

CONFIDENTIALITY

The unit maintaining the files is responsible for the confidentiality and security of the records.
All personnel records are to be kept in a locked file cabinet or, if maintained electronically,
protected by appropriate passwords or other security mechanisms.
Faculty personnel files are maintained as confidential and may be used only by those
administrators who are in the line of supervisory authority or employees who must access files
to perform their official duties. Public information contained in personnel files may be released
upon approval of the Chief Human Resource Officer.
The faculty member may review their personnel files upon request and at such time and place
as may be designated by the unit maintaining the files. The faculty member may seek copies of
the records, but may not remove the original files. The faculty member may request and/or
authorize, in writing, the release of non-public records or the entire personnel file to such
persons or entities identified by the faculty member

CUMULATIVR RECORD
INTRODUCTION
The cumulative record is device for recording information about the student, which is collected
from different sources over a period of time. This information are essential for guidance and
counseling of the students.

DEFINITION
According to Mure
Thomas, “It is information about a pupil collected during a long period.”
According to Allen,
“The cumulative record is defined as a record of information concerned with appraisal
of the individual pupil-usually kept on a card kept in one place.”

IMPORTANCE OF CUMULATIVE RECORDS

Usefulness
Group- based evaluation
Continuity
Re- evaluation
Based on all round development
Full record
Secrecy
Factual information
Simple and complete information

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TYPES OF CUMULATIVE RECORDS
Simple card record:- It is single sheet information recorded on both side.
Pocket folders:- It is a folder with a number of pockets posted inside and different information
can be kept.
Cumulative folder:- This folder can keep maximum information

CONTENTS OF CUMULATIVE RECORD

Health
Attendance
Home and community
Personal
Measurement of abilities:-Personal Interests  Special ability, General ability
Planning in education and for employment
Attitude towards the school
Academic work

STUDENT CUMULATIVE RECORD

ACADEMIC YEAR: 20 - 20
COLLEGE NAME ……………………….. COLLEGE CODE

STUDENT PROFILE
Name of the student
Gender
Class and section
Roll number
Date of birth
Father mane
Mother name
Guardians name
Residential address Student recent
Contact number photograph
Health status Height:
Weight:
Blood group:

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 IDENTIFY THE PROBLEM OF SPECIALTY UNITS AND
DEVELOPS PLAN OF ACTION BY USING PROBLEM SOLVING
APPROACH
INTRODUCTION
Problem solving is a mental process and is part of the larger problem process that includes problem
findings and problem shaping. Considered the most complex of all intellectual function, problem
solving has been defined as higher order cognitive process that requires the modulation and control of
more routine or fundamental skills. Problem solving occurs when an organism or an artificial
intelligence system needs to move from a given state to a desired goal state.

DEFINITION
A Nurse Manager most effective leadership skill in problem solving ability. A problem is a situation
for which an individual has no ready response in her or his behavioral repertoire. An optimist might
see a problem as a poorly defined opportunity for improvements in a situation

At this point one may be wondering about the relationship between decision making and problem
solving. The first step in decision making was to indentify the problem. But problem solving can
involve the making of several decision. The best way to define the relationship between the is to
define the steps of problem solving

PRINCIPLES OF PROBLEM SOLVING

To resolve problem affecting organizational efficiency, the manger should separate large
problem from ones use policy to solve the smaller problem, and conserve managerial time for
major solving problem.
The manager should delegate smaller problems to subordinates and teach them to solve these
by applying existing agency rules.
In resolving operational problems, the manager should consult internal and external experts, so
that solutions will be based on current knowledge.
Problem solutions are most effective when the manager approaches problems in relaxed
fashion and refuses to solve problems under stress.
It is impossible to anticipate all eventualities or to expect 100 percent accuracy in diagnosing
and resolving problems. Therefore, it is unwise to agonize over selecting a solution.
To conserve time, a nurse manager should ensure that job descriptions and personnel-
evaluation forms specify employees’re possibilities for problem-solving. The manager should
be explicit in assigning problem-solving responsibility to particular employees and prepare
detailed agendas for problem-solving meetings. The manager should show appreciation for
unacceptable, as well as acceptable, ideas generated during employees’ search for a problem
solution. An official format should be used in presenting and reviewing proposed solutions to
ensure that all employees’ proposals receive equal consideration. "

