Part One

- Preparation

Preparation

Central Nursing Administration

Dr. Kawthar Mahmoud Mahmoud                               Head of the Central Administration for Nursing

Dr. Nevin Abd Rab Al-Nabi Muhammad                 General Director of Therapeutic Nursing Department

Mr. Amani Farouk Mohamed              Senior Nursing Specialist at the Central Administration of Nursing

Mr. Azza Jalal Ahmed                                Nursing specialist at the Central Administration of Nursing

Mr. Hanan Amin Shousha                             Nursing specialist at the Central Administration of Nursing

Ms. Mona Ali Abdel Rahman                       Nursing specialist at the Central Administration of Nursing

Mr. Yasmine Sayed Abdel Basset                Nursing specialist at the Central Administration of Nursing

Vision of nursing service in hospitals

The Central Administration of Nursing is looking forward to improving the nursing profession and nursing services in hospitals in the Arab Republic of Egypt so that they can compete at the regional and international levels.

Nursing service message in hospitals

The Central Nursing Administration is committed to following up on the Nursing Services Administration to raise the health level of individuals, whether they are sick or healthy, and to provide the best nursing services to all patients who need them in a way that ensures cost effectiveness and is in line with the objectives of the hospital and nursing administration, as well as to work to raise the scientific and practical level of male and female nurses and change their attitudes towards newer trends. Modern sciences in nursing and medical sciences.

Objective of the guide:

Establishing work systems in industrial kidney units.

Confirming the efficiency of performance of the nursing staff in artificial kidney units.

Improving the scientific and technical level of nursing staff.

Protecting workers from expected risks in the unit.

Ensuring the patient's safety while in the unit.

A/ Marwa Muhammad Hassan                     Nursing specialist at the Central Administration of Nursing

Mr. Ahmed Youssef Abdullah                       Nursing specialist at the Central Administration of Nursing

Mr. Angham Hamdy Abdel Khaleq                Nursing specialist at the Central Administration of Nursing

Mr. Mohamed Abdel-Ghani Youssef              Nursing specialist at the Central Administration of Nursing

Mr. Taha Mohamed Ahmed                           Nursing specialist at the Central Administration of Nursing

Faculty of Nursing, Ain Shams University

Dr. Camellia Fouad Abdullah         Professor in the Surgical Internal Medicine Department, Faculty of Nursing, Ain Shams University                                                       

Dr. Mona El-Shazly Mahmoud        Head of the Department of Administration, Faculty of Nursing, Ain Shams University                                                        

Dr. Dina Mohamed Mohamed         Lecturer in the Surgical Internal Medicine Department, Faculty of Nursing, Ain Shams University                                                        

Review and supervision

Dr. Kawthar Mahmoud Mahmoud                               Head of the Central Administration for Nursing

Prof. Dr. Hisham Atta Youssef    Assistant to His Excellency Prof. Minister of Health and Population For H.R development and training                                    

Prof. Dr. Sherif Wadi’                     Advisor to His Excellency Prof. Dr. Minister of Health and Population

For emergency

Dr. Nevin Abd Rab Al-Nabi Muhammad       Director General of Therapeutic Nursing Department

Dr. Ali Abdel-Azim               Director General of Quality Management  Ministry of Health and Population

 

 

- Organizational structure

The definition

The organizational structure is the formal framework through which management takes its place through an illustrative drawing that defines the relationships, by describing the various centers that define the scope of responsibilities and authority, the scope of supervision, and the vertical and horizontal relationships between these divisions.

Types of organizational structure:

1) The formal organizational structure

2) Informal organizational structure

Formal organizational structure:

The formal organizational structure is defined by the executive authority as a result of planning. It draws and clarifies the relationship between people, their positions, responsibilities, and the relationship between them.

Informal organizational structure:

It includes personal and social relationships that do not appear in the formal organizational structure drawing.

Steps to prepare the organizational structure:

· Determine the purpose of the hospital.

· Determine the sub-goals necessary to achieve the goal.

· Identifying the necessary activities and implementing sub-goals, for example (nursing/laboratory/nutrition activities...).

· Determine the work required to implement aspects of the activities.

