Nursing Rounds/VisitsPresented by:-Pranay Vekaria.

Introduction There are several methods that can be

used effectively in clinical teaching. Nursing rounds are conducted by the head nurse or nurse teacher with the members of her staff or students for a clear understanding of the disease and the effect of nursing care for each patient.

Types of nursing rounds1.rounds with doctors.2. rounds with discuss psychological problem of patient.3.social service rounds4.medical round for nurses.5.round with the physical therapist.6.nursing rounds

Purpose of nursing rounds To observe the physical and mental

condition of the patient and the progress made from day to day.

To observe work of staff. To specific observation of the patient

and give report to doctor regarding., for example-wounds,drainage,bleeding.

To introduce patient to personnel and vice versa.

Cont.. To carry out plan made for care of

patient. to evaluate result of treatment and

patient satisfaction. To ensure that safety measures are

employed for patient and personnel. To orient the nurse /student in taking

charge of the patient’s treatment and status of the patient.

Cont.. To teach nursing students or hospital staff

regarding specific condition. To check any preventable condition in patient

such as bedsore, foot drops etc. To check emergency equipment near the patient

for safety and working order. To compare C/F of disease in a patient so that the

students gains better insight. To prescribe any modification in nursing action.

Ways of conducting rounds When ward rounds are conducted , the

teacher goes to the patient’s room with the group of nurses.

Outside of the door, out of his hearing ,they discuss the objectives , after which they go in to see the patient and talk for a few moments with him.

They than move on to the next patient.

Cont.. The discussion must necessarily by brief

including only the outstanding points if the purpose is to visit all the patient in the ward.

Nursing rounds are done in a reporting style regarding the patient’s condition , nursing care, medical care and prognosis.

Advantage of nursing rounds This method is a mean of testing the

knowledge of students and their acquaintance with all the patient on the floor.

The students, who are informed prior to rounds, benefit the maximum in a real life teaching method.

No other type of round is subtitute for nursing rounds.

Cont.. It is very valuable for the head nurses to

go on regular nursing rounds with a clinical instructor.

An intelligent nurse with creative abilities may find many other ways of successfully assisting students nurses to develop nursing skills.

Round helps in orienting a new nurse / student to the patient.

Cont.. Rounds are interesting strategies

involving the students, teacher and the patient.

They offers a real life learning situation. Through rounds , evaluation of nursing

activity hurdles faced by nurse in nursing care can be appraised.

Disadvantage of nursing rounds The confidentiality of the patient is

hampered. The patient may overhear the discussion and

may not like the thought that he is being talked about.

If group is large the teacher may not able to speak loudly enough to be heard in which case the attention of individuals who are on the fringes is lost.

Distractions are present in the ward.

Cont.. An unprepared nursing round has little

teaching learning value. The value of nursing rounds depends on

the quality and presentation of the nurse teacher head nurse.

Nursing Manuals

It is a good practice to compile all the rules/guidelines concerning the management and procedure in a manual that can be made available for reference. These directives generally fall under the following 3 headings.

1. Procedure issued by the administrative office and referring mainly to regulations. This is essential for maintaining discipline.

2. Procedure manuals, e.g.lab procedure manuals, nursing procedure manuals.

3. Unit procedure outline the procedure to be used in unit.

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

Standing Orders/Nursing Protocols

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

Purpose of standing order To meet emergency situation in rural

area. To deliver care at home, school,

community. To provide temporary treatment in the

absence of a doctor. To promote health services in

community.

General standing order instruction Standing order instructions should be

issued jointly by an authorized medical office and a nurse or a committee with a nurse representative.

The community health nurse working in rural areas may be only qualified professional person readily available to the family , so standing instruction must be used with caution and discretion.

Standing orders are these to promote health services in the community.

The medical officer is legally responsible for issuing standing orders, and he should have faith in the sound judgment of his staff.

They reduce danger in acute condition. They create the feeling of responsibility among

the members of the health team. Every health service should issue standing

instruction to meet the health need of the areas.

Role of the nurse in standing order The community health nurse should be

skillful in recording the history and in physical examination in order to detect abnormality.

The community health nurse should be prompt in detecting appropriate action for particular situation.

The nurse should maintain a record of vitals and other care given to the patient.

Cont.. The nurse should have thorough knowledge to

identify the actual problem of the patient and to plan appropriate nursing intervention.

The nurse should intervene with services according to the given community standing orders.

The nurse should develop a good therapeutic relationship with the individual and family.

The nurse should use referral system if it is possible.

Cont.. The nurse should inform the health officer

immediately if there is a communicable disease. He/she should keep the medication safe and

ready to follow standing orders. He/she should ensure a safe and healthy

environment for patient. Recording and reporting is a essential part of

community health services.

Types of standing order1.Institutional standing orders:- They are meant keeping in mind

available resources ,staff position and the objectives of a medical institution or hospital

Ex-standing order of PHC can be differat from those of district hospital.

Cont..

2.Specific standing order:- These orders are meant for trained medical

personnel, mainly the nurses , technical knowledge and specific skills are require to implement these orders.

Ex-giving care at home ,injections , oxygen therapy.

Cont..3.General standing orders:- Owning to a large population , vast

geographical area and the shortage of resources , some standing order are used to propagate health care messages to the masses.

Ex-preventive measures against AIDS.

Advantages of standing order

Community standing orders provides timely treatment during emergencies.

They enhances the quality and activity of health services.

They provide a feeling of confidence and responsibility in the nursing staff and other health workers.

They help to decentralize the health responsibilities.

They help to strenthn the primary services in the community.

Thank you..>>