Dr. Rajesh BhallaMD (Hosp.Adm.), DNB (Health Adm.), M.Sc (Defense Studies)

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Definition2

Nursing Unit or Ward

Grouping of accommodation for patients withservice facilities which enable a team of nurses tocare for inpatients under best possible conditions

Easy observability & quick response Cohesive functioning

Classification of Ward Accommodation3

Primary

Auxiliary

Sanitary

Ancillary

Classification of Ward Accommodation4

Primary Bed accommodation Nursing station Treatment Room

Auxiliary Drs’ room Nurses room Stores Clean Utility

Classification of Ward Accommodation5

Sanitary Toilet block

Dirty Utility

Janitors’ room

Ancillary Ward Pantry

Day room

Conference room

Functions of Nursing Unit6

Physical facilities

Nursing care

Low cost

Optimum patient environment

Congenial work environment

Evolution of Wards7

Nightingale Ward

Established by Florence Nightingale

Traditional nursing unit

35-40 patient beds

Own kitchen, stores, supplies

Centered around Head Nurse

Nightingale Ward Plan8

NS

Ancillary Services

Sanitary Area

Beds

Advantages versus Disadvantages9

ADVANTAGES Easy visibility of patients

DISADVANTAGES Cross Infection

Nurses Fatigue Factor

Lack of privacy

Noise

Lack of personal contact

Planning Considerations10

Economy in space

Patient and his needs

Increasing complexities of nursing procedures

Technical advancement in medicine

Concept of Hospital Infection

Changing expectations of pts

Planning considerations11

Policy

General or Specific Hospital

Bed Strength of Hospital

Progressive Patient Care12

Definition:

Tailor-made according to the need of the patient

Intensive Care Intermediate care Self care Long term care

Progressive Patient Care13

Intensive care

Critically ill patients Unable to communicate needs Requires continuous observation & extensive nursing

care Equipped with life saving equipments, drugs &

supplies.

Progressive Patient Care14

Intermediate care

Moderately ill patients. Require moderate amount of nursing care

Self care

Patients are ambulant during period of convalescence

Able to look after themselves. Minimal nursing care required.

Progressive Patient Care15

Long Term care

Prolonged nursing care Services not available at home

The basis for PPC system is the amount & type of nursing

care required & degree of dependence of the patients on

others.

Physical Facilities16

Area

Location

Size

Shape

Ancillary Accommodation

Water & Electricity supplies

Communication

Air-conditioning

Auxiliary Accommodation

Ward Size and Configuration17

Multistoried buildings

Each floor plan, template of the plan of the floor above.

Horizontal lay out: 150-200 beds

Economy in deployment of nursing staff

WARD LAYOUT – RIGS PATTERN18

Rigs Ward19

Grouping of patients into 6 beds & 4 beds

Serious patients –2 beds

Isolation room –1 bed for infectious patients

Beds arranged parallel to longitudinal wall of the ward

Circular Nursing Unit for seriously ill patients (ICU)

Rectangular units for mobile patients.

Rigs Ward20

Disadvantages –

Direct observation

Communication

Nurses fatigue factor

More Nursing staff

Costly to build & maintain

Modular Grids21

Standardised Planning Grid 1.6

6 grids 3.2m x 4.8m =14sqm

Central corridor = 2.50 m.

4 bed room = 5m x 6m

Ancillary rooms 15m2

Common Service Facilities22

Combining 2 wards

Economy in deployment of nurses

Flexibility in use of beds

Common core of work area

Economical in building design

Efficient functioning

Physical Planning23

Hospital bed 1m x 2.15m

Floor space for bed in multiple bed room – 7.0 m2

per bed

Single bed room - 14 m2 per bed

2 bed room – 21.00 m2

Distance between wall & side of bed > 0.65 m

Centre to centre distance between 2 beds - 2.15 m

Physical Planning24

Ceiling height – 3.0 m

Width of corridors- 2.4m

Windows - 20%of floor area

Doors - 1.2m

Dado - 0.2m

Nursing Station25

Central & close to patients

Critical patients close to N.S

Sister’s room, WC,

Built in cupboard for storage of drugs , dressings & instruments

Closet for narcotics & dangerous drugs

Electric panel for nurses call station visible

Sanitary Facilities26

Sanitary Annex

WC - 1 for 8 beds

1 BR - 1 for 12 beds

1 Wash basin - 1 for 10 beds

Urinal - 1 for 16 beds.

Dirty utility room & karamchari (safai) workers closet

SERVICES27

Water & electricity supplies

Round the clock water supply

300-500 litres for per bed.

Electrical Sockets - industrial switch - 15 amp

- 5 amp

Alternate source of light supply

SERVICES28

Communication

Effective two-way communication

> 500 beds - paging system

Air conditioning (HVAC)

Positive pressure

Provide patient comfort

Reduce Hospital Infection Rate.

ANCILLARY SERVICES29

Treatment & Dressing Room

Isolation room

Ward pantry

Clean Utility Room

Day Room

Auxiliary accomodation

Norms for Nursing Staff 30

Staffing Norms

Nursing Supdt. 1 per hospital

Dy. Nursing Supdt. 1 upto 400 beds

1 addl. for every 200 additional Beds

Asstt. Nursing Supdt. 1 for 100-150 beds for 3-4 wards

Norms for Nursing Staff31

Ward Sisters: 1 for 25-30 beds or one per ward Teaching Hospital: 1 nurse for 3 beds * Non-teaching hospital: 1 nurse for 5 beds *

For ICU / CCU: 1:1 1 nurse for 1 bed *(+ 30 % leave reserve)

Extra nursing staff to be provided for Departments & Research functions.

For each 250 beds - one infection control nurse.

Nursing Hours required32

Category Direct Nursing Nurse patientof illness hours / patient / ratio

day (24 hrs) Critically ill patient 8-10 1:1

ICU care Moderately ill patients 3-5 1:3(T)

HDU care 1:5(N.T) Mildly ill patients 1-2 hrs 1:6

self care (Ambulatory) Chronically ill patients 30 min. 1:12(T)

to 1 hrs 1:18(N.T)

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