· Grouping work into positions such as doctors/nursing personnel/technicians/heads/heads of units/specialties/supervisory/technical categories).

· Grouping jobs into departments, for example (nursing jobs).

· Grouping departments into departments and sectors and then grouping them under one executive body, such as the Directorate of Health Affairs/Treatment Institution/Health Insurance

· Preparing an administrative organization guide that explains the rules, regulations, rules and instructions, the most important of which is the organizational structure.

NB :

1-    The number of department supervisors is determined according to the hospital’s organizational divisions, according to the location of the departments, the number of beds, and the type of specialties.

2-     The number of female heads/heads of departments is determined according to the organizational divisions of the different departments in the hospital.

3-     The number of male/female supervisors, department heads, and nursing staff members and their assistants in shifts and night shift hours is determined for each hospital, according to the workload in each of them.

Organizational Chart

For the nursing department of a large general or specialized hospital

- Job Descriptions

The Definition

It is a list that includes a group of elements specific to a specific job, such as [the name of the job, a summary of the job, the supervision of others over the job and the job’s supervision over others, duties and responsibilities, and the special qualifications to hold this job].

It is also statements that explain the nature of the job and the responsibilities assigned to the job holder, as well as the relationship between the job and other jobs.

The job description of a health worker specifies:

·        His powers, i.e. his right to make decisions.

·        His responsibilities, that is, the amount of work that he is expected to accomplish.

Purpose of the job description:

It is to specify to the worker, the rest of the team members, and the supervisors:

·        What the worker is expected to accomplish.

·        The level of performance expected from him.

·        To whomever is responsible.

·        The people he supervises.

Contents of the job description:

Job name :

It is the official name of the recognized job for the person who does the work or performs the job, for example, nursing technician, nursing specialist, or….

The date :

History is mentioned because the job description is not permanent. Employees and their duties change, and the job description must be reviewed and changed when necessary.

Job Summary: Summarizes the main responsibilities of the job:

Duties:

These are the most important elements of the job description, and even the most important part of it, and each duty alone should be fully defined as a recognized part of the job holder’s work.

Relationships: This is simple data related to the following:

 · The title of the person responsible for the job holder in performing his duties.

 · Titles of the people whose work the incumbent supervises.

Qualifications: The qualifications are described, including basic training and experience, that the job holder is required to have.

Principles of organizing and writing job description information:

· Arranging the description of duties in a logical manner.

· State the separate duties clearly and concisely, and not going into detail becomes a motor analysis.

· He begins sentences with kinetic, functional verbs such as: performed, used.

· Uses quantitative words whenever possible, meaning achieving the goal by 90%. For example, using specific words whenever possible is better than unclear words.

· He begins by mentioning the duties as duties and then delaying the qualification information.

· Avoid generalization.

· If possible, determine the percentage of the total position that is spent on activities.

· Limit the use of the word “maybe” in relation to performing certain duties.

· Using the daily routine, the department, and sometimes, if defined in a good way, will make the meaning more specific and clear.

Uses of job descriptions:

· Job descriptions are used in career guidance for new employees.

· It is used as a basis for performance evaluation.

· Using job description items when making promotions.

· It can be used to identify weaknesses in performance.

· It is used to determine the numbers needed for work.

· It is used to determine or increase wages.

 Job description card

Job title: Head of Artificial Kidney Unit Nursing	Class: first - second
Department:    Artificial kidney unit

Organizational relations:

Under the supervision of: Director of Nursing at the hospital

Supervises: Nursing staff members of the artificial kidney unit

work's relationships :

Primary purpose of the job:

1- Determine the tasks of all individuals

2- Achieving the organization's goals

3- Improving individuals' performance

4- Improving the quality of nursing service

 Roles and responsibilities :

1- It plans, organizes, and distributes work to the nursing staff in the unit

2- Estimating the unit's needs for nursing staff

3- It trains nursing staff and on-the-job training personnel, especially new ones or transfers, while motivating them to continue acquiring information and skills, and participates in their training.

