2. NE-Chap2-NCP (2).pdf in 2. NE-Chap2-NCP (2).pdf in

Ne

1. ONLINE TRAINING PROGRAM ON
NURSING EXCELLENCE (NE) STANDARDS
Chapter-2
Nursing Care of Patient (NCP)

2. 2
Nursing Care of Patient (NCP)
This standard aims to guide and
encourage patient safety and
quality care as the overall principle
for providing nursing care to
patients

3. 3
NCP 1
A nursing manual shall be
established and reviewed
periodically as defined by
the HCO.

4. 4
Objective Elements
Separate
Nursing
manual
ICU,OT
Dialysis
Chemo unit,
Endoscopy
a) Nursing manual shall
include standard operating
procedures and guidelines
for nursing care in all settings.

5. 5
Objective Elements
b) Nursing manual shall also include policy on nursing station management.
Dressing trolleys
arrangement
Nurse call
system
Record
maintenance
Crash cart
arrangement
Hazmat
Telephone
Inventories
Scope, nursing administrative policy and procedures, functions and activities.

6. 6
Objective Elements
Vital charts
Intake and
output
Flow chart
Nursing care
plan
Timely nursing
note
Medication
chart
Initial
assessment and
reassessment
c) Nursing manual shall contain a
master list of various forms and
formats used by nursing professionals.

7. 7
Objective Elements
d) Nursing manual shall be available for and
followed by the nursing professionals
uniformly.

8. 8
Objective Elements
e) Nursing manual shall be reviewed and updated regularly at least once annually
Should incorporate changing national, international guidelines time to time and
based on good clinical practice (GCP).

9. 9
NCP 2
The initial assessment
shall be done by the
nursing professionals in
predetermined format at
prescribed time and/or as
per the needs of the
patients.

10. 10
Objective Elements
a) Initial assessment of in-patients includes nursing assessment done and documented
at the time of admission.
§Identify the nursing needs
§Special needs of the patient
§Completed within a defined time frame.
A checklist or template could be used for
the same.

11. 11
Objective Elements
b) Initial assessment includes assessment of actual and potential needs and problems.
§Head to foot observation,
§Checking of vitals, height, weight, input-output charts and special needs etc.
§Actual needs: Ineffective airway clearance, pain management etc.
§Potential needs: Risk for falls, risk for infection.

12. 12
Objective Elements
c) The initial nursing assessment results in a documented nursing care plan.
This shall be documented by the assigned nursing staff in the patient record
§Nursing assessment / diagnosis
§Plan of care
§Implementation
§Evaluation
§Modification of plan of care

13. 13
Objective Elements
d) The care documentation must include preventive aspects of the care where
appropriate.
§The documented nursing care plan should cover preventive actions as necessary
in the case and could include diet, drugs, air mattress for prevention of bed sore,
DVT stockings in high-risk patients etc.
§This can be done in a later period if it is not done initially
§Patient education can be done through booklets/patient information leaflets etc.

14. 14
NCP 3
The reassessment shall be done by the nursing
professionals in a pre-determined format at
prescribed time.

15. 15
Objective Elements
a) Patients are reassessed at appropriate intervals.
§Patient is reassessed periodically and documented in the case sheet
§The frequency may be different for different areas , eg: patients in ICU and ER
need to be reassessed more frequently
§Reassessments shall also be done in response to significant changes in patient's
condition
§Every patient shall be reassessed once every shift
§Day care/ ED patients are reassessed before discharging or awaiting
admission/bed.

16. 16
Objective Elements
b) Patients are reassessed at the time
of receiving and transferring from one
unit to another.

17. 17
Objective Elements
c) Patients are also reassessed before and after shifting for investigations.
d) Nursing care plan is modified when emergency situations arise.
e) Nursing professionals evaluate outcomes using reassessment and revise action plans as
needed.

18. 18
NCP 4
For provision of nursing care, appropriate number of
nursing professionals shall be maintained as per
workload.

