Nursing_Management_-_2nd_year_-_Copy[1] REEMA PAL

INDEX
S.NO. CONTENT P.NO.
1. Prepare a Vision and Mission Statement for Hospital
2. Organization chart of nursing education
3. Organization chart of nursing Unit
4. Developing Budget Proposal
5. Design a layout for specialty unit for Hospital
6. Design a layout for specialty unit for Community
7. Design a layout plan for educational institution
8. Developing Staffing Pattern Nursing services
9. Developing Staffing Pattern Nursing education
10. Plan of action for recruitment process
11. Preparation of job description for ICU nurse
12. Preparation of job description for OT nurse
13. Duty Roaster
14. Performance Appraisal
15. Anecdotal record
16. Incident report
17. Reports
18. Official Letters
19. Curriculum Vitae
20. Developing Nursing standards for patient care
21. Preparing For an Assessment Tool
22. Preparation of phototype personal record
23. Disaster Management
24. Group work or project work
25. Field/Performance Appraisal
1
SCPM COLLEGE OF NURSING AND PARAMEDICAL SCIENCES
(LUCKNOW ROAD, HARIPUR, GONDA-271003)
ASSIGNMENT ON
Prepare a Vision and Mission Statement for

Hospital
SUBMITTED TO
SCPM COLLEGE OF NURSING AND PARAMEDICAL SCIENCES,

GONDA
SUBMITTED BY
MISS. REEMA PAL
M.Sc. NURSING 2ND YEAR,

GONDA
2
Prepare a Vision and Mission Statement for Hospital
Introduction
The hospital’s mission, vision, and values are the foundation of a solid strategic plan. And the
board of trustees, more than any other group of leaders, is responsible as the “keepers” of these critical
success factors. Before developing detailed strategies and objectives, the board needs to review and revise
these statements to ensure they are powerful and compelling, and that they solidify the organization for
future success. Once solid mission, vision and values statements have been agreed upon by the board,
these statements should be placed at the forefront of board decision making, and be at the top of trustees’
minds as they develop their strategic plan.
The mission
It is the core purpose of the hospital. It should be a unique description that clearly defines the
hospital’s market and service distinctiveness and differentiation. The values are the principles and beliefs
that drive organizational behavior at every level throughout the hospital.
The vision
It is a vivid description of what the hospital seeks to become in the future, on whatever time
horizon the board and senior management choose. It takes into account future challenges, future
possibilities and future choices. And, when it’s properly crafted it can serve as a set of far-reaching goals
that drive strategies and objectives.
The Mission Statement
Mission statements are crucial because they define the reason an organization exists. Great
mission statements are short, memorable, and enduring. To ensure the mission remains squarely at the
forefront of board and leadership dialogue and decision making, consider printing it on the first page of
all board documents, including board agendas, bylaws, the conflict of interest statement, and, of course,
the strategic plan. Keeping the mission visible will help to make it memorable. In addition, it will ensure
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that one important question is asked often by board members: “how will this action or activity further our
ability to achieve our mission?”
The Vision Statement
While the mission explains the hospital’s core purpose – what the organization is and what it does
- the vision describes the future the hospital is striving for. The vision should be inspiring, unique and
visual; it should be written in a way that creates a mental image of the hospital at a future point in time.
Dynamic of vision
The key components of a vibrant vision are straightforward: they consist of the now - where the
hospital is today; the future – an assessment of where the environment is headed; the focus – what
responses the hospital intends to undertake to be successful in that future; and the future reality - where
are the hospital anticipates it will be when its successful in achieving its prioritized strategic initiatives.
A good vision statement should also be challenging and focused. It should be “enduring,” and
able to stand the test of time. And it should be hopeful, empowering and measurable. It should provide
purpose and focus in a dynamic, rapidly changing environment. And while it should be a “stretch,” and
be very challenging to achieve, it should also be realistic and attainable, with hard, focused work by
everyone in the organization. It should inspire enthusiasm and commitment throughout the organization,
and should have a bit of the “gulp factor,” which causes those responsible for achieving it to gulp a bit as
they consider the challenges inherent in achieving the vision.
Elements of a Value-Based Vision
Many people believe that a vision should be short, concise and general in nature. This is the wrong
way to both develop and attempt to put a vision to work in the strategic planning process. Instead, a
successful, high-value, strategically usable vision should be one that vividly describes what the hospital
seeks to become in the future in several critical organizational success areas. For example, what is the
hospital’s vision for improvement in the community’s health? What does the board want to be able to say
4
about the level of quality and patient safety in five years? How will the hospital adopt and implement new
information technology, such as electronic health records, online appointments and e-prescribing in five
years? In order to successfully achieve the mission, what other organizations will the hospital seek
partnerships with, and what will those partnerships look like? What new services will the hospital develop
and excel in as a center of excellence? What changes in governance and leadership will be in place in five
or 10 years, and how will those changes benefit the organization? These are the types of questions that
should be asked by the board in the process of developing a value-focused strategic vision. And they’re
the kinds of questions that establish an agenda for strategic change that must be supported by defining
strategies and measurable objectives.
The Values Statement
The third leg of the strategic planning foundation, the values statement, is comprised of the core
principles and ethics that guide the actions and beliefs of the organization at every level. The values are
the inspirational guideposts or “ethical compass” that inspires people to live their professional lives in a
certain way, and relate to patients, families, visitors, competitors, and others by exhibiting certain
organizational and personal qualities and characteristics.
Ensuring a Continual Focus on the Mission, Values and Vision
To keep the mission, values and vision in the forefront, the board of trustees should consider
incorporating the following into its governance processes:
 Examine the mission, vision and values in relation to today’s challenges and opportunities; ensure
that each is appropriate and forceful in driving strategies, objectives, action plans, opportunities
and obligations over the next several years.
 Ensure that mission, values and vision are prominent elements of decision making at all board
meetings; review annually at the board retreat, challenging the assumptions in place at the time
the mission and vision were conceived, and modify based on the realities of today’s environment.
5
 Test all policy and strategy decisions by asking how/if they will strengthen the ability to achieve
the mission and vision.
 Regularly review the status of strategies and objectives, and ensure fit with mission and vision;
 Ensure that a well-defined board-approved system is in place to measure progress toward
achieving mission, vision and strategies, and take timely corrective action, when necessary;
 Ensure that medical staff leadership is actively involved in all phases of strategic planning
leadership;
 Demand well thought-out strategic options and alternatives from management prior to defining a
strategic course of action;
 Ensure that a continual flow of new information and assumptions are presented at board meetings,
and that trustees use the information to quickly modify strategic direction as necessary;
 Produce strategically-oriented committee and task force reports that enable a continual focus on
strategic issues;
 Continue to conduct an annual board self-assessment to identify specific “leadership gaps” and
governance improvement opportunities;
 Continually scan the environment for meaningful change critical to hospital success; present
findings to keep the board focused on issues and priorities vital to organizational success;
 Develop and implement a process for creating an annual governance improvement plan; and
 Annually assess environmental and organizational changes on the horizon, and determine new
governance skills required to forcefully and effectively lead throughout the change process;
develop skills through education and board renewal.
Example for the preparation of Vision and Mission Statement for Hospital
Our Mission
To enhance lives and preserve health by enabling access to a comprehensive, fully integrated
network of the highest quality and most affordable care, delivered with kindness, integrity and respect.
Our Vision
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To lead the evolution of healthcare to enable every member of the communities we serve to enjoy
a better, healthier life.
Example for the preparation of Vision and Mission Statement for Community
Our Mission: Identifying the gaps in regional development under different sectors and the backwardness
of the area in general.
Bridge the gaps through the planning process systematically in a definite period of time, by
preparing the annual plan containing programme and projects by involving the public representatives,
Deputy Commissioners, Chief Executive Officers of Zilla Panchayats and other development departments
for the development of Malnad Area; and also to monitor and evaluate the implementation of its plan.
Our Vision
To reduce the regional imbalances in the state more particularly to overcome the grave differences
in the status of development between the district to district, taluk to taluk
Example for the preparation of Vision and Mission Statement for Educational Institution
Vision
The College of Nursing strives for outstanding educational outcomes exemplified by graduates
who will be recognized for excellence, leadership, and compassionate care.
Mission
The College of Nursing educates and inspires students to become passionate healers who
demonstrate integrity, innovation, caring and excellence.
Reference:
1. http://www.businessdictionary.com/definition/vision-statement.html#ixzz3OGy3r4Gn
7
2. Jump up, Ozdem, Guven (2011). "An Analysis of the Mission and Vision Statements on the
Strategic Plans of Higher Education Institutions" (PDF). Educational Sciences: Theory and
Practice: 1887–1894.
3. Jump up to: a b c Lipton, Mark (Summer 1996). "Demystifying the Development of an
Organizational Vision" (PDF). Sloan Management Review. 37 (4): 83.
8
ASSIGNMENT ON
Organization Charts of Nursing Education

SUBMITTED TO

GONDA
SUBMITTED BY
MISS. REEMA PAL

GONDA
9
Organization Charts
Organization chart of nursing education
10
Organization chart of nursing Unit
Nursing unit
11
ASSIGNMENT ON
Organization chart of Nursing Unit
SUBMITTED TO

GONDA
SUBMITTED BY
MISS. REEMA PAL

GONDA
12
Developing Budget Proposal
Introduction
In order to develop a budget you have to know which costs are allowable and what are the special
requirements of the sponsor. Read carefully through the sponsors guidelines and follow the instructions
for budget development and justification. Even though the sponsor might ask you only for a modular
budget, our office always requires a detailed budget. We can develop a budget together with you and
ensure that all federal and sponsor requirements are met.
The University Capstone College of Nursing

of Alabama
PI Name
Project Start
Date
Sponsor & Project Title
Budget
Grant Period
YEAR
YEA YEA
R R
BUDGET ONE
CATEGORY TWO THRE TOTA
E L
PERSONNEL* Role on Type % Base
Project Appt. Effort Salar
(month on y
s) Projec
t
A. Key
Personnel
(KP):
PI Name Principal Please 0.000
Investigator select % - - - - -
KP Name Role Please 0.000
select % - - - - -
select % - - - - -
select % - - - - -
select % - - - - -
TOTAL
KEY - - - -
13
PERSONNE
L
B. Other
Personnel:
Name Role Please 0.000
select % - - - - -
select % - - - - -
select % - - - - -
select % - - - - -
Name Graduate Please 0.000
Assistant select % - - - - -
TOTAL OTHER
PERSONNEL - - - -
TOTAL PERSONNEL
- - - -
PERSONNEL - FRINGE Rate
BENEFITS**
UA Fringe Benefit Rate 32.00
(faculty, FT staff % - - - -
exempt)
UA Fringe Benefit Rate 36.61
(FT staff non-exempt) % - - - -
GA Health flatrate $1,13
Insurance 2015- 8 - - - -
Academic 2016
Year
GA FICA 7.70%
(summer only) - - - - -
TOTAL BENEFITS
- - - -
TOTAL PERSONNEL AND BENEFITS
PROFESSIONAL SERVICES/ CONSULTANTS
Name Consultant
Name Consultant
Name Consultant
EQUIPMENT
Type of Equipment & Quantity
Type of Equipment & Quantity
TOTAL EQUIPMENT
SUPPLIES AND MATERIALS
Type of Supplies & Quantity

TOTAL SUPPLIES
TRAVEL
Travel Type description
14
TOTAL TRAVEL
OTHER***
GRA Tuition support
Subawards
TOTAL OTHER
CONSORTIUM/CONTRACT
UAL COSTS
TOTAL
CONSORTIUM/CONTRACTUAL
TOTAL DIRECT COSTS
(including consortium)
TOTAL MODIFIED DIRECT COSTS

(Direct costs less equipment, subawards
and tuition)
TOTAL 49% MTDC

INDIRECT
COSTS
TOTAL PROJECT COSTS

(Direct plus Indirect)
*Personnel salaries include a 5%

inflation rate in year 2 &3
**Please connect the correct salaries with the correct fringe rates (current fringe rates can be found
at the UA OSP website)
*** GRA tuition support estimated rate of inflation 8% annually
Modified Total Direct Cost (MTDC): (excludes tuition, equipment & Subawards > $25,000)
updated7/24/2015
Sample Budget
The University of NIH - Sample Budget

Alabama
Principal Investigator Budget
Start date: 04/01/2016 R21
costs
BUDGET CATEGORY
PERSON Role on Type % Base
NEL Project Appt. Effort Salary
(month on
s) Proje
ct
A. Key
Personnel:
15
Name PI Principal AY 20.00
Investigato 0% 129,24 25,8 26,6 52,4
r 7.27 49 25 74
Name PI Principal SMR 10.75
Investigato 0% 43,082 4,63 4,77 9,40
r .42 1 0 2
Name Co- Co-PI AY 12.50
PI 0% 115,02 14,3 14,8 29,1
4.35 78 09 87
Name Co- Co-PI SMR 7.000
PI % 38,341 2,68 2,76 5,44
.45 4 4 8
Name Co- Co-PI AY 6.250
PI % 71,242 4,45 4,58 9,03
.50 3 6 9
Name Co- Co-PI SMR 3.500
PI % 23,747 831 856 1,68
.50 7
TOTAL
KEY 52,8 54,4 107,
PERSON 27 11 238
NEL
B. Other
Personnel:
Name Data Data AY 2.500
Analyst Analyst % 133,61 3,34 5,31 8,65
3.70 0 6 6
Name Data Data SMR 2.500
Analyst Analyst % 44,537 1,11 1,55 2,66
.90 3 0 3
Name EEG EEG AY 3.000
Analyst Analyst % 101,34 3,04 3,13 6,17
9.15 0 2 2
Name EEG EEG SMR 5.000
Analyst Analyst % 33,783 1,68 1,74 3,42
.05 9 0 9
Name EEG EEG AY 5.000
Analyst Analyst % 67,696 3,38 3,48 6,87
.65 5 6 1
Name EEG EEG SMR 5.000
Analyst Analyst % 22,565 1,12 1,16 2,29
.55 8 2 0
Name data Data Safety 12 mo 2.000
safety Monitor % 134,81 2,69 2,77 5,47
monitor Officer 7.90 6 7 4
officer
TBA Graduate $6570/ 25.00 based on 8%
Assistant AY 0% 7,663. 7,66 7,89 15,5 increase in
2014- 25 3 3 56 AY 15-16, +
15 8% in AY
16-17; +8%
in AY 17-18
16
TOTAL
OTHER 24,0 27,0 51,1
PERSON 56 56 12
NEL
TOTAL
PERSON 76,8 81,4 158,
NEL 83 67 350
PERSON Rate
NEL -
FRINGE
BENEFIT
S
UA Fringe 32.00
Benefit % 22,1 23,5 45,6
Rate 50 44 94
GA Health
Insurance 1,236. 1,23 1,27 2,50
(flat rate 00 6 3 9
annually)
GA FICA 7.70
(summer % - - -
only)
TOTAL
BENEFIT 23,3 24,8 48,2
S 86 17 03
TOTAL
PERSONNEL AND 100, 106, 206,
BENEFITS 269 284 553
PROFESSIONAL
SERVICES/
CONSULTANTS
EQUIPMENT
EEG $24,000
Mobile less 5% 23,1 - 23,1
unit discout 00 00
plus $300
s&h
TOTAL
EQUIPM 23,1 - 23,1
ENT 00 00
SUPPLIES AND
MATERIALS
MP 3 40 players;
player and $25 each 1,00 1,00
downloads 0 0
17
EEG sterilizing 159.
Supplies solution 8 160
$39.95
each (4)
EEG needle & syringe kit
Supplies $4.89 ea (4); $9.95 30 30
shipping
EEG chin straps
Supplies $15 ea (4): 70 - 70
$9.95
shipping
EEG Q-tips
Supplies 7 7
EEG lotion
Supplies 47 47
EEG WaterPik Classic
Supplies for Professional 50 50
cleaning Water Flosser
Caps
EEG surgical
Supplies gloves 23 23
EEG ASA ERP
Software single 4,00 4,00
license 0 0
EEG waveguard
Software cap - 32 1,40 1,40
channel 0 0
EEG surgical style sponges, needle,
Software syringes; EEG Cap System II 750 750
for QEEG
Cortisol Saliva tests (666 $15/ea

over two years) *9 tests 4,99 4,99 9,99
*74 5 5 0
particip
ants
Ipads (2) $529.99 Apple® - iPad® with
each Retina® display - Wi-Fi + 1,06 - 1,06
4G LTE, 16 GB 0 0
2 iPad $49.99 Apple® - Smart Case for 99.9
cases each Apple® iPad® 2nd-, 3rd- 8 100
and 4th-Generation
TOTAL
SUPPLIE 13,6 4,99 18,6
S 91 5 86
TRAVEL Tra
vel
PI Travel To attend 5-day hotel 143
Society for 2,90 2,90 5,80 7.5
Neuroscience annual 4 4 8
meeting
18
registr 350
ation
TOTAL TRAVEL 2,90 2,90 5,80 airfare 500
4 4 8
meals 375
OTHER Bham 72
parkin
g
1/2 Tuition 25% FTE $5085/semester miles 69
- GRA - 2015-2016 5,085. 5,08 5,49 10,5 to
(academic 00 5 2 77 Bham
year only)
One-day EEG airport 100
on-site Mobile 1,60 - 1,60 shuttle
training & Unit - Ant 0 0 s
installation Neuro
vendor
Participant 290
Incentives 3,70 3,70 7,40 3.5
- 74 @ 0 0 0
$100
TOTAL
OTHER 10,3 9,19 19,5
85 2 77
CONSORTIUM/CONT
RACTUAL COSTS
TOTAL
CONSORTIUM/CONTRACTU - - -
AL
Up to
$275,00 for
2 years
TOTAL DIRECT 150, 1233 Und
COSTS (including 349 75 273, er 1,276
consortium) 724 bud .12
get
TOTAL MODIFIED DIRECT 122, 117,

COSTS (Direct costs less 164 883 240,
equipment and tuition) 047
TOTAL 47%
INDIREC MTDC 57,4 55,4 112,
T COSTS 17 05 822
TOTAL PROJECT 2077 1787

COSTS (Direct plus 66 80 386,
Indirect) 546
19
Budget
sample
July 2015
20
ASSIGNMENT ON
Developing Budget Proposal
SUBMITTED TO

GONDA
SUBMITTED BY
MISS. REEMA PAL

GONDA
21
Design of Hospital Specialty Unit Layout
ICU Planning and Designing in India – Guidelines 2010
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
(1,2,57,58,75) .
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 .
There are pre-existing guidelines on the website of ISCCM, made in 2003. There has been
a sea change since then and therefore need for new guidelines. The existing guidelines have been
taken as base line for the present recommendations.
Following areas are covered.
1 Initial Planning
22
Team Formation and Leader/Coordinator
Data Collection and analysis
Beginning of the Process and decide about Budget allocation , aims and objectives
2. Decision About ICU Level, Number of beds, Design and Future Thoughts
Planning level of ICU like I, Level II or Level III or Tertiary Unit Number of beds and number of
ICUs as needed for the institution Designing each bed lay out and providing optimum space for the same
Modulation according to various types of space availability. Free hanging power columns Vs head end
panel facilities
3 Central Nursing Station designing and planning
-Location, space, Facilities
4 Equipmentation
 Will depend on number of beds, target level of the ICU
 Most important decisions will be No of Ventilated beds and Invasive monitoring
 ICU Vs HDU
Collecting information about various equipments available with specifications
5 Support System Recommendations
Storage
Communication
Computerisation
Meeting needs of Nursing and Doctors
Meeting needs of relatives and Attendants
23
Relationship and Coordination with other areas like ER and other super speciality
ICUs
6 Environmental Planning
Effective steps and planning to control nosocomial infections
Flooring, walls, pillars and ceilings
Lighting
Surroundings
Noise
Heating/ AC/Ventilation
Waste disposal and pollution control
Protocol about allowing visitors, shoes etc inside ICU
7 Human Resource development
Doctors , Nurses , Respiratory Therapist , Computer Programmer , and support staff like Clerks
,X-ray technician, Lab technicians , Cleaning staff who are trained to the needs of ICUs . This
is a very Critical area and turn over is very high because of big gap between demand and supply
and can put a lot of stress on the team and patient outcome.
8 Other areas like
Research
Data Collection
Documentation
Record keeping
Team Formation
Team may consist of following -
Intensivist
Administrator
Finance officer
Architect and Engineers
24
Nurse
Any other person if is relevant
Who should Co-ordinate/lead the team ?
Coordinator is the most important person who coordinates with everyone involved.
Intensivist/In-charge is best suited to be the Co-ordinator because –
He has technical skill and knowledge to plan and guide
He will prevent mistakes to bare minimum
He can suggest changes during the development phase itself if finds problems However, in
some countries or some set ups particularly public sector hospitals administrators are usually
the coordinators of such project implementation process since they can coordinate with all
the major individuals and groups whose inputs/help are needed in achieving the target in time
and quality, It may be difficult for Intensivist to spare so much of time needed and coordinate
with others.
Aims and Objectives, Budget allocation and other target settings
It is important to decide about priorities based on inputs from Team members and should
answer following questions –

Budget available Level of
ICU needed Location
Number of Beds needed
Designs
Human Resource Development
Engineering and designing constraints
What type of Case mix the ICU team is likely to deal with and therefore help in
prioritise equipment type
In Case of existing facility being upgraded or relocated, then the review of past mistakes
Patient safety and prevention of infection programme
25
Transition in case of relocation during reconstruction of the existing ICU
Following thoughts may help in making decisions and implementation easier (88s) Features
that must be adopted
Features that should be adopted

Features that can be adopted Features
that should not be adopted Features that
must not be adopted.
When everything has been put in writing and approved by the whole team, the process must be began in
the earnest and a time frame work should be fixed and all efforts must be made to accomplish the
implementation within the stipulated time unless there are unforeseen circumstances.
Budget and Human Resource (Residents and Nurses) are the most important limiting factors.
Engineering related problems like drainage systems, leaks, slopes etc are easily overlooked. It is advised
that engineering work be done in a manner so that repairing when ever needed should be easily possible
without jeopardising patient care. Therefore, least concealed or over-the-false roof pipelines, wires
should be avoided.
Designing ICU/Level/No of ICUs/No of Beds and Individual Bed
Following ICU Levels are proposed
Level I
It is recommended for small district hospital, small private Nursing homes, Rural centres
Ideally 6 to 8 Beds
Provides resuscitation and short-term Cardio respiratory support including
Defibrillation.
ABG Desirable.
It should be able to Ventilate a patient for at least 24 to 48 hrs and Non invasive
26
Monitoring like - SPO2, H R and rhythm (ECG), NIBP, Temperature etc
Able to have arrangements for safe transport of the patients to secondary or tertiary centres
The staff should be encouraged to do short training courses like FCCS or BASIC ICU Course.
In charge should be preferably a trained doctor in ICU technology and knowledge
Blood Bank support
Should have basic clinical Lab (CBC, BS, Electrolyte, LFT and RFT) and Imaging back up
(X-ray and USG), ECG
Some Microbiology may be desirable
At least one book on Critical Care Medicine as ready reckoner
Level II (Recommendations of Level I Plus)

Recommended for larger General Hospitals Bed
strength 6 to 12
Director be a trained/qualified Intensivist
Multisystem life support
Invasive and Non invasive Ventilation
Invasive Monitoring
Long term ventilation ability
TC Pacing
Access to ABG, Electrolytes and other routine diagnostic support 24 hrs Strong
Microbiology support with facility for Fungal Identification desirable Nurses and
duty doctors trained in Critical Care
CT must & MRI is desirable
Protocols and policies for ICUs are observed
Research will be highly recommended
Should be supported ideally by Cardiology and other super specialities of Medicine and
Surgery
HDU facility will be desirable
Should fulfil all requirements for IDCC Course
27
Resident doctors must be exposed to FCCS course/BASIC course/Ventilation workshops
and other updates
Blood banking either own or outsourced
Level III (All recommendations of Level II Plus)

Recommended for tertiary level hospitals
Bed strength 10 to 16 with one or multiple ICUS as per requirement of the institution
Headed by Intensivist
Preferably Closed ICU
28
Protocols and policies are observed
Have all recent methods of monitoring, invasive and non invasive including continuous
cardiac output, SCvO2 monitoring etc
Long term acute care of highest standards
Intra and inter-hospital transport facilities available
Multisystem care and referral available round 24 hrs
Should become lead centres for IDCC and Fellowship courses
Bedside x-ray, USG, 2D-Echo available
Own or outsourced CT Scan and MRI facilities should be there
Bedside Broncoscopy
Bedside dialysis and other forms of RRT available
Adequately supported by Blood banks and Blood component therapy
Optimum patient/Nurse ratio is maintained with 1/1 pt/Nurse ratio in ventilated patients.
Protocols observed about prevention of infection
Provision for research and participation in National and International research

programmes
Patient area should not be less than 100 sq ft per patient (>125 sq ft will be ideal). In addition
there is optimum additional space for storage, nursing station and relatives
The unit is assisted by an Ethical Committee which formulates policies about DNAR, Organ
donation, EOLS etc
Doctors, Nurses and other support staff be continuously updated in newer

technologies and knowledge in critical Care
There is regular sharing of knowledge, mishaps, incidents, symposia and seminars etc related closely to
the department and in association with other specialties
Human Resource for ICU
Human resource development is one of the most important task and component of the whole
programme. Dedicated, highly motivated, ready to work in stress situations for long periods of time
are the type of personal needed. They include
Intensivist/s
Resident doctors
Nurses,
29
Respiratory Therapists,
Nutritionist
Physiotherapist
Technicians, Computer programmer,
Biomedical Engineer, and
Clinical Pharmacist
Other support staff. Like cleaning staff, guards and Class IV.
Not only they have to be qualified but have to be trained and have to be a team person Scarce availability
of these qualities all in one has made their availability extremely difficult and the turn over is high.
30
Team Leader
It is important to have a good team led by an Intensivist (who spends >50% of his time in
ICU). He should be a full timer particularly for tertiary centres. He should be qualified and trained
and able to lead the team. Experience is absolutely essential to lead the ICU team .
Resident Doctors (only MCI endorsed)
Post graduates from Anaesthesia, Medicine or Respiratory Medicine or other allied branches
even surgical specialties. Other residents may be graduates depending upon total Bed strength
of ICU.
Though need of resident doctors per number of patient has not been prescribed in literature,
however, it is understood and recommended that one doctor cannot take care of more than
five patients who are critically sick on ventilator and/or undergoing invasive monitoring with
MOFS.
Therefore, it is suggested that one PG resident with one graduate resident may be good
for an ICU of 10 to 14 beds with 1/3 of the pts may be falling into above category. Total no of
residents should include who will relieve those going on leave or have to take sudden offs.
Nursing staff ( only NCI Endorsed) (34,35,36,37,38,39)
Nursing – 1/1 nursing for Ventilated or MOFS patients is desirable but in no circumstance
the ratio should be < 2 /3 (Two nurses for 3 such patients).
This will affect the outcome immensely.