4- Providing and completing the machines, tools and equipment necessary for nursing work

5- Prepares schedules for shifts, nights, rest, and vacations, and distributes work among nursing staff members

6- Supervising nursing staff members and following up on the implementation of nursing work through department visits to clinics

7- Supervising attendance and departure and related records

8- Evaluating the performance of the unit’s nursing staff

9- Assessing patients' nursing needs and developing unit nursing plans

10- Follow up on the implementation of treatment, observation, nutrition, and tests, and give directions to the nursing staff in the event of a deficiency or negligence in performance

11- Review registration and recording of files, records and patient tickets

12- Organizing meetings related to nursing work

13- She prepares a daily report on the condition of patients and the problems that obstruct nursing work, submits it to her direct superior, and follows up on the implementation of the observations thereon.

14- It suggests rewards and punishment

15- Training new recruits from the nursing staff and lower categories

16- Follow the rules and principles of infection control and ensure the quality of performance of various nursing tasks

17- She supervises the teaching and education of patients in the unit

18- Follows professional etiquette and behavior in dealing with members of the health team, individuals, patients and their families

19- Carrying out similar tasks assigned to it

Job description card

Job title: Nursing staff members in the artificial kidney unit	Class: second - third - fourth
Department: Artificial Kidney Unit

Organizational relations:

Under the supervision of: Supervisor of the Artificial Kidney Unit

Supervises:

work's relationships :

Primary purpose of the job:

1- Determine the tasks of all individuals

2- Achieving the organization's goals

3- Improving individuals' performance

4- Improving the quality of nursing service

Roles and responsibilities :

1- Make patients' beds in the morning according to the patient's need.

2- Visiting doctors to see their patients

3- Implementing doctors’ orders, giving treatment, bathing the patient, changing clothes, and food

4- Follow the infection control system, write it down, and note vital signs as well as a fluid chart.

5- Performing the required tests and measuring blood sugar in the department (with a device trained by the department’s nursing staff).

6- Proper, complete and accurate recording and notation

7- Delivery and Receipt: (patients, devices, consumables)

8- Carrying out similar tasks assigned to it

- Introduction to the artificial kidney unit

Kidney failure is a chronic disease whose patient needs care of a special psychological and physiological nature to help these patients achieve a healthy and balanced psychological life.

The artificial kidney unit is one of the vital specialized departments in the hospital, so it must be dealt with with special skills. Because the nursing administration represents an important member of the health team, the nursing staff must be familiar with all the skills specific to the field of the artificial kidney unit.

Vision of the nursing service, artificial kidney unit

The hospital administration aspires to advance the nursing profession and provide nursing services to patients in the artificial kidney unit in an effective, safe and quality manner.

Nursing service message for the Artificial Kidney Unit Department

The hospital's nursing administration is committed to raising the health standard of patients and providing them with the best nursing services in line with the hospital's goals and procedures. It also works to raise the scientific and practical level of all members of the nursing staff in the artificial kidney unit and change their attitudes towards modern trends in nursing and medical sciences.

- Renal dialysis unit

·   The artificial kidney unit consists of two wards, one for hemodialysis and another for peritoneal dialysis. It is preferable to have central air conditioning.

First: The bloody cleansing suite:

·  It is a room whose size varies depending on the number of machines designated for hemodialysis that will be used in the unit, and it must be taken into account that the entire space is open so that it allows all patients to be seen at the same time.

A) Machines:-

·   It should be taken into account that each machine and bed should have a space of about 3 meters wide and 2.70 meters long, and there should be next to each machine: -

·   Places for its own electrical connections and more than one backup electricity source

·   Water connections necessary to supply the machine with treated water

·   Connections for dispensing the products of the hemodialysis process, especially for each machine

·   Oxygen connections next to each bed

·   Liquid suction connections next to each bed

B) The family: It must have the following:

·   The ability to move, whether from the head or the feet, and the ease of moving from one place to another

·   The ease of movement of the chair designated for hemodialysis, which is preferred by some patients, and that it has the ability to place the patient horizontally when any emergency situation occurs.

·   The mattress must be covered with tarpaulin or plastic to avoid the possibility of contamination with blood or used solutions.

·   Each bed is allocated 2 sheets and a coverlet or blanket, depending on the weather condition.

