Admission, Transfer, Discharge, & Referral PDF

Admission, Transfer, Discharge, & Referal Margaret Ayorinde Faculty of Nursing, ABUAD Introduction Admission is entering a health care agency for nursing care and medical or surgical treatment Management o...

Admission, Transfer, Discharge, & Referal Margaret Ayorinde Faculty of Nursing, ABUAD Introduction Admission is entering a health care agency for nursing care and medical or surgical treatment Management of inpatient admissions and discharges is essential to enhance the quality of patient care across all sectors of healthcare. Team working and partnership at all levels of health care service delivery must be encouraged to ensure that health care is planned, managed and delivered based on a patient centred approach which ensures quality and fairness for all. To meet patients' healthcare needs during the admission process, nurses provide holistic care and establish the Principles Underpinning Best Practice in Hospital Admissions provision of patient centred services, which are accessible to the population without compromising safety, quality and clinical standards, to the right people in the right location and at the right time. Patients should be consulted and included in all decisions about their care. Clinical practice and care should be based on the most up to date evidence. Co-operation and clinical networking between hospitals and between care groups are essential to optimise outcomes, particularly where complex care issues are involved. A service based on good clinical governance (i.e. founded on Admission Types Emergency admissions Elective admissions observational admission Day-case admission Direct admission International admission Emergency Admissions An emergency hospital admission is defined as one that is not planned and which results from trauma (injury) or acute illness which cannot be treated on an outpatient basis. Only emergency patients should be admitted to hospital through the Emergency Department. The philosophy of care must shift emphasis from admission to assessment to ensure appropriateness of admission and maximise bed availability for elective admissions. Importance of ED Admission Extended access to rapid assessment clinics and outpatient radiology and pathology services. Rapid assessment and extended access to diagnostics Early Senior Medical decision making available at the point of admission. Close multidisciplinary team work. National agreed standardised triage processes to ensure clinical prioritisation of patients on their arrival in the Emergency Department and to ensure timely and appropriate care is delivered. Care pathways to minimise delays in the Emergency Department if admission is definite. These pathways should be developed in consultation with the relevant professionals and stakeholders. Before Admission There should be a clearly defined pre-admission process, which applies to both emergency and elective admissions. The decision to access a hospital service should be shared between the patient and a member of the primary care team (PCT) where possible. Pre-admission services are integrated into secondary care service delivery. Pre-admission assessment is conducted on an outpatient basis wherever possible; some aspects of pre-admission assessment may be undertaken by the PCT if appropriate. Pre-admission assessment aims to optimise a patient’s health status before planned admission to hospital. At the pre-admission visit, the patient and his/her carers are properly informed about their medical condition, proposed treatment and likely hospital procedures. The patient’s General Practitioner and/or the PCT with which the patient is enrolled should be involved in the pre-admission process, as appropriate. ED Patients should be streamed into the following categories:- resuscitation minor illness and injury stream (patients who are unlikely to be admitted) paediatric cases specialised medical/surgical team assessment for patients who may require admission psychiatric case assessment service. key processes for effective elective admissions Centralised waiting list management and agreement on the parameters for scheduling theatre lists with clinicians. Pre-admission assessment should be a standard requirement for all elective admissions to ensure appropriate planning of the entire patient journey. The anticipated length of stay (this should be indicated as early as possible to facilitate scheduling) for elective admissions should be indicated as early as possible to facilitate scheduling. Increased day surgery can also be supported by before admission assessment to ensure appropriate scheduling and to minimise transfer to inpatient beds. Discharge lounges may be used to facilitate early discharge as Before Admission The planning for the patient’s discharge from hospital should begin at the preadmission visit and co-ordination of the patient’s care for both admission and discharge is commenced at the pre-admission visit. Patient information is co-ordinated and made available to all relevant providers in an efficient and timely manner. Pre-admission planning to facilitate ‘day of surgery admission’ where appropriate. Pre-admission services may require a dedicated individual e.g. Admissions Manager. Referral pathways for primary care should enhance service Nursing action Recognize and take steps to reduce the patient's anxiety. Anxiety is a natural reaction to the unknown, but it can be reduced by therapeutic communication, teaching, and acceptance. Remember that the medical or surgical condition for which the patient is being treated is only one part of the patient's life. Other concerns include family needs, financial status, and the future. Communicate with the patient as an individual so that he or she can maintain his or her own identity. Take time to learn who the patient being admitted is, including his or her cultural and religious background. Respect the patient's values and beliefs even though they may differ from yours. Encourage the patient's family to participate in and make decisions about all aspects of care nursing action contd. During admission, the nurse acts not only as a practitioner but also as an advocate concerned about the welfare of the patient and the family. Each patient's need for nursing care related to admission should be assessed by a registered nurse; this assessment includes consideration of biophysical, psychosocial, environmental, self-care, educational, and discharge planning factors. Admission Process Authorization from a physician that the person requires specialized care and treatment. Collection of billing information by the admitting department of the health care agency. Completion of the agency’s admission data base by nursing personnel. Documentation of the client’s medical history and findings from physical examination. Development of an initial nursing care plan. Initial medical orders for treatment. Medical authorization. Initial nursing plan for care. Nursing Admission Activities Preparing the client’s room. Welcoming the client. Orienting the client. Safeguarding valuables and clothing. Helping the client undress. Compiling the nursing data base. Psychosocial Responses on Admission Anxiety and fear. Decisional conflict. Situational low self-esteem. Powerlessness. Social isolation. Risk for ineffective therapeutic regimen management. Transfer Transfer means discharging a client from one unit or agency; admitting him or her to another without going home in the interim. Transfers are used when there is a need to: – Facilitate more specialized care in a life-threatening situation. – Reduce health care costs. – Provide less intensive nursing care. Steps Involved in Transfer Informing client and family about the transfer. Completing a transfer summary. Speaking with a nurse on the transfer unit to coordinate the transfer. Transporting the client and his or her belongings, medications, nursing supplies, and chart to the other unit. Discharge Discharge is the termination of care from a health care agency. Good discharge management is vital in ensuring patient satisfaction; bed availability for emergency and elective admissions; and quality of patient care remains high. Planning for discharge actually begins on admission, when information about the patient is collected and documented. The key to successful discharge planning is an exchange of information among the patient, the caregivers, and those responsible for care while the patient is in the acute care setting and after the patient returns home. This coordination of care is usually the nurse's responsibility.  