CHARACTERISTIC OF SKILLFUL PROBLEM SOLVING

In decentralizing authority for clinical decisions, a manager should delegate the responsibility to
the most capable nurses.
Creative solutions are generated by nurses with clinical expertise, understanding of the
problem’s long -range effects and skill in symbolic expression.
Highly creative persons are characterized by their wide range of interests and their knowledge
of several subjects. Persons with research skills are inclined to be politically liberal, cognitively
complex, and reflective.
Nurses use different approaches to problem-solving. Some prefer a serial approach, inwhich
they tackle problems in sequence, completely resolving one before turning to thenext. Others

110
 survey all existing problems, rank them by importance, and solve one at atime in order of
priority. Still, others group problems according to the resources needed toinvestigate and
remedy each, then solve a group of related problems simultaneously.
Creative persons become intrigued by related problems during investigation of theprimary
problem and, so redesign the search to branch in several directions and work onseveral
problems at once, each at a different stage of resolution."

IDENTIFY THE PROBLEMS OF SPECIFY UNITS

A. Psychological problems:
1. Moving from “Novice to Expert”
One of the challenges for beginning nurses is pressure to function as an expert without
adequate knowledge and skills. J

anice (2004) identified six different roles which nurses perform while they move from the sale
of being a Novice to Expert.
The helping role
The teaching-coaching function
The diagnostic and monitoring function
Effective management of rapidly changing situation”
Administering and monitoring therapeutic interventions and regimens
Monitoring and ensuring the quality of health care practice and organizational work-role
competencies.

2. Reality shock
One problem confronted by the new graduates is the seeming impossibility of delivering quality care
within the constraints of the system as it exists. The person undergoing such stress is less able to
perceive the entire situation and to problems effectively.

3. Burnout
Burnout is a form of chronic stress related to one’s job. It can be identified by feelings of hopelessness
and powerlessness, and is accompanied by a decreased ability to function both on the job and in
personal life. Burnout is more frequent in nurses who work in particularly stress full areas of nursing.
It also occurs when staffing is inadequate or interpersonal relationships a restrained. The main causes
for burnout are conflict between ideals and reality, practicing nursing in areas that have high mortality
rates, inadequate staffing, staying overtime, skipping breaks and lunch and running throughout the
shift.

4. Discrimination
Discrimination relates to treating other differently based on stereotypes about groups of
people. Discrimination may occur regarding racial or ethnic background, gender or sex, sexual
orientation and/ or age. Men in nursing have expressed concern about sex discrimination. They are not
allowed to care for women clients, or restrictions are placed on them in terms of obtaining consent
from each client. Female nurses care for men clients in all situations. This has been accepted because
women are commonly seen in nursing and the public associate smothering role with nursing.

5. Mandatory overtime
Mandatory overtime is another way that hospitals deal with poor staffing. It creates a loss of control
for the nurse over the ability to schedule non-work activities, including essential family” functions.
This also puts safe patient care at risk because of nurse’s fatigue and s ubsequent lossof ability to
concentrate and make good decisions.

111
6. Floating
Nurses are sometimes required to ‘float’ from the area in which they normally practice to other
nursing units.
B. Physical problem
1. Harassment and violence
Violence includes a range of behavior from verbal abuse, threats and unwanted sexual attacks to
physical assault and at the extreme, homicide. According to OSHA, two thirds of non-fatal workplace
assaults happen in health and social services facilities, the majority of these are assaults by clients on
nursing staff, and more in psychiatric mental health setting than in other settings. The WHO has
identified violence as a worldwide problem, which threatens the effective delivery of health care
(WHO 2002). Both men and women may be the objects of sexual harassment.
Sexual harassment is a concern in nursing. Harassers in the health care workplace may be clients,
coworkers, or physicians. The most dangerous settings for violence are psychiatric units and nursing
homes, where patients are often confused, disoriented or suffering from mental ailmentsas well as
emergency rooms, where long waits for care can anger patients, and the people withthem.

2. Infection as an Occupational hazard

Transmission of infection is a major concern for the nurses when caring for infected clients. The
higher danger for nurses lies in those clients who have not been diagnosed as having an infection and
for whom specific infection-control measures" have therefore not been prescribed.