·   Each bed is allocated 2 pillows, one for use at the head, and another smaller one for use by some patients, so that the hand with the vestula is placed in a more comfortable position.

C) Sterile supplies:

·  There must be 4 large cupboards (it is preferable that the cupboard be built into one of the walls of the room so as not to disturb the space of the suite), where the cupboard is not less than 3m x 1.5m, divided into shelves to place sterilization packages consisting of the following: -

The first cupboard:-

First shelf:

·   Hemodialysis packets. The number of packets is determined according to the number of patients each day, and 20% more than the daily use must be added as a reserve.

·    Sterilization is reviewed daily in the morning by one of the nursing staff members assigned to that purpose, and one is allocated weekly or monthly to be responsible for sterilization by the unit supervisor. When assigned, it is noted that she is present daily in the morning during the period of her responsibility to review the sterilization dates and carry out the daily pickup and delivery process.

·   Jawan packets (the number is determined according to the number of working health team members in each shift, with the addition of about 20% reserve packets).

·  Masks placed over the nose and mouth, and sterile gloves, whose sizes are determined according to the people working in the unit. A 20% reserve is added, and their numbers are determined according to the number of patients present daily, so that each patient is allocated a sterile glove that is used when installing the vestula, and another glove is used when ending the session (it is possible to use a non-sterile glove or Single-use glove when ending the session)

Second shelf:-

The following is allocated: sterile devices such as: -

·   Intravenous devices (2 per patient per day)

·   The candidate and his connectors (one connector is allocated to each patient daily)

·   Fistula needles (2 per patient per day), taking into account the sizes used for each patient

·   Single-use syringes of different sizes (2, 5, 10 mm). One syringe of each of the previous sizes is allocated for each patient.

·    3 large-sized plaster rolls per day (make sure it is of the transparent type so as not to cause infections for patients).

·   It is taken into account to allocate a daily reserve that represents the need for an additional 5 patients per day to confront any emergency. This is reviewed daily by a member of the nursing staff and allocated by the unit supervisor on a weekly or monthly basis, provided that she is present every day in the morning so that she can continue working, as she must prepare What is needed daily in the morning so that she can continue working, as she must prepare what is needed daily in the morning and not leave the unit before completing it, provided that all the supplies are prepared, present and ready to connect patients to the devices for the next day in the morning. Usually the installation is done early due to the length of time the patient stays on the machine (from 4 to 5 Hours) Therefore, it is expected that patients will be connected to the devices around 7 a.m. daily.

Third shelf:-

It includes disinfection and skin cleaning fluids, which are as follows:

·   Betadine  to disinfect and clean the patient’s skin before and after installation (if the patient does not suffer from allergies when using it).

·  Alcohol for disinfection as well and can be used in chemical sterilization.

·   Savlon for cleaning machines from the outside when they are contaminated with dust and blood.

·   Chlorosidex for disinfecting machines (see the section on disinfecting and sterilizing machines).

The second cupboard: is designated for solutions

First shelf:-

·   Salt solution - Each machine is allocated one liter of salt solution per day for each treatment session, and each patient is allocated one liter of salt solution per day as a reserve (that is, when installing 10 patients per day, 20 liters must be available, i.e. 40 packages of salt solution).

Second shelf:-

Glucose 5% is allocated to each patient once daily as a precaution

Third shelf:-

·   It is designated for solutions that are not used routinely and are used only in emergency situations or in some cases determined by the treating physician, such as: -

·   Glucose 25% sodium bicarbonate. Half-liter containers are required. They are kept in the refrigerator and each container is replaced when used.

·   Mannitol 10%, 15% and is required for about 10% of the number of patients present daily, usually in cases where renal dialysis is performed for the first time or when needed.

·   The concentrated solution designated for the machines, and the quantity and number are determined according to the number of patients per day, with an additional 10% as a reserve.

The third and fourth wheels:-

First shelf:-

·   It is allocated for sheets and the number of sheets is determined according to the number of beds, so that each bed is allocated 2 sheets.

·   When implementing 3 therapeutic departments while keeping a reserve percentage representing 20% ​​of the total daily number used, it is noted that a member of the nursing staff is appointed to review the presence of clean sheets with one of the assistant categories of the nursing staff in the department.