31
1/2 to 1/3 nurse patient ratio is acceptable for less seriously sick patients who do not require
above modalities.
Other staff
Respiratory Therapist looks after the patients being ventilated respiratory
physiotherapy, this takes away lot of load off the duty doctor and the nurses Physiotherapist
help in mobilisation, and Technicians who can perform simple procedures like taking samples
and sending them to proper place in proper manner makes the task easy and less stressful.
Computer person can prepare reports, enter data and bring out print outs as and when needed.
He can also maintain library, Internet and protocols practiced in ICU.
Biomedical engineer within the campus makes the job of ICU less frustrating when snags
creep in within sensitive ICU equipment. He can be correct them fast.
Nutritionist is also a very important professional who can contribute to outcome of patient.
They have to be trained in desired practices and should be more inclined towards enteral feeding
than TPN.
Cleaning, class IV and Guards are also important to ICU particularly when they understand
needs of ICU and its patients. They have a huge role to play in prevention of Nosocomial
infection, keeping ICU clean and protect from overcrowding.
One person should be responsible for observing protocols of Pollution and Infection control.
Such person should act in close collaboration of Microbiology personnel
In addition the ICU should be ably supported by clinical Lab staff, Microbiology and Imaging
staff who can understand the protocols of ICU and act within discipline of ICU protocols.
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Having professionals from Clinical Lab, Microbiology, Imaging, Pharmacy for support
whenever needed will be desirable.
How many ICUS and Beds are needed
Brain storming sessions should be held as to decide how many ICU beds are needed and how
many ICUs should be made which may include Advanced ICU, HDU, PICU and Speciality
related ICU like Neurointensive care, Cardiac Intensive Care and Trauma.
The number of Intensive Care beds will depend on the data available from the hospital and
current/future requirements of the hospital.
Some ICUs particularly in Private set ups in our country may be main speciality in the hospital
and they should be very careful in deciding about the number of beds and budgetary provisions
and viability issues are very important in such cases.
Numbers of ICU Beds recommended in a hospital are usually 1 to 4 per 100 hospital beds
ICUs having <6 beds are not cost effective and also they may not provide enough clinical
experience and exposure to skilled HR of the ICU. At the same ICU with bed strength of >24
are difficult to manage and major problems may be encountered in management and outcome.
Recommendations suggest that efficiency may be compromised once total number of beds
crosses 12 in ICU.
The Canadian Department of National Health and Welfare has developed a formula for
calculating the number of ICU beds required based on the average census in the existing unit
and the desired probability of having an ICU bed immediately available for a new admission.
Therefore, it is recommended that total bed strength in ICU should be between 8 to 12 and not
<6 or not >14 in any case
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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.
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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.
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.
There are also electronic windows which are transparent when the switch is off and are opaque
when the switch is on, Although expensive now, the cost of this option may come down over
time,
Pendant vs Head End Panel

35
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

36
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 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
37
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 female Plugs
Fot 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
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.
Utilities per bed as recommended for Level III Indian ICUs
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3 oxygen outlets, 2 compressed air, 2 vacuum (adjustable), 12 to 14 electric outlets, a bedside light one-
telephone outlets and one data outlet. ( 88,89,90,91,92)
Central Nursing stn
This is the nerve centre of ICU, despite lots of development, the old standard of a central station
is still holds good and endorsed by most guidelines and regulations regardless of today's practice
needs.
All/near-all monitors and patients must be observable from there, either directly or through the
central monitoring system. Most ICUs use the central station, serving six to twelve beds
arranged in an L or U fashion,
Patients in rooms may be difficult to observe and therefore may be placed on remote television
monitoring, These monitors may satisfy regulatory requirements but do not really provide
adequate patient safety if the clarity of the picture is poor.
Some ICUs have unit pods of about four or five beds, each served by a separate workstation,
Nurses assigned to patients in the pod form a team,
A monitor technician is required,
The unit Nursing clerk and the supervising nurse will usually work together to oversee the
efficient interaction among the staff and with support services,
Careful consideration of what level or type of activity will occur in the central station will
insure adequate space planning, New equipment purchased over the next decade will probably
increase the amount of desk and shelf space required.
At times of high use the number of people in the central station can increase several fold.
Having enough space and chairs to meet needs during such times should be provided for.
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The space should accommodate computer terminals and printers. A large number of
communication cables may be required per bedside to connect computers and faxes to other
departments, as well as to other institutions and offices,
Adequate space for charting on the platform is absolutely important.
Patients must be easily visible from the charting area whether the nurse is sitting or standing,
taller chairs are often necessary.
In case of space constraint, Collapsible desktops or shelves that can flip up off the wall
can be planned
Space allotted for storage of the previous charts of patients currently in the unit should also be
provided
It is also important that a storage space is provided for equipment, linen, instruments, drugs,
medicines, disposables, stationary and other articles to be stored at the Nursing station must be
provided. All these cupboards should be labelled
The latest generation of monitoring systems allows access to patient data from any bedside; This
means that the doctor who is busy caring for one patient can monitor others without leaving that
bedside.
Consoles can be programmed to automatically display critical events from one bedside
at several sites without personnel calling for it. There is need for more effective alarming system
with less noise, which can send signals to CNS as well as remote pager carried by the caregiver.
Ideally in Indian ICUs, there are over bed tables with each bed. These tables may be so
deigned of stainless steel to have a broad top to accommodate charts and cupboards enough in
number and size to store medicines, disposables investigations and records of the patient.
40
The CNS has in charge nursing, duty doctors/s, clerk/computer guy, machines, store attached
and monitors and spare machines/spares, linen and other ancillaries
List Of Equipment (12 Bedded ICU and 8 Bedded HDU) (88, 89)
Sr Name of Number Specificatio
1 Bedside Monitors One per Bed Modular -2 Invasive BP, SPO2,NIBP, ECG, RR,
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
4 Non invasive 3 With Provision for CPAP and IPAP
5 Infusion Pumps 2 Per bed in Volumetric with all Recent upgraded drug calculations
ICU
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
8 Defibrillator Two with Adult and paediatric pads with Trascutaneous
TCP facility pacing facility

10 ICU Beds (Shock One for each bed Electronically Manoeuvred with all positions possible
with mattress. Now beds are available which give

11 Over Bed Tables One for each ALL SS with 6 to 8 cupboards in each to store
12 ABG Machine One+One facility for ABG and Electrolytes
13 Crash/ Two for ICU To hold all resuscitation equipment and Medicines
14 Pulse Oxymeter Two As stand bye units
15 Freeze One + One for With deep freeze facility
use of staff
16 Computers 2 (for ICU), With laning, Internet facility and printer to be
One for HDU, connected with all departments

17 HD Machines 2 User friendly so that even a Nurse can Operate
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18 CRRT One High flow /Speed Model
19 CO, SVR, ScvO2 One As Described
20 Intermittent Two To prevent DVT
Leg
21 Airbeds 6 To Prevent Bed sores
22 Intubating One To make difficult Intubations easy
23 Glucometer 2 for ICU,
one for
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Sr Name of Number Specificatio
24 ICU Dedicated One With recent advances to look instantly even at odd
Ultrasound and hours. Vascular filling, central lines, etc

25 Bedside X ray One
26 ETO sterilization One To sterilize ICU disposables regularly
27 Spinal Board Two For spine trauma patients
28 Rigid Cervical 4 For stabilizing cervical spine
29 Ambu Mask 10 sets Silicon, ETO sterilisable
different including two

30 Pollution One set for
31 Trays for Procedures For putting
central lines,
32 I A Balloon Pump One
33 Fibroptic One
This is major list of equipment for ICU, More Equipment can be added to meet the requirements
of each unit. Each unit can modify this list as per their needs.
STORAGE ( 1,2,8,52,88 )
It is important to decide what is to be stored
By the bedside
At the Nursing stn
Nursing stores Remote
central store
Those supplies used repeatedly and in emergencies should be readily available and easy to find,
Storing a large inventory can be costly, but so is wasting personnel time,. Making supplies more
43
available may increase their use. Some over cautious or clever staff may decide to hoard or
hide them. Cost effective and efficient designs are needed.
Staff nurses can always give useful ideas about improvement of systems, which they develop
while working with patients. There opinion can be invaluable.
When medications are kept at the bedside, JCAHO currently requires that the storage be
lockable, these stores can store medicines, disposables, records, injections, tabs etc.
Bedside supply carts that are stocked for different subsets of patients can make storage in
the room more efficient, For example, surgical, medical, trauma patients, cardiac patients where
needs are different. Staff nurses may be specifically trained for such care and work
Determining what supplies are placed near but not at the bedside is based on the size of the
unit, the grouping of patients and the patterns of practice, although many units organize supplies
by the department that restocks them (central services, nutrition, pharmacy, respiratory therapy,
etc,)
it is worth considering grouping supply by activity, like Chest tray, Central line tray, skin care
tray , catheterisation tray , Intracranial pressure tray etc. They may be labelled by name or
colour code.
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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
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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 stabilisation 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.
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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

47
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)
Standard examples are
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.
48
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

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Provisions must be made to accommodate an obese patient
FLOOR, WALL AND CEILING COVERINGS (8,14,17,73) 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.
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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.
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.
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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.
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Similarly outside the ICU there may be major or minor disasters like fire, accidents, Terrorist
acts etc.
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 firef ighting 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 Care givers, other departments and relatives of Pts
Needs of doctors and Nurses
The space and facilities planned for them are often inadequate. Space is usually scarce and it
is tempting to limit the support areas in favour of larger patient rooms.
Multi-purpose rooms may be a solution which may be used for meetings, leisure, lectures,
library, lounge and break areas with food services (microwave, coffeemaker, refrigerator),
This is especially useful for night shift staff when the cafeteria is closed, Multipurpose seating,
stackable or folding chairs and a wide variety of lighting options can increase flexibility.
53
This should be in close proximity to the unit (within the same broader complex) and can even
have windows with curtains, blinds, or one-way glass to allow those inside to continue to
observe unit activity,
Additional space is needed for staff lockers with areas to change clothes and, ideally, shower.
Separate areas are required for men and women,.
In Indian situation it is advisable to have separate change rooms for nurses and doctors.
Whether or not lockers are provided, female staff tends to keep purses or bags near them at the
bedside, (This should be discouraged like helmets of male staff cannot be allowed in main ICU).
This can be addressed by providing a secure place for keeping their belongings in the unit.
A couch with working table and broadband connected computer is quite handy.
Optimum number of journals/books, stationary, view boxes should be provided. Enough
no of restrooms be provided.
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:
Signages--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
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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.
55
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
Communication
A central communication area is also needed for unit, committee and hospital-wide
announcements; newsletters and memos: and announcements of outside events and meetings. Bulletin
boards are necessary but often unsightly. lt is better to plan them because they may be added after the
fact in a less effective or appealing manner
HDU-
It is the area where patient care level is intermediate between ICU and Floors. It is usually
located near the ICU complex or within ICU complex. The staff is also almost similar to ICU
culture. Following type patients may be kept here
Patients recovered from Critical Sickness.
Patient who are less sick like single organ failure not requiring invasive monitoring or invasive
MV
Patients requiring close observation that are strong suspects of getting deteriorated. Size of
such units should be at least 50 % of the main ICU.
Doctor/Pt ratio and Nurse/Pt ratio may be much more relaxed
1/3 of these Beds may be used as palliative unit for patients who are terminally sick and
DNAR is being observed.
56
There are conflicting reports suggesting usefulness of such units. But in Indian circumstances
and surveys indicate that HDU has helped in our circumstances. Possibly in following ways
Cutting costs of patients and health service provider requiring close observation and not needing
ICU
Allows close observation of potentially critically sick patients both who are
transferred from and to ICU
Psychological relief to the family and patients that he is being observed meant for lesser
sick patients.
It may be handy to public hospitals where there is always shortage of ICU beds.
Summary
ICU is a highly specialised 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.
No 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 .
57
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 sometime 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 firefighting /extinguishing machines should be there.
It is desirable to have access to natural light as much as possible to each patient.
58
Head end Panels are recommended over Pendants for monitoring, delivery of oxygen, compressed
air and vacuum and electrical points for equipment use for these patients
List of equipment and no of Oxygen, vacuum, compressed air outlets are listed in the guidelines
Every ICU should have a qualified /trained Intensivist as its leader
One doctor for five patients may be ideal ratio.
1/1 Nurse ideally but < 1/2 nurse –patient ration is recommended for ventilated patients
and patients receiving invasive monitoring and on RRT
Other personnel needed for ICU have been listed.
ICU should practise given protocols on all given clinical conditions.
Requirement of Furniture, storage, light, Noise, flooring, walls, ceiling air- conditioning,
ventilation etc have been described in guidelines in details.
Needs of doctors, Nurses and relatives of patients should be carefully observed
Required standards and equipment for different levels of ICUs have been mentioned.
References
ICU Design Guidelines
1. American Institute of Architects Committee on Architecture for Health and the U.S.
Department of Health and Human Services — Guidelines for Construction and
Equipment/Hospital and Medical Facilities. AIA Press, I 996.
2. American College of Critical Care Medicine's Taskforce on Guidelines: Guidelines for
Intensive Care Unit Design. SCCM and AACN. 1993.
59
3. Joint Commission on Accreditation of Healthcare Organizations: The Joint commission
Accreditation Manual for Hospitals. JCAHO. Chicago
GUIDEUNES FROM THE SCCM, 8101 E. Kaiser Blvd., Anaheim. CA 92808 (714)
282-6000
4. Recommendations for Services and Personnel for Delivery of Care in Critical Care
Settings. Critical Care Medicine 1988: 16(8):809·8ll
5. Recommendations for ICU Admission and Discharge Criteria. Critical Care Medicine
1988; 16(8):807-808
6. Guidelines for Categorization of Services for the Critically ill Patient. Critical Care
Medicine 1991; 19(21):279-285
7. Guidelines for the Transport of Critically Ill Patients. Critical Care Medicine 1993;
21(6):93 1 -947
8. ICU Design Video: Compilation of 3-5 minute video tours and floor plans from the top entrants
since 1992 for the ICU Design Citation.
POSITION STATEMENTS FROM AACN. P0 Box 30008. Lagima Niguel. CA
92607(800) 809-2273
9. Collaborative Practice Model: The Organisation of Human Resources in Critical C are
Units, 1982.
10. Guidelines for Admission Discharge Criteria in Critical Care. 1987.
11. Integration of the Professional Nurse and the Technical Nurse in Critical Care, 1987.
60
12. Day, C: Places ofthe Soul: Architecture and Environmental Design as a Healing Art.
Northamptonshire, England, Aquarian Press (Thorsons Pub. Group). 1990
13. Dubbs D: Partnering means making friends, not foes. Facilities Design and
Management June 1993: p 48
14. Duffy TM. and F1ore11.JM: 1CUs ~ An Integrated Approach to Design. Journal of
Health Care Interior Design 1990; II:I67-179
15. Illuminating Engineering Society of North America: Lighting or Healthcare Facilities.
IESNA. Publication CP29.
16. Iwen PC. Davis JC. Reed EC. et al: Airborne fungal spore monitoring in a protective environment
during hospital construction and coorelation with an outbreak o invasive aspergillosis. Iiyectioii
Control and Hospital Epidemiology 1994; 1515): 303-306.
17. James PW. Tatton—Brown W: Hospitals: Design and Development. Architectural
Press. London. 1986
18. Munn EM. Saulsbery PA: Facility planning · A blueprint for nurse executives. Journal of Nursing
Administration l992; 221 1): 13-17
19. Nardell EA: Fans. filters or rays: Pros and cons of the current environmental tuberculosis
technologies. Infection Control and Hospital Epidemiology 1993;
1411):681-685
20. Nardell EA. Keegan J. Cheney SA. Etkind SC: Airborne infection: Theoretical limits of
protection achievable by building ventilation. Amer Review ofResp Diesase 1991:
144:302-306
61
21. Flynn J. Segil A. Steffy G: Architectural Interior Systents Lighting/Acoustics/Air C
onditioning. Second Edition. New York. Van Norstrand Reinhold. 1988.
22. Flynn PM. Williams BG. Hetherington SV, et al: Aspergillus terreus during hospital renovation.
Infection Control and Hospital Epidemiology 1993; 14(7):363-365
23. Fontaine D: Effect of sensory alterations. ln: Critical Care Nursing. Clochesky J, et al
(Ed), Philadelphia, PA. WB Saunders, 1993: pp 13-30
24. DuMoulin G: Minimizing the potential for nosocomial pneumonia: architectural. engineeringand
environmental considerations for the ICU. EUR J Clin Microbial Inf Dis 1989: Stl):69-74
25. Eagle KA. Mulley AG. Skates SJ, et al: Length of stay in the ICU: Effects of practice guidelines
and feedback. JAMA 1990: 264:992-7
26. Edwards GB, Shoring LM: Sleep protocol - A research-based practice change.
Critical Care Nurse 1993; 13:84-88
27. Critical alarms: Patients at risk. Technology for Critical Care Nurses. ERC]. Plymouth
Meeting, PA, pp 1-5. 1992.
28. Step-down units and telemetry monitoring: optimizing utilization. Health Devices 1993;
22(1):25-7
29. TQPM not TQM. Professional Services Management Journal April 1993: p 1
30. Allinson K: Wild Card of Design: A Perspective on Architecture in a Project
Management Environment. Oxford: Butterworth Architecture. 1993.
31. Integration of the Professional Nurse and the Technical Nurse in Critical Care, 1987.
62
32. Occupational Hazards in Critical Care. 1988.
33. Patient Classification in Critical Care Nursing. 1986.
34. Use of Nursing Support Personnel in Critical Care Units, 1989.
35. The Nurse of the Future. 1993.
36. Harvey M, Ninos N: Fostering more humane critical care - Creating a healing environment.
In: AACN's Clinical Issues in Critical Care Nursing. JB Lippincott. August 1993: 4(3):484-508
37. Heath JV: What the patients say. Intensive Care Nursing 1989; $(3):101-108
38. Henning RJ, McClish D, Daly B, et al: Clinical characteristics and resource utilization of ICU
patients: Implications for organization of intensive care. Critical Care Medicine 1987; 15:264- 269
39. Holt AA, Sibbald WJ, Calvin JE: A survey of charting in critical care units. Critical
Core Medicine 1993; 21(1): 144-50
40. Hoyt JW, Harvey MA. Axon DC; The Critical Care Unit - Design and Recommendations.
ln: Textbook of Critical Care Medicine. Shoemaker W, Ayres S, Greny KA, Holbrook P (Eds).
Philadelphia PA, WB Saunders, 1995.
41. American Society of Heating. Refrigerating and Air-Conditioning Engineers: Handbook of
Fundamentals. ASHRAE. Atlanta.
42. ANSI/EEE Recommended Practice for Electric Systems in Health Care Facilities.
IEEE Inc. 1986.
43. Art1et G: Measurement of bacterial and fungal air counts in two bone marrow transplant
units. Journal of Hospital Infection 1989: l3(l):63-69
63
Annexure
A survey was conducted and a questionnaire was sent across India to 100 ICUs. Almost
50 responded and they included ICUs from Level I to Level III. The summary of response is
presented in tabulated form as under. Lot of personal communication was also obtained. This
response has helped a great deal in forming these guidelines
64
ICU Survey Performa used and responses presented in %
How many minimum 4 6 (>80%) 8 10 >10
How many maximum 8 10 14 16 to 20 >20
Should the no Of ICU Yes No 50 /50

Beds
What is the sq ft area you <100 100 to 125 125 to 150 150 to 200 >200
What is the area in your <50 % of 50 to 75% > 75 to 100% > 100 to 125% >125% of
ICU the
the than total total pt of total
You have utility panel Head End Floor Hanging Any other
power
containing Monitors Panel Pendant
You have pt cabins All open Divided Divided Any other
divided by by
You have allowed shoes Only Only inner With shoe None Any other pls
65
You have a separate HDU Yes if yes No
attached to your ICU then how 50%

Your ICU is Closed Open Mixed
Pt Nurse ratio for Non 1/1 2/1 Any other
Pt Nurse ration for 1/1 2/1 Any other
Pt/Nurse Ratio for Septic 1/1 2/1 Any other
You have separate Stand Yes No

bye
You have minimum 1 2 >2
number
15%
Your ICU is headed by a Yes No
Full
You run a ISCCM IDCC Yes No
Your unit will fit into I II III
You are a IDCC course Yes No
You are a ISCCM Yes No

Fellowship
You are a DNB (Critical 2% 98%
Any other information
your ICU is Level
Facilities in your ICU A separate
Note
66
ASSIGNMENT ON
Design a layout for specialty unit for

Hospital
SUBMITTED TO
SCPM COLLEGE OF NURSING AND PARAMEDICAL

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
67
Design a layout for specialty unit for Community
A sustainable community seeks to maintain and improve the economic, environmental and
social characteristics of an area for its members can continue to lead healthy, productive, enjoyable
lives. The concept sustainability explores the relation among economic development, quality of the
environment and social equity. Policies and strategies for sustainable development should
simultaneously promote continuous economic opportunities, enhance environmental fundamentals and
focus on the social well-being of the community to ensure an evenly balanced environment. Policies
have to advocate impartiality between different generations, races and genders to ensure equal and
uncomplicated access to available opportunities and facilities. Quality of life is a main objective of
sustainable development. The principle of planning for human wellbeing is thus of paramount
importance and hinges significantly on immediate and visual changes to lifestyle.
The major features of sustainable community development include; ecological protection,
density and urban design, infill village centres, local economy, sustainable transport, affordable
housing, liveable community, sewage and storm water, water, energy and the three R’s: construction
waste recycling, environmental sound building materials, provision of in-housing recycling areas.
Planning for sustainable communities
A sustainable community underwrites objectives that reflect respect for both the natural
environment and human nature. In this regard the use of appropriate technology is invaluable. A
sustainable community should essentially strive to achieve the following characteristics and goals:
1. Place a high value on quality of life. A sustainable community accepts that communities are
first and foremost for people and that the primary objective of the planning and development
process is to improve the quality of life of its residents, socially, economically, psychologically,
and spiritually. It implements policies to achieve quality of life and does so in a fair, open, and
democratic manner.
2. Respect the natural environment. A sustainable community recognizes its relationship to nature
and sees nature's systems and components as essential to its well-being. It provides access to
68
nature through metropolitan parks, open-space zones, and urban gardens. It understands the
sensitive interface between the natural and built environment, develops in a way that will
support and complement-not interfere with nature, and avoids ecological disasters.
3. Infuse technology with purpose. A sustainable community uses appropriate technology, while
ensuring that technology in the built environment is a means to an end, rather than an end unto
itself. It emphasizes learning and understanding how existing and new technology can serve
and improve communities, not vice versa. It sets clear and measurable goals for what it wants
technology to achieve.
4. Optimize key resources. A sustainable community takes an inventory of its human, natural, and
economic resources and understands their finite quality. It ensures that forests are not overused,
people are not underemployed, and the places of the built environment are not stagnant and
empty. It reduces waste and reuses resources: it creates conditions in which all these resources
can be used to their fullest and best potential, without harming or diminishing them.
5. Maintain scale and capacity. A sustainable community recognizes the importance of scale and
capacity, with regard to the natural and human environment. It ensures that the environment is
not overdeveloped, overbuilt, overused, or overpopulated. It recognizes the signs of tension that
indicate when the environment is overstressed and can adjust its demands on the environment,
to avoid pollution, natural disaster, and social disintegration. (Geis & Kutzmark, 2006).
The planning and design of sustainable communities are essential. “Everyone has the right to
an environment that is not harmful to their health or well-being; and to have the environment
protected for the benefit of present and future generations through reasonable legislative and
other measures that prevent pollution and ecological degradation promote conservation and
secure ecologically sustainable development and use of natural resources while promoting
justifiable economic and social development” (United Nations (UN). 1997).
6. Layout and design approaches (Place making) “You have to turn everything upside down to get
it right side up” (Project for public spaces, 2011). This emphasises the bottom-up approach and
community-scale of planning. Placemaking was introduced in the planning sphere to address
community-scale planning with the objective to create qualitative, liveable environments that
69
adhere to the principles of sustainability. Figure 1 highlights and summarizes important
elements of place-making. The place-making-approach can be employed to realise liveability
by implementing various functions within one space. This ensues in the transformation of areas
from solely being places that people occupy, so called ordinary spaces, into liveable places. In
order for this to realize, the main focus should be placed on current public spaces within
communities that has potential, and the development of these spaces according to this place-
making approach in order to create places in which people can socialize and interact (Cilliers
et al.,2012:11).
7. Hence, an ordinary space within a community is developed through the inclusion of lively
elements, whereby a space is transformed into a place with good genius loci. In these lively
public spaces that are now created, numerous functions and activities regarding community life
will take place, and the people inhabiting this place will possess a feeling of ownership and
connectedness according to Cilliers et al. (2012:11).
8. The idea is also to include more than one great place in a neighbourhood for a city or town (or
in this case a rural community) to be regarded as a truly lively place (Cilliers et al., 2012:12),
thus integrating a variety of functions within one space.
9. When citizens are effectively engaged in a design process then designers and planners can be
their most effective too; facilitating a process that synthesizes local experience and wisdom
with design principles and technical expertise. Designers can help people uncover their
common interests and work towards practical, creative solutions that build on local character
and assets. (McBride, A. 2013) Irrespective of the environmental attributes of an area, the
community should be the primary source of information when planning and designing a specific
place.
Participation can be seen as an approach to lively planning or as an element needed to create a lively
place. The inclusion of the public in creating places is a difficult and complex process because of the
diversity of the members it tries to accommodate: The more diverse the group, the more needs that need
to be taken into consideration and therefore the more complex the participation process and input will
70
be (Breman et al, 2008:17). Even though it is difficult to implement, participation still remains a critical
part of planning for sustainable communities and public places and this participation of all residents
along with supervision, reviews and awareness are important for effective place making (Loudier &
Dubois, 2001:9).According to Cilliers et al. (2012:11), this qualitative participation approach is needed
to address and successfully implement a bottom-up approach and ensure the planning of functional and
usable spaces that can be regarded as lively. To create this type of situation where active participation
is present, the community needs to play a bigger role in terms of discussions with authorities, policy
formalization, creating solutions.
Equally important is that planning and design approaches should at all times endeavour to
harmonize the needs of the community with the natural layout and resources of the environment to
ensure an effective and sustainable design. Continuous monitoring of the implementation and progress
of the place-making and design process is imperative. Therefore transparent management and
evaluation of the approach should be maintained to ensure that effectual amendments can be made
timeously when deemed mandatory.
4.2. The role of green spaces in place-making
A community is often identified by the quality of their parks, gardens and open green spaces.
This ultimately raises a sense of accomplishment and delight in the people of that community. Green
spaces furthermore enhance the environmental appearance of a neighbourhood and contribute to the
biodiversity of the eco-system. Table 1 describes the 3key principles established by the Perth and
Kinross Council to achieve the objectives and accomplish their vision of greens-paces.
5. Conclusion of layout and design contribution to sustainable communities
The purpose of layout planning is to provide a framework within which numerous collective
and individual investments may be accommodated over time, in a mutually reinforcing and development
manor Behrens and Whatson (1996:7-12). This implies that the layout plan should indicate a minimum
set of spatial interventions rather than attempt to be more comprehensive. Behrens and
Whatson (1996:13)
71
Fundamentals that impact an effective layout plan are: land use management systems, the
availability of land, the financial status and the accessibility of finances, level of implementation of
policies and legislation and political determination. Planning for sustainable development is directed by
a combination of broad planning guidelines and normative planning concerns. General planning
guidelines for urban planning include the movement network and transport, the open space system
which is made up of the hard open spaces and the soft open spaces, public facilities, public utilities,
land subdivision, cross-cutting issues such as: environmental design for safer communities, ecologically
sound urban development and fire safety, economic services such as employment generation, urban
markets, manufacturing infrastructure and urban engendering services (Guidelines for Human
Settlement Planning and Design: 2000: National Department of Housing)
The normative planning concerns include place making, scale, access, opportunity and choice
Beherns and Watson (1996:66). A familiar planning approach for sustainable development is the linking
of various planning guidelines and normative planning focusses.
Reference:
1. Baltimore City Department of Planning. 2010. Downtown open space plan, Baltimore,
Maryland. Project for public spaces. Flannigan Consulting, Sabra Wang Associates. December
2010.
2. Bogopa, KSS. 2005. Managing sustainable development in the city of Tshwane.
http://upetd.up.ac.za/thesis/submitted/etd-08192008-091132/restricted/04chapter4.pdf.
3. Breman, B., Pleijte, M., Ouboter, S. & Buijs, A. 2008. Participatie in waterbeheer. Een vak
apart. 109p. November 2008.
4. Brooks, SJ. & Harrison, PJ. 1998. Slice of modernity: planning for the country and city in
Britain and Natal, 1900-1950, SA Geog Jnl 80(2): 93-100 1998,93)
72
ASSIGNMENT ON