3. Needle stick injuries

Needle stick injuries especially those with large-bore needles (e.g. bone-marrow aspirationneedles)
continue to be the most frequent source of infection transmission. "

4. Hazardous chemical agents

Nurses working in operation rooms should seek information regarding anaesthetic gases that can
increase the risk of foetal malformation and spontaneous abortion in pregnant women who are exposed
to them on a regular basis. Chemotherapeutic agents used in the treatment of cancer are extremely
toxic and nurses who work in setting where such agents are prepared and administered should seek
additional education regarding their administration, not only in relation to the client’s safety but also
personal safety. Contact with any medication, especially antibiotics,during preparation and
administration may cause the nurse to develop sensitivity leading to hand-rash for example. Some
medications are absorbed through the skin and may produce an undesirable effect. Cleansing agents
and disinfectants used in the hospital may also be hazardous if used improperly.

5. Back injuries
Nursing includes providing direct care to incapacitated individuals; hence back injuries are a common
occupational hazard .

6. Bio terrorism
Most biological attacks will be covert, meaning that there will be no warning. Therefore, it is
important that nurses should know and understand what bioterrorism is and how to identify a potential
event because health care workers in hospitals and clinics may have the first opportunity to recognize
the covert event. An alert nurse can save lives, including her own. Anthrax, botulism, plague and
smallpox are considered the four top agents for potential bioterrorism because plague and smallpox
can be disseminated to a population via airborne release. "

"STEPS IN THE PROCESS

The steps of the problem-solving process are the same as the steps of the nursing process and
the decision-making process: access and analyze, plan, implement and evaluate. Assessment
includes systematic collection, organization and analysis of data related to specific problem or

112
need. It involves logical fact-finding, questioning all sources and differentiating between
objective facts and subjective feelings, opinions and assumptions. Knowledge and experience
guide the data collection and analysis of data. Before the process goes any further assessment
should also determine whether a commitment exists to implement a decision or an action.
Making certain that there is no readily apparent solution also saves the time of all the people
who may become involved in problem-solving. Once the problem is identified, it must be
determined whether it requires other than routine handling- that is, whether it is a rare or
unique situation rather than are current one. This leads to the second step of problem-solving
planning.
Planning involves several phases. In nursing terms we determine priorities, set goals and
measurable objectives, and plan interventions. Management literature essentially says the same
thing: break the problem down into components and establish priorities; develop alternative
courses of action; determine probable outcomes for each alternative; decide which course is
best in relation to resources goals, risks, and the like; and decide on and make a plan of action
with a time table for implementation. "

When determining priorities, nurses should relate the problem to the corporate mission.
Decisions involve choosing among alternative courses of action. They must have inacceptable
effect on those directly involved, other areas affected, and the entire organization. Plans should
include when and how to alter a course of action when undesired results occur.

The third step is implementation of the plan. The nurse should keep informed of the status of
the process because it is unlikely that she or he will be directly involved. This is the one step in
the process most likely to be delegated to subordinates. Implementation requires knowledge
and skills appropriate to the specific alternatives selected.

Evaluation, the final step in problem-solving, includes determining how closely goals and
objectives were met, the success or failure of actions taken in resolving the problem, and
whether the plan should be terminated because the problem has been resolved or whether it
should be continued, with or without modification. Effective problem-solving requires that the
practitioner be frequently at a high cognitive level: the level of abstract thinking. "

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 APPROACHES TO PROBLEM SOLVING
Approach to problem solving

Desired results

Management problem

Approaches

• • Decisional • • Quantati
• Routine Scientific Creative
• • Define e ve
• Traditiona Identify
proposition desired • Define • Define
l
• Acquire results problem problem
• S.O.P
prelim • Define • Prepare • Constru
• Abide by ct a
supervisor • Observation problem for
• State • Draw creativity model
• Order • Evaluate
tentative alternatives • Encourag
solution • Evaluate e ideas • Model
• Investigate alternatives • Permit • Place
proposition • innovatio needed
using current n constrai
knowledge • Verify nt
and clarify the • Over
data evaluate used of
method
• Evaluate
the
solution

114
 PREPARE A PLAN FOR DISASTER MANAGEMENT
DEFINITION-

DISASTER MANAGEMENT
Disaster Management can be defined as the organization and management of resources and
responsibilities for dealing with all humanitarian aspects of emergencies, in particular preparedness,
response and recovery in order to lessen the impact of disasters.