Patients and their carers should be partners in the discharge planning process. Discharge planning should be continually updated and improved. Use of the Discharge Lounge should be used to facilitate the early availability of acute beds. A bed management forum should be established to identify and resolve bed management problems with the support of the hospital executive. Early involvement of pharmacy would increase compliance with medication. principles of effective discharge planning A patient’s use of a hospital bed and their discharge should be planned before their admission, where possible. The estimated date of discharge should be documented and communicated to the patient and relevant personnel within 24 hours of admission. Discharge should be “streamlined” (e.g. prescriptions and letter should be completed in a timely manner, transport booked and test results made available promptly). Complex discharges should be discussed at a regular multidisciplinary forum to ensure discharge is expedited. Discharge Planning Discharge planning is key to ensuring that patients return to the community with the appropriate care to support them and their carers at home. Discharge from hospital is a process, not an isolated event. The process can also reduce hospital length of stay and unplanned readmission to hospital, and improve the co-ordination of services following discharge from hospital It involves the development and implementation of a plan to facilitate the transfer of an individual from hospital to theri homes or an alternative setting where appropriate. Components of the system (family, carers, hospitals, primary care providers, community services and social services) must work together. Activity and performance standards should be frequently monitored and there should be openness to innovative solutions. This will ensure that the whole systems approach to admissions and discharges is positively reflected in the Steps in the Discharge Discharge planning – Assessing and identifying health care needs. – Setting goals with the patient. – Important teaching topics about self-care at home must be covered before discharge. – Meeting eligibility requirements for home health care. Obtaining a written medical order. Completing discharge instructions. Notifying the business office. Helping the client leave the agency. Writing a summary of the client’s condition at discharge. Referral A referral is the process of sending someone to another person or agency for special services. Referrals can be made to private practitioners or community agencies. it can be to higher health institutions also. referals can be made on account of proximity General Gerontologic Considerations Older adults may minimize their symptoms Consider methods to facilitate/minimize alterations: planning a transfer to an institutional setting Allow additional time when admitting, discharging, or transferring older adults Pets are an integral social support system Early discharge planning and appropriate community resources may return older adults to their own homes  Barriers to use of community-based services: – a. Lack of finances or reluctance to spend for service payment – b. Unwillingness to admit need; mistrust of service providers – c. Lack of time, energy, or ability to find appropriate services THANK YOU NURSES Sure! Here’s a more detailed breakdown of the article, focusing on key concepts related to polyvalent nursing and the nursing process. ### 1. **Polyvalent Nurse vs. Specialist** - **Polyvalent Nurse**: - Changes specialties based on hospital needs or established periods. - Versatile and adaptable to different roles within the healthcare setting. - **Specialist**: - Remains in the same surgical ward for over two years. - Focuses on a specific area of expertise. ### 2. **Characteristics of a Polyvalent Nurse** - **Communication Skills**: Essential for effective interaction with patients and colleagues. - **Emotional Stability**: Important for managing stress and trauma in the nursing environment. - **Empathy**: Ability to understand and share the feelings of patients. - **Flexibility**: Adapts to changing situations and patient needs. - **Attention to Detail**: Critical for ensuring patient safety and care quality. - **Interpersonal Skills**: Builds strong relationships with patients and team members. - **Physical Endurance**: Required to handle the demands of nursing duties. - **Problem-Solving Skills**: Ability to think critically and make decisions quickly. ### 3. **The Nursing Process** The nursing process is a systematic approach to patient care, consisting of five sequential steps: 1. **Assessment**: - Gathering comprehensive data about the patient’s health status. - Includes physical exams, medical history, and diagnostic tests. 2. **Diagnosis**: - Analyzing assessment data to identify health issues. - Formulating nursing diagnoses based on patient needs. 3. **Planning**: - Setting measurable and achievable goals for patient care. - Developing a care plan that outlines interventions. 4. **Implementation**: - Executing the care plan through nursing interventions. - Involves direct patient care and collaboration with other healthcare professionals. 5. **Evaluation**: - Assessing the effectiveness of the care plan and interventions. - Modifying the plan as needed based on patient responses. ### 4. **Importance of Critical Thinking in Nursing** - **Definition**: Critical thinking involves analyzing information, making judgments, and solving problems effectively. - **Key Skills**: - **Analysis**: Evaluating information and arguments. - **Interpretation**: Understanding and explaining the significance of data. - **Inference**: Drawing logical conclusions based on evidence. - **Self-Regulation**: Reflecting on one’s own thought processes and decisions. - **Application**: Critical thinking helps nurses make informed decisions, prioritize patient care, and respond effectively to emergencies. ### 5. **Developing Critical Thinking Skills** - **Techniques**: - **Promote Interaction**: Learning in groups enhances critical thinking. - **Ask Open-Ended Questions**: Encourages exploration of multiple solutions. - **Use Real-Life Problems**: Apply theoretical knowledge to practical scenarios. ### 6. **Accountability in Nursing** Nurses are accountable in four main areas: - **Professional Accountability**: Adhering to ethical and professional standards. - **Legal Accountability**: Understanding and complying with laws and regulations governing nursing practice. - **Ethical Accountability**: Making decisions that align with ethical principles and patient rights. - **Employment Accountability**: Meeting the expectations set by employers and healthcare organizations. ### Conclusion Understanding these concepts is crucial for your exam. Focus on the roles and characteristics of a polyvalent nurse, the steps of the nursing process, the importance of critical thinking, and the various areas of accountability in nursing. Good luck with your studies! If you have any specific areas you want to dive deeper into, let me know! ### Key Points - A polyvalent nurse is defined as someone who changes their specialty based on hospital needs or established periods, unlike a specialist who remains in the same ward for over two years. - The nursing process includes five sequential steps: assessment, diagnosis, planning, implementation, and evaluation. - The most unique characteristic of nursing as a profession is its focus on caring. - Key characteristics of a polyvalent nurse include communication skills, emotional stability, empathy, flexibility, attention to detail, interpersonal skills, physical endurance, and problem-solving abilities. - Critical thinking is crucial in nursing for problem-solving and decision-making, with essential skills including analysis, interpretation, inference, explanation, self-regulation, and open-mindedness. - Nurses develop critical thinking through techniques like asking open-ended questions, fostering group interaction, and using real-life problems for practice. - Clinical reasoning differs from critical thinking as it applies cognitive and metacognitive processes to specific clinical situations. - The nursing process is patient-centered, dynamic, cyclical, collaborative, and requires critical thinking. - Nurses are accountable in four areas: professional, legal, ethical, and employment responsibilities. CONCEPT OF BASIC HUMAN NEEDS Nurse Damilola O. Bewaji. RN, MSc. Faculty of Nursing Sciences, Afe Babalola University, Ado Ekiti. [email protected] [email protected]  Health and human needs are inextricably interrelated. Humans need a number of essentials to survive. The assertion that all individuals irrespective of age, sex, race or creed have needs that they strive to satisfy is therefore is no exaggeration. Human beings are not merely physiological creatures and their needs are multifaceted and multidimensional. Besides, every individual is a unique being and as such requires some unique needs in addition to