Community
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
73
Design a layout plan for educational institution
Facilities in a nursing college
Facility
a. Teaching and Learning Facility
i. Lecture Halls
1. Adequate in number, spacious and air conditioned
b. Anatomy and Physiology Lab
i. The lab is provided with 900 sq. feet area. This lab is prepared to reinforce the
theory knowledge about Human anatomy & Physiology with the help of
articulated skeletal, various bones, models & charts.
c. Community Health Nursing Lab
i. This lab is provided with 900 sq. feet area. This lab ensures the students to
learn home visiting bag technique & practice the community health nursing
while providing family health care at the door step of the clients using modified
home visiting kits. The lab is equipped with variety of audio visual material to
practice health teaching in the community.
d. Maternal and Child health Nursing Lab
i. This lab is provided with 900 sq. feet area. This lab is designed to help the
learner to reinforce the learning about normal physiology of pregnancy,
midwifery,
e. Obstetrics & child health nursing.
i. The lab is equipped with various manikins, models, palpation modules,
birthing simulators & charts to develop hands on skills under the continuous
guidance& supervision.
f. Nutrition Lab
i. This lab is provided with 900 sq. feet area. This lab is designed to assist the
learner to acquire wide range of knowledge of dietetics in Indian settings & to
74
understand the concepts of “ Nutrition, Health & Disease” while planning the
diet for individuals and groups in the hospital and in the community.
g. Fundamental of Nursing Lab
i. This lab is provided with 1500 sq. feet area. This lab is organized to learn basic
and critical nursing care with the help of manikins and simulators, models &
modules (variety of adult & pediatric). The lab helps to develop the life form
absolutely realistic revolutionary nursing skills through “hands on training”
under continuous supervision & guidance by expert teaching faculties.
h. Computer Lab
i. KDA nursing college computer lab is set in 1000 sq. feet. It is air conditioned
and well ventilated with 20 computers available for training and practice
purpose. This lab will be used by the students to practice the application of
computers in the field of nursing.
i. AV Aid Lab
i. The lab is equipped with various electronic devices for the effective teaching
& learning such as LCD projectors, Over Head projectors, T.V, V.C.R , C.D
Player, Tape recorder etc.
j. Canteen
i. A well-furnished fully air conditioned canteen is located at Kokilaben Hospital
Mezzanine floor which is open from 8.00 a.m to 8.00 p.m throughout the week
which provide tasty and delicious food at subsidized rate at the students, faculty
members and other staff.
k. Library (Learning Resource Center)
i. Library and Learning resource center is an invaluable resource for students,
researchers and faculties of nursing education. It has the most complete
collection of text & reference books, audio-video material, films, charts,
75
professional journal and Magazines. It is a most lively place in the college
providing a comfortable and readers friendly environment that enables learning
and advancement of knowledge, and promotes scholarship.
ii. The fully air-conditioned and wi-fi enabled library and learning resource center
is spread over 3000 sq. ft provides access to the best of Nursing related
resources through its acquisition of various books ,Journals, online databases
consisting of scholarly and Nursing education and service related content. The
learning resource center is coordinating point between the faculty and students
which is supported by highly skilled and trained library and information
Professionals.
l. Lecture Theater
i. Nursing College has total four spacious well furnished, air conditioned and
sound proof class rooms with facility of wall mounted LCD projectors, which
help in making the live and inspiring learning environment for the students.
m. Hostel
i. A specious 224 bedded hostel for students is located at Mahadev Apartment,
Thakur Village, Kandivali (E), approximately 13 kms away from the KDA
Nursing College. The hostel is supervised and managed by well qualified and
experienced Warden Mrs. Aruna Khedkar.
ii. A safe and comfortable stay with adequate facilities of kitchen and dining,
communication room with internet facility, telephone, fax, zerox along with
first aids room and a room for visitors. Here the students can keep themselves
abreast with the events happening around the world.
iii. Hostels also have a separate Study room and a lobby. The hostel also has lobby
servants to cater the small needs of the students along with round the clock
security.
iv. Each student is accommodated in a room on a sharing basis. The hostels are
allotted on the basis of first come first basis. Newspapers and magazines are
76
provided to the students on demand. The College also have 52 seater specious
bus facility for transportation.
References:
1. Fulmer, Jeffrey (2009). "What in the world is infrastructure?". PEI Infrastructure Investor
(July/August): 30–32
2. Stephen Lewis The Etymology of Infrastructure and the Infrastructure of the Internet, blog Hag
Pak Sak, posted September 22, 2008
3. The New York Times, "Money for Public Projects", November 19, 2008 (accessed January 26,
2009)
4. Association of Local Government Engineers New Zealand: "Infrastructure Asset Management
Manual", June 1998 - Edition 1.1
77
Preparation of equipment and supplies to the specialty units
CONTENT
1. INTRODUCTION
2. PURCHASE OF SUPPLIES AND EQUIPMENT
3. FACTORS TO BE CONSIDERED
4. MATERIALS USED IN HOSPITALS
5. ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)
6. CONCLUSION
7. REFERENCES
INTRODUCTION
Hospital supplies and equipments are dealt with under material management. Supplies are those
items that are used up or consumed; hence the term consumable is used for supplies. The supplies in
hospital include drugs, surgical goods (disposables, glass wares), chemicals, antiseptics, food materials,
stationeries, the linen supply etc. The term equipment is used for more permanent type of article and
may be classified as fixed and movables. Fixed equipment is not a structure of the building, but it is
attached to the walls or floors (egg; steriliser,) Movable equipment includes furniture, instruments etc.
PURCHASE OF SUPPLIES AND EQUIPMENT
The purchase of supplies and equipments in a hospital is carried out through;
1. General store
2. Dietary department and
3. Pharmacy department
When planning for the purchase of articles , budgeting is done not only for the actual price of
articles but also for the additional costs that are involved such as ;
1. Transport charges (local delivery reduces the transport charge)
78
2. Incidental costs
3. Cost of chemicals and other consumable to be used with the equipment (eg; ECG paper for
an ECG machine )
4. Operating cost (hiring a technician )
5. Cost of maintenance service; 10-20% of hospital equipment may remain idle if serving is not
done periodically.
6. Cost of technology obsolesces: when a better quality appears in market there is tendency to
discard the old model.
7. Replacement cost of equipment
Selection of article- while buying articles it has to meet the standards. Indian Standards Institution is
the national agency set up to bring standardisation of articles in India. Articles that meet the criteria
specified by the Indian Standard Institution will be marked by ISI markings. The articles bought should
provide safety to the patient and personnel. Faulty instruments and equipments cause not only
inconvenience in the patient care, but also it may cause the loss of life.
Purchasing article:
1. The material used for any equipment should be durable, non-corroding, non toxic and safe for
use.
2. Should have standard shapes and dimensions to fit into various situations
3. Reparability and spare part availability of the article
4. Interchangability of the article
5. All surgical instruments used in a hospital should be sterilisable and they should stand the tests
for leakage , hydraulic pressure tests for bursting etc
6. Should have accuracy in measurements
7. Should have ease of operation
The central supply service
79
Most hospitals have a central department where equipments and supplies are stored and from which
they are distributed to the units. The type of materials that is kept in the central supply room varies from
hospital to hospital. In some hospital the central soppy room deals with only the sterile supplies and
ward trays. In other hospitals all types of equipment such as oxygen, suction, ward trays, catheters,
syringes etc are stored here.
Linen supply: Methods of handling linen supply include;
a) Departmentalised system: Here the supply of linen for each department of the hospital is
marked for that department. The head of the department is responsible for making a linen
standard for his own department.
b) Centralised linen supply: Under centralised system, linen is issued on exchange basis, that is
clean linen is exchanged for soiled linen.
FACTORS TO BE CONSIDERED
a) Type of service provided by the hospital: a maternity hospital requires more equipment related
to gynaecologic procedures than a cardiac hospital.
b) Age of patients: children need different type and amount of equipments than adults.
c) Sex- men and women sometime require different type of equipment.
d) Degree and type of illness- neurologic patients sometimes require more bedsides, rubber
mattress and linen than patients with other type of illness.
e) Cost of items- cost of items will limit the purchase of number of equipment.
GENERAL UTILITY SERVICES IN THE HOSPITAL
a) Electric supply and installations: A hospital must have a steady electrical supply at a stable
voltage. Voltage fluctuations play havoc with sophisticated electronic equipment, endoscope,
sterilisers, X-ray equipments etc. While planning hospital departments, provision should be
made for voltage stabilisation in areas with heavy concentration of electrical and electronic
equipment. This is preferred over using voltage stabilisers with individual equipment. There
80
should be an emergency generator capable of supplying power to all emergency areas of the
hospital. This generator should be of right capacity and kept in working order by periodic test
runs.
b) Water supply: Since safe water supply is not always assured, hospitals must have their own
purification system. Also there should be plumbing system.
Disposal of waste –liquids and solids.
Disposal of waste both solid and liquid is a totally neglected area. A hospital incinarator good
for the waste management.
Refrigeration, air conditioning, ventilation and environment control.
Air conditioning is required for protection of sophisticated electronic equipment, X ray,
machines etc.
Transport
Lifts are needed for vertical transport. There should be separate lifts for patients, visitors, staff
and supply. Patients lift should accommodate a standard hospital bed. Sides of the lift must be protected
to prevent damage by trolleys. Lift surfaces and flooring should be capable of easy cleaning and
disinfection. Ventilation, communication and emergency escape system should be provided on all lifts.
As for horizontal transport also trolleys and ramps with gentle gradient are useful.
Supply of medical gases , compressed air, hot water, vacuum suction and gas plants
Piped supply of medical gases , compressed air, vacuum suction , hot water, steam, necessitates
thoughtful planning at all stages to consider problems of –
a) Easy uninterrupted safe supply
b) Fire and explosion hazards
c) Easy of servicing and maintenance without disrupting hospital services.
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Laundry- A hospital laundry has 2 separate areas, with provision for decontamination and sterilising
of soiled linen.
Fire hazard- there should be consideration of ventilation, exhaust systems and adequate earthing of all
electrical installation.
Communication- public telephone and internal telephones are required in each hospital.
Repairs workshop
There should be provision for repair and maintenance of necessary equipments used in the hospital .
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MATERIALS USED IN HOSPITALS
Hospital material medical side Hospital material management side
 Perfusion materials  Computer, fax, telephone, stationary
 Surgical disposables items
 Instruments  Public address items overhead projector
 Drugs, medicine, oxygen, linen  Audiovisual systems
 Biomedical equipment
 Disinfecting items
 Computers, telephone and fax
 Food and beverage materials
 Anaesthetic equipment
 Electro medical equipment
 Glass ware, dental machines
 Surgical dressing utensils
 Artificial limbs ,bandages, cots for
patient, furniture
 Engineering items and many others
ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)
1) Scope of services
a) Essential clinical services- medicine, surgery, paediatrics., OBG, and acute psychiatry (when
necessary)
b) Optional clinical services – oral surgery, orthopaedic surgery, otolaryngology, neurology and
psychiatry.
c) Essential clinical support- anaesthesia, radiology and clinical laboratory
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d) Optional clinical support services- pathology and rehabilitation including physiotherapy.
2) Essential medical equipment
 Diagnostic imaging equipment –it include x-ray and ultrasound equipment. X-ray equipment
can be stationary in one room or mobile
 laboratory equipment –
 microscope
 blood counter
 analytical balance
 calorimeter( spectrophotometer)
 Centrifuge – a small centrifuge that can accommodate six 15ml tubes should be available.
 Water bath – used for stabilising temperature at 25, 37, 42, or 56degree Celsius.
 Incubator/oven- a small hot air oven to carry out standard cultivations and sensitisations.
 Refrigerator – an ordinary household refrigerator with a freezer unit, for storing preparations,
vaccines, blood etc.
 istillation and purification apparatus - it should be made of metal that resists acid, and alkali
and should be free standing.
3) Electrical medical equipment.
 Portable electrocardiograph
 Defibrillator( external)
 Portable anaesthetic unit – 2 small aesthetic units should be obtained, complete with a range of
masks.
 Respirator – it should be applicable for prolonged administration during post operative care.
 Dental chair unit- a complete unit should be available to carry out standard dental operations.
 Suction pump –one portable and one other suction pump are required.
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 Operating theatre lamp- one main lamp with at least 8 shadows lamp and an auxiliary of 4 lamp
units.
 Delivery table- it should be standard and manually operated.
 Diathermy unit – a standard coagulating unit which is operated by hand or foot switch, with
variable poor control.
4) Other equipment
 autoclave – for general stabilisation
 Small sterilisers- for specific services- eg. Stabiliser
 cold chain and other preventive medical equipment
 ambulance
5) Small , inexpensive equipment and instruments
 Equipment and instrument, such as BP apparatus, oxygen manifolds, stethoscope, diagnostic
sets and spotlights.
CONCLUSION
Health care services are the result of a number of materials used in the process. As hospital
administrators nurses should also know about the materials .Medical items such as perfusion materials,
surgical disposables, instruments, electrical, civil and engineering items for maintenance, housekeeping
materials, and linen, biomedical equipment. Drugs, food items etc. pay an effective role in improving
the quality of health care services.
REFERENCES:
 Barriet J .Ward management and Teaching. 2nd ed. Delhi: EBS Publishers; 1967.
 Jha SM. Hospital Management. Ist ed. Mumbai: Himalaya publishers; 2007.
 District hospitals- Guidelines for development. WHO. Geneva: HTBS publishers; 1994.
85
 Gopalakrishnan & Sunderasan: Material Management, Prentice Hall of India Pvt Ltd. New
Delhi, 1979.
 Kulkarni G R. Managerial accounting for hospitals. Mumbai: Ridhiraj enterprise; 2003.
 Kumar R& Goel SL. Hospital administration and management. Vol 1 (first edn).New Delhi:
Deep & deep publications;
 Gupta S& Kanth S. Hospital stores management, an integrated approach. (First edn). New
Delhi: Jaypee brothers; 2004..
 Wise P S. Leading and managing in nursing. Ist edn. Philadelphia: Mosby publications; 1995.
 Koontz H & Weihrich H . Essentials of management an international perspective. (Ist edn).
New Delhi: Tata Mc Graw Hill publishers; 2007.
 Koontz H & Weihrich H. Management a global perspective. 1st edn. New Delhi: Tata Mc.
Graw Hill publishers;2001.
86
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87
Developing Staffing Pattern Nursing services
Introduction
Staffing is a selection, training, motivating and retaining of personnel in the organization. Nurse
staffing is a constant challenge for health care facilities. Before the selection of the employees, one has
to make analysis of the particular job, which is required in the organization, then comes the selection of
personnel.
Functions in staffing
1. Identifying the type and amount of service needed by agency client.
2. Determining the personnel categories that have the knowledge and skill to perform needed
service measures.
3. Predicting the number of personnel in each job category that will be needed to meet anticipated
service demands.
4. Obtaining, budgeted positions for the number in each job category needed to service for the
expected types and number of clients.
5. Recruiting personnel to fill available positions.
6. Selecting and appointing personnel from suitable applicants.
7. Combining personnel into desired configurations by unit and shift.
8. Orienting personnel to fulfill assigned responsibilities.
9. Assigning responsibilities for client services to available personnel.
Man power planning may be defined as a strategy for the acquisition, utilization, improvement and
preservation of the human resources of an organization. This involves ensuring that organization has
enough of the right kind of people at the right time and also adjusting the requirements to the available
supply.
88
The main objectives of man power planning
1. Ensuring maximum utilization of the personnel
2. Assessing future requirements of the organization
3. Determining the recruitment sources.
4. Anticipating from past records, i.e. resignations, simple discharge, dismissal and retirements.
5. Determining training requirements for management’s development and organizational
development.
Major activities of manpower planning
1. Forecasting future manpower requirements
2. Inventorying, present manpower resources and analyzing the degree to which these resources
are employed optimally.
3. Anticipating manpower problem by projecting present resources into the future and comparing
them with forecast of requirement of requirement to determine their adequacy, both
quantitatively, and qualitatively
4. Planning the necessary program, recruitment, selection, training, development, motivation and
compensation, so that future manpower requirements will be met.
Steps of manpower planning:
1. Scrutiny of present personnel strength.
2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions
Steps of staffing
1. Determine the number and types of personnel needed to fulfil the philosophy, meet fiscal
planning responsibilities, and carryout the chosen patient care management organization
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2. Recruit, interview, select, and assign personnel based on established job description
performance standards.
3. Use organizational resources for induction and orientation
4. Ascertain that each employee is adequately socialized to organizational values and unit norms.
5. Use creative and flexible scheduling based on patient care needs to increase productivity and
retention
6. Develop a program of staff education that will assist employees meeting the goals of the
organization.
Philosophy of staffing
Philosophy is a statement encompassing ontologic claims about the phenomena of central interest to a
discipline, epistemic claims about how the phenomena came to be known, and what members of the
discipline value.
There are three general philosophies of personnel management. The first is based on organizational
theory, the second on industrial engineering, and the third on behavioural science.
1. The organizational theorist believes that
 Human needs are either so irrational or so varied and adjustable to specific situations that the
major function of personnel management is to be pragmatic as the occasion demands.
 If the jobs are organized in a proper manner, he reasons, the result will be most efficient job
structure, and the most favourable job attitudes will follow as a matter of course.
2. The industrial engineer believes that
• The man is mechanistically oriented and economically motivated and his needs are
best met by attuning the individual to the most efficient work process.
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• The goal of personnel management therefore should be to concoct the most
appropriate incentive system and to design the specific working conditions in a
way that facilitates the most efficient use of the human machine.
• By structuring jobs in a manner that leads to the most efficient operation, the
engineer believes that he can obtain the optimal organization of work and the
proper work attitudes.
3. The behavioural scientist believes that
The behavioural scientist focuses on group sentiments, attitudes of individual employees, and
the organizations’ social and psychological climate.
Personnel management generally emphasizes some form of human relations education, in the
hope of instilling healthy employee attitudes and an organizational attitudes and an organizational
climate which he considers to be felicitous to human values. He believes that proper attitudes will lead
to efficient job and organizational structure.
Philosophy of staffing in nursing
 Nurse administrators of a hospital nursing department should adopt the following staffing
philosophy.
 Nurse administrators believe that it is possible to match employees’ knowledge and skills to
patient care needs in a manner that optimises job satisfaction and care quality.
 Nurse administrators believe that the technical and humanistic care needs of critically ill
patients are so complex that all aspects of that care should be provided by professional nurses.
 Nurse administrators believe that the health teaching and rehabilitation needs of chronically ill
patients are so complex that direct care for chronically ill patients should be provided by
professional and technical nurse.
 Nurse administrators believe that patient assessment, work quantification and job analysis
should be used to determine the number of personnel in each category to be assigned to care
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for patients of each type such as coronary care, renal failure, chronic arthritis, paraplegia, cancer
etc)
 Nurse administrators believe that a master staffing plan and policies to implement the plan in
all units should be developed centrally by the nursing heads and staff of the hospital.
 Nurse administrators believe the staffing plan details such as shift- start time, number of staffs
assigned on holidays, and number of employees assigned to each shift can be modified to
accommodate the units’ workload and workflow.
Objectives of staffing in nursing
 Provide an all-professional nurse staff in critical care units, operating rooms, labour and
emergency room
 Provide sufficient staff to permit a 1:1 nurse- patient ratio for each shift in every critical care
unit
 Staff the general medical, surgical, obstetrics and gynaecology, paediatric and psychiatric units
to achieve a 2:1 professional- practical nurse ratio.
 Provide sufficient nursing staff in general, medical, surgical, obstetrics and gynaecology,
paediatric and psychiatric units to permit a 1:5 nurse patient ratio on a day and afternoon shifts
and 1:10 nurse- patient ratio on night shift.
 Involve the heads of the nursing staffs and all nursing personnel in designing the department’s
overall staffing program.
 Design a staffing plan that specifies how many nursing personnel in each classification will be
assigned to each nursing unit for each shift and how vacation and holiday time will be requested
and scheduled.
 Hold each head nurse responsible for translating the department’s master staffing plan to
sequential eight weeks time schedules for personnel assigned to her/ his unit.
 Post time schedules for all personnel at least eight weeks in advance.
 Empower the head nurse to adjust work schedules for unit nursing personnel to remedy any
staff excess or deficiency caused by census fluctuation or employee absence.
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 Inform each nursing employee that requests for specific vacation or holiday time will be
honoured within the limits imposed by patient care and labour contract requirements.
 Reward employees for long term service by granting individuals special time requests on the
basis of seniority.
ANA Principles of Nursing Staffing
The nine principles are:
Patient Care Unit Related
Appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate
patient needs.
There is a critical need to either retire or seriously question the usefulness of the concept of
nursing hours per patient day (HPPD).
Unit functions necessary to support delivery of quality patient care must also be considered in
determining staffing levels.
Staff Related
The specific needs of various patient populations should determine the appropriate clinical
competencies required of the nurse practicing in that area.
Registered nurses must have nursing management support and representation at both the
operational level and the executive level.
Clinical support from experienced RNs should be readily available to those RNs with less
proficiency.
93
Institution/Organization Related
Organizational policy should reflect an organizational climate that values registered nurses and
other employees as strategic assets and exhibit a true commitment to filling budgeted positions in a
timely manner.
All institutions should have documented competencies for nursing staff, including agency or
supplemental and traveling RNs, for those activities that they have been authorized to perform.
Organizational policies should recognize the myriad needs of both patients and nursing staff.
NORMS OF STAFFING( S I U- staff inspection unit)
Norms
Norms are standards that guide, control, and regulate individuals and communities. For
planning nursing manpower we have to follow some norms. The nursing norms are recommended by
various committees, such as; the Nursing Man Power Committee, the High-power Committee, Dr. Bajaj
Committee, and the staff inspection committee, TNAI and INC. The norms has been recommended
taking into account the workload projected in the wards and the other areas of the hospital.
All the above committees and the staff inspection unit recommended the norms for optimum
nurse-patient ratio. Such as 1:3 for Non-Teaching Hospital and 1:5 for the Teaching Hospital. The Staff
Inspection Unit (S.I.U.) is the unit which has recommended the nursing norms in the year 1991-92. As
per this S.I.U. norm the present nurse-patient ratio is based and practiced in all central government
hospitals.
Recommendations of S.I.U:
The norms for providing staff nurses and nursing sisters in Government hospital is given in
annexure to this report. The norm has been recommended taking into account the workload projected
in the wards and the other areas of the hospital.
94
The posts of nursing sisters and staff nurses have been clubbed together for calculating the staff
entitlement for performing nursing care work which the staff nurse will continue to perform even after
she is promoted to the existing scale of nursing sister.
Out of the entitlement worked out on the basis of the norms, 30%posts may be sanctioned as
nursing sister. This would further improve the existing ratio of 1 nursing sister to 3.6. staff nurses fixed
by the government in settlement with the Delhi nurse union in may 1990.
The assistant nursing superintendent are recommended in the ratio of 1 ANS to every 4.5
nursing sisters. The ANS will perform the duty presently performed by nursing sisters and perform duty
in shift also.
The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS per every 7.5
ANS
There will be a post of Nursing Superintendent for every hospital having 250 or beds. There
will be a post of 1 Chief Nursing Officer for every hospital having 500 or more beds.
It is recommended that 45% posts added for the area of 365 days working including 10% leave
reserve (maternity leave, earned leave, and days off as nurses are entitled for 8 days off per month and
3 National Holidays per year when doing 3 shift duties).
Most of the hospital today is following the S.I.U.norms. In this the post of the Nursing Sisters
and the Staff Nurses has been clubbed together and the work of the ward sister is remained same as staff
nurse even after promotion. The Assistant Nursing Superintendent and the Deputy Nursing
Superintendent have to do the duty of one category below of their rank.
95
The Nurse-patient Ratio as per the S.I.U. Norms
1. General Ward 1:6
2. Special Ward - ( pediatrics, burns, neuro surgery, 1:4

cardio thoracic, neuro medicine, nursing home,
spinal injury, emergency wards attached to
casuality)
3. Nursery 1:2
4. I.C.U. 1:1(Nothing mentioned about the shifts)
5. Labour Room 1:l per table
6. O.T. Major - 1 :2 per table
Minor - 1:l per table
7. Casualty-
a. Casualty main attendance up to 100 patients per 3 staff nurses for 24 hours, 1:1per shift.
day thereafter
1:35
b. for every additional attendance of 35 patients
c. gynae/ obstetric attendance

·3 staff nurses for 24 hours, 1:1/ shift
d. thereafter every additional attendance of 15

patients. 1:15
8. Injection room OPD Attendance upto 100 patients per day 1 staff nurse
120-220 patients: 2 staff nurses
9. OPD
NAME OF THE DEPARTMENT
· Blood bank 1
· Paediatric 2
· Immunization 2
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· Eye 1
· ENT 1
· Pre anaesthetic 1
· Cardio lab 1
· Bronchoscopy lab 1
· Vaccination anti rabis 1
· Family planning 2
· Medical 1
· Dental 1
· Central sample collection centre 1
· Orthopaedic 1
· Gyne 2
· Xray 2
· Skin 3
· V D centre 2
· Chemotherapy 2
· Neurology 2
· Microbiology 1
· Psychiatry 2
· Burns 1
In addition to the 10% reserve as per the extent rules, 45% posts may be added where services are
provided for 365 days in a year/ 24 hours.
The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing Council, 1985)
The norms are based on Hospital Beds.
Chief Nursing Officer :1 per 500 beds
Nursing Superintendent :1 per 400 beds or above
D.NS. :1 per 300 beds and 1 additional for evcry 200 beds
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A.N.S. :1 for 100-150 beds or 3-4 wards
Ward Sister :1 for 25-30 beds or one ward. 30% leave reserve
Staff Nurse :1 for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in Non-teaching
Hospital +30% Leave reserve
Extra Nursing staff to be provided for departmental research function.
For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) + 30% leave reserve
For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leave reserve.
It is suggested that for 250 beded hospital there should be One Infection Control Nurse (ICN).
For specialised depertments, such as Operation Theatre, Labour Room, etc. 1:25 +30% leave reserve.
norms are not based on Nursing Hours or Patient's Needs here.
Conclusion
The key to success of any hospital primarily depends upon its human resource than any other
single factor.The core determinants of staffing in the hospital organization are quality, quantity and
utilization of its personnel keeping in view the structure and process. The staffing norms should aim at
matching the individual aspiration to the aims and objectives of the organization.
Research Inputs
1. Fourteen unit attributes to guide staffing (ref-7)
Using the nursing executive center’s hospital data base, researchers contacted a cross section
of leading hospitals nationwide, balanced by size, geography, location and teaching status. For each
hospital, the senior most nursing leader, usually a chief nurse or vice president of patient care services
was asked to participate in a 1 hr interview with center researchers. The fourteen attributes identified
includes: patient at risk for deteriorating rapidly, wide fluctuation in the patients volume,wide disparity
in patient type and treatment, high level of admission, discharge and transfer, high degree of nursing
98
autonomy(less physician oversight), high proportion of protocol driven care, complex patient care needs
post discharge, premium on interdisciplinary communication, high percentage of patient with
comorbidities, premium on highly technical skills, high level of ADL transports, Heightened
observational needs, high percentage of obese patients and premium on multitasking.
2. Nurse staffing and patient outcomes (ref-8)
The authors from the University of Lowa, investigated nurse staffing and patient outcomes in
42 inpatient nursing care units in a large university hospital. Acute care unit level data were collected
from hospital records to examine the relationships among total hours of nursing care, RN skill mix, and
adverse patient outcomes, which included medication errors, patient falls, pressure ulcers, patient
complaints, infections and death. They found that the proportion of hours of RN care was inversely
related to the unit rates of medication errors, pressure ulcers, patient complaints, infections and deaths.
An unexpected finding was that as the RN proportion increased, the rates of adverse outcomes
decreased, up to the level of 87.5%, after which adverse outcomes rates also began to increase. Our
explanation may be that better reporting resulted when more RNs were working.
References:
1. Basavanthappa BT. Nursing administration. Ist edn. New Delhi: Jaypee brothers medical
publishers (p) ltd; 2000.
2. Wise PS. Leading and managing in nursing. Ist edn. Philadelphia: Mosby publications; 1995.
3. Koontz H, Weihrich H . Essentials of management an international perspective. (Ist edn). New
Delhi: Tata Mc Graw Hill publishers; 2007.
4. Koontz H, Weihrich H. Management a global perspective. 1st edn. New Delhi: Tata Mc. Graw
Hill publishers;2001.
5. Anthony MK, Theresa S, Glick J, Duffy M, Paschall F. Leadership and nurse retention, the
pivotal role of nurse managers. JONA. Vol 35, Mar 2005.
6. Beyers Marjorie. Nurse executives’ perspectives on succession planning. JONA. Vol 36. June
2006.
7. Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide staffing. JONA.vol 37, no.3
mar 2007.
8. Blegen MA, Goode C J& Reed L. Nurse staffing and patient outcomes. Nurs res. 1998;
47(1):43-50.
99
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GONDA
100
Developing Staffing Pattern Nursing education
M.Sc. (N)
If parent hospital is super-speciality hospital like cardio-thoracic hospital/cancer with annual intake 10
M.Sc(N) in cardio thoracic/cancer
 Professor cum coordinator 1
 Reader / Associate Professor 1
 Lecturer 2
The above faculty shall perform dual role
B.Sc.(N) and M.Sc.(N)
Annual intake of 60 students in B.Sc.(N) and 25 students for M.Sc.(N)
programme
 Professor-cum-Principal 1
 Professor-cum-Vice Principal 1
 Reader / Associate Professor 5
 Lecturer 8
 Tutor / Clinical Instructor 19
Total 34
One in each specialty and all the M.Sc(N) qualified teaching faculty will
participate in all collegiate programmes.
Teacher Student Ratio = 1 : 10 for M.Sc.(N) programme.

