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Journal of the Academy of Hospital Administration

Analysis of Nursing Work Activities in Relation to Patient Care in Medical Surgical Wards of a Tertiary Level Super Specialty Hospital at Nepal

Author(s): RS Mehta*, N Pokharel*

Vol. 16, No. 2 (2004-07 - 2004-12)

Key Words:

Awareness, Knowledge, HIV

Key Messages:

  • Higher level of education has positive correlation with level of awareness of HIV/AIDS
  • Socio-economic barriers exist in health information about AIDS. Specific interventions are required towards specific channels of communication.

INTRODUCTION

In today's fast-paced, complex, highly regulated health care environment, it is essential that patient care be administered efficiently so patient's outcomes can be achieved as rapidly as possible.1

The Nursing care consists of helping the patients in monitoring personal hygiene, helping in nutrition, environmental sanitation, examination, maintaining body temperature, providing safely and comfort, helping in respiration, rest, sleep and exercise, helping in adaptability, providing health education. Nursing has always been directed to keep people healthy and provide comfort, care and assurance to the ill. Nursing care refers to care of others. The care may involve any number of activities ranging form carrying out complicated technical procedures to something as simple as holding a handle. The central focus of nursing care is the person receiving care and included the physical, emotional, social and spiritual dimensions of that person.2

The Nursing time provided per patient per day is the most useful and realistic measure for staffing requited. According to Levine 3.5 hours nursing care is required per patient in 24 hours. The hours per day (HPD) can be 8-12 hours for acutely ill patient or it can be as low as 1-2 hours for ambulatory patients.3

Some issues that influence nursing care in future are: rising public expectation, changing demographic characteristic of population, changing disease pattern, technology and information explosion (eg-CT scan, MRI, e-mail, Internet etc.), globalization and changing world of work.4

The major dissatisfaction elements of the nursing profession are: high work load, low salary, poor career ladder poor promotion, working environment, no separate autonomous nursing division, lack of improved health and frequent change of the governemnt.5 The lower the educational level, the lower the pay, the lower the morale, the higher risk of accident and error.6

Findings of a study conducted by "Ogilvine L" in 1995 included: low morale along nurses, insufficient knowledge and little awareness about new issues like AIDS; lack of "in service" education and no interest in continuing education.5 Since this research is mostly concerned with nurses working in government health services, these factors may affect nursing service in any institution.

Factors like overflow of patients, imbalanced nurse patient's ratio, lack of correct work distribution, inadequate facilities of in service education training, inadequate supply of equipment & supplies are also major dissatisfiers. Being the first care provider, unaware of the diagnosis, advances in disease pathogens, new trends of disease; twenty-four hour station duty etc may also affect the health of nursing personnel.7 Hence, it's necessary to evaluate it. The dimension of quality care is: technical-competence, effectiveness, efficiency, continuity, interpersonal reasons, safety and amenities.7

People might get sick sometime in their life. Each patient has the right to receive best nursing care. To provide standard and qualitative nursing care, nurses must have thorough knowledge in being rational in their activities or interventions which will help them to provide satisfactory in their performance. The people of our country are not much aware of "What nursing actually is?"

AIM & OBJECTIVES

The aim of the present study is to explore the nursing work activities of the patients admitted in medical surgical wards of a tertiary level superspeciallity hospital.

MATERIALS AND METHODS

  1. A prospective survey study was conducted among all the admitted patients in the medical-surgical units of BPKIHS from 1 May 2003 to 6 June 2003 i.e. 37 days.
  2. A structured observational check list was prepared and it's validity was established. All wards were incharges and second ward Incharges of all four units of medical and surgical wards were involved in the study from planning to end of collection of data. The second ward Incharge(s) herself daily filled the prepared observational checklist continuously for thirty seven days under the supervision of ward Incharges and Investigators.
  3. The collected data was analyzed using pre-set format applying statistical analysis.

RESULTS & ANALYSIS

There are 34 beds in each medical-surgical units, 81% beds were occupied daily. In medical units there were 19% new admission and 16% discharge daily; where as in surgical units there were 14% admission and discharge daily. In medical units there were: 12% DM, 11% HTN, 6% CVA, 7% TB, 5% tetanus, 11% COPD, where as in surgical units; there were: 4% DM, 5% HTN, 3% TB, 4% Burn and 2% prostectomy cases daily, which need special attention.