the basic human needs. Overview of Individual Needs Needs are things essential to life and quality living. Human needs are many. They encompass both physical and non- physical elements needed for human growth and development, as well as all those things humans are innately driven to attain. Human needs therefore can be broadly classified into two; a)Primary needs b)Secondary needs Example 1 The urge to write poetry, the desire to acquire an automobile, the desire for a new pair of shoes are, in the extreme case, forgotten or become of secondary importance. For the man who is extremely and dangerously hungry, no other interests exist but food. He dreams food, he remembers food, and he thinks about food, he emotes only about food, he perceives only food and he wants only food Perhaps it should be mentioned that any of the physiological needs and the consummatory behaviour involved with them serves as channels forall sorts of other needs as well. That is to say, the person who thinks he is hungry may actually be seeking more for comfort, or dependence, than for vitamins or proteins. Physiological Need This is the first need of the body is and it is to achieve homeostasis. This is achieved through the consumption of food, water and air; elimination of exogenous and endogenous wastes; sleep and rest; activity and exercise; and sexual gratification. If all these needs except for sexual gratification are nit ment, the humans cannot survive. Security and Safety Needs Once the physiological needs are relatively well gratified, there then emerges a new set of needs, which we may categorize roughly as the safety needs. All that has been said of the physiological needs is equally true, although in lesser degree, of these desires. They may equally well wholly dominate the organism. They may serve as the almost exclusive organizers of behaviour, recruiting all the capacities of the organism in their service, and we may then fairly describe the whole organism as a safety-seeking mechanism.  Again we may say of the receptors, the effectors, of the intellect and the other capacities that they are primarily safety-seeking tools. Again, as in the hungry man, we find that the dominating goal is a strong determinant not only of his current world-outlook and philosophy but also of his philosophy of the future. Practically everything looks less important than safety, (even sometimes the physiological needs which being satisfied, are now underestimated). A man, in this state, if it is extreme enough and chronic enough, may be characterized as living almost for safety alone. Whereas the physiological drive have certain limit to their satisfaction, security needs seems to be infinite in nature  Excessive indulgence in eating could be harmful to people. Characteristics of safety include: predictability, stability, familiarity, as well as feeling safe and comfortable and trusting other people. Inherent in the above statement is that safety needs contains both physical and psychological components. Freedom from harm, danger and fear, financial security, need for shelter and warmth all are therefore subsumed under safety and security need Physical Safety Maintaining physical safety involves reducing or eliminating threats to body or life. The threat may be illness, accident, danger, or environmental exposure, lack of shelter and warmth. The threat could even be orchestrated by medical or surgical complications following a protracted illness or surgical intervention. Although lack of shelter may not create an immediate threat to life, its cumulative effect may eventually squeeze out life out of people. Furthermore, it will thwart the ability of an individual to progress towards a higher level needs.  The need for warmth is however predicated on the fact that the human body functions in a relatively narrow range of temperature and any deviation from this narrow range will spell doom for the whole body. The nurse may assist in removing threats from patient’s environment through keen observation and continual assessment, ensuring adequate bed spacing, Keeping wards well illuminated and aerated, scrupulous hand-washing, aseptic wound dressing, locking up of poisons at home to safeguard children, to mention but a few. Psychological Safety To be safe and secure psychologically, a person must understand what to expect from others, including family members and healthcare professionals, and what to expect from procedures, new experiences, and encounters within the environment’. Everyone feels some threat to psychological safety with new and unfamiliar experiences. By extension, a newly hospitalized patient may feel threatened by the strange hospital environment and a patient/client about to undergo a diagnostic test may equally feel threatened by the technology involved.  The fact that people rarely open up that their psychological safety is threatened makes assessment of psychological safety often difficulty. To this end, the nurse will have to interpret the patient/client language and behaviour. The nurse may assist in alleviating psychological threat through explanation of procedures to patients before actual intervention, health education etc. Affiliation and Social Needs (Love) These encompass the need for friendship, love, belongingness, and acceptance. When both the physiological and the safety need are fairly well gratified, then the affiliation needs will emerge and dominate the behaviour of human being. Now the person will feel keenly, as never before, the absence of friends, or a sweetheart, or a wife, or children. He will hunger for affectionate relations with people in general, namely, for a place in his group, and he will strive with great intensity to achieve this goal. He will want to attain such a place more than anything else in the world and may even forget that once, when he was hungry, he sneered at love.  The drive to belong and be accepted by other people stems from the gregarious nature of human. Everyone needs to feel that they are wanted and belong to a group. Non-fulfilment of these needs may affect the mental health of the individual and indeed has implicated in the aetiology of maladjustment and more severe psychopathology. For instance, a usually mild-tempered person may become easily irritated; an outgoing person may suddenly become withdrawn from friends and co-workers; could even affect a person’s work habits leading to increased absenteeism or over commitment to the job.  For this reason, the nursing care plan for an ill hospitalized patient should include means by which love and belonging needs can be met. Some of the ways by which this need could be met include: getting patient/client actively involved in the development of their care plan; giving nursing care in friendly and empathetic manner; encouraging presentation of greeting cards to patient and visits by friends and relatives; and short social visits by members of the health care team. MASLOW HIERARCHY OF NEEDS Abraham Harold Maslow was a renowned psychologist and philosopher who lived between April 1, 1908 and June 8, 1970. He was a scholar and was referred to as the father of humanistic psychology. In 1943, Abraham H. Maslow observed and concluded that: 1. Needs are hierarchical in nature. That is, each need has a specific ranking or order of obtainment. 2. The need network for most people is very complex, with a number of needs affecting the behaviours of each person at any point in time.  3. People respond to these needs in a progressive manner from simple physiological needs (survival needs) to more complex (aesthetic) needs; and that they do so as whole and integrated beings. 4. When one set of needs is satisfied, it cease to be a motivator. 5. Lower level need must be satisfied in general, before higher level needs are activated sufficiently to drive behaviour. 6. There are more ways to satisfy higher level needs than there are for lower level needs Consequently, he identified various needs that motivate behaviour and place them in sequential hierarchy or graded order according to their significance to human survival i.e. in ascending order from lowest to the highest needs  QUESTIONS ASSIGNMENT With the aid of a well labelled diagram, describe Abraham Maslow’s hierarchy of needs Discuss the Application of the theory Discuss the criticisms of the theory CONCEPT OF HEALTH AND ILLNESS Nurse Damilola O. Bewaji. RN, MSc. Faculty of Nursing Sciences, Afe Babalola University, Ado Ekiti. [email protected] [email protected] Introduction Health is a fundamental human rights it is individually defined by each person and it is affected by so many factors and a standard definition is difficult Each person define health according to how they feel their values and beliefs Health is the level of functional or metabolic efficiency of a living organism. In humans, it is the general condition of a person's mind and body, usually meaning to be free from illness, injury or pain. Systematic activities to prevent or cure health problems and promote good health in humans are undertaken by health care providers. Definition of Health The widely accepted definition of health is by World Health Organisation (WHO 1948) which is stated as a state of complete physical, mental and social well-being not merely the absence of disease or infirmity Health is a dynamic state in which the individual adapts to changes in internal and external environment to maintain a state of well-being.  