nursing rounds.pptx

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1. INTRODUCTION A small group of the staff members ,not more than five and a leader & teachers visit the bed sides of the clients nursing superintendents, ward sisters taking rounds of hospital wards. it helps the nursing members to know about all the patients in the wards there problems & ways of solving. Nursing rounds is an excursion in to patients area involving the student learning experiences.

2. Purposes of nursing rounds • To acquaint nurses with all patients on the more purposeful care may be achieved for each patient. • To help nurses to get acquainted with new patients. To demonstrate symptoms important in nursing. To clarify terminology used. To compare the clients reaction to disease. To demonstrate the effects of drugs.

3. Purposes of nursing rounds To explain the plan to the patient. To illustrate skillful nursing care. To compare methods of meeting the needs. Instructional purpose for student nurses. To learn about disease, pattern of care, treatment. To illustrate successful improvisation & to give opportunity for the use of different application

4. FACTORS TO BE KEPT IN MIND WHEN PLANNING NURSING ROUNDS. To consult students previous clinical experience to avoid repetition & to add to earlier experience. Keep in mind the probable value & availability of clinical material.  Explain the plan to the patient. Introduce the patient to the group. Make the patient feel important. Have a post-conference for summary & further explanation. Records the nursing rounds in the ward teaching records.

5. STEPS INVOLVED IN ROUNDS Patients are selected with nursing problems to reinforce their theoretical knowledge. The entire clinical group of students are assembled at the bedside of a pre selected patient who has agreed to participate and who has been briefed before hand as to his role in the learning experience. The instructor of the student who is caring for the patient briefs the nursing care. The staff nurses of the ward are also allowed to contribute certain genuine points regarding patient care

6. Background information of the patient can be provided away from the bedside. • The main focus is made on nursing care and only important aspects of the care are discussed. At the end the instructor concludes the discussion by giving her opinion, guidance and relevant instructions. • The patient is finally briefed up on the conclusions reached following discussion. The staff nurse on duty records all the instructions and suggestions given by the instructor and a register (providing the information) is maintained in the ward.

7. SOME EXAMPLES & TYPE OF NURSING ROUNDS 1) Demonstration of symptoms. 2) To clarify terminology. a) Herpes simplex. b) Anemic pallor. 3) Effects of drugs. a) Allergic reaction. b) Sedative effect. 4) Skilful nursing care. a) Progressing improvement of bed sore. b) Maintenance of adequate fluid intake(oral). 5) Successful improvisation a) use of a chair as back rest.

8. ADVANTAGES OF NURSING ROUNDS  It ensures high degree of autonomy among students. • The presence of the patients as a means to illustrate assessment parameters or intervention techniques. Nursing rounds provides input and feedback from the perspective of patient care and therefore gives an opportunity to clarify issues related to patient care. • It facilitates a detailed discussion on the nursing care of a single patient.   • Nursing Rounds helps the students to develop psychomotor skills and inculcate proper attitude among the nurses. Interaction with the senior members promote team spirit and professionalism among students.

9.  Nursing Rounds motivate students to develop an ability to discriminate or classify the patients into high risk, risk, and no risk categories depending on the severity of illness. Helps students to learn in depth regarding a case management.

10. DISADVANTAGES Requires very careful planning. The patient may overhear the discussion and he may not like the thought that he is being talked about. Other patients in the same ward may over hear the discussion which the patient may not like.  Insufficient information may lead to inappropriate result. • There may be distractions in the ward and there could be problems for the nurses to stand in the ward. It cannot be organized for large group and hence teaching cannot be done for more number of students. If the nurses are familiar with all the patient’s the discussion may be held in the conference room.

11. PREPARATION BY THE HEAD NURSE - The head nurse selects the patients before hand according to time available. - Rounds not least longer than an hour. - The head nurse needs to read the patients histories know the plan for their treatment and it’s results the patients progress and prognosis, their nursing care and it’s effectiveness - Rounds for staff nurse should be held separately from those of junior students. - The central figure in nursing round is the patient. - If the purpose of the round is instructional or problem solving the patient will be included in the discussion.