Table-I : Daily Patient Census

Units Total Bed Strength Average Occupied bed/day Admission/Day
No. (%)
Admission/ Day
No. (%)
Discharge/ Day
No. (%)
LAMA/ Day
No. (%)
Death/Day
No. (%)
Medical I 34 29 (85) 4.7 (16) 4.8 (16) ------ ------ -0.2 (.7) 0.4 (1)
Medical II 34 26 (76) 5.5 (21) 4 (15) 1.2 (5) 0.4 (2) 0.6 (2)
Medical (Total) 68 28 (81) 5 (19) 4.4 (16) 0.6 (3) 0.3 (1) 0.5 (2)
Surgical I 34 29 (81) 4.5 (15) 4 (14) 0.5 (2) 0.06 (.2) 0.2 (.7)
Surgical II 34 26 (76) 3.5 (13) 3.5 (13) 0.3 (1) ----- ---- 0.1 (.4)
Surgical (Total) 68 28 (81) 4 (14) 4 (14) 0.4 (2) 0.03 (.1) 0.1 (0.5)
Grand Total 136 28 (81) 5 (17) 4 (15) 0.5 (3) 0 (.5) 0.3 (1)

Table II : Distribution of Patients according to their diagnosis

  Diagnosis
  DM HTN CVA TB Tetanus COAD Burn Prost
  No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) No. (%)
Medical I   (12) 2.9 (10) 1.6 (5) 1.5 (5) 0.8 (3) 3.4 (12) --- --- --- ---
Medical II 3 (11) 3 (11) 1.5 (6) 2 (8) 1.5 (6) 3 (11) --- --- --- ---
Medical Total 3.3 (12) 3 (11) 2 (6) 2 (7) 1 (5) 3 (11) --- --- --- ---
Surgical I 1 (3) 1.7 (6) ---- ---- 0.8 (3) ---- ---- ---- ---- 1.5 (5) ---- ----
Surgical II 1 (4) 1 (4) ---- ---- 0.5 (2) ---- ---- ---- ---- 2 (8) 1 (4)
Surgical 1 (4) 1 (5) ---- ---- 0.7 (3) ---- ---- ---- ---- 2 (4) 0.5 (2)
Grand Total 2 (8) 2 (8) 1 (3) 1 (5) 0.5 (3) 2 (5) 1 (2) 0.2 (1)

Table III: Record of Daily Nursing care activities/procedures

Nursing Care activities procedures
Units Pt. on IV Infusion Pt. needs Suctioning Pt. on O2 therapy/ Completely Bed ridden Patients/ Pt. on Nebulization/ Pt on ETT/ Ventilator
No (%) No (%) No (%) No (%) No (%) No (%)
Medical I 11 (38) 2 (7) 5 (17) 5 (17) 4 (14) 0.5 (2)
Medical II   (35) 2 (8) 5 (19) 8 (30) 8 (30) 1 (4)
Medical 10 (37) 2 (8) 5 (18) 7 (24) 4 (15) .7 (3)
Medical 10 (37) 2 (8) 5 (18) 7 (24) 4 (15) .7 (3)
Surgical I 8 (27) 0.03 (.1) 1.5 (5) --- --- 0.5 (1.7) 2 (7)
Surgical II 10 (38) 0.03 (0.1) 1 4 1 (4) 1 (4) 3 (15)
Grand Total 10 (35) 1 (4) 3 (11) 4 (13) 2 (9) 1.5 (7)

Table III (Continue) : Record of Daily Nursing cares activities/procedures

NSG. Care activities procedures
Units Pt. Received
Enema
No. of Dressing/Day Postoperative Pt (within 24hrs) No. of Specimen /Day (Samples) N-G/ Feeding Catheterized
No (%) No (%) No (%) No (%) No (%) No (%)
Medical I 1 (3) 2 (7) ---- ---- 16 (54) 4 (14) 4 (14)
Medical II 0.3 (1) 1 (4) ---- ---- 12 (46) 5 (19) 7 (25)
Medical Total 0.6 (2) 2 (6) ---- ---- 14 (50) 5 (17) 5 (20)
Surgical I 1 (3) 7 (24) 3 (11) 5 (15) 2 (5) 3 (10)
Surgical II 1 (4) 6 (23) 4 (13) 4 (14) 3 (11) 5 (19)
Surgical Total 1 (4) 7 24 3 (12) 4 (15) 2 (8) 4 (15)
Grand Total 0.8 (3) 5 (15) 3 (12) 9 (33) 4 (13) 5 (18)