DISASTER NURSING
Disaster nursing can be defined as the adaptation of professional nursing skills in recognizing
and meeting the physical, health and emotional needs of the affected community resulting from
disasters.

TYPES OF DISASTER
NATURAL DISATERS
According to the International Federation of Red Cross & Red Crescent Societies Natural
Disasters are naturally occurring physical phenomena caused either by rapid or slow onset events
that have immediate impacts on human health and secondary impacts causing further death and
suffering. These disasters can be

• Geophysical (e.g. Earthquakes, Landslides, Tsunamis and Volcanic Activity)

Earthquake: Earthquake is a sudden and violent shaking of ground causing great destruction as a
result of movement of earth’s crust. An earthquake has the potential to tsunami or volcanic eruption.

Tsunami: Tsunamis are giant waves, initiated by a sudden change, usually in relative position of
underwater tectonic plates. The sudden jerk is enough to propagate the wave; however, its power can
be enhanced and fed by lunar positioning and boundaries that focus its energy.

• Hydrological (e.g. Avalanches and Floods)

• Climatologically (e.g. Extreme Temperatures, Drought and Wildfires)
• Meteorological (e.g. Cyclones and Storms/Wave Surges)

Cyclone: Cyclones (or more properly called Tropical Cyclones) are a type of severe spinning storm
that occurs over the ocean near the tropics.

• Biological (e.g. Disease Epidemics and Insect/Animal Plagues)

The United Nations Office for Disaster Risk Reduction characterize Natural Disasters in relation
to their magnitude or intensity, speed of onset, duration, and area of extent e.g. Earthquakes have
short durations and usually affect a relatively small region, whereas Droughts are slow to develop
and fade away and often affect large regions.

MAN-MADE DISASTERS
Man-Made Disasters as viewed by the International Federation of Red Cross & Red
Crescent Societies are events that are caused by humans which occur in or close to human
settlements often caused as a results of Environmental or Technological Emergencies. This can
include

• Environmental Degradation
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• Pollution
• Accidents (e.g. Industrial, Technological and Transport usually involving the production, use or
transport of hazardous materials)
COMPLEX EMERGENCIES
Some disasters can result from multiple hazards, or, more often, to a complex combination
of both Natural and Man-made causes which involve a break-down of authority, looting and
attacks on strategic installations, including conflict situations and war. These can include

• Food Insecurity
• Epidemics
• Armed Conflicts
• Displaced Populations
According to ICRC these Complex Emergencies are typically characterized by
• Extensive Violence
• Displacements of Populations
• Loss of Life
• Widespread Damage to both Societies and Economies
• Need for Large-scale, Humanitarian Assistance across Multiple Agencies
• Political and Military Constraints which impact or prevent Humanitarian Assistance
• Increased Security Risks for Humanitarian Relief Workers

PANDEMIC EMERGENCIES
Pandemic (from Greek pan "all" and δῆμος demos "people") is an epidemic of infectious
disease that has spread across a large region, which can occur to the human population or animal
population and may affect health, disrupts services leading to economic and social costs. It may
be an unusual or unexpected increase in the number of cases of an infectious disease which
already exists in a certain region or population or can also refer to the appearance of a significant
number of cases of an infectious disease in a region or population that is usually free from that
disease. Pandemic Emergencies may occur as a consequence of Natural or Man-Made Disasters.
These have included the following Epidemics.
• Ebola
• Zika
• Avian Flu
• Cholera
• Dengue Fever
• Malaria
• Yellow Fever

FACTORS AFFECTING DISASTER

• Age
• Immunization status
• Host factors
• Degree of mobility
• Emotional stability
• Physical Factors
• Chemical Factors Environmental
• Biological Factors
• Social Factors
• Psychological Factors

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PRINCIPLES OF DISASTER MANAGEMENT
Disaster management planning should focus on large-scale events.
• Individuals are responsible for their own safety.
• Organizations should function as an extension of their core business
• Disaster management should use resources that exist for a day-to-day purpose
• DM arrangements must recognise the involvement and potential role of non- government
agencies
• DM planning must take account of the type of physical environment and the structure of the
population.
• DM planning should recognize the difference between incidents and disasters. disaster
management is the responsibility of all spheres of government