19. 19
Objective Elements
a) Nurse patient ratio is planned and provided based on the scope of the unit.
§As per the guidelines laid down by Indian Nursing Council
§WISN (Workload indicator for staffing need)
§SIU (Staff Inspection Unit ) norms
§International nurse staffing norms
§1:1 for ventilated patient and high critical patient
§1:2 for HDU
§1:6 for wards
§Leave reserve 25% Ref:INC

20. 20
Objective Elements
b) Nurse patient ratio is monitored in every shift
by the designated senior nursing professionals.

21. 21
Objective Elements
c) Patient condition and nurses' competency while assigning nursing professionals
to patient care in each shift
Patient assignment is followed wherever possible
§Nurse competency
§Acuity based staffing
§Clinical needs and criticality of the patient

22. 22
NCP 5
The nursing care planned and provided by the
nursing professionals is recorded.

23. 23
Objective Elements
a) Nursing professionals document assessment, nursing activities and care
outcomes in accurate and timely manner.
b) Documented information shall be checked and supervised by the senior
nursing professionals wherever appropriate.

24. 24
Objective Elements
c) There shall be a consistent pattern adopted by the nursing service for
documentation of nursing care.
Uniform pattern is practiced across the hospital.

25. 25
Objective Elements
d) Adequate supervision is ensured for the junior staff after delegating the
responsibilities
Senior nursing member in the department is totally accountable and answerable
for all the activities of the nursing professionals in the respective area.

26. 26
NCP 6
The nursing care is individualized to address
the needs of patient and family.

27. 27
Objective Elements
a) Nursing protocols are developed by nursing professionals based on current best
practices and shall focus on patient safety.

28. 28
b) Assignment of patients for nursing care is based on patient needs to
maximize the outcome.
Acuity based staffing

29. 29

30. 30

31. 31
Objective Elements
c) Nurse use patient specific sensitive communication and interactive
techniques to individualize the care
§Age specific
§Disease specific
§Gender specific
§Enhanced communication
§Interactive technique will be used
§Do's and don’ts of communication.

32. 32
Objective Elements
d) Care of patients is coordinated in all care settings within the organization.
§OPD, emergency, IP, ICU etc.
§Effective communication amongst the care providers in all settings
§Handover :ISBAR
§PASS THE BATON

33. 33
NCP 7
Information is exchanged and documented during
each staffing shift, between shifts and during
transfers between units/departments.

34. 34
a) Documented information shall be clearly dated, timed and signed by the assigned nurse
and endorsed by the senior nursing staff at every shift.
Occassions for
endorsement

35. 35

36. 36
b) Transfers between departments /units are done in a safe manner
§Intra-organization transfers
§Transported in a safe
manner
§Proper handover and
takeover
§Radiation safety
§MRI safety
§Patient belongings

37. 37
NCP 8
There shall be established policies and protocols for
vascular access devices (VADs).

38. 38
a) There shall be established policies and protocols for vascular access devices.

39. 39
Objective Elements
b) The nurse shall select the appropriate type of catheter (peripheral or central) to meet
the patient’s vascular access needs.
§Based on prescribed therapy or treatment
regimen
§Length of treatment
§Duration of dwell
§Vascular integrity
§Patient preference
§Ability and resource available to care for the
device
§Lumens: double, single, triple

40. 40
c) The catheter selected shall be of the
appropriate gauge and length with the
fewest number of lumen and shall be
the least invasive device needed to
accommodate and manage the
prescribed therapy.

41. 41
Objective Elements
d) The nurse shall not alter the vascular device outside the
manufacturer’s direction for use.

42. 42
Objective Elements
e) Vascular access bundle care (for prevention of complications) should be followed.
(Follows CDC Guidelines)

43. 43
NCP 9
The nursing care of inpatients shall be supervised by
senior nursing professionals.

44. 44
Objective Elements
a) A senior suitably experienced nursing professional should guide and
supervise the nursing professionals in each shift in each department.
§Team leader, Head nurse, Nurse manager/supervisor
§Intensive care
§High dependency units
§Wards
§Emergency unit
§Specialized areas like cathlab, endoscopy, dialysis etc.

45. 45
Objective Elements
b) Senior nursing professionals are responsible for the implementation of the
policy, protocol and procedures of the respective areas.