The characteristics of health are: 1. A concern for the individual as a total system. 2. A view of health that identifies internal and external environment. 3. An acknowledgment of the importance of an individual’s role in life Dimensions of health Physical dimension: it includes genetic inheritance, developmental level, race, gender Emotional dimension: it encompasses how the mind affects body functions and respond to body condition Intellectual dimension: It includes cognitive abilities, educational background and past experiences Environmental dimension: it includes housing, sanitation, climate, pollution, food and water Socio-cultural dimension: it includes practices and beliefs that can be influenced by a person's economic level lifestyle family and culture Spiritual dimension: it includes spiritual beliefs and values Key determinants of an individual's health Health is not just a state, but also "a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. The Interdependent fields that determine individual's health are: 1. Biomedical: all aspects of health, physical and mental, developed within the human body as influenced by genetic make-up. 2. Lifestyle: the aggregation of personal decisions (i.e., over which the individual has control) that can be said to contribute to, or cause, illness or death. 3. Environmental: all matters related to health external to the human body and over which the individual has little or no control.  Focusing more on lifestyle issues and their relationships with functional health, people can improve their health via a) exercise, b) enough sleep, c) maintaining a healthy body weight, d) limiting alcohol use, and e) Avoiding smoking.  The environment is often cited as an important factor influencing the health status of individuals. This includes characteristics of the a) Natural environment, b) The built environment, and c) The social environment. Factors such as clean water and air, adequate housing, and safe communities and roads all have been found to contribute to good health, especially to the health of infants and children. For example, lack of neighbourhood recreational spaces including natural environment leads to lower levels of personal satisfaction and higher levels of obesity, which is linked to lower overall health and wellbeing.  Genetics, or inherited traits from parents, also play a role in determining the health status of individuals and populations. This can encompass both the predisposition to certain diseases and health conditions, as well as the habits and behaviours individuals develop through the lifestyle of their families. For example, genetics may play a role in the manner in which people cope with stress, mental, emotional or physical. Obesity is a very large problem in the Nigeria that contributes to bad mental health and causes stress in a lot of people's lives. Other Factors That Influence Health More specifically, key factors that have been found to influence whether people are healthy or unhealthy include the following: a. Income and social status b. Social support networks c. Education and literacy d. Employment/working conditions e. Social environments f. Physical environments g. Personal health practices and coping skills.  h. Healthy child development i. Biology and genetics j. Health care services k. Gender l. Culture Concept of Illness Definition An illness is the response of the person to a disease or an abnormal process in which a person's level of functioning change when compared with a previous level This a state in which a person’s physical, emotional, intellectual, social developmental or spiritual functioning is diminished or impaired. It is a condition characterized by a deviation from a normal, healthy state. Stages of Illness 1. Stage of Denial – Refusal to acknowledge illness; anxiety, fear, irritability and aggressiveness. 2. Stage of Acceptance – Turns to professional help for assistance 3. Stage of Recovery (Rehabilitation or Convalescence) – The patient goes through of resolving loss or impairment of function Classification of illness Acute illness Chronic illness Acute illness The characteristics of acute illness are Has rapid onset of symptoms Severe symptoms may appear suddenly Patient return to normal functioning afer prompt medical attention Resolves with self medication and over the counter drug illnesses disappear Example are common cold, appendicitis, malatria Chronic illness Characteristics include Has slow onset Requires a long period of care or support It can cause permanent damage and irreversible alteration in normal anatomy and physiology It requires patient education for rehabilitation Example of chronic illnesses are heart disease, stroke, cancer, type 2 diabetes, obesity, arthritis etc. Models of Health and Illness Cultural and professional models of illness influence decisions on individual patients and delivery of health care. Health care systems are social organisations, and their continuing health depends on members of society using a congruent model of illness and system of values to decide the rights and responsibilities associated with health and illness and the sick role. Health-Illness Continuum (Neuman) Degree of client wellness that exists at any point in time, ranging from an optimal wellness condition, with available energy at its maximum, to death which represents total energy depletion  High – Level Wellness Model (Halbert Dunn) Dunn's High-Level Wellness Grid composed of two axis’s a) Health axes which ranges from peak wellness to death. b) Environmental axes which ranges from very favorable to very unfavorablethe health The grid is made up of 1) high-level wellness in a favorable environment e.g., a person who implements healthy life-style behaviors and has the biopsychosocial spiritual resources to support his/her life-style. is a holistic approach that acknowledgesthe interaction between physical, psychological, social, and spiritual aspects to patient care and patient well-being (Beng, 2004). 2) Emergent high-level wellness in an unfavorable environment e.g., a woman who has the knowledge to implement healthy life-style practices but doesnot implement adequate self-care practices because of family responsibilities, job demands, or other factors that may affect her. 3) Protected poor health in a favorable environment e.g., an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction that they will use in order to be protected and cure.  4) poor health in an unfavorable environment e.g., a young child who is starving in a drought ridden countryThe health axis ranges from death at the left extremity to “peak wellness “at the right. The area in between the extremes proceeds through serious and minor illnesses into the area of positive health or freedom from illness High Level Wellness involves progress being made in a progressive and upward direction, with the goal of reaching a greater level of functioning. In the functioning process, the whole individual's full being—body, mind, and spirit—is integrated. Direction in progress forward and upwards towards a higher potential of functioning 1) Model (Leavell) The level of health of an individual or group depends on the dynamic relationship of the agent, host and environment. Agent – any internal or external factor that causes disease or illness. Host – the person or persons who may be susceptible to a particular illness or disease Environment – consists of all factors outside of the host n within the environment. Health – Belief Model Addresses the relationship between a person’s belief and behaviours. It provides a way of understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies. Components of Health Belief Model include 1. The individual’s perception of susceptibility to an illness 2. The individual’s perception of the seriousness of the illness 3. The perceived threat of a disease 4. The perceived benefits of taking the necessary preventive measures Health Promotion Model A “complimentary counterpart model of health protection” is directed at increasing a client’s level of wellbeing. Explain the reason for client’s participation in health-promotion behaviours. The model focuses on three functions: 1. It identifies factors (demographic and socially) enhance or decrease the participation in health promotion 2. It organizes cues into pattern to explain likelihood of a client’s participation health-promotion behaviours 3. It gives the reasons that individuals engage in health activities QUESTIONS ? Assignment Discuss Health and illness Continum COURSE TITLE: FOUNDATION OF NURSING 1 COURSE CODE: NSC 201 INTRODUCTION Nurse Damilola O Bewaji RN, M.Sc. Faculty of Nursing, Afe Babalola mUniversity, Ado Ekiti, Nigeria [email protected] Alt email: [email protected]  Welcom e We are disciplined professionals Rules for this class General rules FACULTY OF NURSING, AFE BABALOLA 2 UNIVERSITY, ADO EKITI, NIGERIA. WHAT IS NURSING AND WHO IS A NURSE ? X FACULTY OF NURSING, AFE BABALOLA UNIVERSITY, ADO EKITI, NIGERIA. 