101
QUALIFICATIONS & EXPERIENCE OF TEACHERS OF COLLEGE OF NURSING
Qualification & Experience
1. Professor-cum-Principal
- Masters Degree in Nursing
- 14 years experience after M.Sc. (N) in College of
- Nursing .
- 3 years experience in administration (Years of
- experience is relaxable if suitable candidate is not
- available) (If a candidate is not available, minimum 5
- years of experience in college of nursing, with an
- aggregate of 14 years teaching experience)
Desirable :
Independent published work of high standard / doctorate degree / M.Phil.
2. Professor-cum-Vice Principal
- Masters Degree in Nursing
- 14 years experience after M.Sc. (N) in College of
- Nursing .
- 3 years experience in administration (Years of
- experience is relaxable if suitable candidate is not
- available) (If a candidate is not available, minimum 5
- years of experience in college of nursing, with an
- aggregate of 14 years teaching experience)
Desirable:
Independent published work of high standard / doctorate degree / M.Phil.
102
3. Reader / Associate Professor
- Master Degree in Nursing.
- 10 years experience after M.Sc.(N) in a College of
- Nursing. (If a candidate is not available, 5 years of
- experience in College of Nursing with an aggregates
- of 10 years teaching experience.
Desirable :
Independent published work of high standard /doctorate degree / M.Phil.
4. Lecturer
- Master Degree in Nursing.
- 3 years teaching experience after M.Sc. (N)
Note: Qualifications & Experience of Nursing Teaching faculty
relaxed till 2012 & placed under Annexure - I
External /Guest faculty may be arranged for the selected units in different subjects as
required
NOTE:
1. No part time nursing faculty will be counted for calculating total
2. no. of faculty required for a college.
3. Irrespective of number of admissions, all faculty positions
4. (Professor to Lecturer) must be filled.
5. For M.Sc.(N) programme appropriate number of M.Sc. faculty in
6. each speciality be appointed subject to the condition that total
7. number of teaching faculty ceiling is maintained.
8. All nursing teachers must possess a basic university or equivalent
9. qualification as laid down in the schedules of the Indian Nursing
103
10. Council Act, 1947. They shall be registered under the State
11. Nursing Registration Act.
12. Nursing faculty in nursing college except tutor/clinical
instructors
13. Must possess the requisite recognized postgraduate qualification
in nursing subjects.
14. Holders of equivalent postgraduate qualifications, which may be
15. approved by the Indian Nursing Council from time to time, may
be
16. Considered to have the requisite recognized postgraduate
qualification in the subject concerned.
17. All teachers of nursing other than Principal and Vice-Principal
18. should spend at least 4 hours in the clinical area for clinical
19. Teaching and/or supervision of care every day.
Other Staff (Minimum requirements)
(To be reviewed and revised and rationalized keeping in mind the
mechanization and contract service)
 Ministerial
o Administrative Officer 1
o Office Superintendent 1
o PA to Principal 1
o Accountant/Cashier 1
 Upper Division Clerk 2
 Lower Division Clerk 2

104
 Store Keeper 1
1. Maintenance of stores 1
2. Classroom attendants 2
3. Sanitary staff As per the physical space
4. Security Staff As per the requirement
 Peons/Office attendants 4
 Library
a) Librarian 2
b) Library Attendants As per the requirement
 Hostel
a) Wardens 2
b) Cooks, Bearers, As per the requirement
Sanitary Staff
c) Ayas /Peons As per the requirement
d) Security Staff As per the requirement
e) Gardeners & Dhobi Depends on structural facilities
105
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106
Plan of action for recruitment process
Recruitment is defined as the art of identifying. The process starts by acquiring candidates for
the job and scrutinizing the right candidates and ends once the candidates are identified.
The result is a pool of applicants from which new employees are picked out. Though, in a
theoretical manner the recruitment procedure is expressed to end with the acknowledgement of
applications, in practice the activity continues to the screening of applications so as to get rid of those
who are not qualified for the job.
Recruitment methods
Recruitment refers to the discovery and development of the sources of required personnel so
that a sufficient number of candidates will always be available for employment in the organization. It
involves identifying a right candidate who has the required abilities, attitudes and motivation so as to
meet the manpower requirements of the enterprise.
Recruitment is defined as an important activity of finding the competent workers and training
them to utilize them to their maximum capacity in the organization.
Factors determining recruitment
1. Size of the business.
2. Employment conditions in the locality of recruitment.
3. The past recruiting policy of the organization in retaining good workers.
4. Working environment and compensation package that influence employees to continue or take
exit from the organization.
5. The rate of growth of the organization; future, cultural, legal and economic factors.
6. Cost of recruitment.
Recruitment policy
This provides a framework for recruitment and contains aspects such as
107
(1) Organizational objectives,
(2) Identification of the recruitment needs,
(3) Preferred sources of recruitment (internal or external),
(4) Criterion of selection and preferences and
(5) The cost of recruitment and financial implementations of the same.
According to Yoder, the following factors are involved in a recruitment policy:
1. To give each employee an open road and encouragement in the continuous growth of his/ her
skills and talents.
2. To ascertain each employee of the organization, concern in his/ her employment objectives and
personal goals.
3. To follow up on advancement of the employees.
4. To introduce the employee to his/ her superiors.
5. To maintain records. 6. To carry on final interviews.
6. To carefully keep an eye on the letter and spirit of the concerned public policy on hiring and, on
the whole, employment relationship.
7. To furnish individual employees with the maximum employment protection, preventing frequent
lay-off or lost time.
Manpower forecasting
The process is as follows:
1. Receive employee indent from line staff which contains vacant positions, tenure of employment,
salary offered, etc.
2. Check the indent against the allotted posts of each department.
3. Check financial implications for proposed recruitment.
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4. Find out whether the recruitment is within the budgetary sanctions of the concerned departments.
5. Authorize the proposed recruitment with job specifications and salary details.
Methods of recruitment
1. Transfer: A transfer denotes the changing of an employee from one job to the other without a
measure modification in the status and responsibilities of the employee.
2. Promotion: This involves shifting an employee to a higher position with higher responsibilities,
higher status and more pay.
3. Advertisements: Another very popular source of recruitment is advertising in trade and professional
journals or newspapers.
4. Employment agencies: The Government of India has set up a network of employment exchanges
throughout the country. These exchanges maintain detailed records of job seekers and refer appropriate
candidates to the relevant employers.
5. Educational institutions: For managerial and technical professional jobs, institutes and colleges of
management and technology have become a popular source of recruitment.
6. Recommendations: Applicants introduced by present employees or their friends and relatives may
prove to be a good source of recruitment.
7. Casual callers: Many well-reputed business organizations draw a steady stream of unsolicited
applicants in their offices. Such job seekers can be a valuable source of manpower.
8. Direct recruitment: Under this source of recruitment, a notice is placed on the notice board of the
enterprise specifying the details of the jobs available.
9. Labour contracts: Labour contracts maintain close contacts with labourers and they can provide the
required number of workers at short notice.
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Selection procedure
After recruitment, a selection procedure has to be implemented. The selection process relates
to the securing of relevant information about an applicant. This information can be obtained in different
ways. Selection implies matching people with the right job. The human factor is the quality that matters
a lot in an organization. It is essential therefore to select quality personnel for placing in the right
positions to render quality services. Selection of men is a critical activity. It is a process of choosing
from among external candidates the most suitable persons for the current position or for future positions.
Manpower planning explains the positions required and they are based on objectives, forecasts, plans
and strategies of the organization.
This plan will be converted into position and job design requirements which are matched to
skills, intelligence, knowledge, attitude, etc., of the individuals. This will be carried out considering
both internal environment (company policies, supply and demand for human resources in the
organization and organizational climate) and external environment (government regulations and
availability of human resources).
Steps of selection procedures
1. Receipt of Application: Everyone who applies for job in an enterprise may not be qualified for the
job. Those who do not possess adequate experience and qualifications should not be included in the list
of candidates to be called for a preliminary interview. If this is done, even candidates with inadequate
experience and qualifications will be called for preliminary interviews. This means wasting time and
money of the employers and the deserving candidates who have applied for the job. Hence, a proper
scrutiny of applications is made to select the candidates to be called for a preliminary interview.
2. Preliminary Interview: In the preliminary interview, the employer tries to find out whether the
candidate is physically and mentally fit for the job. In general, the candidates are asked about their
qualifications, experience, interests, residence, age, etc. Employers should not take much time for
conducting the preliminary interview.
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3. Selection Test: Those candidates who have passed the preliminary interview will be asked to appear
for the selection tests. Tests serve as an important device in the process of selection. Tests aim at
discovering and measuring selected qualities, abilities and skills of a candidate in terms of job
specifications.
4. Employment Interview: Interview is a ‘face-to-face observational and personal appraisal method’
to evaluate a candidate’s fitness for the job. Every person who is selected by a company for interview
is interviewed by one or more persons. This system helps the employer to assess the prospective
employee’s motivation, personality, smartness, intelligence and his/ her overall attitude.
Types of interviews
Different types of interviews that may be conducted by the employers are as follows (Fig. 4.9):
1. Direct interview: This is a straightforward face-to-face question– answer session between the
interviewer and the interviewee. In this, the interviewer tries to assess the candidate’s knowledge of the
job, attitude, motivation and other personal characteristics.
2. Nondirect interview: No direct questions are asked; the candidate is asked to express his/ her views
on any topic of his/ her liking. The interviewer mainly listens without interrupting the candidate. This
method provides freedom of expression to the interviewee and also keeps him more at ease. It helps the
employer make a better assessment of the personality of the candidate.
3. Patterned interview: Under this method, a number of standard questions to be asked of a candidate
are framed in advance. Even the answers to these questions are determined beforehand. The answers
given by the candidate are compared with the answers determined beforehand in order to find out the
suitability of the candidate for the job for which he/ she is being interviewed.
4. Stress interview: In this method, the interviewer puts forth such questions that can make the
candidate lose his/ her temper or make him/ her angry or irritated. For example, the interviewer may
ask: ‘Did your previous employer sack you from the job because he was not satisfied with your
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performance?’ In case the candidate answers such questions without getting irritated, he/ she has a good
chance of being selected for the job.
5. Board or panel interview: Here, a panel of members interview the candidate. Each member may
ask questions in the particular area that is assigned to him/ her. Immediately after the interview, the
panel members together will evaluate the candidate’s performance with reference to his/ her answers to
questions put by each member.
6. Group interview: Here, a group of candidates is observed in a group discussion on a specific
problem. If a specific candidate’s performance is impressive, he/ she may be considered for the job.
Placement Placement may be defined as ‘the determination of the job to which an accepted candidate
is to be assigned,’ and his/ her assignment to that job. It is a matching of how the supervisor has reason
to think a candidate can handle the job demands (requirements); it is a matching of what he/ she imposes
(in stressed workingconditions); and what he/ she offers in the form of payroll, companionship with
others, promotional possibilities, etc. A proper placement of workers reduces employee turnover,
absenteeism and accident rates, and improves morale.
Effective placement
Placement can be made effective in the following ways:
1. Job rotation: This enables an employee to satisfy his/ her aptitude for challenging work.
2. Teamwork: This allows employees to use their skills, knowledge, etc., thereby minimizing the
problems in placement.
3. Training and development: Continuous training and development programmes help employees
acquire new skills and knowledge.
4. Job enrichment: This gives the opportunity of utilizing the varied skills of the employees and
minimizing problems in management. 5. Empowerment: Empowering employees makes the employer
exploit their potentialities and most effectively make use of them.
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Plan of action for recruitment Process
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113
Preparation of job description for ICU nurse
Critical care nursing is a complex and challenging nurse specialty to which many registered
nurses (RNs) aspire. Also known as ICU nurses, critical care nurses use their advanced skills to care for
patients who are critically ill and at high risk for life-threatening health problems.
Critical Care Nurse Duties and Responsibilities
When a patient suffers a heart attack, stroke, shock, severe trauma, respiratory distress or other
severe medical issue, it is vital that they receive immediate and intensive nursing care. Critical care
nurses are adept at providing such care in settings where patients can be given complex assessments
and treatment.
Specific critical care nurse duties and responsibilities can include:
1. Assessing a patient’s condition and planning and implementing patient care plans
2. Treating wounds and providing advanced life support
3. Assisting physicians in performing procedures
4. Observing and recording patient vital signs
5. Ensuring that ventilators, monitors and other types of medical equipment function properly
6. Administering intravenous fluids and medications
7. Ordering diagnostic tests
8. Collaborating with fellow members of the critical care team
9. Responding to life-saving situations, using nursing standards and protocols for treatment
10. Acting as patient advocate
11. Providing education and support to patient families
Critical care nurses may also care for pre- and post-operative patients. In addition, some serve as case
managers and policy makers, while others perform administrative duties.
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ASSINGMENT ON
Preparation of Job Description for ICU

Nurse
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Preparation of job description for OT nurse
It Include:
1. Assessing patients prior to surgery and alleviating their concerns
2. Gathering all supplies needed for the operation
3. Assuming responsibility of keeping the operating room sterilized
Job brief
We are looking for a competent Operating room nurse (or perioperative nurse) to assist
surgeons during operations and keep the operating room sterile at all times.
They need to possess phenomenal efficiency and attention to detail with a strong knowledge of
operation procedures and patient safety. Being compassionate and sensitive is a prerequisite for the
profession. The ideal candidate goes one step further by being a critical thinker, fast to act in
emergencies.
Responsibilities
1. Assess patients prior to surgery (e.g. NPO status) and alleviate their concerns
2. Gather all supplies needed for the operation
3. Assume responsibility of keeping the operating room sterilized
4. Position and prepare patient on operating table
5. Pass medical instruments or other objects to the surgeon during operation
6. Monitor patient’s vital signs to detect anomalies
7. Evaluate patient in postoperative phases
8. Adhere to safety standards and precautions
9. Assume duties within or out of the sterile field as assigned
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ASSINGMENT ON
Duty Roaster
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Duty Roaster
For nurses who are taking on management responsibilities, one of the most daunting tasks can
be tackling the dreaded ‘off duty’. Here are some tips for success
It is perhaps the biggest challenge of management. For although working out the ‘off duty? offers
a keen sense of power, the responsibility that comes with it can be more trouble than it is worth. How
you discharge that responsibility will not only determine how popular you are with members of the
team, but more importantly, how effectively your work area is resourced and therefore the level of
patient care that can be given.
The main aim in working out staffing levels is to provide consistent and effective nursing care to
those patients for whom you are responsible. In essence, staff rosters should ensure that:
The service is delivered by competent staff in the right numbers at the right times; Team members
have a reasonable workload and acceptable periods of rest betweenshifts, as outlined by the general
norm.
Shift-based nursing, found in both acute and community settings, poses a major challenge to a
manager who has not only to take into consideration the human resources in numbers, often expressed
as whole time equivalents (WTE), but also the staff mix, competencies and the needs of the patient/client
group, as well as other activities to be performed during the shift.
Even if you do not work in a 24/7 service, you will need to take into consideration annual leave
and requests for days off, as well as other absences.
What often increases the challenge is the use of many part-time staff. For example, five WTE
staff nurses may comprise at least seven people.
Influenced by the government’s Improving Working Lives initiative, nurses are gradually being
offered more flexibility to help with other commitments and promote a healthy work-life balance.
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We are now seeing fewer standard patterns of work, for example 10 or 12-hour shifts, and
instead find nursing staff working anything from five to 37.5 hours a week, often with ‘half shifts’ that
relate to the length of a school day.
In addition, different staff do not have the same skills and competencies. Patient needs also
change, not only from day to day, but from shift to shift. There are, in addition, considerable resource
issues, both in terms of available supply and budgets.
Budget management is complex and varies between organisations, but it is common for staff to
be funded at the mid-point of their grade. If you have many senior personnel then the actual budget
needs adjusting. It is expected that, with vacancies and staff members below mid-point, these will
balance out your more expensive staff. The aim of Agenda for Change is to even out over the whole
year extra payments for unsocial hours such as bank holidays, but this system is still under review.
Contact your area’s AfC representative if you have queries relating to the new system.
When sitting down to draw up your roster, first consider:
How many weekends do staff work per month and what are the night duty expectations?
Are routine shifts agreed for certain staff?
Next look at absences, for example annual leave, sickness and study leave, and mark them in. Then
make a list of their grades, or AFC bands, and how many shifts each staff member usually covers. If it
is your first time doing the roster, it can be very useful to refer to previous ones to identify any pattern
- as long as these worked well.
After that, identify the grade/skill mix of the shifts required. Certain shifts may require different
grades or competencies of nurses, for example assessment days, theatre days or consultant/specialist
visits.
Only then are you in a position to be able to consider requests for certain shifts or days off.
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Rest assured that it will often be impossible to authorise all requests without further negotiation.
As much as you would like to please everyone, the priorities of the service must be met within the
budget.
A further challenge is covering sickness absence. Most settings will build in a percentage in
anticipating annual leave, study leave and short absences. However, for longer periods it is the
remaining team members who must be flexible in their working practices. Financial considerations must
be made before employing bank or agency staff, so you should familiarise yourself with your
organisation?s policy with regard to their usage.
` Once you have finished filling in the roster, you will need to display it where all staff will see
it. Amendments may be needed due to changing circumstances relating to the clinical setting or staff.
Because you have taken time and energy to write it, you are the one who is best placed to answer any
questions.
The time and effort involved in completing the off duty will vary from person to person - but
as a novice you should expect it to take many hours. Be sure to have all the information you require,
such as requests, patterns and financial information, before you start and, where possible, arrange in
advance some undisturbed time - preferably using some of your allotted ‘admin time’.
Taking time and consideration to complete the process, maintaining good communication with
team members, will ensure you provide an effective roster that all staff can work with, and that allows
patient care to be safely delivered.
Learning the secrets of ‘doing the off duty’:
1. Work with another person who is practiced at writing rosters;
2. Discuss the financial implications with the accountant/finance officer for your area;
3. Attend in-house training for budget management (this may be arranged with human
resources and finance departments);
4. Allot specific administration time to the task and do not leave it until the last minute;
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5. If you believe that there are fundamental shortfalls or problems with staffing levels or other
human resources issues, arrange to discuss this with your line manager, director of nursing,
human resources department or, failing that, union representative.
References
1. Adams, A., Bond S. (2003) Staffing in acute hospital wards: part 1. The relationship
between number of nurses and ward organisational environment. Journal of Nursing
Management; 11: 5, 287?292.
2. Department of Trade and Industry (2001) Implementation of the Working Time
Regulations. London: HMSO.
3. DoH (2000) Working Lives: Programmes for Change: Team based Self-rostering. London:
HMSO.
4. DoH (2000) Improving Working Lives Standard. London: HMSO.
5. Marquis, B., Huston, C. (2003) (4th Ed) Leadership Roles and Management Functions in
Nursing: Theory and Application. Philadelphia, PA: Lippincott.
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ASSINGMENT ON
Performance appraisal
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122
Performance Appraisal
A performance appraisal (PA), also referred to as a performance review, performance
evaluation, (career) development discussion, or employee appraisal is a method by which the job
performance of an employee is documented and evaluated. Performance appraisals are a part of career
development and consist of regular reviews of employee performance within organizations.
Main features
A performance appraisal is a systematic general and periodic process that assesses an individual
employee's job performance and productivity in relation to certain pre-established criteria and
organizational objectives. Other aspects of individual employees are considered as well, such as
organizational citizenship behavior, accomplishments, potential for future improvement, strengths and
weaknesses, etc.
Applications of results
A central reason for the utilization of performance appraisals (PAs) is performance
improvement ("initially at the level of the individual employee, and ultimately at the level of the
organization"). Other fundamental reasons include "as a basis for employment decisions (e.g.
promotions, terminations, transfers), as criteria in research (e.g. test validation), to aid with
communication (e.g. allowing employees to know how they are doing and organizational expectations),
to establish personal objectives for training" programs, for transmission of objective feedback for
personal development, "as a means of documentation to aid in keeping track of decisions and legal
requirements" and in wage and salary administration.
Potential benefits
1. Facilitation of communication
2. Enhancement of employee focus through promoting trust
3. Goal setting and desired performance reinforcement
4. Performance improvement
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5. Determination of training needs
Potential complications
1. Detrimental to quality improvement:
2. Subjective evaluations:
3. Negative perceptions:
4. Errors:
5. Legal issues:
6. Performance goals:
7. Derail merit pay or performance-based pay:
Improvements
1. Training
2. Providing Feedback to Raters
3. Subordinate Participation
Opposition
Not everyone is in favor of formal performance appraisal systems. Many employees, especially
those most affected by such ratings are not very enthusiastic about them. There are many critics of these
appraisals including labor unions and managers.
Labor Unions
Labor unions represent 11% (7% in the private sector) of the work force in the United States. In some
cases they may require that seniority be taken as one of the main criteria for promotion. However, length
of job experience may not always be a reliable indication of the ability to perform a higher level job.
Managers
Managers who have had unsatisfactory experiences with inadequate or poorly designed
appraisal programs may be skeptical about their usefulness.

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Some managers may not like to play the role of a judge and be responsible for the future of
their subordinates.
They may be uncomfortable about providing negative feedback to the employees.
This tendency can lead them to inflate their assessments of the workers’ job performance,
giving higher ratings than deserved.
Conducting
Human resource management (HRM) conducts performance management. Performance
management systems consist of the activities and/or processes embraced by an organization in
anticipation of improving employee performance, and therefore, organizational performance.
Consequently, performance management is conducted at the organizational level and the individual
level.
Methods of collecting data
There are three main methods used to collect performance appraisal (PA) data: objective
production, personnel, and judgmental evaluation. Judgmental evaluations are the most commonly used
with a large variety of evaluation methods.
Peer and self-assessments
While assessment can be performed along reporting relationships (usually top-down), net
assessment can include peer and self-assessment. Peer assessment is when assessment is performed by
colleagues along both horizontal (similar function) and vertical (different function) relationship. Self-
assessments are when individuals evaluate themselves.
Employee reactions
Numerous researchers have reported that many employees are not satisfied with their
performance appraisal (PA) systems.
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Studies have shown that subjectivity as well as appraiser bias is often a problem perceived by
as many as half of employees. Appraiser bias, however, appears to be perceived as more of a problem
in government and public sector organizations. Also, according to some studies, employees wished to
see changes in the PA system by making "the system more objective, improving the feedback process,
and increasing the frequency of review.
In light of traditional PA operation defects, "organizations are now increasingly incorporating
practices that may improve the system. These changes are particularly concerned with areas such as
elimination of subjectivity and bias, training of appraisers, improvement of the feedback process and
the performance review discussion.
Developments in information technology
Computers have been playing an increasing role in PA for some time (Sulsky & Keown, 1998).
There are two main aspects to this. The first is in relation to the electronic monitoring of performance,
which affords the ability to record a huge amount of data on multiple dimensions of work performance
(Stanton, 2000). Not only does it facilitate a more continuous and detailed collection of performance
data in some jobs, e.g. call centres, but it has the capacity to do so in a non-obvious, covert manner.
References
1. Muchinsky, P. M. (2006). Psychology applied to work (8th ed). Belmont, CA: Thomson
Wadsworth.
2. Broady-Preston, J. & Steel, L. (2002). Employees, customers, and internal marketing strategies
in LIS. Library Management, 23, 384-393.
3. Cederblom, D. (1982). The performance appraisal interview: A review, implications, and
suggestions. Academy of Management Review, 7(2), 219-227.
4. Josh Bersin. "Time to Scrap Performance Appraisals"
(http://www.forbes.com/sites/joshbersin/2013/05/06/time-to-scrap-performance-appraisals/).
Retrieved 6 May 2013.
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5. Richard Charles Grote (2002). The Performance Appraisal Question and Answer Book:
Survival Guide for Managers. 28-29.
6. Muczyk, J. P. & Gable, M. (1987, May). Managing sales performance through a comprehensive
performance appraisal system. Journal of Personal Selling and Sales Management, 7, 41-52.
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ASSINGMENT ON
Anecdotal Record
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Anecdotal record
Introduction
An anecdotal record (or anecdote) is like a short story that educators use to record a significant
incident that they have observed. Please see the Observing section for a short discussion of what
educators might consider significant. Anecdotal records are usually relatively short and may contain
descriptions of behaviours and direct quotes. 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.
Definitions
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.
Uses
Anecdotal records are easy to use and quick to write, so they are the most popular form of
record that educators use. Anecdotal records allow educators to record qualitative information, like
details about a child’s specific behaviour or the conversation between two children. These details can
help educators plan activities, experiences and interventions. Because they can be written after the fact,
when an educator is on his break, for example, or at the end of the day, using anecdotal records allows
the educator to continue to work (this is often referred to as the “participant-observer role”) without
having to stop to write down his observations.
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1. Record unusual events, such as accidents.
2. Record children's behavior, skills and interests for planning purposes.
3. Record how an individual is progressing in a specific area of development.
4. 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.
5. Clear, complete, accurate and factual documentation provides a reliable, permanent
record of patient care.
Way of writing an anecdotal record.
Anecdotal records are written after the fact, so use the past tense when writing them. Being
positive and objective, and using descriptive language are also important things to keep in mind when
writing your anecdotal records. Remember that anecdotal records are like short stories; so be sure to
have a beginning, middle and an end for each anecdote.
Characteristics of anecdotal records
Anecdotal records must possess certain characteristics as given below-
1. They should contain factual descriptions of what happened, when it happened, and under what
circumstances the behavior occurred.
2. The interpretations and recommended action should be noted separately from the description.
3. Each anecdotal record should contain a record of a single incident.
4. The incident recorded should be that is considered to be significant to the students’ growth and
development of example
a. Simple reports of behavior
b. Result of direct observation.
c. Accurate and specific
d. Gives context of child's behavior
e. Records typical or unusual behaviors

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Purpose
1. To furnish the multiplicity of evidence needed for good cumulative record.
2. To substitute for vague generalizations about students specific exact description of behaviour.
3. To stimulate teachers to look for information i.e pertinent in helping each student realize good
self- adjustment.
4. To understand individual’s basic personality pattern and his reactions in different situations.
5. The teacher is able to understand her pupil in a realistic manner.
6. It provides an opportunity for healthy pupil- teacher relationship.
7. It can be maintained in the areas of behaviour that cannot be evaluated by other systematic
method.
8. 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.
9. Can be used by students for self-appraisal and peer assessment.
Guidelines for making anecdotal record
1. 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.
2. 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.
3. In your anecdotal record identify the time, child, date and setting.
4. Describe the actions and what was said.
5. Include the responses of other people if they relate to the action.
6. Describe the event in the sequence that it occurred.
7. Record should be complete.
8. They should be compiled and filed.
9. They should be emphasized as an educational resource.
10. The teacher should have practice and training in making observations and writing records.
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Items in anecdotal records
1. To relate the incident correctly for drawing inferences the following items to be incorporated.
2. The first part of an anecdotal record should be factual, simple and clear.
3. Name of the students
4. Unit/ ward/ department
5. Date and time
6. Brief report of what happened.
7. 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.
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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
1. Supplements and validates of other structured instruments.