·   It is ensured that the morning work administration supplies for the next day are complete and prepared so that patients are attended and connected directly to the equipment.

Second shelf:-

·  It contains coverlets and pillowcases, as many as the number of beds, noting that there is a 20% reserve.

Third shelf:-

·   It contains blankets, 2 blankets are allocated for each bed, and a 10% reserve is allocated.

Location of the nursing staff in the hemodialysis room:

·   It should be in the middle of the room and allow all the beds, patients, and equipment to be seen.

·   The nursing staff’s place contains a nursing station with a number of drawers or shelves that allow the files of patients present during treatment to be placed in one shift.

·   A place for the phone.

·   A place for the emergency cabinet containing emergency medications, the quantity of which is determined according to the number of patients present daily and hospital policies.

·   Location of emergency supplies used in emergency situations, such as (stomach tube, laryngeal incision, laryngoscope, tongue depressor, urinary catheters (regular, Foley), oxygen mask, ambubag (artificial respirator).

·   A place where a solid object is kept for use in cases of cardiogenic shock

·   A scale to weigh patients before and after treatment sessions.

·   A place to store blood pressure devices, and there must be a number of at least 5 devices for a unit containing 15 machines, meaning that each number (5 patients) will be allocated a blood pressure measuring device, and any device that malfunctions will be replaced immediately, with a note of keeping (3) new spare pressure devices. In the unit's warehouse to deal with emergency situations.

·   It is necessary to have a number of stethoscopes with pressure devices

·   A place to store thermometers. A thermometer is allocated for each patient who brings it with him during every treatment session or when the patient comes for an emergency examination, in implementation of the infection control system among patients - while ensuring that there is a reserve of thermometers for new patients for emergency cases.

·   There must be a sink and a water source next to the nursing staff’s place, and it should be designated for them only, and no one is allowed to use it, and the faucet should be prepared for use in washing hands before wearing sterile gloves (i.e., so that it can be easily closed using the elbow).

·   Allocate a number of sinks at the entrance to the hemodialysis room immediately before patients enter, as the patient must wash his hands up to the elbows before entering the room for treatment. Cold and hot water must be available in these sinks, as well as soap or disinfectant and towels for drying.

·   It is preferable to use liquid soap and dry the hands to prevent the spread of infection and skin diseases.

Tools that should be available in the hemodialysis room:

·   A television placed in a place that allows all patients to see it from all angles

·    It is possible to have one television for each patient to help pass the time and not get bored.

·   An hour or more so that each patient can know the time when needed.

·   An electric refrigerator is designated for storing medications (heparin, sodium chloride, and insulin), and patients are not allowed to use it.

·   A room attached to a glass wall is allocated that allows seeing and observing the progress of work inside the unit and is allocated for the doctors supervising the work in the unit. It also allows the patient’s family to check on them through this glass wall.

Special service areas for the hemodialysis room:-

- Locker room

a. Allocate a dressing room for nursing staff members

B. Allocate a locker room for female patients

C. Allocate a locker room for male patients

- Bathrooms :-

a. Private bathrooms for unit workers

B. Private bathrooms for patients and kept in them (urinal and bidet in a special cupboard for use when necessary).

A place for the unit secretary to be located:

There must be a unit at the entrance to receive and guide patients, and it must be permitted as follows:

·   A large cupboard for storing patient files. It is preferable to have a cupboard in the wall equipped with shelves. The shelves are divided and their area according to the area and size of the patient files. It is divided so that patient files for the years are kept on the upper shelves and patient files for the current year are kept on the nearby shelves.

·   A different color is assigned to the files for each group of patients, for example:

- Green color for morning shift patients, blue color for evening shift patients

- Red color for nocturnal patients

·   The files are arranged in shelves designated for the following days:

·   A shelf for a group of days (Saturday, Monday, and Wednesday) and a shelf for a group of days (Sunday, Tuesday, and Thursday) in all morning, evening, and night periods.

·  A place is allocated for the files of absent or deceased patients, which include a summary of the period of their stay in the unit, the complications that occur to them, the causes and manner of their death, or the reasons for their discontinuation of attendance, for use in patient research and statistics. It is preferable to have a computer to store the information.