3  NURSING Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient’s needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise. FACULTY OF NURSING, AFE BABALOLA 4 UNIVERSITY, ADO EKITI, NIGERIA.  Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people However, nursing has a unifying culture: In assessing a patient, nurses do not just consider test results. Through the critical thinking exemplified in the nursing process , nurses use their judgment to integrate objective data with subjective experience of a patient’s FACULTY OF NURSING, AFE BABALOLA 5 UNIVERSITY, ADO EKITI, NIGERIA.  Definitions of Nursing Many definitions exist, some of which misrepresent the complex knowledge and skill of professional nursing. The word nurse originated from t he Lat i n word nut ri x, meaning" to nourish.'' Most definitions of nurse and nursing describe the nurse as a person who nourishes, fosters, and protects and who is prepared to take care of sick, injured, and aged people. FACULTY OF NURSING, AFE BABALOLA UNIVERSITY, ADO EKITI, NIGERIA. 6  Definition of Nursing by Florence Nightingale. Florence Nightingale is known as the mother of modern Nursing. She defined Nursing as “It is the act of utilizing the environment of the patient to assist him in his recovery” (Nightingale,1860). She considered the following measures as vital power for patient recovery i. Fresh air ii. Good light source iii. Warmth iv. Cleanliness v. Quiet environment vi. Proper selection and administration of diet. 7 FACULTY OF NURSING, AFE BABALOLA UNIVERSITY, ADO EKITI, NIGERIA.  Definition of nursing contd Definition of Nursing by WHO: Nursing is an autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled, and dying people. FACULTY OF NURSING, AFE BABALOLA 8 UNIVERSITY, ADO EKITI, NIGERIA.  Definition of nursing by Virginia Henderson: It is assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge”(Henderson,1966). FACULTY OF NURSING, AFE BABALOLA 9 UNIVERSITY, ADO EKITI, NIGERIA. Definition of nursing by Dorothea Orem: “It is the act of assisting others in the provision and management of self-care to maintain/improve human functioining at home level of effectiveness.” FACULTY OF NURSING, AFE BABALOLA 10 UNIVERSITY, ADO EKITI, NIGERIA. Definition of Nursing by Effie Taylor: “The adaptation of the prescribed therapeutic and preventive treatment for physical and psychological needs specific person.” Nursing Defined by International Council of Nursing: “Nursing is autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. FACULTY OF NURSING, AFE BABALOLA 11 UNIVERSITY, ADO EKITI, NIGERIA. Canadian Nurses Association (C N A) Describe nursing practice as '' a dynamic , caring , helping relationship in which the nurses assists the client to achieve and maintain optimal health”(CNA,1973). Definition of nursing by ANA (American Nurses Association): Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations (ANA, 2010). FACULTY OF NURSING, AFE BABALOLA UNIVERSITY, ADO EKITI, NIGERIA. 12 There are certain themes common to these definitions: Nursing is caring Nursing is an art Nursing is a science Nursing is client centered Nursing is holistic Nursing is adaptive FACULTY OF NURSING, AFE BABALOLA 13 UNIVERSITY, ADO EKITI, NIGERIA.  Nursing is concerned with health promotion, health maintenance, and health restoration Nursing is a helping profession The central focus in all definitions of nursing is the patient (the person receiving care) and includes the physical, emotional, social, and spiritual dimensions of that persons. Nursing is no longer considered to be concerned primarily with illness care. FACULTY OF NURSING, AFE BABALOLA 14 UNIVERSITY, ADO EKITI, NIGERIA.  Nursing's concepts and definitions have expanded to include the prevention of illness and the promotion and maintenance of health for individuals, families, and communities. FACULTY OF NURSING, AFE BABALOLA 15 UNIVERSITY, ADO EKITI, NIGERIA.  Recipients of Nursing The recipients of nursing are sometimes called consumers, sometimes patients, and sometimes clients. A consumer is an individual, a group of people, or a community that uses a service or commodity. A patient is a person who is waiting for or undergoing medical treatment and care. A client is a person who engages the advice or services of another who is qualified to provide this service. FACULTY OF NURSING, AFE BABALOLA 16 UNIVERSITY, ADO EKITI, NIGERIA.  NURSE The word nurse originated from the Latin word nutrix, meaning" to nourish.'' Most definitions of nurse and nursing describe the nurse as a person who nourishes, fosters, and protects and who is prepared to take care of sick, injured, and aged people. FACULTY OF NURSING, AFE BABALOLA 17 UNIVERSITY, ADO EKITI, NIGERIA.  WHO IS A NURSE? According to International Council of Nurses (ICN), a Nurse is a person who has completed a program of basic, generalized nursing education and is authorized by the appropriate regulatory authority to practice nursing in his/her country. This individual must be prepared and licensed; to practice the general scope of nursing which includes promotion of health, prevention of illness, care of physically ill, mentally ill and disabled of all ages in all settings; to carry out health care teaching; to actively participate in the health care team; and to be involved in research (ICN, 1987). FACULTY OF NURSING, AFE BABALOLA 18 UNIVERSITY, ADO EKITI, NIGERIA.  Every activity that involves the patient is usually planned and carried out with the nurses’ involvement. According to Nursing and Midwifery Council of Nigeria (NMCN), a Nurse is a person who has received authorized education, acquired specialized knowledge, skills and attitudes, and is registered and licensed with the Nursing and Midwifery Council to provide promotive, preventive, supportive and restorative care to FACULTY OF NURSING, AFE BABALOLA 19 UNIVERSITY, ADO EKITI, NIGERIA. individuals, families and communities, independently, and in collaboration with other members of the health team. FACULTY OF NURSING, AFE BABALOLA 20 UNIVERSITY, ADO EKITI, NIGERIA.  Roles and Functions of a Nurse Care Provider – The Nurse is responsible for rendering services wherein the patient or client can feel that his or her needs are being met. The use of the term “care” means that the nurse is concerned about the welfare of the patient. She views the patient as a person who needs not only physical care but as well as other aspects of being a person such as emotional , psychological , spiritual , biological and cultural needs. FACULTY OF NURSING, AFE BABALOLA 21 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd Communicator – A nurse is actually an agent of communication. Communication is very important in the field of nursing as this is the means of giving and receiving information. Therapeutic communication is studied by nurses in order to give better nursing care. As a communicator, she must be a good listener so that she can address the needs of the client or patient in various health care personnel. She is obviously the one who gives bedside care, therefore she is also the first hand to get updates and progress of the patient’s condition. It is her task to give this information to other medical personnel. The nurse must be able to communicate clearly and accurately for client’s health care needs to be met. FACULTY OF NURSING, AFE BABALOLA 22 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd Teacher – A nurse is also expected to be a teacher in her daily activities. Giving nursing care is geared towards better health practices and this can be addressed through teaching the proper ways and health habits. Aside from that, the nurse is not only concerned in teaching the patient but also the significant others who will be responsible for caring of the p a t i e n t w h e n d i s c h a rg e d f r o m t h e h e a l t h institution. Health teachings were intended to promote health and maintain the healthy set-up thus preventing the incidence of hospital admissions. FACULTY