46. 46
Objective Elements
c) The scope of services for senior nursing professionals includes supervision and
monitoring of all nursing activities related to patient safety, quality of nursing care
rendered and turnaround time.
§This should be included in the job description of team leader/head nurse/nursing
supervisor/nurse manager
§The nursing department shall define the turn around time for various
procedures/activities
ØEg: Initial assessment.
ØMedication administration
ØCritical value intimation and intervention
ØPain reassessment

47. 47
Objective Elements
d) The nursing professionals should ensure availability of patients reports in their
respective records.
Nurses are the custodian of case sheet

48. 48
e) Nursing professionals seek additional knowledge and assistance as needed, in a
timely manner.
§Every nurse must attend in service education
§Departmental/unit based training to be organized
§Escalation matrix

49. 49

50. 50
f) Nursing professionals recognize any limitations to safe, competent, and ethical care
and report concerns and consult and/or initiate appropriate changes as necessary.
Whistle blower
§Unsafe practice by anyone
§Procedure done by incompetent
person
§Unethical practice
§Maintaining confidentiality and
anonymity of the person reporting

51. 51
Objective Elements
g) Nursing professionals evaluate, disseminate and support the integration of
evidence-based practice findings into practice.
§Use of bundles
§Evidence based practiced interventions (buzz- cold and vibration, breastfeeding
while immunization, chewing gum during injections for children, z track technique
during IM injection)

52. 52
NCP 10
The nursing care of vulnerable paients (elderly,
children, physically and/or mentally challenged) shall
be supervised by senior nursing professionals.

53. 53
Objective Elements
a) There are protocols governing care of vulnerable patient.
b) The nursing staffs are trained to care for vulnerable patient.

54. 54
Objective Elements
c) All vulnerable patients are identified as per HCO policy and then assessed
and reassessed more frequently at periodic intervals.
d) Nursing professionals monitor vulnerable patients closely participating with
the family whenever required

55. 55
NCP 11
The nursing care of patients under restraints
(physical and/or chemical) shall be supervised by
senior nursing professionals.

56. 56
a) These include both physical and chemical restraint measures.
b) These patients are more frequently monitored.
c) Staff receives training and periodic updating in control and management of
restraint techniques.

57. 57
NCP 12
Appropriate pain management practices shall be
supervised by senior nursing professionals.

58. 58
Objective Elements
a) All patients screened for pain at the time of admission and reassessment of
pain is done for those patients who require pain management.
§Post surgery
§Post Trauma
§Other areas of pain
§Not done for labour pain

59. 59
Objective Elements
b) Nursing professionals are trained to identify level of pain in various categories
of patients and document the same.
§Wong bakers faces pain scale – Pediatrics
§Numerical pain rating scales – Adults
§Behavioral pain scale
§FLACC
§BPS

60. 60
Objective Elements
c) Nursing professionals shall provide care both pharmacological and non-
pharmacological care based on the hospital policy.
§ Pharmacology-Analgesics
§ Non-pharmacology
ØMusic therapy
ØMassage
ØComfort measures
ØPositioning
ØMind distraction methods (pet therapy)
ØPresence of spouse during labour

61. 61
Objective Elements
d) The organization respects and supports nursing management of pain for
such patients.
e) The nursing professionals educate the patient and their family on various
pain management techniques wherever appropriate.
§Pre procedure and pre-operative counseling
§Deep breathing: IM injections

62. 62
NCP 13
Appropriate end of life care shall be provided to
patients needing the same by the nursing
professionals.

63. 63
Objective Elements
Nursing professionals are aware of end-of-life care policy of the organization.
End of
life care
Psychological
support
Physical
support
Spiritual
support
lAST
OFFICE

64. 64
Objective Elements
b) Nursing professionals shall provide care to meet the unique end of life care
needs of the patient and family.
§Social, spiritual, legal needs of the family need to be considered
§Presence of family members

65. 65
Objective Elements
c) Symptomatic treatment is provided by the nursing professionals for all end-
of-life care patients with special emphasis on alleviating pain and helping them
to cope psychologically.
d) Nursing professionals are educated and periodically trained on end-of-life
care.

66. 66

67. 67
Exercise
Compute the number of nursing staff required for a 100 bedded tertiary hospital
with 20 ICU beds, 40 beds in medical ward, 20 beds in surgical ward and 10 beds
in HDU.

68. Thank You!
68