·   A place is allocated to store office supplies and monthly orders, including papers, pencils, ballpoint pens, carbon paper, slottapes, files, paper clips, staplers, needle pins, plastic, colored felt-tip pens, and envelopes of regular, medium and large sizes.

·   A computer and a printer to write medical reports or leave letters to direct to the patient’s employer or anything else that the patient’s condition may require, as well as to create a database for the unit.

·   It is preferable to also have a camera to use when needed.

·   There must be a special telephone for the unit’s secretariat.

NB :-

The medical secretary is for the entire unit, and there must be at least two secretaries, one for the morning shift and another for the evening shift.

Second:- Peritoneal drainage suite

Family:-

·   A large room whose size varies depending on the number of beds that will be placed in it, and it must be taken into account that the position of the beds allows all patients to be seen at the same time.

·   It must be taken into account that each bed has the same space as before, 3 meters x 2.70 metres.

·   Each bed should have a solution holder attached to it on one or both sides.

·   The same previous specifications should be taken into account in the beds for hemodialysis in terms of ease of movement and transfer.

·   There must be oxygen connections, suction, and electrical outlets next to each bed.

·   There should be a table or nightstand next to each bed to store medications and the patient’s special tools (thermometer - cup for drinking water).

·  Pillows, sheets, and blankets must be available, as in the hemodialysis unit.

Cupboards:-

The first cupboard for storing sterilization supplies:

First shelf:-

·   Peritoneal dialysis packets (their number is determined according to the number of patients per day), so that a packet is allocated to each patient and 20% of the packets are kept as a reserve.

·   Packets of jaundice according to the number of patients, where a jaundice is used when installing each patient and 20% is kept as a reserve.

·   Jaun packs for nursing staff members or doctors to use during installation and while in the unit to handle cases (their number is determined according to the unit’s workers and reserve percentages are determined as previously).

·  Sterile protective gloves for installation, as previously mentioned, in hemodialysis, as well as for single use.

Second shelf:

·   For sterile devices, which are: - intravenous devices, devices used in peritoneal dialysis, plastic syringes, bags to collect peritoneal fluid after it leaves the patient’s abdomen and are determined according to the number of patients and the reserve percentage (20%) is added.

Third shelf:-

·   Disinfection and skin cleaning fluids, which are as follows:- Betadine or alcohol, to disinfect the patient’s skin before and after application. The quantity is determined according to daily use and the number of patients.

The second cupboard is designated for solutions

First shelf

·   It contains 2-liter peritoneal dialysis bags of low concentration (the quantity and number of bags are determined according to the number of patients per day).

The second shelf

·   It contains peritoneal dialysis bags with a capacity of 2 liters of high concentration (the quantity and number of bags are determined according to the number of patients per day and according to use).

Third shelf:-

·   It includes solutions for use in case of emergency, such as: - salt solution - glucose solution 5%, glucose 25%, mannitol 10%, sodium bicarbonate 15% (the required quantity is determined every two weeks according to the number of patients visiting the unit. 20% percentage determines the required quantity every two weeks According to the number of patients attending the unit, the reserve rate is 20%.

The third cupboard:-

·  First shelf: for sheets

·  Second shelf: covers and pillowcases

·  Third shelf: blankets

Location of the nursing staff in the peritoneal recovery room:

·   It should be taken into account that the location of the nursing staff is in the middle of the patients, so that the nursing staff present can observe all the patients and the assistant nursing staff members while they are caring for the patients.

·   All the above-mentioned specifications must be met with the unit of hemodialysis.

Tools that should be available in the peritoneal drainage room:

·    TV - electric refrigerator.

Special service areas attached to the peritoneal recovery room:

·   A dressing room, water departments, and a room attached to the main room. It has a desk and a glass wall for the presence of doctors, and through the glass wall it allows the patient’s family to check on him with the same specifications mentioned above.