OF NURSING, AFE BABALOLA 23 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd Counselor – Being a counselor means that the nurse helps the client to develop coping mechanisms that are healthy enough. Since each client faces different degrees of stress, the nurse must be able to facilitate the recognition of the patient to cope with the challenge of certain alterations in the daily living brought about by health-related problems. The role encompasses emotional, intellectual, and psychological support FACULTY OF NURSING, AFE BABALOLA 24 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Change Agent – The nurse catalyzes the change that is needed for the patient’s improvement. Using the nursing process, the nurse will identify first the problem areas and develop a plan of action in order for the patient to change his mind and eventually change his behavior. Being a change agent means that the nurse will help the patient to get out of the usual scenario, identify the need for the change and implement the changes, and getting accustomed to these changes. FACULTY OF NURSING, AFE BABALOLA 25 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Client Advocate –As a client advocate, the nurse represents the patient when the patient is not able to represent himself. They also assist clients in exercising their rights and help them speak up for themselves. In order to be a client advocate, listening, and placing yourself in the shoes of the patient will enable you to know what it feels like and react with the situation. The next thing is to plan for ways to voice out the part of the patient so that the health care team will be able to know how to deal with the case of the patient. FACULTY OF NURSING, AFE BABALOLA 26 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Leader – As a nurse, he or she must be an inch or a foot ahead of other personnel. It means that he or she must have a wider view of the situation and create goals and objectives that were attainable for the group. Leading as a nurse means that you can influence others to be together in the same goal or objective. FACULTY OF NURSING, AFE BABALOLA 27 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Manager – A nurse can be both a leader and a manager, however, there are differences between these two terms. Although used interchangeably, it really means a lot differently. Being a manager means that you have the responsibility to give directions, organize, plan, and implements things out while being a leader has to do with influencing and motivating others to achieve things. FACULTY OF NURSING, AFE BABALOLA 28 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Role Model – A nurse must also be able to be true with what he or she is saying. The cliché “walk the talk” defines this role. A nurse must be able to put into practice the proper ways that he or she has been teaching so that he or she can teach people by example. FACULTY OF NURSING, AFE BABALOLA 29 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Researcher – The work of a nurse involves changes in nursing care. This change can only be known for using research. Scientifically, a nurse should function as a researcher in order to improve their practice as well as achieve good patients’ outcome FACULTY OF NURSING, AFE BABALOLA 30 UNIVERSITY, ADO EKITI, NIGERIA.  Functions of a Nurse contd… Nurse as a Confidant The nurse is bound by the ethics of the profession to maintain confidentiality. She is to protect the privacy of her client in exception of a situation of an imminent risk of harm to the client or others. The awareness that information shared with the nurse remains private and safe encourages the client to confide and entrust with the nurse, information about them. Having a listening ear to share with, helps promote the client psychological status, thereby promoting health. FACULTY OF NURSING, AFE BABALOLA 31 UNIVERSITY, ADO EKITI, NIGERIA.  Qualities of a good Nurse Caring and compassion Excellent communication skills Empathy Organization and attention to detail Problem-solving skills Stamina and endurance Sense of humor and resilience Commitment to patient advocacy Willingness to learn and grow Strong critical thinking Integrity and leadership FACULTY OF NURSING, AFE BABALOLA 32 UNIVERSITY, ADO EKITI, NIGERIA.  International Nurses Anthem Stanza 1 We are called to serve humanity Endowed with art, science of caring We are built on integrity and discipline That transcends through every generation Immaculate and amicable We are the source of hope to ailing ones And the foundation for the building a healthy world Together we shall stand FACULTY OF NURSING, AFE BABALOLA 33 UNIVERSITY, ADO EKITI, NIGERIA. Chorus Nurses are great Nurses are caring And epitome of humanity in service We are specially ordained for this profession Yes, am proud to be a nurse FACULTY OF NURSING, AFE BABALOLA 34 UNIVERSITY, ADO EKITI, NIGERIA. Stanza 1 From near and fa we have gathered with one goal To uphold the good name of our profession N - Neatness and splendor U - Understanding R - Responsiveness S - Selfless service I - Innovative and initiative N - Nobility G - Gentleness and love FACULTY OF NURSING, AFE BABALOLA 35 UNIVERSITY, ADO EKITI, NIGERIA.  Assignment Write out the Nurses’ Pledge Discuss the qualities of a good Nurse FACULTY OF NURSING, AFE BABALOLA 36 UNIVERSITY, ADO EKITI, NIGERIA.  THANKS FOR LISTENING FACULTY OF NURSING, AFE BABALOLA 37 UNIVERSITY, ADO EKITI, NIGERIA. Health Maintenance Agencies: National and International Nurse Damilola O. BEWAJI, R.N, MSc, PGDE, R.T Faculty of Nursing Sciences, Afe Babalola University, Ado Ekiti. [email protected].  Some organisations are saddled with the responsibilities of maintaining the health and wellbeing of the society. They ensure that public health matters are giving the rightful attention to ensure the safety of the society. T h e s e o rg a n i s a t i o n s a r e a t b o t h n a t i o n a l a n d international level and they includes the Nigeria Centre for Disease Control and Prevention (NCDC), National Agency for Food and Drug Administration and Control (NAFDAC) , World health organization (WHO) among others. We shall discuss them one after the other: The Nigeria Centre for Disease Control and Prevention (NCDC) The Nigeria Centre for Disease Control and Prevention (NCDC) is the national public health institute with the mandate to lead the preparedness, detection and response to infectious disease outbreaks and public health emergencies. The first formal step to establish the NCDC took place in 2011 when some departments in the Ministry of Health, including the Epidemiology Division, the Avian Influenza Project and its laboratories; and the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) were moved to form the nucleus of the agency. The Bill for an Act to establish NCDC was signed into law in November 2018, by President Muhammadu Buhari. NCDC Contd…. Vision A healthier and safe Nigeria through the prevention and control of diseases of public health importance. Mission To protect the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a one health approach, guided by research and led by a skilled workforce. Core Functions Prevent, detect, and control diseases of public health importance. Coordinate surveillance systems to collect, analyse and interpret data on diseases of public health importance. Support states in responding to small outbreaks and lead the response to large disease outbreaks. NCDC Contd…. Develop and maintain a network of reference and specialised laboratories. Conduct, collate, synthesise, and disseminate public health research to inform policy. Lead Nigeria’s engagement with the international community on diseases of public health relevance Organisation of the Nigeria Centre for Disease Control and Prevention The NCDC under the leadership of the Director General has a staff size of over 500. At the national level, this comprises staff working across three sites - the Headquarters and National Reference Laboratory (NRL), located in Abuja as well as the Central Public Health Laboratory (CPHL) in Lagos State, a campus of the NRL. At the subnational level, there are State Surveillance Officers across the 36 States of the federation and the Federal Capital Territory (FCT). NCDC Contd…. The NCDC currently operates through seven departments. These include: Public Health Laboratory Services Health Emergency Preparedness and Response Planning, Research and Statistics Surveillance and Epidemiology Administration and Human Resources Finance and Accounts Subnational Support Department NCDC Contd…. Location of campuses There are three campuses within the NCDC in Nigeria, located in Abuja, Federal Capital Territory, and Yaba, Lagos State. NCDC Headquarters in Jabi, Abuja NCDC National Reference Laboratory in