Table IV : Unit wise distribution of specific cases/problems

No. of Cases (Problems) Average per day
Units HBSAg/
HCV
HIV Cancer Thrombophlebitis Blood Transition CPCR
No (%) No (%) No (%) No (%) No (%) No (%)
Medical I 0.2 (.7) 0.6 (2) 0.2 (7) 0.7 (2) 0.6 (2) 0.3 (4)
Medical II 0.1 (4) ---- ---- 0.03 (.1) 2 (7.60) 1 (4) 0.6 (2)
Medical Total 0.2 (.5) 0.3 (1) 0.1 (14) 1 (5) 0.8 (3) 0.4 (2)
Surgical I ---- ---- ---- ---- 1.7 (6) 0.3 (1) 0.2 (.7) ---- ----
Surgical II ---- --- --- --- 2 (8) 0.5 (2) 0.5 (2) ---- ----
Surgical Total ---- --- --- --- 2 (7) 0.4 (2) 0.4 (1) ---- ----
Grand Total 0.2   0.3 (1) 1 (6) 1 (4) 0.6 (2) 0.4 (2)

In medical units 37% patient were on IV infusion daily, 8% needs suctioning, 18% on O2 therapy, 24% completely bedridden, 15% on nebulizaiton, and 3% having ET tube or ventilation daily, where as in surgical units: 33% on IV infusion, 9% on oxygen therapy, 2% completely bedridden, 3% on nebulization and 11% having ET tube or on ventilation daily.

In medical units; 2% patient received enema daily, 6% needed dressing, 50% had investigations, 17% on N/g tube or enteral feeding and 20% patients were catheterized daily; where as in surgical units: 24% have dressing and 15% catheterized. In medical units 5% cases having thrombophlebitis where as in surgical units 2%.

DISCUSSION

Nursing care refers to care of others. The care may involve any number of activities ranging from carrying out complicated technical procedures like NG tube insertion to something as simple as holding a hand. The central focus of nursing care is the person receiving care and includes the physical, emotional, social and spiritual dimensions of that person.

In spite of high bed occupancy rate (81%) and in availability of super specialty service facility, the LAMA (0.5%) and death (1%) rates are very low.

In medical wards, DM, HTN, TB, tetanus and COPD were major problems of the patients, which needs skilled and trained nurses to provide better nursing care. A great number of patients were receiving IV infusion, oxygen therapy, nebulization and were completely bedridden which signifies the demand of great number of nurses for quality patient care.

IMPLICATIONS OF THE STUDY

  • The study will aid to identify the components of nursing care and nursing service.
  • This study will help to determine the number of nursing service personnel required to staff a patient unit.
  • It will help to estimate the average number of nursing hours needed for quality patient care.
  • To determine the ancillary nursing service hours.

REFERENCES

  1. Basavanthapa BT. Nursing administration. Ist Ed. Jaypee. New Delhi 2000.
  2. Taylor C, Lillis C, lemone P. Fundamentals of nursing. 3rd. ed. Lippincott; 1977.
  3. Marrellis TM. The nurse manager survival guide. 2nd ed Mosby, London.
  4. Mehta RS, nursing; A challenging profession. Vision, BPKIHS, Dharan, Nepal; 2000; 30-1.
  5. Sing S. Nursing situation Nepal at present. A proceeding of international nurses day. NAN; 1998:25.
  6. Health Hazards of Human environment. The work environment; WHO, Geneva; 1972:1251.
  7. Vision, Souvenir, BPKHSI; Dharan, Nepal, 1999; 1-3.

* Lecturers, College of Nursing B.P.Koirala Institute of Health Sciences, Dharan, Nepal Journal of the Academy of Hospital Administration, Volume 16 No. 2 July-December 2004

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