THE COMPREHENSIVE DISASTER MANAGEMENT (CDM) CYCLE

• Jamaica, through the ODPEM, has embarked on a Comprehensive Disaster Management
(CDM) programme that illustrates the cyclic process by which we plan for and reduce the
impact of disasters, and take steps to recover after a disaster has occurred. Appropriate actions
at all points in the CDM cycle will lead to greater preparedness, better warnings, reduced
vulnerability or the prevention of disasters during the next repetition of the cycle.
• The figure below illustrates the four phases of the CDM cycle: mitigation, preparedness,
response and recovery.

COMPRESSIVE DISASTER MANAGEMENT (CDM)

CYCLE

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PHASES OF THE CDM CYCLE
There are four phases in the CDM cycle:
1. MITIGATION:
During the mitigation phase structural and non-structural measures are undertaken to limit the
adverse impact of natural hazards, environmental degradation and technological
hazards. According the United Nations International Strategy for Disaster Reduction (UNISDR),
the adverse impacts of hazards often cannot be prevented fully, but their scale or severity can be
substantially lessened by various strategies and actions.

Management activities in the mitigation phase encompass engineering techniques and hazard-
resistant construction as well as improved environmental policies and public awareness, as well
as hazard vulnerability and risk assessment.

Measures taken during the mitigation phase also address preventing natural or man-caused
events from giving rise to disasters or any emergency situations, e.g. not allowing child to have access
to matches, gasoline, or kerosene oil.

2. PREPAREDNESS:
During the preparedness phase of the CDM cycle measures are taken to reduce the minimum level
possible, of loss in human life and other damage, through the organization of prompt and efficient
actions of response and rehabilitation such as practicing earthquake and fire drills.
Preparedness activities are geared towards minimizing disaster damage, enhancing disaster
response operations and preparing organizations and individuals to respond. They also involve
planning, organizing, training, interaction with other organizations and related agencies, resource
inventory, allocation and placement, and plan testing.
Disaster preparedness refers to measures taken to prepare for and reduce the effects
of disasters. That is, to predict and, where possible, prevent disasters, mitigate their impact on
vulnerable populations, and respond to and effectively cope with their consequences. International Red
Cross

3. RESPONSE:
Actions carried out in a disaster situation with the objective to save life, alleviate suffering and reduce
economic losses. The main tool in response is the implementation of plans which were prepared prior
totheevent.
Response activities are post activities geared towards:
Providing emergency assistance
• Reducing probability of additional injuries or damage
• Speeding recovery operations
• Returning systems to normal level

4. RECOVERY:
In the recovery phase, also referred to as the recovery and rehabilitation phase, activities are geared
towards the restoration of basic services and the beginning of the repair of physical, social and
economic damage e.g. lifelines, health and communication facilities, as well as utility systems.
The recovery phase also includes efforts to reduce disaster risk factors.

IMPACT OF DISASTERS
• Population movement and migration
• Food shortage and Malnutrition
• Damage water supply and basic sanitation

118
 • The destruction of the health care infrastructure,
• Mental health (disaster syndrome)
• Excess NCD mortality
• Increase risk of communicable diseases and epidemics outbreak
• Severe injuries requiring extensive treatment
• Death