Gaduwa, Abuja NCDC Central Public Health Laboratory in Yaba, Lagos The current Director General of NCDC who is the 3rd DG is Dr. Jide Idris and its official website is https://ncdc.gov.ng/ National Agency for Food and Drug Administration The National Agency for Food and Drug Administration and Control (NAFDAC) was established by Decree No. 15 of 1993 as amended by Decree No. 19 of 1999 and now the National Agency for Food and Drug Administration and Control Act Cap N1 Laws of the Federation of Nigeria (LFN) 2004 to regulate and control the manufacture, importation, exportation, distribution, advertisement, sale and use of Food, Drugs, Cosmetics, Medical Devices, Packaged Water, Chemicals and Detergents (collectively known as regulated products). The agency was officially established in October 1992. NAFDAC Contd… The NAFDAC’s organization consists of the Director General’s Office and twenty (20) Directorates executing the functions of the Agency: The Agency also has six (6) Zonal Offices as well as FCT and Lagos State Office, all headed by Directors. Leadership of the Agency’s overall functions which include administration and control of regulated products is directly under the Director General, Prof Moji Christianah Adeyeye. NAFDAC Contd… There are ten (10) Units or Programs under the Director General’s Office, namely Public Affairs, NAFDAC Training and Research Institute (NT&RI), Information and Communication Technology (ICT), Procurement, Internal Audit, One Stop Investment Centre (OSIC), Reforms, Quality Management System (QMS), WHO- Global Benchmarking Program and Health Safety and Environment (HSE) Units. NAFDAC Contd… Vision To be a World Class Regulator that ensures availability of quality and safe Food, Drugs, and other Regulated Products. Mission To protect and promote the public health by instituting an effective and efficient regulatory system that ensures only the right quality Food, Drugs and other regulated products are manufactured, exported, imported, advertised, distributed, sold, and used. NAFDAC Contd… Core Values Ensure availability of efficacious and good quality NAFDAC regulated products. Maintain reference laboratories of International Standards. Promote an effective and efficient well motivated and disciplined workforce. NAFDAC Contd… Functions of NAFDAC The functions of NAFDAC as provided in the enabling law that establishes it are to: Regulate and control the importation, exportation, manufacture, advertisement, distribution, sale and use of food, drugs, cosmetics, medical devices, bottled water, Chemicals and detergents (Regulated Products); Conduct appropriate tests and ensure compliance with standard specifications designated and approved by the Council for effective control of quality of regulated products and their raw materials as well as their production processes in factories and other establishments; Undertake appropriate investigation into the production premises and raw materials for regulated products and establish relevant quality assurance systems, including certification of the production sites and of the regulated products; Functions of NAFDAC Contd… Inspecting imported regulated products and ensuring quality assurance through manufacturing site certification. Developing standards, regulations, and guidelines for regulated products' production, import, export, sale, distribution, and registration. Managing registration processes for foods, drugs, cosmetics, medical devices, bottled water, chemicals, and detergents. Overseeing export activities and issuing quality certifications for export-bound products. Establishing and maintaining laboratories and facilities nationwide to support regulatory functions. Functions of NAFDAC Contd… Evaluate and certify the quality and safety of products following rigorous analysis. Regulate the use of narcotics and psychotropic substances, restricting them to medical and scientific purposes. Authorize and oversee the import/export of controlled substances, including narcotic drugs and psychotropic substances. Partner with NDLEA to combat drug abuse in Nigeria. Provide expert advice to governments, private sector entities, and stakeholders on regulatory provisions for regulated products. Functions of NAFDAC Contd… Develop guidelines, approve, and monitor advertising for food, drugs, cosmetics, medical devices, bottled water, chemicals, and detergents. Compile and publish data from Agency performance or other sources. Organize and sponsor national and international conferences. Collaborate with relevant domestic and international institutions. Undertake necessary activities to fulfill Agency objectives World Health Organization (WHO) The United Nations’ specialised organisation for health, the World Health Organization (WHO), was established in 1948. The organisation’s headquarters is in Geneva, Switzerland. There are 194 Member States, 150 Country Offices, and six Regional Offices in the Organisation. It is an intergovernmental organisation that collaborates with its member nations, generally through their health ministries. The WHO leads the global health issues by setting the research agenda, establishing norms and standards, articulating evidence-based policy alternatives, helping nations with technical assistance, and monitoring and analysing health trends. It began operations on April 7, 1948, now observed as World Health Day every year WHO Contd… WHO also leads global efforts to expand universal health coverage. It directs and coordinates the world’s response to health emergencies. It promote healthier lives – from pregnancy care through old age. Its Triple Billion targets outline an ambitious plan for the world to achieve good health for all using science- based policies and programmes. The World Health Assembly is the decision-making body of WHO and is attended by delegations from all Member States. WHO Goals WHO's mission is to ensure universal access to optimal healthcare. To achieve this, WHO's objectives include: 1. Global Healthcare Leadership: Establishing authority in international healthcare. 2. Technological Collaboration: Fostering healthcare innovation through global cooperation. 3. Government Support: Enhancing national healthcare services through technical assistance. 4. Emergency Response: Providing critical aid and relief in crises. 5. Disease Prevention and Control: Combating epidemics, endemics, and other health threats. WHO Goals Contd… 6. Environmental Health: Promoting nutrition, housing, sanitation, and occupational hygiene through partnerships. 7. Research and Development: Advancing global biomedical and health services research. 8. Healthcare Education: Raising teaching and training standards in healthcare professions. 9. Global Standards: Establishing standards for biological, pharmaceutical, and diagnostic products. 10. Mental Health: Promoting initiatives for mental wellbeing. The Roles of WHO in Public Health WHO fulfils its objectives through its core functions: providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalysing change, and building sustainable institutional capacity; and monitoring the health situation and assessing health trends.  QUESTIONS ? You can also use my mail. Reading Assignment The WHO has an office of the Chief Nursing Officer, read more about the office and its programs especially the 25 X 25 initiative. Pause and Ponder The Nurse is a powerful health professional, central to care and well being of the public, an asset to the world at large not just to his family. Nursing is a powerful weapon in the hand of a diligent nurse. The nurse is the only one who can limit himself.  HOSPITAL ORGANISATION Nurse Bewaji RN, MSc. Faculty of Nursing Science, Afe Babalola University, Ado Ekiti. [email protected]  According to the American Hospital Association (AHA), hospitals are licensed institutions with at least six beds whose primary function is to provide diagnostic and therapeutic patient services for medical conditions; they have an organized medical staff; and they provide continuous nursing services under the supervision of registered nurses. The World Health Organization (WHO) considers an establishment to be a hospital if it is permanently staffed b y a t l e a s t o n e p h y s i c i a n , c a n o ff e r i n - p a t i e n t accommodation, and can provide active medical and nursing care.  Hospital is an institution that is built, staffed, and equipped for the diagnosis of disease; for the treatment of both medical and surgical conditions of the sick and the injured; and for their housing during this process. Hospital is an integral part of surgical and medical organization whose function is to provide for the population complete health both curative and preventive and whose outpatient services reach out to family and its environment.  