2. Provision of insight into total behavioral incidents.
3. Needs no special training.
4. Use of formative feedback.
5. Economical and easy to develop.
6. Open ended and can catch unexpected events.
7. 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
1. If carelessly recorded, the purpose will not be fulfilled.

2. Only records events of interest to the person doing the observing.
3. Quality of the record depends on the memory of the person doing the observing.
4. Incidents can be taken out of context.
5. Subjectivity.
6. Lack of standardization.
7. Difficulty in scoring.
8. Time consuming.
9. May miss out on recording specific types of behaviour.
10. Limited application.
Reference
1. Gibson, Rhonda; Zillman, Dolf (1994). "Exaggerated Versus Representative Exemplification

in News Reports: Perception of Issues and Personal Consequences". Communication Research.
21 (5): 603–624.
2. Schwarz J, Barrett S. Some Notes on the Nature of Evidence.Link. Retrieved 26 August 2012.
3. Vandenbroucke, J. P. (2001). "In Defense of Case Reports and Case Series". Annals of Internal
Medicine. 134 (4): 330–33.
4. Jenicek, M. (1999). Clinical Case Reporting in Evidence-Based Medicine. Oxford:
Butterworth–Heinemann. p. 117.
5. Altman, D. G.; Bland, M. (1995). "Absence of evidence is not evidence of absence". British
Medical Journal. 311 (7003): 485.
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ASSINGMENT ON
Incident Report
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134
Incident report
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.
It is important to ensure that prompt reporting of an incident, as well as appropriate corrective
action, take place. Time lines for both will also be legally imposed. You should therefore understand
that the requirement of incident reporting in your workplace should result in improvements in your
practice environment.
Incident reporting is the responsibility of all team members. This article will provide you with
a clear overview of writing an effective incident report, what to include and how to describe the situation
objectively.
It is important to ensure that prompt reporting of an incident, as well as appropriate corrective
action, take place. Time lines for both will also be legally imposed. You should therefore understand
that the requirement of incident reporting in your workplace should result in improvements in your
practice environment.
Incident reports comprise two aspects. First, there is the actual reporting of any particular
incident (this may be something affecting you, your patient or other staff members), and the relevant
corrective action taken. Secondly, information from incident reports is analysed to identify overall
improvements in the workplace or service.
You should be familiar with, and follow, incident reporting procedures in your workplace. The
following tips are provided to help this process.
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Generally, according to health care guidelines, the report must be filled out as soon as possible
following the incident (but after the situation has been stabilized). This way, the details written in the
report are as accurate as possible.
Most incident reports that are written involve accidents with patients, such as patient falls. But
most facilities will also document an incident in which a staff member or visitor is injured. In the event
that an incident involves a patient, the patient will often be monitored for a period of time following the
incident (for it may happen again), which may include taking vital signs regularly.
The latest guidebook for the index of the International Classification of Diseases, Edition 10,
Clinical Modifications (the ICD-10-CM) has, in Chapter 20 (External Causes of Morbidity, Codes V00-
Y99), a section of external cause codes to identify and track the occurrence of certain serious medical
and surgical errors and other serious events, which could constitute malpractice. Some of this data this
data is collected by the National Quality Forum's never events. The federal and state governments use
the never events list as the basis for quality indicators and state-based reporting systems. Some of these
are: Y65.51 (Performance of the wrong procedure or operation on the correct patient); Y65.52
(Performance of a procedure or operation on a patient not scheduled for a procedure or operation); and
Y65.53 (Performance of the correct procedure or operation on the wrong side or the wrong body part
of the patient).
What is Included in an Incident Report?
1. The name of the person(s) affected and the names of any witnesses to an incident
2. Where and when the incident occurred
3. The events surrounding the incident
4. Whether an injury occurred as a direct result of the incident
5. The response and corrective measures that were taken
6. It should be signed and dated prior to handing it in to the appropriate person, such as a
supervisor.
What Situations Should be Reported?

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Examples include:
1. Injuries – physical such as falls and needle sticks, or mental such as verbal abuse
2. Errors in patient care and medication errors
3. Patient complaints, any episodes of aggression
4. Faulty equipment or product failure (such as running out of oxygen)
5. Any incident in which patient or staff safety is compromised
We should keep the Following Points in Mind when Documenting an Incident:
1. Use objective language
2. Write what was witnessed and avoid assigning blame; write only what you witnessed and do
not make assumptions about what occurred
3. Have the affected person or witnesses tell you what happened and use direct quotations
4. Ensure that the person who witnessed the event writes the report
5. Report in a timely manner
Complete your report as soon as the incident occurs, or as soon as is feasible afterwards. Never try to
cover up or hide a mistake! Nurses practice within a Code of Conduct. Detailed discussion is essential,
especially thorough communication in aged care settings where residents remain in the nurse’s care for
longer periods of time.
Reference:
1. United States of America, National Fire Protection Association (NFPA). (2013) [online].
Available from:
http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=1600&cookie%5Ftest=1
[Accessed 10 April 2013].
2. Federal Emergency Management Agency (FEMA). (2012) [online]. Available from:
http://www.ready.gov/business/implementation/incident [Accessed 10 April 2013].
3. United Kingdom Government legislation, Civil Contingencies Act (CCA) 2004. (2012)
[online]. Available from: http://www.legislation.gov.uk/ukpga/2004/36/contents [Accessed 10
April 2013].
137
ASSINGMENT ON
Reports
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
138
Reports
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.
Definitions
1. A report is a system of communication aimed at transferring essential information necessary
for safe and holistic patient care.
2. A report consists of oral or written exchanges of information shared between members in the
health team in a number of ways. For instance, a nurse always reports on patients at the end of
a hospital work shift.
Importance of reports
1. Good reports save duplication of effort and eliminate the need for investigation to learn the
facts in a situation.
2. Full reports often save embarrassment due to ignorance of situation.
3. Patients receive better care when reports are thorough and give all pertinent data.
4. Complete reports give a sense of security which comes from knowing all factors in the situation.
5. It helps in efficient management of the ward.
Purposes of reports
1. To communicate progress of the patient’s health status to all nurses in different shifts.
2. To prepare staff members for their day’s work.
3. To ensure that all members of the health care team have the same information.
4. To provide quality and continuity of care from one shift to the next.
5. To show the kind and amount of service rendered over a specific period.
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6. To illustrate progress in reaching goals.
7. To act as an aid in studying health conditions.
8. To act as an aid in planning.
9. To interpret the services to the public and to other interested agencies.
10. To help coordinate care given by several people.
11. To prevent patients from having to repeat information to each health team member.
12. To promote accuracy in the provision of cure and lessen the possibility of error.
13. To help the health personnel make the best use of their time by avoiding overlapping activities.
Types of oral reports
These are given when the information is for immediate use and not for permanency. They may
be based on material included in a written report. They include the following:
1. Reports between the head nurse (nurse in-charge) and her assistant, e.g. on patients’ conditions,
treatment, medications, observations, admissions and discharges.
2. Reports between nurses who are assigned to bedside care.
3. Reports of staff members to the charge nurse: during the day and when on duty, e.g. on patients’
conditions, results of treatment carried out, etc.
4. Nurse in-charge reports to bedside nurses, e.g. on change in orders.
5. Report of the charge nurse to the nurse supervisor: includes names, diagnosis, treatment of each
patient, condition, problem in nursing care, complaints, general picture of the unit.
6. Report of the charge nurse to the clinical instructor.
7. Report of the supervisor to the director of nursing.
8. Report of the charge nurse to the physician, e.g. on patient’s symptoms, results of treatment,
complaints, problems, etc.
9. A report can be given orally in person or by audiotape. An in-person report permits the nurse
to obtain immediate feedback about unclear or incomplete information.
10. The report may be conducted in the conference room or during the nurse’s ‘walking rounds’.
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Types of written reports
1. Census report: Daily census or the number of patients in the nursing unit at midnight.
2. Reports on mistakes and accidents: Accurate and comprehensive reports on both the patients’
charts and the accident report are essential to protect the hospital (documentation for legal
consequences). For example, medication errors, falls, refusal of treatment, consent for
treatment, complications from procedures, dissatisfaction with care, etc.
3. Interdepartmental reports: For example, reports to the admitting office and information desk
of patients to be discharged, medicolegal cases, patients needing social support and extended
health services.
Criteria for a good report
1. Reports should be made promptly if they are to serve their purpose well.
2. A good report is clear, complete, concise.
3. 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.
4. It is clearly stated and well organized for easy understanding.
5. No extraneous material is included.
6. Good oral reports are clearly expressed and presented in an interesting manner. Important points
are emphasized.
Types of reports
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.
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Reports used in hospital setting
1. Change- of- shift reports or 24 hours report
a) Provide only essential background information about client (name, age sex, diagnosis and
medical history) but do not review all routine care procedures or task.
b) Identify clients’ nursing diagnosis or health care problems and other related causes
c) 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
d) Share significant information about family members, as it relates to clients’ problems.
e) Continuously review ongoing discharge plan. Do not engage in gossip.
f) Describe instructions given in teaching plan and clients’ response.
Sample Of An Change- Of- Shift Report Or 24 Hours Report
WARD: NUMBER OF BEDS: DATE:
Morning
Bed NO. Name & Age Diagnosis Evening Shift Night Shift
Shift
Final Census
Signature
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2. 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) Client’s name, age, primary doctor, and medical diagnosis.
b) Summary of medical progress up to the time of transfer.
c) Current health status- physical and psychosocial.
d) Current nursing diagnosis or problems and care plan.
e) Any critical assessment or interventions to be completed shortly.
f) Needs for any special equipments etc.
3. Incident reports
a) The nurse who witnessed the incident or who found the client at the time of incident should
file the report.
b) The nurse describes in concise what happened specifically objective terms, etc.
c) The nurse does not interpret or attempt to explain the cause of the incident.
d) The nurse describes objectively the clients, conditions when the incident was discovered.
e) Any measures taken by the nurse, other nurses, or doctors at the time of the incident are
reported.
f) No nurse is blamed in an incident report
g) The report is submitted as soon as possible.
h) The nurse should never make photocopy of the incident report.
4. 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
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single mistake in the census figures made buy one of the nurses make the census report of the entire
institution incorrect.
5. Birth and death report
The nurses are responsible for sending the birth and death reports to governmental authorities for
registration within the specified time.
6. 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.
How to write a better report
1. Before anything can be written clearly, it must be clear in one’s own mind.
2. Reports, lacking facts, may be biased or worthless.
3. Conciseness, accuracy and completeness are essential to good reports.
4. It is better to write several reports than one when there is more than one main subject upon
which to report
5. Use terminology in keeping with the nature of reports:
a. Short, simple, commonly used words for nontechnical reports.
b. Scientific terms when issuing reports to professional personnel.
c. Specific rather than general words
d. Use a single meaningful term rather than phrases.
6. Observes mechanics of good writing.
a. Use goods sentences and paragraphs
b. Observe margins
c. Spell properly; avoid abbreviation except in clinical charting.
d. Use correct pronoun
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e. Don’t forget punctuation
f. Be neat
7. Write report in a conversational manner.
8. Date reports
9. If report is typed by someone else, check it before signing it.
Nurses responsibility for record keeping and reporting
1. The patient has a right to inspect and copy the record after being discharged
2. Failure to record significant patient information on the medical record makes a nurse guilty of
negligence.
3. Medical record must be accurate to provide a sound basis for care planning.
4. Errors in nursing charting must be corrected promptly in a manner that leaves no doubts about
the facts.
5. 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.
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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.
Conclusion
Maintaining good quality records and reports has both immediate and long-term benefits for
staff. In the long term it protects individuals and teams from accusations of poor record-keeping, and
the resulting drop in morale. It also ensures that the professional and legal standing of nurses are not
undermined by absent or incomplete records, if they are called to account at a hearing.
Handing and taking over report

In healthcare, a Handing and taking over report or change-of-shift report is a meeting between
healthcare providers at the change of shift in which vital information about and responsibility for the
patient is provided from the off-going provider to the on-coming provider (Groves, Manges, Scott-
Cawiezell, 2016). Other names for change-of-shift report include handoff, shift report, handover, or
sign-out. Change-of-shift report is key to inpatient care because healthcare providers (nurses,
physicians, nursing assistants etc.) are essential to providing around the clock care.
During report, the outgoing nurses discuss with the oncoming nurses the condition of each
patient and any changes that have occurred to the patient during the shift. The purpose is not to cover
all details recorded in the patient's medical record, but to summarize individual patient progress.[2] The
content of the report often depends on the local organization.
Issues with report While report is necessary in order to communicate important information between
nurses, various problems are posed by the giving of report.
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Nurses in many places are legally not permitted to leave the facility until the provider has given
report to the next shift. "Walking off the job" may be considered abandonment, which may be grounds
for revocation of the nurse's license. At the same time, facilities are not legally required in all places to
pay nurses for the extra time beyond their shift they are forced to stay over to complete report. It is not
uncommon for nurses to attend report in their own time before and after a shift.
While privacy laws require report to be given in a location where unauthorized people cannot
hear the report (patients and authorized visitors for that patient are allowed to hear their report, but
patients and visitors are not allowed to hear reports for other patients), some facilities prohibit family
members from visiting patients during report times. In contrast, some facilities require shift reports to
take place in front of each affected patient, including authorized visitors.
Nursing Bedside Shift Report and Patient Safety
There is evidence to suggest that performing change of shift report at the bedside is key to
patient safety. In 2001, the Institute of Medicine stated that "it is in inadequate handoff that safety often
fails first." This is because at every change of shift, there is a chance for miscommunication about vital
patient information. A specific type of change-of-shift report is Nursing Bedside Shift Report in which
the off going nurse provides change-of-shift report to the oncoming nurse at the patient's bedside. Since
2013, giving report at the patient bedside has been recommended by the Agency for Healthcare
Research and Quality (AHRQ) to improve patient safety. However, it wasn't until recently that it was
known how Nursing Bedside Shift Report works to keep patients safe. A qualitative study by the nurse
researchers Groves, Manges, and Scott-Cawiezell developed a grounded theory on how bedside nurses
can use nursing bedside shift report (NBSR) to keep patients safe. According to Groves et al. (2016)
NBSR is used by nurses to keep patients safe by "reducing risk of harm through conveying the patient
story from shift to shift." Additionally, NBSR is key to reducing risk of harm because it supports the
nurses ability to identify and address risks.
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References:
1. I, Clement. Management of Nursing Services and Education. 9 th edition. Elsevier Health
Sciences. pp. 286-287.
2. Foundations of Caregiving, published by the American Red Cross.
3. Lamond, D (2000). "The information content of the nurse change of shift report: a
comparative study.". J Adv Nurs. 31 (4): 794–804.
4. Groves, P. S., Manges, K. A., & Scott-Cawiezell, J. (2016). Handing Off Safety at the
Bedside. Clinical nursing research.
5. Groves, Patricia S.; Manges, Kirstin A.; Scott-Cawiezell, Jill (2016-02-08). "Handing Off
Safety at the Bedside". Clinical Nursing Research
148
ASSINGMENT ON
Official Letters
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
149
Official Letters
Official letters -they can shape others' perceptions of you, inform the reader of a serious issue,
or get you a job. There are two main types of business letter styles: block style and Administrative
Management Style (AMS). Block style is the most commonly used formal letter format; it has a
salutation and closing, and is good for letters to businesses you are applying to or someone you have
met before. AMS style is more succinct and better for internal memos and situations where you have to
be very direct
Write the sender’s address and telephone number on the top left hand side of the page. If you
are representing a company, write the company’s address. If you are the sender, write your address.
Write your street address on the second line. Write your city, state, and zip code on the line below that.
Include your telephone under your address. In cases where you represent a business, you can put your
logo and address right in the middle of the page. Make sure to center it so that it looks uniform.
Place the date directly below the sender's address. It should be one line beneath the sender’s
address (two hard returns on a keyboard). The date is important for two reasons: if you're trying to get
the person or organization to complete a task in a timely manner (send a paycheck, fix an order, etc.),
it will give them a time frame to work with or if you need to save a copy of the letter for legal reasons
or posterity, the date is absolutely necessary. If you are writing in a Modified Block style, everything is
formatted to the left except for the date and closing. When writing the date, tab over to the center of the
page and place the date in the center.
Place the recipient’s name one line beneath the date (two hard returns on a keyboard). Include
his or her title (Mr., Mrs., Ms., Miss, Dr. etc). Follow the recipient’s name with his/her job title. Below
the name, write the name of the company. One line below that, write the recipient’s street address. On
the next line, write the recipient’s city, state, and zip code.
If you do not know the recipient’s title, do some background research or call the company to
find out. Always use a woman’s preference (Mrs. Ms., Miss or Dr.) If you do not know a woman’s
preference, use Ms.
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Give the person you're addressing a salutation. "Dear Sir/Madam" works fine, or if you know
the name of the person, address them directly; ensure, however, that you address them formally using
"Rev.", "Dr.", "Mr.", "Mrs.", or "Ms.", and include their full name if known. Place a colon after the
salutation and add a line (two hard returns) between the salutation and the body of the letter.
If you know the recipient and typically address them by his or her first name, it is fine to use
only the first name. (ie. Dear Cody:)
Write the body of the letter. The body of the letter need not be more than three paragraphs. If
you can't say it in three paragraphs or less then you're probably not being concise enough. Single space
and left justify each paragraph within the body.
In the first paragraph, write a friendly opening and then state the reason or goal of the letter.
Cut straight to the chase.
In the second paragraph, use examples to stress or underline your point, if possible. Concrete,
real examples are always better than hypothetical examples.
In the final paragraph, briefly summarize your purpose in writing and suggest how you might want to
proceed further.
Sign off your letter with the appropriate salutation. Leave space between your salutation and
your printed name for a signature, if possible. "Yours sincerely," "Sincerely," and "Best," are all
appropriate. Leave a space under your printed name for your signature. Finish with your title underneath
your signature if applicable.
If you are writing in Modified Block style, everything is left justified (the same as Block Style)
except for the date and the closing. Tab to the center of the page and then write your closing.
Add the word ‘Enclosure’ below your signature block or job title. Only do this if you enclosing
other material, such as a resume or schedule, along with the letter. If there is more than one extra item,
it would be a good idea to list the names of the enclosed items.
151
ASSINGMENT ON
Curriculum Vitae
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
152
Curriculum Vitae
Curriculum vitae, commonly known as a CV, is an alternative to writing a resume to apply for
a job. While a resume is typically a page or two in length, a CV is more detailed and longer. A CV often
contains more information on one’s academic background than a resume.
CVs also differ from resumes in their format. CVs vary depending on one's field and
experience, but there are a number of general format and style guidelines one can follow when creating
a CV. There are also certain sections most people include in their CVs.
Here are tips for both how to format your curriculum vitae and what to include. Review these tips and
use the format example as a template for your own CV.
Curriculum Vitae Format Example
Your Contact Information
1. Name
2. Address
3. Telephone
4. Cell Phone
5. Email
Optional Personal Information
1. Date of Birth
2. Place of Birth
3. Citizenship
4. Visa Status
5. Gender
6. Marital Status
7. Spouse's Name
8. Children
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Employment History
 List in chronological order, include position details and dates
 Work History
 Academic Positions
 Research and Training
Education
 Include dates, majors, and details of degrees, training and certification
 High School
 University
 Graduate School
 Post-Doctoral Training
Professional Qualifications
 Certifications and Accreditations
 Computer Skills
 Awards
 Publications
 Books
 Professional Memberships
 Interests
Curriculum Vitae Format:
CV Length: While resumes are generally one page long, CVs are longer. Most CVs are at least two
pages long, and often much longer.
Font and Size: Do not use ornate fonts that are difficult to read; Times New Roman, Arial, Calibri, or
a similar font is best.
154
Your font size should be between 10 and 12 points, although your name and the section headings can
be a little larger and/or bolded.
Format: However you decide to organize the sections of your CV, be sure to keep each section uniform.
For example, if you put the name of one organization in italics, every organization name must be in
italics.
If you include a sentence or two about your accomplishments in a particular position, fellowship, etc.,
make a bullet list of each accomplishment. This will keep your CV organized and easy to read.
Accuracy: Be sure to edit your CV before sending it. Check spelling, grammar, tenses, names of
companies and people, etc. Have a friend or career services counselor check over your CV as well.
Curriculum Vitae Format: What to Include
Not all CVs look the same. You may choose to include only some of these sections because others do
not apply to your background or your industry. Include what seems appropriate for your area of
specialty.
Contact information: At the top of your CV, include your name and contact information (address,
phone number, email address, etc.). Outside of the US, many CVs include even more personal
information, such as gender, date of birth, marital status, and even names of children.
Education: This may include college and graduate study. Include the school attended, dates of study,
and degree received.
Honors and Awards: This may include dean's list standings, departmental awards, scholarships,
fellowships, and membership in any honors associations.
Thesis/Dissertation: Include your thesis or dissertation title. You may also include a brief sentence or
two on your paper, and/or the name of your advisor.
Research Experience: List any research experience you have, including where you worked, when, and
with whom. Include any publications resulting from your research.