12. METHOD OF CONDUCTING NURSING ROUND’S - A brief conference at the side of the patient’s room/ward has to be held. - Necessary data are given. - The purpose of the visit to the patient is outlined by the head nurse, special observation to be made or pointed out at this time. - 4-5 patients are selected for instruction. - The head nurse herself may present the uses or she may ask the students who are assigned to these patients to answers the questions of the group or her questions. - The students are asked to present the cases regarding other particulars. - The participants may also be involved such as counting pulse, respiration, examining the conjunctive, pitting edema etc. - The patients case sheet can also be utilized with presentation. - Thank the patient before leaving & tidy up the bed.

13. Procedure manual It is a good practice to compile all the rules/guidelines concerning the management and procedure in a manual that can be made available for reference. These directives generally fall under the following 3 headings. 1. Procedure issued by the administrative office and referring mainly to regulations. This is essential for maintaining discipline. 2. Procedure manuals, e.g.lab procedure manuals, nursing procedure manuals. 3. Unit procedure outline the procedure to be used in unit.

14. The contents of the manual , particularly in relation to the specific procedure, will be more acceptable if compiled following a group discussion. It is important that manual should be keep up to date and old procedure should be removed when new materials is issued.

15. Standing orders are specific instruction regarding treatment for condition that nurses and other health workers may encounter in home, school and industries where a doctor is not readily available. The standing order are intended to provide treatment only in emergencies and temporarily in the absence of a doctor, they should be limited.

16. Purpose of standing order To meet emergency situation in rural area. To deliver care at home, school, community. To provide temporary treatment in the absence of a doctor. To promote health services in community.

17. General standing order instruction Standing order instructions should be issued jointly by an authorized medical office and a nurse or a committee with a nurse representative. The community health nurse working in rural areas may be only qualified professional person readily available to the family , so standing instruction must be used with caution and discretion.

18. Standing orders are these to promote health services in the community.  The medical officer is legally responsible for issuing standing orders, and he should have faith in the sound judgment of his staff.  They reduce danger in acute condition.  They create the feeling of responsibility among the members of the health team.  Every health service should issue standing instruction to meet the health need of the areas. 22.  Role of the nurse in standing order  The community health nurse should be skillful in recording the history and in physical examination in order to detect abnormality.  The community health nurse should be prompt in detecting appropriate action for particular situation.  The nurse should maintain a record of vitals and other care given to the patient. 23.  Cont..  The nurse should have thorough knowledge to identify the actual problem of the patient and to plan appropriate nursing intervention.  The nurse should intervene with services according to the given community standing orders.  The nurse should develop a good therapeutic relationship with the individual and family.  The nurse should use referral system if it is possible. 24.  Cont..  The nurse should inform the health officer immediately if there is a communicable disease.  He/she should keep the medication safe and ready to follow standing orders.  He/she should ensure a safe and healthy environment for patient.  Recording and reporting is a essential part of community health services.

19. nursing protocol A specific written procedure that prescribes nursing actions in a given situation. Health agencies and physicians establish protocols to ensure consistency and quality of care. A protocol may describe mandatory nursing assessments, behaviors, and documentation for establishing  and  maintaining invasive appliances; methods of administering specific drugs;  specialcare  modalities for patients with certain disorders; other components of patient care; lines of authority; or channels of communication under particular circumstances.

20.   Types of standing order 1.Institutional standing orders:-  They are meant keeping in mind available resources ,staff position and the objectives of a medical institution or hospital  Ex-standing order of PHC can be differat from those of district hospital.

21. Cont.. 2.Specific standing order:-  These orders are meant for trained medical personnel, mainly the nurses , technical knowledge and specific skills are require to implement these orders.  Ex-giving care at home ,injections , oxygen therapy.

22. .. 3.General standing orders:-  Owning to a large population , vast geographical area and the shortage of resources , some standing order are used to propagate health care messages to the masses.  Ex-preventive measures against AIDS.

23. Advantages of standing order  Community standing orders provides timely treatment during emergencies.  They enhances the quality and activity of health services.  They provide a feeling of confidence and responsibility in the nursing staff and other health workers.  They help to decentralize the health responsibilities.  They help to strenthn the primary services in the community.