The modern hospital also often serves as a center for investigation and for teaching. It is also a center for training of health workers and research Hospitals may be classified by type of service, ownership, size by number of beds, and length of stay. Objectives of the hospital 1) Diagnosis and Treatment: A key objective of the hospitals is to accurately diagnose medical conditions and provide appropriate treatment. This is done utilizing advanced medical technologies, diagnostic tests, and specialized medical expertise to identify and address patients’ health issues. 2) Emergency Care: Hospitals serve as centers for emergency medical care, providing immediate attention to patients with life-threatening conditions or injuries. Their objective is to stabilize patients, administer critical interventions, and ensure timely access to specialized emergency medical services. 3) Research and Innovation: Many hospitals engage in and are center for research and innovation to advance medical knowledge and improve patient care. They participate in clinical trials, conduct studies, and collaborate with medical institutions and research organizations to explore new treatment modalities, develop breakthrough therapies, and contribute to medical advancements. 4) Education and Training: Hospitals often have educational and training programs to nurture the next generation of healthcare professionals. They provide clinical training opportunities for nursing students, medical students, resident doctors, and other healthcare trainees. Hospitals also offer continuing education programs for their staff to enhance their skills and knowledge. 5) Preventive care: hospitals also render preventive care to the community they serve. Such care include health education, immunization, family planning etc. All the above objectives are done without respect to race, color, creed, economic and social status of the clients.  Functions of the Hospital 1) Therapeutic Functions This includes diagnostics, emergency care, patient care, rehabilitative and promotion of health 2) Preventive Functions This include antenatal and postnatal services infant welfare and immunization, health education, family planning etc. 3) Educational Functions Hospitals offer teaching services to train younger ones in professional courses. These include nursing education, medical education, pharmacy education etc through undergraduate and postgraduate levels 4) Research Functions It is a secondary function and it is to conduct or serve as center for research purposes which in turn brings about improvement of health and prevention of diseases. Classification of Hospital The most commonly acceptable criteria for the classification of modern hospital are: Length of stay of the patient (long-term or short- term) Ownership or control basis Objective Size Management System of medicine  Classification according to the length of stay of patient: Some hospital can only treat patients for a short time (clinics) while some can treat patients for a long time like in issues of chronic disease. Classification based on ownership/control: in this caregoty, hospitals can be divided into 1) Public Hospital: controlled by government either at federal, state or local government. 2) P r i v a t e H o s i t a l / N u r s i n g h o m e : O w n e d b y individual(s) who may or may not be health professionals. They are run on a commercial basis. 3) Public-Private partnership Hospital: These are facilities owned by both government and private individuals. Classification according to objectives: hospitals can be classified into three categories 1) Teaching cum research hospitals: These are hospitals to which a college is attached for nursing, medical, dental or pharmacy education. The main objective is teaching and research and provisional of heath care is secondary. 2) General hospitals: These are the hospitals that provide treatment for common diseases and conditions. Usually established and permanently staffed by Nurses and at least two or more doctors which can offer one category of medical discipline such as General medicine general surgery, obstetrics and genealogy, pediatrics etc. the main objective is to provide medical care to the people while research is secondary. 3) Specialized hospitals specialize hospitals are hospitals providing medical and nursing care primarily for specific diseases or conditions of one system e.g mental health hospitals, oncology hospitals , maternity centres.  Classification according to the size: This classification is based on bed strength 1) Teaching hospitals: 250 to 500 bed spaces (but maybe increased according to number of patients) 2) District or General Hospitals: usually > 200bed spaces 3) Basic health centers: up to 10 bed spaces depending on the need. Classification according to management: This could be: 1) Federal government owned, 2) States government owned, 3) Local government owned, 4) Autonomous bodies, private or voluntary organization. Classification according to system of medicine e.g 1) Homeopathic hospitals. 2) Allopathic hospitals. 3) Ayurvedic hospitals etc. Units in a standard hospital Accident and emergency unit General outpatient department Medical outpatient department Surgical outpatient department Intensive care unit Ear, nose and throat unit Ophthalmology unit Operating theater Dental department Family planning department  Works departments Diagnostic departments including ultrasound CT scan, MRI, laboratory Central sterilization supplies departments Physiotherapy department Record and statistics departments Administration department Store and procurement department Laundry department kitchen department Workers in the hospital The hospital comprises of many workers across profession and cadre that provide holistic care for the client and some see to the smooth running of the hospital. The workers in the hospital include: Nurses /Midwives Doctors pharmacist administrators laboratory scientist and technicians ICT  social workers technical department workers Aids, health assistants and attendants, cleaners morticians security officers Ward Organization The hospital contains one or more words that houses hospital beds for in-patients and other equipment for the care of the patient. The care of the ward is handled by the nurse because they are the custodians of the wards. She does this by overseeing the allied health-workers under her Nurses organize the ward setting, arrangement of the beds, spacing of the hospital beds (4 to 6 inches), arrangement of hospital equipment and supervision of all other allied earth workers for example health attendants, porters, cleaners etc.  In-patients are housed on the wards according to illness and also according to gender and age, hence, there are medical wards , surgical wards, orthopedic wards ( care of bone disorder or injury), pediatrics ( that deals with the care of children) maternal and child wards (that deal with pregnancy, childbirth and women related issue), psychiatric wards (that houses patients suffering from mental illness), geriatric wards (that focuses on the care of the elderly). The ward is arranged in such a way that the nurses will be able to overlook it at a glance. Bed should not be arranged behind the nursing station but in front.  In an idea setting, a ward should accommodate 6 to 12 beds with 4 to 6 ft distance in between beds to prevent cross infection among patients as the nurses are the custodians of the patients, they make decisions in the best interest of the patients and also the comfortability of the health workers. Ways by which the hospitals wards can be made conducive for patients include: 1) Ventilation The windows in an hospital ward must be largely constructed and opposite each other in order to allow for cross ventilation to remove unpleasant stale odour that can come from urine draining, wounds, vomitus e.t.c. 2) Noise The ward environment must be free from noise either from outside (i.e moving vehicles, hence wards should not be situated close to the roads) or noise from within (e.g from carrying metal equipments). Communication should be reduced to the bearest minimum, noise from television or radio sets should be minimized.  A quiet environment is needed for sound sleep and rest which is needed for patient recovery. The nurse must also ensure visitors are only allowed during visiting hours and maintain a quiet environment always. 3) Cleanliness The ward environment should be clean and neat at all times to prevent hospital acquired infection (nosocomia infection). The floor should be swept, scrubbed and dried to avoid fall  Proper hand washing and hand dryer or cleaning towel should be put in place. 4) Lightening There must be adequate lightning on the ward especially on the passage and corridor both at daytime and night time to keep the patients from injury.