2. The wind may blow from
any direction, in which, you
go depends on how you set
the sails.
3. Managing change:
Reasonable man adapts himself
to world; the unreasonable one
persists in trying to adapt others
to himself. - Peter F Druker
History of Dinosaurs?
4. Errors Due To Human Factors
Poor Training
Fatigue
Staffing level
Communication
Distractions
Punitive culture
Nurses
Many Roles One Profession
5. Importance of Nursing in Hospital Services
Hospital service is a complex service because:
Diversity of goal
Verities of employees
Works 24 hours
Dowel authority
Output is difficult to measure
Quality is difficult to measure
Public demand increasing
Hospital deals with life and death
Difficult to organize and manage.
6. The World is a book. Every step we
take, opens up a new page for us.
-Lamartine
7. Introduction:
• Hospitalized patients are under
nurses control.
• Nurses are responsible for patient
care.
• Nurses: Frightened with
medicological problems.
• Has inadequate knowledge.
• Needs : Input in curriculum,
refresher course
8. Growing complexity of health care system:
1. Different products and services.
2. Different types of personnel.
3. Work force retention & migration issues.
4. Different stakeholders group.
5. Different modes of health care delivery.
6. Different processes to plan & define priorities.
7. The need for effective communication
8. Advanced technology.
9. Financial constrains.
10. Political influences on health.
11. Increased media intrest in health.
9. Living on the edge:
Some global & national trends are:
Globalization.
Competition.
Workforce diversity.
Explosion of information & technology.
Economic & social upheaval.
Message, “if survival is the aim, change is the game”
So, we are “living on the edge”.
World wise changes:
Collapse =if not adopt change
10. Some basic things you have
to learn to live by:
1. You cannot live with the status quo.
2. You may need to make major changes in
thinking and behaviour.
3. If you keep trying to resist or block major
changes, people may just step ground
you- you become invisible to the people in
power.
4. You must continue to look for opportunities,
even when the issues seem enormous.
5. You must be proactive, not reactive.
11. We have choice.
Governments have a choice.
Organizations have a choice.
Nursing has a choice.
Nurse leaders have a choice.
13. If you have the power of positive
thinking…
You can Face whatever comes
You stay Light and Easy
No Worries
No Confusion
You take Benefit from all Scenes
You love Life
You love People
14. Positive Thinking Demands
that You:
Create Positive Thoughts
Resist Negative Thoughts
Accumulate internal power
Accumulate determination
Can say ‘No’ when necessary
Can say ‘YES’ when necessary
16. The Law
Laws may be thought of as rules of
conduct that guide interactions among
people.
17. Laws RT Nursing and Health
Muluki Yen (Antarim Sambidhan)
Swath Sewa Niamabali
NNC Act
Abortion Law
Narcotic Drug Law
Oragan Transplant Law
BPKIHS Niamabali
Quality of Drug Law
Etc
18. Nurses Facing Difficulties in MLC at BPKIHS
My own Experiences:
Corrections of documents:in Emg.
Dead body-OPP-handover to relateves M-2
Physical assult-verbally told police to hand
over body- court ask for postmortem report-
M-2
19. Medico Legal Cases Nurses has to Care:
Insurance policy cases.
Compensations
Self-Injury.
Mal-practice suits.
Will-cases:during hospitalization.
Criminal cases: murder, disfigurement, rape,
RTA, Burn, poisoning, political cases,Suicide
etc.
20. Difficulties Common in All Wards:
Problems
:Ad,Dis,TRF,LAMA,absconded,free
process,Death, DDA,Deoisit of
bills,Redeposit,IP Number,visitor
control,security.
Lacking consent and finger prints in
admission sheet.
Missing case sheet.
Communication problem with police, visitors,
doctors and other heath team members.
21. Legal Issues in Specialties
Community Health
Emergency Dept.
Pediatrics
Medical –Surgical and Geriatrics
Critical Care
Operating Room
Psychiatric
Home Health
22. IN EMERGENCY UNIT:
MLC cases brought without relatives.
False history – attendants.
MLC stamp-- missing.
Miss handling of specimens.
Poor recording and reporting of MLC.
MLC forms some times not filled by DMO.
Problems with: uncooperative, alcoholic, suicidal
Lack of cooperation from police:brought by
police and left in emergency.
Problem with security:absconded and close
observation.
23. Continue
Problems With Police:.
Not available in time.
Poor communication.
More verbal response (don’t want to write)
24. In Medical Surgical Wards
MLC stamp-missing.
Communication with police.
Absconded-Lack of security-Nurse
busy.
Missing documents and reports-MLC.
Lawaris/dead body-TRF/hand over.