NURSES ROLE IN DISASTER MANAGEMENT

• Serving within their organization: - Developing an understanding of the disaster
preparedness and response plans, operational protocols, and security measures can help nurses
understand what their employers expect of them.
• Providing education: - Educating consumers and the community gives them the knowledge
they need to make it safely through a disaster and help others. Knowledge can also do much to
alleviate fear and anxiety.
• Volunteering:- Nurses who volunteer and become involved with an organized disaster
response system are better prepared when disaster strikes. A few organizations that offer
opportunities to assist with relief efforts include the American Red Cross, the Federal
Emergency Management Agency (FEMA), and the United States Public Health Service (PHS).
• Assisting during a disaster: - A nurse may be assigned a variety of tasks during a disaster
such as delivering first aid and medication, assessing the state of victims, and monitoring
mental health needs.
• Preparing self and family:- Some nurses have family members who rely on them. Personal
preparation with an emergency plan and basic emergency supplies can help to ensure their
families' safety while easing the nurse's worries. Other things to consider include arranging a
meeting place if separated, ensuring reliable communication, and compiling important
paperwork.
• Within the employing organization:- help initiate or update the disaster plan, provide
educational programs and material regarding disasters specific to the area, and organize
disaster drills.
• Community health nurse:- provide an updated record of vulnerable populations within the
community. Individualized strategies should be reviewed, including the availability of specific
resources, in the event of an emergency.
• Leader: - an intimate knowledge of the institution and familiarity with the individuals who
work there. Persons with disaster management training, and especially those who have served
on "real" disasters, make valuable members of any preparedness team as well
• As a community advocate: - should always seek to keep a safe environment. Recalling that
disasters are not only natural but also man-made, the nurse in the community has an obligation
to assess for and report environmental health hazards.

TRAIAGEING IN DISASTER MANAGEMENT

Triage refers to the evaluation and categorization of the sick or wounded when there are
insufficient resources for medical care of everyone at once. Historically, triage is believed to have
arisen from systems developed for categorization and transport of wounded soldiers on the battlefield.
Triage is used in a number of situations in modern medicine, including:
• In mass casualty situations, triage is used to decide who is most urgently in need of
transportation to a hospital for care (generally, those who have a chance of survival but who
would die without immediate treatment) and whose injuries are less severe and must wait for
medical care.
• Triage is also commonly used in crowded emergency rooms and walk-in clinics to determine
which patients should be seen and treated immediately.

119
 • Triage may be used to prioritize the use of space or equipment, such as operating rooms, in a
crowded medical facility.

In a walk-in clinic or emergency department, an interview with a triage nurse is a common first
step to receiving care. He or she generally takes a brief medical history of the complaint and measures
vital signs (heart rate, respiratory rate, temperature, and blood pressure) in order to identify seriously
ill persons who must receive immediate care.
In a disaster or mass casualty situation, different systems for triage have been developed. One
system is known as START (Simple Triage and Rapid Treatment). In START, victims are grouped
into four categories, depending on the urgency of their need for evacuation. If necessary, START can
be implemented by persons without a high level of training. The categories in START are:
• the deceased, who are beyond help
• the injured who could be helped by immediate transportation
• the injured with less severe injuries whose transport can be delayed
• Those with minor injuries not requiring urgent care.

Another system that has been used in mass casualty situations is an example of advanced triage
implemented by nurses or other skilled personnel. This advanced triage system involves a color-
coding scheme using red, yellow, green, white, and black tags:
• RED TAGS - (immediate) are used to label those who cannot survive without immediate
treatment but who have a chance of survival.
• YELLOW TAGS - (observation) for those who require observation (and possible later re-
triage). Their condition is stable for the moment and, they are not in immediate danger of
death. These victims will still need hospital care and would be treated immediately under
normal circumstances.
• GREEN TAGS - (wait) are reserved for the "walking wounded" who will need medical care at
some point, after more critical injuries have been treated.
• WHITE TAGS - (dismiss) are given to those with minor injuries for whom a doctor's care is
not required.
• BLACK TAGS - (expectant) are used for the deceased and for those whose injuries are so
extensive that they will not be able to survive given the care that is available.

SUMMARY
Natural hazards and disasters associated with flooding, landslides, earthquakes and hurricanes in
particular. Disaster management is governed by principles associated with the mitigation of,
preparedness for, response to, and recovery from the impact(s) of hazards. The course aims to impart
knowledge on each of these principles in relation to the processes associated with natural hazards and
disasters, and to teach students how this knowledge may be applied to improve the state of
preparedness and reduce the vulnerability of livelihoods and infrastructure in case of natural disasters.
Given the relatively low levels of economic and social development in the region, and the need to raise
these levels, risk reduction on the part of individuals and governments and other organizations should
be a key part of each country's development goals.

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 FIELD APPRAISAL REPORT
The exploration phase of the petroleum field life cycle closely links with the next stage which is
known as the appraisal phase.
Once an exploration well has found hydrocarbons, considerable effort will still be required to
accurately assess the potential of the discovery and the role of appraisal is to provide cost-effective
information that will be used for subsequent decisions (development).
During appraisal, more wells are drilled to collect information and samples from the reservoir and
other seismic survey might also be acquired in order to better delineate the reservoir.