155
Work Experience: List relevant work experience; this may include non-academic work that you feel
is worth including. List the employer, position, and dates of employment. Include a brief list of your
duties and/or accomplishments.
Teaching Experience: List any teaching positions you have held. Include the school, course name, and
semester. You may also include any other relevant tutoring or group leadership experience.
Skills: List any relevant skills you have not yet mentioned. This may include language skills, computer
skills, administrative skills, etc.
Publications and Presentations: List any publications you have written, co-written, or contributed to.
Include all necessary bibliographic information. You should also include any pieces you are currently
working on. Include papers you presented at conferences and/or associations: list the name of the paper,
the conference name and location, and the date.
Professional Memberships: List any professional associations to which you belong. If you are a board
member of the association, list your title.
Extracurricular Activities: Include any volunteer or service work you have done, as well as any clubs
or organizations to which you have belonged. You can also include any study abroad experiences here
if you have not already mentioned them.
156
ASSINGMENT ON
Developing Nursing Standards for Patient Care
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
157
Developing Nursing standards for patient care
Nursing standards Standards are established rules or a basis of comparison in measuring or
judging capacity, quantity, context and value of objects in the same category. The term ‘norm’ is
frequently used synonymously with standard in the given literature. Selected standards are reliable and
relevant in terms of the category being compared, e.g. standard of ideal height and weight. A standard
is a broad statement of quality. It is a fine-level activity of excellence wherein the standard and actual
performances are compared. A standard is defined and
recognized as standard comparison of computable and approximate value, criteria and values. Nursing
care and skills bring together the client, surroundings or environment, health and nursing concepts.
Diligent care is provided to different kinds of patients throughout their life as well as to groups and
communities. Nursing caring is a fundamental service wherein the nurses as professionals are dedicated
to applying nursing standards by critically analysing and appraising significant attitudes, psychomotor
skills and prudence. Meaning of nursing practice standards 1. A standard is a commanding statement
that frames the legal and professional base for nursing practice. 2. A standard is a regulation that guides
to provide complete care with good quality and established standards. 3. A standard is a requisite for
providing safe and excellent ethical nursing care. Reasons to develop standards for patient care Nurse
is a caregiver, which means treating the client in a therapeutic way and providing care in the best way.
Therefore, guidance is needed for establishing the standards that act as foundation for providing good
nursing care. We cannot expect all the nurses to think ethically and have good attitude towards
providing care. It is better to have the standards of care which every nurse has to strictly adopt. These
standards ultimately increase the therapeutic effect of the nursing care and can be taught to the nursing
students so that they provide nursing care with moral values formally and informally. Every institution,
whether it is educational or service provider, has to maintain the standards and implement standards.
While providing nursing care, the head in-charge nurse and supervisors have to frame acceptable level
of nursing standards format and introduce these to their subordinates for practice so that they are trained
to provide satisfactory care by implementing these nursing care standards. Purpose of setting standards
for nursing practice Standards have to be established as policies for the institution by the board
158
members. These standards are implemented for those who provide direct care to the patients in the
health institution and also for those who practise nursing in any setting, thereby affecting their decision
making in providing care based on the standards. If these standards are violated, then strict disciplinary
actions need to be taken to prevent negligence in nursing care. The main purposes of developing
standards are as follows: 1. To regularize and formulate bedside care. 2. To improve and upgrade the
professional nursing care.
3. To promote the good appraisal of the provision of nursing care. 4. To determine patient satisfaction
about the nursing care. 5. To act as a guideline for nurse researcher to evaluate the relationship between
the provision of nursing care and extent of output in patient care. 6. To provide proper direction for the
nurse administrators to improve their skill and efficiency in providing ethical nursing care within the
health agencies. 7. To provide direction for the nurse educators in developing the goals of educational
programs. 8. To provide basic conceptual structure for framing the specialty nursing standards. 9. To
show the congruence in the important roles of nurses and nursing care practices within the health care
team. In more specific terms: 1. Standards provide guidelines and give direction for the performance of
nursing staff. 2. They help in maintaining records of care. 3. They provide conceptual structure for
evaluating the quality of nursing care, graded from good care to unsafe care.
I, Clement. Management of Nursing Services and Education - E-Book (p. 261). Elsevier Health
Sciences. Kindle Edition.
4. They improve efficiency, increase effectiveness of care and quality of nursing care. 5. They help in
determining whether the nursing care is appropriately carried out and accordingly provide corrective
action. 6. They help to upgrade the skills in decision making and frame alternative options for providing
nursing care. 7. They help supervisors in guiding nursing staff to improve performance. 8. They help in
clarifying a nurse’s area of accountability. 9. They help in justifying demands for resources. 10. They
help nurses in defining different levels of care. Characteristics of standards 1. They must be realistic,
attainable and acceptable. 2. They must be wide enough to apply to a range of settings. 3. They must in
159
positive terms narrate standard performance that is graded as excellent, good, etc. 4. Nursing care
standards must be formed by nursing staff, preferably by practising nurses with the help of experts.
5. They must be easily understood and stated in clear and simple terms. 6. They must show what will
be the desirable optional level. 7. They must be revised and reviewed regularly. 8. They must be updated
on recent scientific practice and knowledge. 9. They should be framed to guide in providing minimal
standard, safeguarding from below-par standards. The standards should be applicable, goal oriented,
modifiable and attainable according to their hospital policies. 10. They may be directed towards an
ideal, i.e. optional standard, or they may only specify the minimal care that must be attained, i.e. a
minimum standard. One must remember that standards that work are acceptable, objective, flexible and
achievable. Sources of nursing care standards Standards are framed based on the acceptable levels of
performance that have been found to be accurate and are needed for a particular purpose. These
standards are applied, framed and established after clinical trials comprising critical evaluation. Various
sources of nursing standards are as follows:
1. Established health care institutions such as NIMHANS, JIPMER and nursing universities. 2. Specific
patient care units where research is done after providing evidence-based care such as ICU, ICCU, NICU
and PICU. 3. Ministry of Health and Family Welfare in the country sets up the government units at
local, state and national levels. 4. Professional nursing bodies such as Trained Nurses Association of
India. 5. Nursing licensing organizations such as State Nursing Council, Indian Nursing Council,
International Nursing Council. Classification of nursing care standards Different types of nursing
standards are applied to provide bedside care, and supervise and control the nursing care. Standards can
be framed as norms out of rich experiences based on empirical observations as such rich experiences
provide fruitful nursing care. Two types of standards are applied, as listed below: 1. Empirical standards
2. Normative standards Empirical standards Empirical standards are framed based on the scientific
finding and controlled observation. Practices are observed under large group of
patient care settings. Research is conducted on the present and expected innovative care to provide
excellence in care under controlled setting before nursing standards are framed. Normative standards
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Normative standards are framed by a group of authorities who consider certain nursing practice
standards to be good and effective in providing nursing care. Usually, the normative standards are higher
than the empirical standards. The local nursing bodies, such as the Trained Nurses Association of India,
encourage normative standards, but regulatory bodies, such as Indian Nursing Council, encourage
empirical standards. The standards of nursing care can be parted into means and ends standards. A
means standard is nursing oriented; it describes the activities and behaviour designed to achieve the
ends standard, whereas an ends standard is patient oriented; it describes the changes desired in a
patient’s physical status or behaviour. A means standard calls for information about the nurse’s
performance, whereas an ends (or patient outcome) standard requires information about the patients.
Standards are expected to be understandable, measurable and achievable. Standards established for
whatever sources and however developed must be available to the nursing staff on the patient care units.
Interpretation of standards
1. Standards are measured empirically in terms of evaluating behaviour, encouraging role modelling,
giving instruction, providing guidance by active supervision and appraising the client care programs. 2.
Standards that are set should not create an exhaustive state in the workers, and workers should not be
evaluated on the theoretical basis of the standard document. Principles related to patient care standards
1. Every individual client should be treated as a worthy, respectable and unique person. 2. Every
patient’s safety should be considered and protected, which should be delegated completely to the
subordinate staff. 3. Every patient has the right to privacy and confidentiality of documents. 4. Adequate
information should be given to the patient and the family members, right from admission till discharge,
about the hospital routines, therapeutic treatments and services available. 5. All the nurses are expected
to adopt professional ethics, take up responsibility and develop trustworthiness in the public in practice
of quality care. 6. It is the responsibility of nurses to provide intercollaborative
patient care involving the physician, anesthetist, surgeon, psychologist, dietitian, radiologist and lab
technician Responsibilities of head nurse in maintaining standards The head nurse is the nursing officer
and overall in-charge of a ward unit. She is responsible to the medical officer in-charge as well as the
matron for efficient performance of her own duties and those of nursing personnel placed under her
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charge. She is responsible for the following: 1. Carrying out the instructions of medical officers
regarding treatment of patients, observing and recording the progress of treatment and generally
assisting a medical officer achieve his therapeutic aim. 2. General cleanliness: cheerful environment for
the patients. 3. Supervision of care and maintenance of buildings, furniture, fittings and reporting on
them through the chief nursing officer or medical officer. 4. Keeping the ward equipment in optimum
state of readiness by prompt repairs and replacement through condemnation boards. 5. Assignment of
duties for patient care to the staff working in the ward, taking into consideration the capabilities of each
personnel.
6. Indenting the collection of various items of medical, quality materials and other stores. 7. Ensuring
that all specimens are sent to the laboratory in time and results collected when due. 8. Maintaining strict
control over accounting and distribution of controlled and dangerous drugs. 9. Requisitioning of diet as
per instructions of the medical officer and ensuring that the diets and extras are distributed to patients
as per the requisition. 10. Ensuring that sufficient linen is available in the ward. 11. Maintaining all the
registers and documents required in the ward. 12. Overall supervision of all that is happening in the
ward, in order to ensure that the patient’s treatment and recovery is as smooth and pleasant as possible.
13. Training of nursing and other personnel working in the ward. Implementation and enforcement of
standards 1. Violation of the standards by the staff and students should be reported to the higher
authorities in a constant manner as per the procedures framed by the health institution.
2. Procedures for evaluating the student’s performance should be fair and devoid of malpractices found
in any procedures concerning the academic. Evaluation should be made judiciously without any
partiality. 3. All the disciplinary actions taken should be based on the rules and regulations established
by the institution. 4. To safeguard the patient’s health, the chief director has full right to terminate any
staff who violates the standards and misbehaves in the working environment. The main applications of
the nursing standards are as follows: 1. Standards should be applied at all times regardless of the
designation or position of the care giver, under any situation in clinical setting. 2. Standards help nurses
in solving the problems by encouraging proper decision making. 3. Standards support nurses by
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delineating the expected nursing care. 4. Standards create awareness among the public about that nurses
practice and quality nursing care. 5. Standards function as legal evidence for good nursing care.
I, Clement. Management of Nursing Services and Education - E-Book (p. 264). Elsevier Health
Sciences. Kindle Edition.
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ASSINGMENT ON
Preparing for an Assessment Tool
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
164
Preparing For an Assessment Tool
Five most important points to keep in mind when preparing for an assessment.
Practice. You may have heard people say there is no way to prepare for an assessment, but that
is not true. If you practice the tests and assignments that are often used in an online assessment, you
know what to expect, your speed will increase and you know what you should pay attention to. You
could for example practice by taking the free IQ test.
Be well rested. A good rest may just be the most important preparation for an assessment. Make
sure that you get a good night's sleep before the assessment. Also, in the morning take the time to get
ready so you will not arrive in a hurry and exhausted.
Trust yourself. Prepare well for the assessment but also trust your own abilities. Nerves can be
killing when you are completing an assessment, and by trusting and believing in yourself you can largely
keep them at bay. If you already think you will fail when you start the assessment you will not make a
self-confident impression and you probably will fail.
Be present but not overwhelming. Be yourself during the assessment but do not exaggerate in
being authoritarian and present. Of course attention will be paid to your ability to lead and express
yourself clearly, especially in the case of management assessments, but do not forget to listen to what
others have to say and respond to it. A forced presence and persistence can give an untrue impression.
Do not underestimate it. Trust your own abilities, but do not think lightly about it. Appear well-
prepared and groomed for the assessment and take all assignments seriously. If it is clear you are only
making a halfhearted attempt, no company will ever hire you.
If you want to be well-prepared it might be a good idea to study the system of assignments,
interviews and reports used for assessments. This system is called the assessment center.
These tools are for immediate use with students in the classroom. They are suitable for use in
many different contexts and are aimed at improving assessment practices. A range of schools across
Victoria have used some of these tools and their feedback and suggestions for use are included.
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The tools are grouped under the following headings:
Graphic organisers - tools to visually represent thoughts, ideas, knowledge and concepts. They
help to organise thoughts and to promote understanding. This section contains sample graphic
organisers and some examples of how they were successfully used by schools for various purposes.
Review and reflection tools - enable students to review and reflect on their knowledge, progress,
and what they have learnt and achieved during a unit, topic or project. Some tools are specifically
designed for early years students.
Feedback tools - enable students to provide feedback on their work and performance. It also
includes strategies for teachers to increase the wait time when asking questions in class.
Rubrics - printed sets of criteria for assessing knowledge, performance or product and for giving
feedback. The following tools are examples of rubrics and how they are used in schools.
Tools for planning and auditing assessment practices
The following tools can be used by teachers and school leadership teams when planning and
auditing their assessment practices:
Familiarisation and discussion tools - help develop a common understanding of assessment in
a school and are designed to familiarise teachers with formative assessment and the purpose of
assessment for learning, as learning and of learning.
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Components of a successful employee learning experience
1. Based on adult learning principles, here is a checklist for a successful employee learning
experience:
2. The goals of the employee training or development program are clear
3. The employees are involved in determining the knowledge, skills and abilities to be learned
4. The employees are participating in activities during the learning process
5. The work experiences and knowledge that employees bring to each learning situation are used
as a resource
6. A practical and problem-centered approach based on real examples is used
7. New material is connected to the employee's past learning and work experience
8. The employees are given an opportunity to reinforce what they learn by practicing
9. The learning environment is informal, safe and supportive
10. The individual employee is shown respect
11. The learning opportunity promotes positive self-esteem
The employee training and development process
Learning happens all the time whether or not you are fully aware of it. Are you a person who
forgets to save your work on your computer on a regular basis? If a power failure occurs and you loose
some data, do you learn anything? If you say to yourself, "I must remember to save more often", you
have done some learning. This type of learning is called incidental learning; you have learned without
really thinking about it or meaning to. On the other hand, intentional learning happens when you engage
in activities with an attitude of "what can I learn from this?" Employee development requires you to
approach everyday activity with the intention of learning from what is going on around you.
Who is responsible for employee training and development?
Employee training is the responsibility of the organization. Employee development is a shared
responsibility of management and the individual employee. The responsibility of management is to
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provide the right resources and an environment that supports the growth and development needs of the
individual employee.
 For employee training and development to be successful, management should:
 Provide a well-crafted job description - it is the foundation upon which employee training and
development activities are built
 Provide training required by employees to meet the basic competencies for the job. This is
usually the supervisor's responsibility
 Develop a good understanding of the knowledge, skills and abilities that the organization will
need in the future. What are the long-term goals of the organization and what are the
implications of these goals for employee development? Share this knowledge with staff
 Look for learning opportunities in every-day activity. Was there an incident with a client that
everyone could learn from? Is there a new government report with implications for the
organization?
 Explain the employee development process and encourage staff to develop individual
development plans
 Support staff when they identify learning activities that make them an asset to your organization
both now and in the future
 For employee development to be a success, the individual employee should:
 Look for learning opportunities in everyday activities
 Identify goals and activities for development and prepare an individual development plan
The individual development planning process
An individual development plan is prepared by the employee in partnership with his or her
supervisor. The plan is based upon the needs of the employee, the position and the organization. A good
individual development plan will be interesting, achievable, practical and realistic. It is implemented
with the approval of the employee's supervisor.
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An effective training program is built by following a systematic, step-by step process. Training
initiatives that stand alone (one-off events) often fail to meet organizational objectives and participant
expectations. In today’s post we outline the five necessary steps to creating an effective program.
1) Assess Training Needs: The first step in developing a training program is to identify and assess needs.
Employee training needs may already be established in the organization’s strategic, human resources
or individual development plans. If you’re building the training program from scratch (without
predetermined objectives) you’ll need to conduct training needs assessments.
2) Set Organizational Training Objectives: The training needs assessments (organizational, task &
individual) will identify any gaps in your current training initiatives and employee skill sets. These gaps
should be analyzed and prioritized and turned into the organization’s training objectives. The ultimate
goal is to bridge the gap between current and desired performance through the development of a training
program. At the employee level, the training should match the areas of improvement discovered through
360 degree evaluations.
3) Create Training Action Plan: The next step is to create a comprehensive action plan that includes
learning theories, instructional design, content, materials and any other training elements. Resources
and training delivery methods should also be detailed. While developing the program, the level of
training and participants’ learning styles need to also be considered.Many companies pilot their
initiatives and gather feedback to make adjustments before launching the program company-wide.
4) Implement Training Initiatives: The implementation phase is where the training program comes to
life. Organizations need to decide whether training will be delivered in-house or externally coordinated.
Program implementation includes the scheduling of training activities and organization of any related
resources (facilities, equipment, etc.). The training program is then officially launched, promoted and
conducted. During training, participant progress should be monitored to ensure that the program is
effective.
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5) Evaluate & Revise Training: As mentioned in the last segment, the training program should be
continually monitored. At the end, the entire program should be evaluated to determine if it was
successful and met training objectives. Feedback should be obtained from all stakeholders to determine
program and instructor effectiveness and also knowledge or skill acquisition. Analyzing this feedback
will allow the organization to identify any weaknesses in the program. At this point, the training
program or action plan can be revised if objectives or expectations are not being met.
Step 1
Analyze your organizational needs. Interview managers and supervisors and identify employee
performance areas that need strengthening. Review employee performance appraisals to locate common
performance problems. Call the human resources department of similarly sized and focused
organizations and ask what training programs have been valuable to them.
Step 2
Present your research findings to the committee or the company’s leadership team. Prepare a
detailed presentation and be prepared to answer questions. Outline the benefits of each proposed
program, anticipated costs and time requirements. Demonstrate the need for each program by preparing
detailed analysis of problem areas and possible solutions. Ask for input, suggestions and changes.
Step 3
Finalize your plan and determine your budget for the next fiscal year. Request funds using your
company’s budgeting process. When calculating your employee training budget, include materials,
travel, speaker fees, computer access charges and food in the budgeted amount. Ask for funds before
the fiscal year begins rather than requesting unbudgeted money during the fiscal year.
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Step 4
Take the total budget and allocate the funds by department, per employee or per training
program, recommends the American Society for Training and Development. Consider the benefits you
expect from each training program and decide if the cost of the program will give you the desired results.
Decide if training programs will be required or optional.
Step 5
List the training classes you will offer over the next year. Divide the classes by type and
employee attendance. Prepare a schedule and publish it on your company’s intranet. If possible, allow
employees to sign up electronically to save valuable personnel time. Be sensitive to departmental
schedules and work flow.
Step 6
Contract with outside firms or select and internal trainer to provide training. Call the potential
trainer’s references and verify that his materials and presentation style fit your needs. Ask him to give
you samples of his work, a quote of his complete fees and a list of any needed equipment. Outsourcing
training can save money when you consider the administrative and program costs.
Select an internal trainer for training programs you will handle. Ask an employee with expertise
in the field to teach a class or utilize member of your company’s human resources department. Set clear
expectations of class content and have a feedback system in place. Consider extra compensation if
training is not part of the employee’s job description.
Step 7
Evaluate the success of each program immediately after the program’s completion. Ask the
participants to fill out prepared evaluation forms. Analyze the comments to plan for further training.
Follow-up with supervisors during the year to gauge the continued effectiveness of the training
programs.
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STAFF DEVELOPMENT
Rationale for Policy on Staff Development
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 and professionally to prepare themselves for advancement in the institution or beyond the
campus.
Because job descriptions, individual goals and even the mission of the institution, division or
department may change, staff development plans will be reviewed on a regular basis. Changes to the
staff development plan shall be made as needed. Both the supervisor and the staff member must agree
upon changes.
Staff development policy should be directed toward the following objectives:
 Clarify expectations for the continued professional education of each staff member
 Specify the options available for staff improvement
 Make clear the connection between continuous professional development and institutional
rewards
 Ensure adequate funding for staff development activities
 Purposefully determine staff development activities based upon a careful assessment of staff
member needs
 Employ accepted methods of teaching and learning in staff development activities
Policy Statement
All members of the student affairs division will participate in an ongoing process of staff
development. Because the particular mission of each unit is different, supervisors will develop a plan
for staff development that encompasses the missions of the Institution, the Division of Student Affairs,
and the department.
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Divisions of student affairs should adopt a policy that all staff members have an individual staff
development plan. Staff development plans should be developed collaboratively between the staff
member and supervisor and reviewed on a regular basis.
At minimum, staff members should participate in at least one professional organization related
to the field of student affairs. Because of the importance of this, each unit should have a line item in the
department's budget to help defray the costs associated with attending professional conferences and
other professional development activities. In addition, each unit is strongly encouraged to coordinate
professional development activities that are open to the entire division.
Because of the diverse population in which today's colleges and universities serve, all staff
members of student affairs divisions should participate in a program of diversity education. It is
recommended that the chief student affairs officer of the institution have such a program housed at the
division level. It is also recommended that each unit within the division plan and implement diversity
education and training programs.
Using The Staffing Model in Staff Development
The integrated staffing model suggests a close relationship between staff development and
performance appraisal. Like performance appraisal, staff development practices are contingent upon
the context of the institution Effective staff development should be congruent with:
 Mission and goals of the institution.
 Mission and goals of the division of student affairs.
 Mission and goals of the department.
 Appropriate professional association's statement of professional practice.
 Job description for the position that the staff member occupies.
 Goals of the individual staff member.
Effective and comprehensive staff development practices must attend to staff and organization
improvement, derive from a developmental plan, include attention to both process and product, be
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anchored in day-to-day work, be multifaceted and ever changing, and recognize maturation and growth
in staff.
Dual Purposes: Staff and Organization Development
Staff development practices have a dual focus in that they must attend to individual staff and to
organization development. For staff development to be successful, both goals must be achieved -- that
is, they must be mutually supportive. This commitment requires creativity and flexibility in plans for
staff development.
Developmental Plan
Staff development must be intentional, active, and potent. A plan for individual growth should
reflect current personal and professional status regarding attributes needed to perform assigned duties,
short- and long-term goals, and alternative methods for achieving those goals. There should also be a
plan for organization improvement. Both individual and organizational needs are included in this plan.
Process and Product
The goal of staff development is improvement in staff and organizational effectiveness. This is
a process that affects interpretations of job requirements, relationships with colleagues, and perspectives
on the methods of education.
Staff development occurs in a social context and emphasizes teamwork, built on a foundation
of collaboration. Staff development is a process that demonstrates the commonness of purpose of all
staff and the crucial nature of individual knowledge and skills to perform assigned duties in relation to
the achievement of these larger goals.
Anchored in Day-to-Day Work As a process, staff development is ongoing and anchored in day-to-
day work making it visible in all personnel functions of the division. All other staffing functions are
related to staff development. This is especially true in supervision and performance appraisal.
Multifaceted, Ever Changing
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Staff development is multifaceted, targeted to many different people in different roles and thus,
it must be ever changing. Staff development activities should require thoughtful interaction and
reflection couched in a context of requirement of the job. This is more likely to result in desired effects
on behavior.
Recognizes Maturation and Growth
Staff development must be cognizant of the variations in the maturity and growth of individuals
and the organization. While some staff members may have served the profession for many years, others
may be only beginning their professional careers.
The functional roles of staff members may also change and may require retooling for the new
responsibilities. Such circumstances may require tailoring staff development opportunities if they are
to be effective. These development opportunities must reflect multiple individual and organizational
conditions. Holmes (1998) developed a human performance systems model for student affairs, which
has the following components:
Recruitment, Selection, and Retention - All activities, which are associated with identifying
potential professional staff candidates, identifying the candidates who are the best fit for both the job
and the institution, and providing systems, and activities geared toward ensuring that staff members
stay in the organization.
Performance Coaching - Student affairs administrators and staff members should develop
performance plans and engage in a continuous process of leading and motivating staff members.
Effective coaching allows supervisors and staff members to build stronger relationships and to work
collaboratively to attain performance goals.
Performance Assessment - Performance appraisal processes are necessary to establish and
maintain the conditions required for effective performance management. When properly facilitated,
performance assessment confirms employee understanding of roles, evaluates the extent to which
performance goals are being met, identifies problems and barriers in the work environment, provides
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positive and constructive feedback, encourages regular job-related conversations between supervisors
and staff members, and provides the information needed for the performance reward process.
Performance Reward - It is important that compensation by aligned with organizational goals,
and facilitates staff development. The performance reward process consists of the allocation of
employeesalary and benefits. When effectively implemented, the reward system provides specific
consequences for actual performance and feedback concerning the merit of accomplishments.
Employee Development - Employee development includes all activities that directly or
indirectly influence the ability of the student affairs professional to do her or his current or future job.
This requires identifying the competencies needed by staff members to perform one's job and ensuring
that development activities are geared toward enhancing those competencies. This can take the form of
professional conferences, on-the-job training, new employee orientation, on-site workshops and
programs.
Career Planning and Development - Career planning consists of the systematic approaches used
to ensure that each staff member's interests, values, and skills find confluence with the department's
workforce requirements and needs. Career development can consist of tuition reimbursement, career-
planning workshops, staff orientation programs, career coaching, job enrichment, and release time to
take graduate classes.
Career Transition - Without fail, some staff members will leave the organization, either
voluntarily or involuntarily. In either case, it is important that supervisors make this transition as smooth
as possible. Staff members who leave an institution should have the skills and knowledge necessary to
make a seamless transition into her or his next position.
Organizational Development - The primary focus of organizational development in student
affairs is on a planned implementation of organizational changes that benefit students, staff members,
and the institution as a whole. These changes are geared toward improving relationships and processes
among individuals and groups so that work processes can be facilitated more effectively and efficiently.
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Diversity Empowerment
Diversity can be described as a mosaic of people who bring a variety of backgrounds, styles,
perspectives, values and beliefs as assets to the groups and organizations with which they interact.
Diversity empowerment provides the philosophical foundation for the human performance system
model. It is an intentional, proactive, approach to creating an environment in which members accept,
respect, celebrate, and effectively use the diversity within an organization as a source of added value.
With this in mind, the environment should fully support the benefits of diversity within
communities and organizations, include members of diverse social groups as full participants, reflect
the contributions and interests of these diverse constituencies, and act to eradicate all forms of social
injustice.
Dixon (2001) offers an Equity-Sensitive Perspectives (ESP) (Figure 1) model of leading,
educating, and managing. ESP is a synergistic change model, focusing on people, processes, and
programs in the context of institutional change (p 72). According to Dixon, in order to best promote
equity, student affairs professionals attend to each concept in the model for all significant activities and
programs.
One particular problem that Dixon discusses is the sense of exclusion experienced by groups
not included in gender and race-based programming. Attention to the ESP principles during the planning
and implementation stages of programming can minimize such problems. Staff development activities
should recognize and attend to the categories offered in the ESP model. Application of the ESP model
(Table 1) highlights the role of the student affairs professional in focusing attention on key items relating
to people, process, and program.
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ASSINGMENT ON
Preparation of Phototype Personal Record
SUBMITTED TO

SCIENCES,
GONDA
SUBMITTED BY
MISS. REEMA PAL

SCIENCES,
GONDA
178
Preparation of phototype personal record
Staff nurses/Faculty
Policy
The collection, availability and disclosure of the contents of personnel files is governed by
regulations established by the University and applicable laws.
The Faculty and Staff Records Office, the Medical Center Staff Records Office and the
custodian of personnel files or records in various departments, schools, colleges or other University
offices are subject to these regulations.
Regulations and Definitions:
Personnel Record
A personnel record is considered to be any accumulation of documents relating to the terms and
conditions of employment of individual faculty and staff members. Such documents include but are not
limited to:
 application
 supplemental information form
 publications lists
 changes in status form
 performance evaluations
 reference checks (see 2.a. below)
 letters of commendation
 position description
 position evaluation
 disciplinary letters
Personnel Record does not include:
 Reference letters or checks supplied to an employer if identity of the person making the
reference would be disclosed.
 Materials relating to the employer’s staff planning with respect to more than one employee.
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 Medical reports and records made or obtained by the employer if the records or reports are
available to the employee from the doctor or medical facility involved.
 Information about a person other than the employee if disclosure of the information would
constitute an unwarranted invasion of the other person’s privacy.
 Information that is kept separately from other records and that relates to an investigation by the
employer about a complaint or about criminal conduct by the employee.
 Records limited to grievance investigations.
 Records kept by an executive, administrative, or professional employee that are kept in the sole
possession of the maker of the record, and are not accessible or shared with other persons.
However, a record concerning the occurrence or fact about an employee kept pursuant to this
paragraph may be entered into a personnel record if entered not more than six (6) months after
the date of the occurrence or the date the fact becomes known.
Other Personnel Information: In addition to the File Folder, the University’s Personnel Office
maintains:
 Computer data base of appointment and address information for individual faculty and staff
members
 Computer data base of information about the employment selection process
 Grievance files
 Job applicant files
 Temporary hourly appointment files
 Unemployment compensation claims files
 Maintenance of Personnel Information
 The University’s Personnel File Folder is maintained by the Faculty and Staff Records Office
or the Medical Center Staff Records Office (for staff members in the Hospitals, Medical School,
Nursing School and Health Service).
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 The Faculty and Staff computer data bases of appointments and addresses are maintained by
the Faculty and Staff Records Offices and the Medical Center Staff Records Office.
 Grievance files are maintained by the Personnel Staff and Union Relations Sections.
 Job applicant files are maintained by the Personnel Service Center Employment Sections.
 Temporary hourly appointment files are maintained by the Faculty and Staff Records Offices.
 Availability of Records: Personnel files will be available in the Personnel Office as follows:
 Members of University management may review files when there is a need in connection with
their University functions. Remote terminal access to the data base is available on the same
need to know basis.
 Staff members may review the University’s Personnel File Folder or other files regarding their
employment in the presence of a Personnel Representative. Faculty may review the University’s
file folder in the presence of a supervisor in the Faculty and Staff Records Office. Portions of
the file which were secured in confidence (reference checks) or which contain confidential facts
about other staff members will be removed prior to this review.
 Faculty and staff members may submit rebuttals to any documents in their personnel files which
will also be included in the file.
 A copy of the file or selected portions of it will be made available to the staff member upon
request, subject to a duplication fee.
Retention of Personnel File Data
Central University Files
The University’s Personnel File Folder and data base information will be retained for the entire
length of service of each staff member and for seven years following termination. Thereafter the
personnel records on the data base will be removed and the file folder will be destroyed unless legal
proceedings have been filed.
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A long term, permanent record of selected personnel information will be retained on a Personnel
History Record, housed in the Faculty and Staff Records Office or the Medical Center Staff Records
Office and on a segment of the Personnel data base (see appendix I).
Forms G will be retained for two fiscal years following the fiscal year of payment.
Job applicant files will be retained for three fiscal years following the fiscal year of the filling
of the position.
Temporary hourly appointment forms will be retained for two fiscal years following the fiscal
year of appointment.
Operating Unit Files
Departmental copies of forms and/or data listed previously should be kept for a period of two
years plus the current fiscal year.
Departmental information relating to individual staff members outside the definition of a
personnel record should be retained in accordance with individually established departmental policies
which should be documented. For example, for materials supplied in support of appointment of a new
faculty member, the department may wish to retain until the faculty member is evaluated and promoted.
Publications need only be kept to document what appears on a curriculum vitae.
School and college files about the tenure and promotion process should be retained for a period
of six (6) years plus the current fiscal year.
Release of Information to Third Parties by Faculty and Staff Records and/or Medical Center
Staff Records Office.
Central University Files
Files or information from files will be made available to those outside the University only if
such action legitimately serves the purposes of the University or with the consent of the staff member,
or as required by law.
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Verifications of employment, current or past, will be limited to name, title, date of hire, current
or final salary, and termination date, if any.
Request for information by government agencies or other investigatory bodies, resulting from
individual complaints will be referred to the University General Counsel’s Office.
When disclosure of a file is forced by subpoena or a Freedom of Information Act (FOIA)
request, efforts will be made to notify currently employed staff members as quickly as possible so they
will have an opportunity to react on their own behalf.
When responding to a FOIA request, all materials exempt from disclosure under section 13 of
public act 1976, No. 442 (MCLA 15.243) will be removed to preserve the privacy rights of individual
staff members.
Except for disclosure pursuant to a legal action or arbitration, disciplinary information more
than four years old will not be released.
Personnel files relating to an individual’s employment history at the University remain the
property of the University.
Operating Unit Files
Other offices maintaining personnel files as defined in II. A. 1. will observe the same standards
of protection and access to files as described in II. F.
Operating units should be aware that personnel information contained in their older faculty
personnel files may be unique. The Faculty and Staff Records Office holds personnel files for a period
of seven years following termination. The appointments computer data base includes information from
1978. Neither the Faculty and Staff Records Office nor the Bentley Historical Library, the archives of
the University, has the staff to maintain older personnel records or to extract information from them.
Therefore department and units may wish to hold personnel files until they are no longer of value to
them and then destroy the files.
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Procedure:
RESPONSIBILITY ACTION
A. For a faculty or staff member to review folder and obtain copies of documents:
Faculty/Staff Member 1. Staff call and make an appointment to review

folder with the Personnel Representative in his/her
Personnel Service Center or Faculty in the Faculty
and Staff Records Office, as appropriate.
Personnel Representative/Supervisor 2. Obtain folder from the Faculty and Staff Records
Office or Medical Center Staff Records Office.
3. Examine folder and remove any information
secured in confidence and/or any information of a
confidential nature relating to other staff
members.
Faculty/Staff Member 4. Read the contents of the folder. If copies of

material in folder are desired, request from
Personnel Representative or Supervisor Faculty
and Staff Records.
Personnel Representative/Records 5. Arrange for copies to be made.