25. In Operation Theater
High risk consent problem.
Bill payment and material management.
O.T.death-no admission register.
Gyanae O.T.-case sheet sent to bill
counter and patient send to OT with out
case sheet(IP No/ bill/consent.)
27. In Maternity Ward
Unmarried mother.
Criminal abortion.
Baby – full term- Marriage late.
Rape.
Married-abortion-husband out.
False history
privacy
Ethical Legal problem
Human rights
Blame-baby exchange.
29. Values and ethics
Values and ethics are inherent in all
nursing acts.
A value is a strong personal belief; an
ideal that a person strives to uphold.
Your values reflect cultural and social
influences, relationships and personal
needs. Vary among people and develop
and change over time.
30. Six Standards of Nursing Practice
Accountability
Continuing Competence
Application of Knowledge, Skills and Judgment
Professional Relationships and Advocacy
Professional Leadership
Self-Regulation
32. Nursing Practice & the Law
Nursing practice falls under both public
and civil law.
Nurses are bound by rules and
regulations stipulated by the nursing
practice act given by NNC and GON.
33. Skillful Communications
The nurse must communicate accurately
and completely both verbally and in
writing.
Many malpractice or negligence cases
complain of a lack of communication by
the nurse.
34. Skillful Communications (FLAT)
F – factual: charting should express what the
nurse sees, not what he or she thinks happened
L – legible: no erasures; corrections should be
made with a single line drawn through the error
and initialed
A – accurate: complete (What color was the
drainage and how much was present? How many
times, and at what times, was the doctor notified
of changes?)
T – timely: completed as soon after the
occurrence as possible; “late entries” should be
avoided or kept to a minimum
35. Legal Safe-guards in
Nursing Practice
Licensure:valid and current.
Good Samaritan laws:In emergency.
Good rapport with client.
Standards of care:set standards,procedure
manuals.
Standing orders:better in written than oral.
Inform consent:Admission,treatment,operation
Correct identity: Name tag in OT, New born,
dead body.
36. Legal Issues in Nursing
Abortion
HIV/AIDS
Death and Dying
Right to Refuse Treatment
Physician-Assisted Suicide
Organ Donations
Surrogate Pregnancy Contracts
Living Wills
37. Legal - Summary
We live in a legality society.
We live in a high technological world.
We live in a society that is evolving rapidly
with what is acceptable or not.
Know the laws regarding health care and
the nursing practice.
Know how to prevent legality, follow
standards of care.
Know the legal issues in nursing practice.
38. Summary
• Hospitalized patients are under
nurses control.
• Nurses are responsible for patient
care.
• Nurses: Frightened with
medicological problems.
• Has inadequate knowledge.
• Needs : Input in curriculum,
refresher course
42. I liked in Singapore
Building
Planned city
Road
Cleanliness
Security
Train services
Bus services
Aeroplane
43. I liked in Singapore
Job oriented
Rule and regulation
Equal treatment/Behavior for all
Cultural harmony: Malaya, Chinese, Tamil
Punctuality
Cultural diversity: Indian, Chinese colony
Food from Malaysia
Goods from china
Freedom for Individuals: under rule eg: smoking
44. I liked in Singapore
Single: Tax 45%
With 2 or more child: Tax 6% only
Policy: Plenty of child plenty of money
No bargaining
Every shopping complex auto detector
machines.
No cheating of tax.
Phone, Email free inside airport
No public telephone shops only coin phones
45. CGH at a glance
800 beded hospital
Government funded hospital
Facilities : Class A, B1, B2, C
2000 staffs
1200 Nurses
Clinical trial facilities separate units
No separate hospital pharmacy: drugs supplied
in hospital
Established before 15 years
46. CGH at a glance
Separate home care teams
Diet as per individual patient choice
Birth day special diet
Diet and laundry service by Robert
Charge A : 400 S$/day
Insurance for most of citizens
Best referral systems
47. CGH at a glance
Nurse patient ration: 1:6 , (Australia 1:4)
Emergency : 500 patient/day
Celebration of special days: patient
safety, food festival etc.
For new nurses: 2 days hospital
orientation and 4 weeks nursing
orientation by in-service education team
on CPR, IVI, etc
48. CGH at a glance
Nurses from: Philippine, Thai, Burmese,
Chinese etc
Salaries: 2000 S$/Month
IEC in OPD complex, indoor corridors, duty
stations and other public places.
Need based inventions: e.g. during SARS,
invention of autodetection mechine in OPD
for screening of all patients TPR BP SPO2
etc.
49. In OPDs Patient first Screened by Nurses
and then send to specific specialty
department. Recorded Vitals.