Dr.

Rajesh Bhalla
MD (Hosp.Adm.), DNB (Health Adm.), M.Sc (Defense Studies)

Definition
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Nursing Unit or Ward

Grouping of accommodation for patients with service facilities which enable a team of nurses to care for inpatients under best possible conditions
Easy observability & quick response Cohesive functioning

Classification of Ward Accommodation

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Primary Auxiliary Sanitary Ancillary

Classification of Ward Accommodation

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Primary Bed accommodation Nursing station Treatment Room Auxiliary Drs room Nurses room Stores Clean Utility

Classification of Ward Accommodation

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Sanitary Toilet block Dirty Utility Janitors room Ancillary Ward Pantry Day room Conference room

Functions of Nursing Unit

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Physical facilities Nursing care Low cost Optimum patient environment Congenial work environment

Evolution of Wards
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Nightingale Ward

Established by Florence Nightingale Traditional nursing unit 35-40 patient beds Own kitchen, stores, supplies Centered around Head Nurse

Sanitary Area

Nightingale Ward Plan

Ancillary Services

NS

Beds

Advantages versus Disadvantages

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ADVANTAGES

DISADVANTAGES

Easy visibility of patients

Cross Infection Nurses Fatigue Factor Lack of privacy Noise Lack of personal contact

Planning Considerations
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Economy in space Patient and his needs Increasing complexities of nursing procedures Technical advancement in medicine Concept of Hospital Infection Changing expectations of pts

Planning considerations
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Policy General or Specific Hospital

Bed Strength of Hospital

Progressive Patient Care

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Definition: Tailor-made according to the need of the patient

Intensive Care Intermediate care Self care Long term care

Progressive Patient Care

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Intensive care
Critically ill patients Unable to communicate needs Requires continuous observation & extensive nursing

care Equipped with life saving equipments, drugs & supplies.

Progressive Patient Care

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Intermediate care
Moderately ill patients. Require moderate amount of nursing care

Self care
Patients are ambulant during period of

convalescence Able to look after themselves. Minimal nursing care required.

Progressive Patient Care

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Long Term care

Prolonged nursing care Services not available at home
The basis for PPC system is the amount & type of nursing care required & degree of dependence of the patients on others.

Physical Facilities
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Area Location Size Shape Ancillary Accommodation Water & Electricity supplies Communication Air-conditioning Auxiliary Accommodation

Ward Size and Configuration

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Multistoried buildings Each floor plan, template of the plan of the floor

above. Horizontal lay out: 150-200 beds Economy in deployment of nursing staff

WARD LAYOUT RIGS PATTERN

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Rigs Ward
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Grouping of patients into 6 beds & 4 beds Serious patients 2 beds Isolation room 1 bed for infectious patients Beds arranged parallel to longitudinal wall of the

ward Circular Nursing Unit for seriously ill patients (ICU) Rectangular units for mobile patients.

Rigs Ward
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Disadvantages Direct observation Communication Nurses fatigue factor More Nursing staff Costly to build & maintain

Modular Grids
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Standardised Planning Grid 1.6 6 grids 3.2m x 4.8m =14sqm Central corridor = 2.50 m. 4 bed room = 5m x 6m Ancillary rooms 15m2

Common Service Facilities

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Combining 2 wards Economy in deployment of nurses Flexibility in use of beds Common core of work area Economical in building design Efficient functioning

Physical Planning
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Hospital bed 1m x 2.15m Floor space for bed in multiple bed room 7.0 m2

per bed Single bed room - 14 m2 per bed 2 bed room 21.00 m2 Distance between wall & side of bed > 0.65 m Centre to centre distance between 2 beds - 2.15 m

Physical Planning
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Ceiling height 3.0 m Width of corridors- 2.4m Windows - 20%of floor area Doors - 1.2m Dado - 0.2m

Nursing Station
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Central & close to patients Critical patients close to N.S Sisters room, WC, Built in cupboard for storage of drugs , dressings &

instruments Closet for narcotics & dangerous drugs Electric panel for nurses call station visible

Sanitary Facilities
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Sanitary Annex WC - 1 for 8 beds 1 BR - 1 for 12 beds 1 Wash basin 1 for 10 beds Urinal - 1 for 16 beds. Dirty utility room & karamchari (safai) workers closet

SERVICES
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Water & electricity supplies Round the clock water supply 300-500 litres for per bed. Electrical Sockets - industrial switch - 15 amp - 5 amp Alternate source of light supply

SERVICES
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Communication Effective two-way communication > 500 beds - paging system Air conditioning (HVAC) Positive pressure Provide patient comfort Reduce Hospital Infection Rate.

ANCILLARY SERVICES
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Treatment & Dressing Room Isolation room Ward pantry Clean Utility Room Day Room Auxiliary accomodation

Norms for Nursing Staff

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Staffing Norms
Nursing Supdt.

1 per hospital Dy. Nursing Supdt. 1 upto 400 beds 1 addl. for every 200 additional Beds Asstt. Nursing Supdt. 1 for 100-150 beds for 3-4 wards

Norms for Nursing Staff

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Ward Sisters:

1 for 25-30 beds or one per ward Teaching Hospital: 1 nurse for 3 beds * Non-teaching hospital: 1 nurse for 5 beds * For ICU / CCU: 1:1 1 nurse for 1 bed * (+ 30 % leave reserve) Extra nursing staff to be provided for Departments & Research functions.

For each 250 beds - one infection control nurse.

Nursing Hours required

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Direct Nursing hours / patient / day (24 hrs) Critically ill patient 8-10 ICU care Moderately ill patients 3-5 HDU care Mildly ill patients 1-2 hrs self care (Ambulatory) Chronically ill patients 30 min. to 1 hrs

Category of illness

Nurse patient ratio 1:1 1:3(T) 1:5(N.T) 1:6 1:12(T) 1:18(N.T)

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