This phase of the E& P process aims to

• reduce the range of uncertainty in the volumes of hydrocarbons in place
• define the size and configuration of the reservoir
• collect data for the prediction of the performance of the reservoir during the forecasted
production life

Having defined and gathered data adequate for an initial reserves estimation, the next step is to
look at the various options to develop the field.
During the appraisal phase, reservoir engineering increases its contribute in reaching the
technical and economic targets.
Reservoir Engineering is a branch of petroleum engineering that applies scientific principles to
the exploitation of oil and gas reservoir to obtain a high economic recovery
Reservoir Engineering analyzes the production potential of the reservoir and determine the
technical ways and means that should be used to optimize oil or gas recovery.
Reservoir engineers makes description of the reservoir from the available data and refine these
data by applying the laws of physics to forecast reservoir behavior during production and
depletion.

Activities of the appraisal phase include:

planning and execution of a data acquisition program (seismic)
reprocessing existing seismic data
drilling of appraisal wells
evaluation of the results obtained from the seismic and drilling activities
]use of the data update reservoir models
carry out initial development planning and an environmental impact assessment (EIA) study

121
 Appraisal plan
work
Gathering data
programmed
and budget

HD Appraisal
result to Development
department Appraisal assets model
set

Propose Develop scenario

conceptual
development plan

122
FIELD APPRAISAL REPORT
Field appraisal date______________
Project Name__________________________________
A) FIELD APPRAISAL

The field appraisers are recommended to be three in numbers but not less than two and the
presence of the CMP supervisor and one engineer, geologist or an expert capable of
selecting/confirming water point site from the Woreda Water Resource Development office is
a must.
1. General

a) Is the project the priority need of the community? yes No

How is this confirmed__________________________________________________
____________________________________________________________________
b) Proposed project description: Describe the type of technology & proposed activities (works) to be
undertaken in the project( quantify if possible)
_____________________________________________________________________________
_____________________________________________________________________________
___________________________________________________________________________
c) Expected number of beneficiaries of the water point
Total number of households_______, Female headed HHS…………………… Male headed
HHS…………………..
No of people………………………………. Male……………………………………. Female
……………………………………
d) Number of people contacted during filed appraisal
Number of WASHCO member’s __________
Number of beneficiary community member’s __________
Number of Keble administrative member’s __________

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2} SOCIAL FEASIBILITY

Appraisal criteria Yes No

A A Verify if the community established WASHCO members with
appropriate rules and regulations? Assess how they are elected
B Do beneficiaries of the water point participate at different stages of
the project cycle:
b1 Beneficiaries have participated in the need identification
b2 Beneficiaries have participated in design preparation and site
selection
b3 Beneficiaries are committed to be involved in implementation
b4 Beneficiaries are committed to Operation and Maintenance
Management
C Is the water point site/source/ selected for construction acceptable
to the community
c1 Culturally
c2 Religion wise
c3 Psychologically
D Is there an agreement with the owner of the land where the water
point is to be constructed?

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BIBLIOGRAPHY:-

• BT Basavanthappa. Community health nursing. 1st edition. New Delhi:

Jaypee brothers; 2003
• BT Basavanthappa. Nursing administration. Ist edn. New Delhi: Jaypee
brothers; 2000. Management and leadership for nurse managers,
second edition, russel c.swansburg
• Function of nursing management- Nursing management- open access
articles on nursing management
http://currentnursing.com/nursing_management/staffing_nursing_units.
html38
• Staff Inspection Unit
http://finmin.nic.in/the_ministry/dept_expenditure/staff_inspection_uni
t/index.html
• Staffing in nursing management
http://www.scribd.com/doc/16245136/Staffing-in-Nursing
Management
• Staffing in the 21st Century: New Challenges and Strategic
Opportunities http://jom.sagepub.com/content/32/6/868.abstract

JOURNAL

• Andrea Baumann, PhD, RN; Jennifer Blythe , Globalization of Higher

Education in Nursing,The Online Journal of Issues in Nursing, 9
(2):217-223.

INTERNET

• http://www.faqs.org/abstracts/Human-resources-and-labor
www.google.co

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