Supervisor
B. To submit rebuttal:
Faculty/Staff Member 1. Present hand-written or typed document (not to

exceed 5 sheets of 8 1/2 x 11 inch paper) through
the Personnel Representative or a Supervisor of
the Faculty and Staff Records Office to be included
in the University personnel file.
Personnel Representative 2. Forward the rebuttal to the Faculty and Staff

Records Office or the Medical Center Staff Records
Office with instructions to file in the individual’s
personnel file folder.
C. Management’s Access to Personnel File Folders
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Department Head or Other 1. Contact either the appropriate manager of Staff
and Union Relations, Employment, or the manager
of the Faculty and Staff Records Office.
D. Management’s Access to Files on Data Base
University Department 1. Contact the Office of Administrative Systems,

Information Center to request access to the
personnel data base.
E. Freedom of Information Act (FOIA) request for access to file folders
Individual 1. Forward request to the Manager of the Faculty

and Staff Records Office.
Manager of Faculty and Staff Records 2. Answer request within five (5) business days.
Information to Be Recorded
1. Professional preparation and experience including record of credits earned toward a degree or
in post-doctoral work and/or certificates, diplomas, licenses, and degrees received.
2. Professional membership activity.
3. Student advising and counseling.
4. Professional activities external to the University including awards, recognition, research
activities, travel.
5. Teaching assignment, workload, publications, exhibitions, and other professional performance.
6. Personnel data including promotions, tenure, leaves, retirement credits.
7. Quality of teaching including departmental summaries of students' evaluations, research and
service to the University.
8. General performance including, but not limited to, discipline, counseling, and other behavioral
records.
9. Procedure for Recording Information for Faculty Personnel Records.
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10. It shall be the responsibility of the President of the University or his delegate to gather the
information in a timely and efficient manner.
Use of Information Contained in Faculty Records
1. In accord with OAR 580-042-0735, only the following four kinds of information may be
released, upon request, without the faculty member's consent.
2. Directory information that is, information generally needed in identifying or locating a named
faculty member including information as is readily to be found in published documents such as
the University's catalogs and directories. A faculty member may stipulate that this information
not include telephone number.
3. Objective evidence of a faculty member's academic achievement, limited to information as to
the number of credits earned toward a degree or in post-doctoral work, and certificates,
diplomas, licenses, and degrees received.
4. Salary information and the record of terms or conditions of employment.
5. Records tabulated from students' classroom survey evaluations and used by students in selecting
courses or instructors.
6. All other information contained in faculty records shall be considered personal and subject to
restricted access, being available only to the faculty member and to the University's personnel
who have a demonstrably legitimate need to review it in order to fulfill their official,
professional responsibility and including those individuals and/or committees responsible for
making recommendations or decisions regarding retention, tenure, promotion, and salary
increases.
7. These records may not be released to any other person or agency without the faculty member's
written consent, except upon receipt of a valid subpoena or other court order or process or as
required by state statute, federal law, or valid federal rules, regulations or orders, or upon a
finding by the President of the University that the public interest in maintaining individual
rights to privacy in an adequate educational environment would not suffer by disclosure of such
personal records.
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8. In accordance with OAR 580-042-0740(2) requiring the designation of institutional officials to
appear in court to test the validity of a subpoena or other court order or process relating to
release of faculty records when validity is in question, the President of the University or his
delegate is designated to so appear.
9. Access cannot be limited for records of academic achievement or for records more than 25
years old.
10. The entire contents of a faculty member's personal records files shall always be available to the
member. A faculty member may at any time enter into the member's personal records files such
comments, explanations, or rebuttals as the member may wish.
11. A copy of each written evaluation of the faculty member, containing or having attached to it a
statement that the member may discuss the evaluation with the evaluating official, shall be
given the member. A copy of the evaluation signed, by the member signifying receipt, shall be
placed in the member's evaluation file. The faculty member may enter into the evaluation file
such comments, explanations, or rebuttals as desired. There shall be attached to each copy of
the evaluation retained by the University, school, college, or department a copy of such
comments, explanations, or rebuttals.
12. If and when statements, either oral or written, are solicited concerning the scholarship, teaching
or general performance of a faculty member, it must be made clear to the person from whom
the statements are solicited that the University maintains an open file and that such statements,
including the identity of the authors, will be available to the faculty member.
13. Any evaluation received by telephone shall be documented in each of the faculty member's files
by written summary of the conversation with the names of the conversants. After July 1, 1975,
the University or any of its subdivisions when evaluating its employed faculty members shall
not solicit nor accept oral or written statements from individuals or groups who wish their
identity kept anonymous or the information they provide kept confidential.
14. If a department head or other administrative officer receives a written statement concerning a
faculty member, and it is determined that the statement is significant, there must be an
immediate notification to the faculty member that such statement has been received, and if it is
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decided that such material should be retained, it must be retained only in the faculty member's
personal records files.
 Confidential letters and other information submitted to or solicited after July 1, 1975, by the
University or any of its subdivisions prior to the employment of a faculty member are exempt
from the provisions of this section. However, if the applicant is employed by the University,
the confidential preemployment information shall be placed in the three authorized files. If a
faculty member requests access to the member's files, the anonymity of the contributor of
confidential preemployment letters and other preemployment information shall be protected.
The full text shall be made available, except that portions of the text which would serve to
identify the contributor shall be excised and retained in a file other than the three designated in
OAR 577-040-0005(4).
 Faculty members at the University who feel adversely affected by the University, school,
college, or departmental personnel action or lack thereof may request from the President of the
University or his delegate objective or quantitative information contained in files, which are
limited as to access, concerning the personnel actions affecting categories of faculty members,
where such actions appear to have relevance to the case of the faculty member making the
request for information. The President or his delegate will make such information available.
Such information may include: assignment, load, list of publications, and such other
information as determined by the President or his delegate to be relevant, but will, in no event,
include any evaluative statements concerning faculty members. Such information shall also be
available to any other faculty member at the University upon request.
 Information about the faculty member requested for research purposes may be made available
but without identifying the faculty member whose personal data or information are being
included in the research. If the confidentiality of faculty records would seem in any way
jeopardized by the release of requested information, the University through the President or his
delegate, shall obtain the written consent of the faculty member prior to releasing information
about him for research purposes.
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 Survey evaluations by students of a faculty member's classroom or laboratory performance shall
be anonymous. The record of tabulated reports of evaluations shall be placed in at least one of
the files designated in section 577-040-0005(4). All survey instruments used to obtain
evaluation data shall be returned to the faculty member. No other evaluative material shall be
accepted from students unless they are first clearly informed that the faculty member will have
access to such material and that students' anonymity cannot be preserved.
Permanence, Duplication, and Disposal of Faculty Records
 The individual faculty member's records shall be maintained only during the time that he is
employed by the University and for one year after his employment is terminated. Thereafter,
the faculty member's file shall be transferred to the office of the President or his delegate where
it shall be determined whether any part of the file should be permanently retained. Only such
records as are determined to be of long range value to the faculty member, to the University, or
to the public shall be retained.
 Faculty records may be duplicated only when authorized by the President or his delegate or by
the faculty member himself or his duly appointed representative.
 All records not retained permanently and all duplicate copies of any permanently retained
records shall be destroyed as soon as their purpose is concluded as determined by the President
of the University or his delegate, and said records or said duplicates shall be destroyed, in such
manner as to protect their confidentiality, in accordance with the rules of the State Archivist.
Cumulative Record: Meaning, Need and Other Details
Meaning of Cumulative Record Card:
A Cumulative Record Card is that which contains the results of different assessment and
judgments held from time to time during the course of study of a student or pupil. Generally it covers
three consecutive years. It contains information regarding all aspects of life of the child or educed-
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physical, mental, social, moral and psychological. It seeks to give as comprehensive picture as possible
of the personality of a child.
“The significant information gathered periodically on student through the use of various
techniques – tests, inventories, questionnaire, observation, interview, case study etc.”
Basically a Cumulative Record Card is a document in which it is recorded cumulatively useful
and reliable information about a particular pupil or student at one place. Hence presenting a complete
and growing picture of the individual concerned for the purpose of helping him during his long stay at
school. And at the time of leaving it helps in the solution of his manifold problems of educational,
vocational and personal-social nature and thus assisting him in his best development.
According to Jones, a Cumulative Record is, “A permanent record of a student which is kept
up-to-date by the school; it is his educational history with information about his school achievement,
attendance, health, test scores and similar pertinent data,” If the Cumulative Record is kept together in
a folder it is called Cumulative Record Folder (CRF). If the Cumulative Record is kept in an envelop it
is called a Cumulative Record Envelop (CRE). If the cumulative Record is kept in a card it is called a
Cumulative Record Card (CRC).
Need for School Record:
The modern type of Cumulative Record was first made available in 1928 by the American
Council on education. The need for such a record was felt in view of an inadequate information that
was contained in the various forms as available. The Secondary Education Commission has made the
following observations regarding the need for School records “neither the external examination singly
or together can give a correct and complete picture of a pupils all round progress at any particular age
of his education, yet it is imparted for us to assess this in order to determine his future course of study
or his future vocation.”
For this purpose, a proper system of school records should be maintained for every pupil
indicating the work done by him in the school from day to day, month to month, term-to-term and year
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to year. Such a school record will present a clear and continuous statement of the attainment of the child
in different intellectual pursuits through-out the successive stages of his education. It will also contain
a progressive evolution of development in other directions of no less importance such as the growth of
his interest, aptitudes and personal traits, his social adjustments, the practical and social activities in
which he takes part.
Characteristics of Cumulative Record:
The Cumulative Record is characterised in the following grounds:
1. The Cumulative Record is a permanent record about the pupil or student.
2. It is maintained up-to-date. Whenever any new information is obtained about the pupil it is
entered in the card.
3. It presents a complete picture about the educational progress of the pupil, his past achievements
and present standing.
4. It is comprehensive in the sense that it contains all information about the pupil’s attendance,
test scores, health etc.
5. It contains only those information’s which are authentic, reliable, pertinent, objective and
useful.
6. It is continuous in the sense that it contains information about the pupil from the time he enters
for pre-school education or kindergarten system till he leaves the school.
7. Whenever any information is desired by any-body concerned with the welfare of the child he
should be given the information but not the card itself.
8. Confidential information about the pupil is not entered in the CRC but kept in a separate file.
Basic Principles that Should Govern the Maintenance of the CRC:
Data contained in the cumulative record card (CRC) should be:
1. Accurate
2. Complete
3. Comprehensive
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4. Objective
5. Usable
6. Valid
1. Keeping of record is a continuous process and should cover the hole history from pre-school or
kindergarten to the college and this should follow the child from school. The Card will furnish
valuable information’s about the growth of a child and the new school can place him and deal
with him to a greater advantage.
2. All the teachers and the guidance workers should have access to these records. Matters too
confidential may be kept at a separate place. The child concerned may have an opportunity to
study his own Cumulative Record in consultation with the counseller.
3. The essential data should be kept in a simple, concise and readable form so that it may be
convenient to find out the main points of life of the child at a glance.
4. Records should be based on an objective data. They should be as reliable as possible.
5. The record system should provide for a minimum of repetition of items.
6. It should contain reliable, accurate and objective information.
7. A manual should be prepared and directions for the guidance of persons, feeling out of using
the records given in it.
8. The record should be maintained by the counsellor and should not be circulated throughout the
faculty for making entries on it by other members of the staff. These entries should made by
them on other forms and the entry in this card should be made very carefully by counsellor.
Types of Information Maintained in the-CRC:
The types of information which are collected and entered or included in the CRC are as follows:
1. Identification Data:
Name of the pupil, sex, father’s name, admission No., date of birth, class, section, any other
information that helps in easy location of the card.
2. Environmental and Background Data:
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Home-neighbourhood influences, socio-economic status of the family, cultural status of the
family, number of brothers and sisters, their educational background, occupations of the members of
the family.
3. Physical Data:
Weight, height, illness, physical disabilities, etc.
4. Psychological Data:
Intelligence, aptitudes, interests, personality qualities, emotional and social adjustment and
attitudes.
5. Educational Data:
Previous school record, educational attainments, school marks, school attendance.
6. Co-curricular Data:
Notable experiences and accomplishment in various fields-intellectual, artistic, social,
recreational, etc.
7. Vocational Information:
Vocational ambitions of the student.
8. Supplementary Information:
It is obtained by the use of standardized tests.
9. Principal’s overall remarks.
Sources of Collection of Information: Information about every pupil or child for the
maintenance in the CRC should be collected from the following sources:
1. Parents or guardian’s data form:
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Family background and the personal history of the child may be gathered from the parents who
are asked to fill in the form.
2. Personal data form:
In order to obtain information regarding the pupils interest and participation in extra-curricular
activities and his vocational preferences the personal data is of great use. The pupil may be asked to
give details of himself. This will supplement the information obtained from the parents data form.
3. School records:
These include:
(i) Records of achievement tests.
(ii) Records of other tests.
(iii) Admission and withdrawal record.
4. Other sources:
These include:
(i) Personal visits by the teachers
(ii) Observations made by the teachers.
Maintenance of the Record:
The maintenance of the Cumulative Record Card should begin when the student enters school
and should follow the student from class to class within a school and from school to school as he
continues his progress.
The class teacher will maintain the Cumulative Record. In view of the fact that he spends much
time with the students he will be in a greater position to judge them from different aspects. He will
maintain a diary or note-book in which he will note down from time to time his observations about his
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students. At the end of the year he will make the necessary entries in the Cumulative Record Card
(CRC). It is very desirable that he consults his colleagues who also know the pupils. These entries
should be made after careful consideration.
These entries should be made after careful consideration.
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Problem Solving and Action Planning
Your team and the operation will encounter challenges or problems that must be overcome. We
have outlined a seven-step process to assist you in solving problems.
The Seven Steps of Action Planning
 Define the Problem(s)
 Collect and Analyze the Data
 Clarify and Prioritize the Problem(s)
 Write a Goal Statement for Each Solution
 Implement Solutions: The Action Plan
 Monitor and Evaluate
Restart with a New Problem, or Refine the Old Problem
The following is a simple example of the problem solving process in practice: The dairy farm
owner notices that the bulk tank weights are lower this week than last week. In the next sections we will
go through the seven steps to solve this problem:
Step 1: Define the Problem(s)
Evaluate the situation. Have all possibilities been considered? In this stage, explore all
possibilities, ask all involved or interested individuals for their input into identifying the problem. Is
there just one problem or are there more?
Our farm owner conducts a thorough investigation in trying to determine why the bulk tank
weights are down. He checks with the veterinarian to be sure there is not a contributing health factor.
He also has the nutritionist evaluate the ration to be sure they are feeding at the proper level. In addition,
he interviews employees who interact with the cows on a daily basis. This is what he finds:
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Standard Operating Procedures are being followed thoroughly in the milking parlor.
Several substitute feeders found some premixes in short supply. In order to feed the milking
cows they had to prepare premixes before mixing the herd rations.
 The veterinarian visits and reports the cows are in good health.
 The nutritionist evaluates the rations and finds them to be appropriate for the various production
groups.
 The farm owner begins to suspect the problem is a result of variation in the feed ration being
fed as a result of different people mixing the feed.
Step 2: Collect and Analyze the Data
Now that we have identified the problem, we collect and analyze data to prove or disprove the
assumption that our problem is a result of inconsistent ration. We analyze the situations by asking
questions.
What ingredient(s) in the computer ration is the likely problem?
What do others (veterinarian, nutritionist, herdsman) see as the reason for the lower bulk tank
weights?
What do the feeders see? How much feed is in the alley when new feed is put out?
What does test data indicate? Compare the sample analyses of the ration being fed, the ration
being eaten by the cows, and the ration left when new feed is delivered.
In our scenario, the farm owner reviews the bulk tank weights and confirms that tank weights
are down. Next he checks the cow numbers to see if perhaps these are down. Instead, he finds that cow
numbers are up. As he is gathering data from the employees he is reminded that the old feeder left for
a new position. He finds that different people have been pitching in to mix the feed ration. The owner
begins to suspect that the cow's daily rations are not being made consistently. He reviews analysis of
feed samples at the next three feedings and finds that the variation is beyond the limits for acceptability.
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Step 3: Clarify and Prioritize the Problem(s)
If there is more than one problem, you will need to prioritize the problems so you can focus on
the most important problems first. Ask the following questions to help you sort the problems with the
higher priority issues at the top of the list.
 Which problem could result in negative consequences in terms of cow or employee health?
 Are any of the problems putting the operation in danger of being in noncompliance with
regulations?
 Which problems have the greatest impact on the long-term economic stability of the operation?
 Which problems have short-term impact on the stability of the operation?
 In this case we only have one problem — lack of a consistent ration so prioritization is not
necessary.
Step 4: Write a Goal Statement for Each Solution
The next step in the process is setting S.M.A.R.T. goals, or goals that are:
S - Specific
M - Measurable
A - Achievable
R - Relevant
T - Timely
The team needs to go through the problems that have been identified and evaluate them for each
of these items. If all the goals that have been set are S.M.A.R.T. goals, great — you are ready to move
on to Monitoring Progress. Otherwise, work with the team to make the necessary adjustments to make
the goals S.M.A.R.T.
S - Specific
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Specific goals are clear and focused, not broad, ambiguous, or general. Specific goals provide
specific information on the behaviors that are associated with the goal. These goals indicate who will
do what, when and how.
Example of a goal that is not specific - "The advisory team will improve Pleasantview Dairy's
profitability."
Example of a specific goal - "Employees of Pleasantview Dairy will lower feed costs by producing
high-quality forages (RFV>125), having forage equipment in top working order by May 1, storing the
first crop of hay silage by May 25, and continuing to harvest at 31-day intervals throughout the growing
season."
M - Measurable
Measurable goals provide a measurable indicator of success, so that it becomes easy to monitor
progress and determine when success has been attained. Measurements of success may be quantified
with numbers or a simple yes/no determination.
Example of a goal that is not measurable - "Employees of Pleasantview Dairy will improve
feed quality."
Example of a measurable goal - "Employees of Pleasantview Dairy will increase the average
relative feed value from 100 to greater than 140 for all hay silage stored this summer" or "All ingredients
in the TMR will be weighed using the electronic scales and delivered to the feed bunk by 10:00 a.m."
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A - Achievable
Achievable goals are realistic, and well within the abilities, responsibilities and resources of the
management and staff. This does not mean that goals must be easy to achieve. Every effort should be
made to reach a higher level of performance. Sometimes "stretch" goals can encourage someone to step
out of their comfort zone and tackle tasks in a new, challenging, yet achievable way that results in
overall improvement for the operation.
Example of a goal that is not achievable - "Milk yields will exceed x amount," where x is
beyond the limitations for the breed of cattle, facilities and management of the operation.
Example of an achievable goal - "Farm employee x will mix feed ingredients accurately (wet
feed less than 5 percent and dry feed less than 1 percent error) and deliver it to the cows by 10:00 a.m."
R - Relevant
A relevant goal is appropriate to a person who will be attempting to achieve it and to the overall
goals and objectives of the farm.
Example of a goal that is not relevant - "All feed will be delivered to the cows by 10:00 a.m."
This goal is easy enough to measure and achieve, but doesn't do anything to ensure the quality of the
feed.
Example of a relevant goal - "Farm staff will improve milk production and lower feed waste by
assuring that the computed ration is fed to the cows accurately, in the proper amounts and by 10:00 a.m.
each morning."
T - Timely
The attainment of a goal should not be open-ended, but set for a specific time. As much as
possible, the exact date the goal is to be achieved should be determined. When a goal has a deadline, it
provides a measurable point and speeds progress toward critical goals. Employees will generally put
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more emphasis on goals that have specific deadlines than on those for which no time for measurement
has been established.
Example of a goal that is not timely - "We will increase milk sold per worker to 1.2 million pounds."
Example of a timely goal - "We will increase milk sold per worker to 1.2 million pounds by July 1 of
next year."
Now, back to our example - an appropriate S.M.A.R.T. goal for this situation would be to write a
standard operating procedure (SOP) by tomorrow evening's feeding so that everyone that is assigned to
feed the cows unexpectedly can easily follow the steps and assure that the cows are fed correctly twice
daily, at 6 a.m. and 6 p.m.
Step 5: Implement Solutions - The Action Plan
Step five is to write an action plan that addresses the problems. An action plan is written so that
any employee can do the task successfully alone and is followed much like a recipe. It converts the goal
or plan into a people process. It has three essential parts:
 Based on the goal the action plans answers five questions - What? When? How? Where? Who?
 Lists Resources
 Lists Potential Barriers
The example below applies these steps to our sample problem. Some of the steps in the action plan are
obvious.
 What? - Feed the cows correctly twice a day.
 When? - By tomorrow night.
 How? - The written SOP.
Some questions still need answers in the action plan:
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Where? - Feed is to be mixed in the feed wagon using the green tractor on the concrete pad by the
commodity bins next to the silos. The feed is then to be fed to the cows in lots 2, 3, and 4 twice daily,
at 6AM and 6 PM.
Who? - To be assigned by the herdsman until a new feeder is hired and trained.
Resource List:
Ask the herdsman for help if any questions arise.
1. The feeds are in the feed storage area and will be replaced as they are used.
2. The tractor and mixing wagon are in the shed by the feed storage.
3. The feeder is authorized to order feed or ask the office to do so.
4. The feeder can spend up to $300 to correct problems when the office is closed and should get
parts on account at Dickerson's Equipment.
Potential Barriers:
 Depleted feeds in silos or bins.
 Tractor is in use somewhere else.
 Broken equipment.
 Sick employees.
 Cows in the wrong lot.
 Scales broken.
 You will want to post an alternative plan for each of these contingencies.
Step 6: Monitor and Evaluate
Our next step in the problem solving process is to design a method for monitoring the outcome.
The method we select should assess whether the goal and action plan corrects the problem. In addition,
a well-designed monitoring method will help the team to determine when the action plan needs to be
improved.
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A team of professionals should not spend much time going over numerous data sets. They
should have simple spreadsheets or graphs that tell how well the action plan is working and move on to
bigger problems. Most teams need a short list of key parameters related to goals that they follow each
meeting. An extensive list of production items is provided in the Resource/Special Tools section for
ideas. Many teams track summary data from accounting reports, inventories of resources, or other items
critical to monitoring action plans.
At each team meeting, the team should receive an update on the progress towards meeting the
goals including any difficulties encountered or benefits received. Printed reports, summaries and
spreadsheets speed the work of the team and help track progress. As time passes and situations change,
the team will need to reevaluate individual goals and action steps as well as eliminate any that are no
longer necessary. Add new goals as the need arises.
In our example, there were several components of the monitoring and evaluation process.
Grab samples were taken and analyzed at each feeding for the next two weeks.
The herdsman routinely observed the feed mixing process to see that the standard operating procedure
was being followed.
Bulk tank weights were monitored and plotted with cow numbers on a graph on a wall in the parlor
office.
Monitoring Tools: Sample Herd Report
Step 7: Restart With a New Problem, or Refine the Old Problem
The problem solving steps are cyclical. If the first cycle is successful the process starts over
with a new problem. If the same problem persists, there must be refinement, so the process starts over
with refinement of the original problem as more current data is analyzed.
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The problem solving process can last minutes or extend to years depending on the difficulty
and complexity of the problem being addressed. Some problems will be addressed "on the fly" by the
farm owner. Others will require careful consideration by the farm advisory team.
What is a Problem Solving Action Plan?
In short, an Action Plan clearly defines and quantifies the actions (for example: projects, change
management, process improvement, training……) that you must take to solve the problem. Now that
you have gone through the first 4 steps to define and investing the problem, determine the root cause ,
and make decisions on what to do – you need to take action (do some things!) to actually solve the
problems. Follow the above links to read our previous 4 articles.
Do we really need an Action Plan for Problem Solving?
Have you ever been in one of those strategic planning sessions where you did all kinds of great
brainstorming and came up with a big list of objectives – only to realize a year later that you didn’t
accomplish any of those things??! We have all been there! Too often, we stop there without a clear
plan on what needs to be done, who will do it and when. We all hope that someone is following up. But
unless you agree to a plan, and attach someone to it – chances are it won’t be done.
Let’s continue with our previous example of low cash flow in a particular month. Once we
realized it was due to a flu epidemic that ran through the sales department, we considered several very
different options. So perhaps we decide that we want to reduce absenteeism by ensuring that people
don’t get the flu. You are probably seeing lots of agreement. After all, that is a very wise choice, both
for the benefit of the company and for the employees themselves. Perhaps you even discuss some ways
that can happen – flu shots, education of hand washing, making sure you aren’t overworking people at
that time…… But what specific activities are involved in each of these? Who will take responsibility?
What will it cost? How long will it take to implement?
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If we all just leave the session feeling that we have solved the problem – chances are that
everyone will be expecting that someone else is taking care of it. The action plan provides structure
and focus.
How do we develop an Action Plan for Problem Solving?
It really comes down to setting SMART Goals (Specific, measurable, attainable, relevant and
time bounded). You can refer to one of my previous articles on SMART Goals that goes into some
detail on this. But unlike a typical business goal setting, where it is clear as to which manager is
responsible for what (ie Manufacturing, sales, distribution……), this is a new and often interdependent
set of activities. So it is important that the managers work together to:
1. identify the specific activities
2. define the inter-dependencies between these activities
3. determine the sequence of events that needs to happen (and set deadlines!)
4. assign the people and the resources to each of these tasks
Depending on the scope of your problem solving action plan, you may need to take a phased
approach. For example, consider that educating people of hand washing is a major behavioural change
that will take time. You may need to have different “campaigns” each quarter for a year or more, until
it has become a habit. But at the same time, you can start scheduling flu shots and look at your work
flow to reduce overtime and ensure that employees can take their vacations.
How can Managers learn to develop effective Problem Solving Action Plans?
This is an important topic in strategic management I cover it in my Advanced Problem Solving
and Decision-Making Techniques course. But it is also helpful to have training in organizational
performance planning and management. Because while developing the plan is important, you also need
to understand how to set and monitor effective performance measures.
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ASSINGMENT ON
Disaster Management
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209
Disaster Management
Disaster management Disaster is a natural damage occurring to the people in the community
and environment, causing complications and altering their normal life. It is a destructive event occurring
in the geographical area where there is an immediate need to rescue the people and requires adequate
immediate resources to enhance the survival rate of the people rescued from the disaster. Any kind of
disaster that occurs in the community cannot be handled alone; therefore, combined team force is
required, such as people drawn from civil defence, fire rescuers, government, nongovernment officials
and voluntary organizations, to handle the emergency situations effectively.
Definitions of hazard/ disaster
1. Hazard is an unusual drastic event that can be natural or can be caused by humans, and affects
the survival of human life.
2. Disaster is the destructive event that causes loss of human life, affecting the health of the
humans and causing financial loss.
3. Disaster is the disturbance in the normal ecology that cannot be replaced immediately to the
original conditions.
4. Disaster is a man-made or naturally occurring destructive event that needs multiple assistance
from several agencies.
5. The occurrence of disaster in any area affects the total equilibrium of the nearby hospital that
cannot deliver the care or cannot bear the threshold of services needed to equalize or treat the
entire population affected by the disaster.
6. Disaster is an unexpected destructive event that occurs in short period of time, which creates a
bitter experience among the survivors since the survivors would have lost their family, become
handicapped, lost their belongings, or ended up with any diseases condition.
7. Disaster is defined as the man-made act of destruction that results in the loss of human life,
material loss followed by physical injury or other effects.
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Types of hazards/ disasters
1. Unexpected onset of hazards or geological and climatic hazards: This type of hazards include
natural hazards that occur suddenly such as earthquakes, tsunamis, tropical storms, volcanic
eruptions, landslides, avalanches (rock or snow), forest fires, leading to deforestation,
geomagnetic storms, mudflows, etc.
2. Man-made environmental hazards: These include deforestation, famine and poverty. Examples
are agricultural hazard, the shrinking of the Aral Sea, salinity in Australia, etc.
3. Industrial and technological hazards: These include failure in security systems, accidental
spillage of acids, explosions, fire accidents, etc. For example, Minamata disease because of
mercury poisoning in Japan (in 1950s and 1960s) and Ontario Minamata disease in Canada.
4. Wars and civil strifes: Through the wars and conflict thousands of people are injured. Many
lose their homes and many are disabled.
5. Epidemic hazards: These occur due to the sudden entry and increase in any new disease in the
area, affecting the health of the people and causing death and disability. For example, Ebola
virus outbreak in Africa, malaria, dengue fever, etc.
Natural disasters
1. Earthquake: Vigorous tremors of the surface of the earth cause severe devastating consequences
due to the shock waves generated by the movement of rock masses deep within the earth, particularly
near the boundaries of tectonic plates, which can be measured using the Richter scale that shows the
magnitude of an earthquake ranging from 2.5 to 7. Greater magnitude indicates major tremor.
2. Floods: Among all natural disasters, floods are regarded as most damaging in terms of human lives
and property. The flood is an annual feature in respect of major rivers and tributaries during the
monsoon season. Populations living on alluvial plains prone to flooding are worst affected. Mortality is
high in case of sudden flooding. Besides fracture injuries and bruises, cases of accidental hypothermia
also occur during cold weather. Deaths due to poisonous snakes and insects are also common.
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3. Drought: Factors responsible for drought are low rainfall, reduction in vegetation, soil erosion and
surface evaporation. In rural communities, economic factors (agronomy) and sociocultural factors cause
migration. This affects the health and survival of families. Famine and desertification are their most
fearsome consequences. Draughts cause protein-energy malnutrition (PEM), vitamin A deficiency,
measles, acute respiratory infection (ARI), diarrhoea with dehydration, etc. Drought-affected
populations who migrate and settle down on the outskirts of cities and towns face the problem of poor
hygiene and sanitation. Overcrowding further exposes them to communicable diseases like diarrhoea,
TB, parasitic infestations and malaria.
4. Volcanic eruptions: A volcano has a vent in the earth’s surface and the cone formed by it. This vent
extends to the layers of molten material called magma. The cone is called volcanic edifice and is formed
by the material thrown from the vent.
5. Tropical cyclones: They are also known as typhoons and hurricanes. Tsunamis are the most powerful
and destructive marine hazards.
The impact of tsunamis and cyclones on human health cannot be underestimated. In addition to
the public health and medical consequences of these natural calamities, the social, cultural and
psychological impact of tsunamis and cyclones have an enormous and long-lasting impact across the
world, and a direct impact on human development in general. Drowning that takes place during the
impact phase of the disaster causes the overwhelming majority of deaths from tsunamis and cyclones.
People are at risk of death simply by being close to low-lying areas and the coastline. Injury is the major
cause of morbidity for tropical cyclones.
Man-made disasters
1. Nuclear warfare: Nuclear warfare is a military conflict or a political strategy in which nuclear
weapons are used to inflict damage on the enemy, which causes blast of heat and radiation. a. Blast: It
is a nuclear explosion that occurs as a result of the rapid release of energy from a high-speed nuclear
reaction. The resulting consequence will be nuclear fission or nuclear fusion or a multistage cascading
combination of the two. A fusion device is used to initiate fusion, which creates blast waves causing
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damage to the people and building. Affected people suffer from burns, fractures, sprains, cuts and
injuries. b. Heat: Radiation of intense heat exposed to the people’s skin affects the skin conditions
causing cancer c. Radiation: Explosion of the nuclear bombs causes sudden discharge of excessive
radiation similar to X-rays, which causes victims to suffer from the nuclear burns.
2. Biological warfare: One possible method of enemy attack is to introduce diseases that affect humans,
domestic animals or food crops. Either germs or toxins (poisons) produced by germs may be spread by
bombs or aerial sprays or by saboteurs who add the dangerous organisms directly to food or water
supplies.
3. Chemical warfare: In case of massive attacks on civilian population, the most likely chemical agents
are nerve gas and mustard gas. Nerve gases are a group of highly poisonous chemicals that are colourless
and odourless. They are likely to be introduced in the form of a liquid spray from planes, bombs or
shells. The liquid can quickly penetrate clothing and get absorbed through the skin. Speed is essential
in dealing with the nerve gas, since even in low concentration, they can produce serious illness or Mustard
gas: It is a group of oily liquids ranging in colour from yellow to brown and smelling like garlic, shoe
polish or rotten fish. It is used in the form of liquid spray from aircraft, bombs or shells. Drops on the
skin quickly produce blisters that are very slow to heal. The liquid slowly evaporates, producing a gas
that is very harmful to the eyes, causing redness, soreness and ulceration. If the vapour is inhaled, it
affects the lungs, leading to coughing, difficulty in breathing and fever.
4. Conventional warfare: Conventional arms have been used for a long time, and include explosives
and fire bombs.
They produce the following effects:
a. Wounds and fractures caused by flying splinters of the explosives.
b. Rupture of ear drums, lungs and small intestines.
c. Falling buildings may cause multiple injuries and fractures.
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d. Fire caused by the destroyed buildings may cause severe burns.
Psychological reaction to a disaster People of different age groups tend to react to a disaster in
different ways, although loss of appetite and sleep disturbances are common at all ages. Other common
reactions in different age groups include the following:
Preschool (1– 5 years)
1. Fearfulness
2. Nightmares
3. Clinging to parents
Early childhood (5– 11 years)
1. Night terrors, nightmares, fear of the dark
2. Aggressive behaviour at home or at school
3. Stomach aches and headaches
4. Clinging or wheezing
5. Poor concentration in school
Preadolescence (11– 14 years)
1. Rebellion in the home, such as refusal to do chores
2. Stomach aches or headaches
3. Loss of interest in friends
4. School problems such as loss of interest or attention seeking behaviour
Adolescence (14– 18 years)
1. Loss of interest in dating
2. Irresponsible and/ or delinquent behaviour
3. Poor concentration
4. Hypochondria
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Adulthood
1. Distress and depression
2. Intrusive memories of the disaster
3. Flashbacks of upset feelings
4. Intense distress at reminders
5. Irritability, blunting of feelings
Disaster trauma People who are affected by a disaster may have individual and collective trauma.
Individual trauma manifests itself in stress and grief while collective trauma results in survivors
severing their social ties with each other. Stress and grief are normal responses to any abnormal situation
and particularly in disaster survivors. The common elements of any disaster are casualties,
homelessness, disruption of sanitary facilities, some degree of panic and need for emergency medical
services. People affected by such events are panic struck and need first-aid care, emergency treatment,
food, shelter, clothing and the basic requirements of life, which are not easily available in such
circumstances. Any community when faced with a disaster, of whatever magnitude, responds to the
situation in its own way. Disaster brings grief, anxiety and anger caused by loss of life and property.
Health sector involvement in disaster management.
1. National organization: It is an important responsibility of all the state governments to protect
the people from all kinds of disaster. There is a team of members such as cabinet secretary, who
have the team of nodal ministers who implement the rescue system to save people from disaster.
The rescue team conducts the assessment of the disaster and releases the funds and makes plans
to provide relief to the people affected by the disaster.
2. State-level organization: There is usually the in charge staff from the state cabinet to provide
relief activities for the people affected from the disaster. Money is realized from the funds of
the state governments. Many voluntary organizations also give hand by providing clothes,
drugs, and other daily need materials for the people affected by the disaster.
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3. District-level organization: A district-level coordination and review committee is constituted;
it is headed by the collector as chairman with participation of all other related agencies and
departments.
4. Community-level helpers (CLHs): Any community when faced with a disaster displays a
response to the situation by the local people who immediately come forward to help. They are
called community-level helpers (CLHs). They are a vital link between the affected population
and the helping agencies (individuals, nongovernmental organizations and governmental
organizations) Community-level helpers can provide psychological intervention through daily
visits. During such visits they talk to the survivors about their feelings and experiences, impart
health education, discuss health problems, motivate individuals to hold group meetings and
organize educational activities. Community-level helpers therefore have to educate the
survivors about common stress reactions following a disaster and ways to cope with stress and
the available resources.
Nurses play an important role in providing relief to the people affected by the disaster by initiating the
preventive measures, being well prepared and trained to possess the skill of readiness to help people
any time and implementing the relief measures.
1. Immediate care providers: The reflections from the ICN, or International Nursing
Council, initiates and motivates the nursing community to provide the care immediately
by training the team of disaster nurses in every health centre to act immediately in the
scenario to rescue the victims.
2. Government and voluntary organizations: The concerned state government and the
voluntary organization constitute a core team, which manages the team of disaster
nurses, health team members, paramedical workers, and provide drugs, supplies, food
and diagnostic lab equipment to the disaster areas. They establish camps and treat the
affected victims.
3. Human rights: The rights of the affected victims should not be violated any time
during and after the disaster.
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4. Alternative care: Alternative refers to using a nonmainstream approach in place of
conventional medicine. The health of the people should be maintained by following the
complementary medicine system. It generally refers to using a nonmainstream
approach together with the conventional medicine system. This kind of treatment
usually follows the allopathic medicine to treat the disability as a result of the disaster
where alternative therapies are used, e.g., acupuncture, massage therapy, meditation,
progressive relaxation techniques, spinal manipulation therapy, etc.
5. Maintain the social justice and equality: All the victims should receive equal care
impartially in terms of social class, caste or race or religion.
6. Accountability: Every member in the health team should be responsible in the
administration of the disaster care and should keep the care recorded. The members are
accountable for the health of the victims during the disaster.
7. Relief development and planning: Plan effectively to manage the disaster by
releasing the resources in time for providing relief to the victims who experienced the
disaster.
Prevention, mitigation and preparedness activities
It is necessary to
1. be familiar with methods of raising public awareness of those natural disasters that the
region and country are most likely to experience.
2. be informed of disease and social behaviour patterns associated with disasters that may
be exacerbated by deteriorated living conditions.
3. be aware of associated physical and mental health, and socioeconomic and nursing
needs.
4. lobby institutions and governments to prepare in advance for disaster by information
on potential hazards and vulnerabilities and by increasing the ability to predict and
respond to the situation.
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5. actively participate in strategic planning and implementing of disaster plans ensuring
nursing input.
6. support the development of an accountable chain of command within the network or
relief organizations (e.g. government or designated expert organization) and the
division of the affected area.
7. urge the development and implementation of relevant policies, procedures (e.g. disaster
simulation exercise, mobilization teams, etc.) and legislation.
8. celebrate World Disaster Reduction Day every October.
Relief response
A nurse should also do the following:
1. In the short term, assist in efforts to mobilize the necessary resources (e.g. food, water,
sanitation, shelter, etc.), including emergency medical assistance, giving special attention
to vulnerable groups such as the sick, handicapped, children, women and the elderly.
2. Work with existing capacities, skills, resources and organizational structures.
3. In the long term, assist with resettlement programme, psychosocial, economic and legal
needs (e.g. counselling, documentation, mobility)
4. Partner with independent, objective media, local and national branches of government,
international agencies and nongovernmental organization.
5. Provide care for those who are providing direct services.
Hospital disaster manual
A hospital disaster manual is a written statement of a disaster plan, which is implemented during
a disaster. It includes the following:
1. Introduction: This should include the disaster alert code, general principles of conduct and
brief synopsis of the total plan. When the alert is given, all personnel must report to duty and
take over their assigned jobs.
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2. Distribution of responsibilities: Duties of each individual and department are put on an action
card. These cards describe in detail the responsibilities and actions to be taken by each and
every member of the hospital staff, starting from the hospital administration to stretcher bearers
and ward boys.
3. Chronological action plan: The action should be listed in chronological order.
a. Initial alert: This may be received through the casualty itself or through telephones or
through authorities like the police. On receipt of this information, the concerned person
must gather information regarding the place, time and type of emergency, and the
estimated number and type of casualties.
b. Activate hospital plan: The designed hospital staff activates the disaster plan. All the
departments and people involved get into readiness to attend to casualties and
depending upon the nature and number of casualties, crisis expansion of hospital beds
is undertaken, utilizing additional space by discharging minor cases and transfers to
other hospitals.
c. Formulation of command nucleus: The command nucleus should be formed
immediately and located in the casualty department.
d. Management of casualties: The next phase in the hospital will involve further
treatment of patients and collection of information for the management. The issues
faces by the management during disaster
Disaster plan
Every hospital, regardless of its size, requires a practical plan. This includes enhancement and
coordination of medical performance and additional important skills. Every hospital should create one
disaster plan to manage disaster conditions lot of money can be saved by timely preparations, which
otherwise can put an additional cost on the hospital as well as on patients.
Principles of a disaster plan
1. Mobilization of manpower within short notice
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2. Predefined and prepared site with required infrastructure
3. Delegation of competencies to achieve immediate execution within short time period
4. Ensuring smooth run of the routine hospital work
5. Availability of resources on the existing base
Conclusion
The emergency and disaster management is concerned with the provision of immediate care
needed in terms of medical, surgical and other specialty care. This type of care should be functional
round the clock in a day to deal with a wide variety of complex problems. Emergency department staff,
particularly medical and nursing staff, should be conversant with the legal aspects of emergency
services. Every hospital must have a well-established and well-rehearsed contingency plan to cover
internal or external disasters when several emergency cases arrive at the hospital. To manage the
emergency situation, it is important to have competent efficient team whose functions are actively
organized and supervised, and which is able to consume the available resources and has all kind of
emergency care preparedness. Training and updating of knowledge and skill are required to manage the
disaster situation in the workplace and the community.
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ASSINGMENT ON
Group Work OR Project Work
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221
Group work or project work
Introduction
The nurse as an employee in any health care institution or hospital has the right to become a
member of any union or association. Professional nursing associations have provided leadership that
affects many areas of nursing; it is a fundamental right of the nurse to become a member of a state and
central council of nursing.
The union government has set up the Indian Nursing Council (INC), by an act of parliament in
1947. The purpose of the INC is to formulate a national policy for training and practice of nursing in
harmony with the culture and philosophy of our country. Membership with a professional organization
Professional nursing organizations provide a means through which membership efforts can be
channelled. They also provide opportunities for expansion of viewpoints, develop leadership abilities
and provide current information of professional news and trends. Registration is of vital importance for
a professional nurse
Participation in research activities Research is a systematic investigation to discover facts or
collect information. It is a scientific process with variable results. Research findings answer questions
based on facts. Nowadays, there is a demand for research in each and every field. Nursing research also
plays a vital role in the education of nurses. Nursing depends upon the selection a systematic application
and evaluation of knowledge from basic sciences. It is through creativity that this knowledge is utilized
in advancing nursing practise and in modifying the systems for providing nursing services that nursing
evolves its own significant contribution to the well-being of people. Nursing can also develop its own
body of knowledge. Research process
The essential steps of the research process are as follows:
1. Definition of the problem, including what others have experienced, learned and thought about
the problem.
2. Delineation of the facts for study.
3. Determination of the facts pertinent to the focus of study.

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4. Employment of appropriate and expedient techniques and precise measurements for collection
of facts with due consideration to adequate control of factors other than the variables under
investigation.
5. Decision about degree of breadth and depth sought, which in turn influence the nature, scope
and sources of facts, as well as the characterization of subjects selected for study.
6. Submission of quantitative and quantifiable data to statistical analysis.
7. Selection of the data analysis to be done and use of original imaginative thinking to reveal
preciously undiagnosed relationships between variables.
8. Presentation of findings and results of analysis in communicative and verifiable form.
Need for research in nursing
1. To mould the attitudes, intellectual competence and technical skills of nurses
2. To fill in the gaps in knowledge and practise
3. To foster commitment and accountability
4. To provide basis for professionalism
5. To identify the role of nurses in changing society
6. To discover new measures for nursing practise
7. To help to take prompt decisions in administration-related problems
8. To help to improve the standards in nursing education
9. To refine the existing theories and discover new ones
Purposes of research in nursing
1. Identification and description: In this, the researcher observes and classifies the problem.
2. Exploration: The researcher investigates the full nature of the phenomenon.
3. Explanation: The goal of explanatory research is to understand the underpinnings of specific
phenomena and to explain systematic relationships among phenomena.
4. Prediction and control: The researcher makes predictions and control phenomena based on
research findings even in the absence of complete understanding.
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Responsibility of nurses in doing research
1. To read and interpret report of research in own nursing field
2. To identify areas of nursing where research is needed
3. To collaborate intelligently with researchers
4. To discuss with patients any research in which they are being asked to participate
5. To use research findings as a basis for teaching
6. To plan and supervise students’ project work in a way which will help the students to develop
thinking, questioning, observing and analysing capabilities
7. To obtain information about resources (financial, human, mechanical, etc.)
8. To monitor the progress of research project
9. To acquire skill in application of research technology Preparation and participation in research
activities Researchers are not ‘born’; they learn the development of skills.
Training: Any intellectual nurse can go into research because nurses have been trained to be sharp
observers in designing studies, selecting appropriate techniques, analysing data, reporting the findings,
judging and making decisions and applying the findings in the work situation.
Other disciplines: Nurse educators must select the best that other disciplines have to offer and then
apply these learnings in practise. Doctoral studies by nurses provide varied information. Findings of the
student doctorates can be published and shared with others who could benefit from them.
Student nurse: A beginner student in nursing is academically prepared to learn the basic methodology
and technologies of research. A nurse who is well prepared to conduct research always has need of other
individuals or groups with similar preparation for identification and feedback. Schools of nursing offer
research methodology at different levels in a graduate programme. They have adequate knowledge and
skill as they have attached from their previous educational preparation included in their graduate work.
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ASSINGMENT ON
Field Performance Appraisal
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Field/Performance Appraisal
Performance appraisal can have many positive effects if the employee views the appraisal as valuable
and valid.
Scenario: A group of registered nurses (RN), with five to ten years of work experience in your
department had verbalised that the appraisal they received from another Nurse Manager was unfair.
You are tasked to re-appraise these RNs. Describe the strategies that you would undertake to ensure a
fair assessment process.
Objectives
1. Discuss the types of Performance Appraisal
2. Highlight the benefits of Performance Appraisal
3. Elaborate on disadvantage of Performance Appraisal
4. Underline the Performance Appraisal system in hospital
5. Compare the Performance Appraisal forms of four hospitals
6. Explore strategies taken to deal with the situation in the scenario
Types of appraisal
Management By Objectives (MBO)
1. A method in which managers or employers set a list of objectives and make assessments on
their performance on a regular basis, and finally make rewards based on the results achieved
(Nandy, 2011)
2. This method mostly cares about the results achieved (goals) but not to the way how employees
can fulfill them.
360 Degree Performance Appraisal
A method that employees will give confidential and anonymous assessments on their
colleagues.
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Types of appraisal
Performance Ranking Method
 Used to assess the working performance of employees from the highest to lowest levels
 Managers will make comparisons of an employee with the others, instead of making
comparison of each employee with some certain standards (Dhami, 2010)
Peer Review Appraisal
 A way to more effectively gauge the performance of employees by establishing relevant
evaluation criteria, using those best equipped to speak about individual’s work to grade him /
her accordingly
 Peer review can take the form of disciplinary panels or ongoing feedback between co-workers
(Lovering, 2006)
 This method helps to enhance employee trust and communication
Benefits of Performance Appraisal
Organization
 Recognize and manage staff performance
 Planning and decision making
 Improve staff retention
Appraiser
 Framework for sharing feedback
 Promote career planning for staff (Chandra & Frank, 2004)
 Feedback on own management style and leadership skills (Parkin & McKimm, 2009)
Disadvantages of Performance Appraisal
 If not done right, they can create a negative experience.
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 Performance appraisals are very time consuming and can be overwhelming to managers with
many employees.
 They are based on human assessment and are subject to rater errors and biases.
 They can create a very stressful environment for everyone involved.
Performance Appraisal system in hospital
 Performance Appraisal are usually done annually (interim is done 6 months after appraisal is
given)
 Open appraisal system as a measure of employee’s performance (individual competency and
development)
 An employee who is served with a Written Warning during the appraisal period shall
immediately receive a performance rating of “4”. He / She will be subject to a second
performance review in 6 months.
 Both the appraisee and the appraiser will sign the Performance Appraisal Form and the
employee can request a copy of the completed appraisal form (SGH Performance Appraisal,
2011).
 Total Performance Management Form
 Five parts to the form (Key Results Areas, Competencies, Overall Assessment, Career
Development and Performance Review)
 Five overall ratings (Exceptional, Exceed expectations, Meets expectations, Needs
Improvement and Unsatisfactory)
 Four parts to the form (Key Results Areas / Performance Targets, Competencies, Overall
Assessment and Career Development )
 Five overall ratings (Exceed job requirements - Outstanding and deserves special
commendations, Fully meets job requirements - Has made major contributions, Fully meets job
requirements - Has performed well, Meets job requirements in key area - But performance in
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some areas needs improvement and Does not meet job requirements - Significant Improvement
required for continued employment in current position)
Performance Appraisal Form
Four parts to the form (Employee’s Feedback, Job Performance Factors, Hospital Core Values and
Overall Rating)
Four overall ratings (Performance and behaviour consistently far exceed job requirements, Performance
and behaviour fully meet and often exceed job requirements, Performance and behaviour fully meet job
requirements and Performance and behaviour are below basic job requirements. Significant
improvement is needed)
Four parts to the form (Key Responsibility Areas, Work Challenges, Career Development and Agreed
Performance Standards)
Five overall ratings (A* - Outstanding, A - Very Good, B - Good, C - Fair and D – Poor)
Performance rating is determined by weightage of Key Responsibility Areas
Process of Employee Appeal
 Every employee has a RIGHT TO APPEAL against management’s decision affecting them
 The Hospital shall resolve all employees grievances fairly as soon as they surface so as not to
allow them to grow in magnitude.
 Where the grievance cannot be resolved at the immediate Supervisor's level, the employee may
bring it to the next supervisory level.
 Management must ensure that the employee’s grievance is responded in a timely manner
(usually within 7 working days)
 The employee has the right to appeal until his grievance is resolved or reaches the level of the
CEO whose decision shall be final.
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 There will be no reprisal against any party concerned. The employee in particular will not suffer
victimization from anyone as a result of seeking resolution of a grievance through this
procedure.
 The employee may request to be accompanied by a fellow employee as spokesman at any time.
Where additional time is required in making a determination, the employee will be informed of
the expected period of extension and the reasons (SGH Employee Appeal Procedure, 2011)
Approach in re-appraisal
Know your organization appraisal tools well
Analyze the objective and subjective data. To substantiate rating, get ready the subordinate’s reference
records such as incident reports, anecdotal entries, etc. (Dessler, 2003).
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Approach to Re-appraisal
Many employees view performance appraisals as negative events. Thus, supervisors should be aware
of common errors that can result in inaccurate appraisals (Bacal, 2012).
 Halo Effect: the tendency to rate someone high or low in all categories because he/she is high
or low in one or two areas
 Recency Effect: the tendency to assess people based on most recent behaviour and ignoring
behaviour that is “older”
 Different standards of evaluation. When using categories such as fair, good, excellent, etc, the
meanings of these words will differ from person to person.
 Opportunity bias: assigning credit or blame to the employee when the true cause of the
performance was opportunity
 Leniency effect: tendency to rate higher than is warranted, usually accompanied by some
rationalization as to why this is appropriate
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 Central tendency effect: tendency / habit of assessing almost everyone as average. A person
applying this bias will tend not to rate anyone very high or very low
 Spill over effect: tendency to evaluate much on the basis of past performance.
 Exhibits effective communication skills with the ability to listen (Vasset, 2010)
 Direct subordinate to focus on organizational objectives in PPA discussion (Dessler, 2003)
 Understand the subordinate‘s root causes for under performance (Ellis, 2008)
 Supervisor should not put personal spins on the PPA but must project to staff how she could
improve herself. (Ellis, 2008)
 Supervisor should not view subordinate with under performance as punitive (Vasset, 2010)
Change in Rating
 Higher management (SNM / ADN) to approve for re-appraisal by another appraiser
 Collate and present facts to higher management who will act as a mediator
 Final decision lies with higher management
 Regardless of outcome, previous appraiser to conduct the re-appraisal session
o Save face (previous appraiser)
o Maintain trust (appraisee)
Status Quo
 Focus on their actions, not on the person
 Be specific and timely
 Be calm
 Reaffirm your faith in the person
 Define positive steps
 Get over it
Conclusion
There is no one perfect appraisal tool
232
 Compilation record of positive or negative incidents are useful in justifying PPA rating
 Appropriate communication skills used are REALLY essential
 Constant evaluation and feedback should be given to subordinate to enhance expectation on
performance and progress and to avoid surprises during PPA.
References
1. Bacal, R. (2012). A Performance Management Bias and Error Glossary. Retrieved from
http://performance-appraisals.org/Bacalsappraisalarticles/articles/bias.htm)
2. Chandran, A., & Frank, D. Z. (2004). Utilization of Performance Appraisal Systems in Health
Care Organizations and Improvement Strategies for Supervisors. The Health Care Manager,
23(1), 25-30.
3. Dessler, G. (2003). Human Resource Management (9th ed.). New Jersey: Prentice Hall.
4. Dhami, R. 2010. Performance appraisal methods. Retrieved from
http://www.humanresources.hrvinet.com/performance-appraisal-methods/
5. Ellis, J. (2008). Managing Performance. Nursing Management, 1(15), 28-33
6. Finlay, K., & McLaren, S. (2009). Does appraisal enhance learning, improve practice and
encourage continuing professional development? A survey of general practitioner’s
experiences of appraisal. Quality in Primary Care, (17), 387-395.
233

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INDEX

S.NO. CONTENT P.NO.

1. Prepare a Vision and Mission Statement for Hospital

2. Organization chart of nursing education

3. Organization chart of nursing Unit

4. Developing Budget Proposal

5. Design a layout for specialty unit for Hospital

6. Design a layout for specialty unit for Community

7. Design a layout plan for educational institution

8. Developing Staffing Pattern Nursing services

9. Developing Staffing Pattern Nursing education

10. Plan of action for recruitment process

11. Preparation of job description for ICU nurse

12. Preparation of job description for OT nurse

13. Duty Roaster

14. Performance Appraisal

15. Anecdotal record

16. Incident report

18. Official Letters

19. Curriculum Vitae

20. Developing Nursing standards for patient care

21. Preparing For an Assessment Tool

22. Preparation of phototype personal record

23. Disaster Management

24. Group work or project work

25. Field/Performance Appraisal

Prepare a Vision and Mission Statement for

SCPM COLLEGE OF NURSING AND PARAMEDICAL SCIENCES,

MISS. REEMA PAL

M.Sc. NURSING 2ND YEAR,

minds as they develop their strategic plan.

that drive organizational behavior at every level throughout the hospital.

that drive strategies and objectives.

The Mission Statement

ability to achieve our mission?”

The Vision Statement

they consider the challenges inherent in achieving the vision.

Elements of a Value-Based Vision

strategies and measurable objectives.

The Values Statement

organizational and personal qualities and characteristics.

Ensuring a Continual Focus on the Mission, Values and Vision

incorporating the following into its governance processes:

and obligations over the next several years.

the mission and vision.

 Ensure that a well-defined board-approved system is in place to measure progress toward

strategic course of action;

governance improvement opportunities;

develop skills through education and board renewal.

a better, healthier life.

of the area in general.

in the status of development between the district to district, taluk to taluk

who will be recognized for excellence, leadership, and compassionate care.

demonstrate integrity, innovation, caring and excellence.

3. Jump up to: a b c Lipton, Mark (Summer 1996). "Demystifying the Development of an

Organizational Vision" (PDF). Sloan Management Review. 37 (4): 83.

Organization Charts of Nursing Education

SCPM COLLEGE OF NURSING AND PARAMEDICAL SCIENCES,

M.Sc. NURSING 2ND YEAR,

SCPM COLLEGE OF NURSING AND PARAMEDICAL SCIENCES,