Note :

·   If the hospital instructions allow for the treatment of patients with chronic kidney failure and hepatitis, an isolated place must be allocated for them in which all the previous things are provided, whether in the hemodialysis or peritoneal infusion room, provided that members of the nursing staff are allocated to them to care for them, using the aforementioned isolation steps. And I hope you take it into consideration

Emergency vehicle:

First drawer	Number	Morning time	Evening period	Sleeping period
Adrenaline	5
lasix.mg40	5
Dopamine	5
Depotrex	5
Noradrenaline	5
Aminophylline	5
Trideal	5
Calcium	5
Magnesium sulfate	5
Soyum bicarb	15
Potassium chloride	10
Coradaron	10
Solio Cortef	5
Isopten	5
Andral	5
Epanutin	5
Xylocaine vial	1
The department is yours	5
Second drawer	Number	Morning time	Evening period	Sleeping period
10mm syringe	10
5 mm syringe	10
3mm syringe	10
Cannula sizes	10
[Gauze bandage	3
Blaster	1
Sterile gel	1
Tongue depressor	1
IV device	10
Blood transfusion device	10
Rail syringe	5
Latex glove box	1
Intravenous connection	5
Arterial connection	5
Triple link	5
50 mm syringe	5
Identification bracelet	5
Laboratory tubes (various)	10
Sterile gaskets	10
Heart drawing paper	1
Electrode bag	1
Third drawer	Number	Morning time	Evening period	Sleeping period
Laryngoscope	1
Laryngeal tubes (sizes)	10
Air passage (sizes)	5
Ampoubag Mask (Sizes)	5
Oxygen mask (adults - children)	5
Nebulizer mask (adults - children)]	5
Get oxygen	5
Extra batteries	4
Fourth staircase	Number	Morning time	Evening period	Sleeping period
Gastric tube (rail) sizes	5
Urinary catheter (sizes)	5
Suction catheter (sizes)	5
Urine collection bag	5
Chest tube + jar	1
I wanted a steriliser	1
Sterilized scissors	1
catheter cvp	2
Guide wire for cvp	1
Silk stitches	5
Surgical condition	10
Betadine 10% (bottle)	1
A box of alcohol swabs	1
wind	1
searchlight	1
Fifth staircase	the number	Morning time	Evening period	Sleeping period
Salt solution...9%	5
Ranger	5
Glucose 5%]	5
Glucose 10%	2
Glucose 25%	2
Hesteril	2
Hemagel	2
Mannitol 20%	2
on the roof	Number	Morning time	Evening period	Sleeping period
Electric shock device	1
Pressure device	1
Earphone	1
Large ampobag	1
Small ampoubag	1
solid cpr board	1
Oxygen cylinder	1
Solution holder	1
The signature

- Patients' Rights Charter

◾    Rights determined by regulations and laws

◾   The right to receive care if it is available in the hospital

◾    The right to know the treating physician, supervising physician and/or responsible physician

◾    The right to receive care that respects the patient’s personal values ​​and beliefs

◾   The right to know and participate in decisions regarding their care

◾    The right to refuse care and not continue treatment

◾    The right to security, personal privacy, confidentiality and dignity

◾    The right to receive appropriate treatment for pain

◾    The right to file a complaint or suggestion without fear of persecution

◾   The right to know the prices of services and procedures

◾    Patient rights must be clear and communicated to patients and staff

◾   The availability of policies and procedures that define patient duties, which include at a minimum the following:

◾   Follow hospital policies and procedures

◾   Financial compliance in accordance with the law, regulations and hospital policy

◾    Show respect for other patients and healthcare workers.

◾    Follow the suggested treatment plan

◾   The availability of policies and procedures that define patients and their families’ awareness of their rights and duties regarding refusing or not continuing treatment.

◾    Availability of policies and procedures that define the process for patients to submit complaints or suggestions, verbally or in writing, anonymously.

◾    Availability of policies and procedures that define the process for obtaining patient-identified consent, and state the validity period of signed consent before obtaining new consent

◾    The hospital has a list of procedures or types of treatment that require patient-identified consent, which includes the following:

◾    Surgical interventions.

◾    Anesthesia/kidney or hemiplegia.

◾   Blood transfusion.

◾    High-risk procedures or treatment (including but not limited to electrotherapy, radiotherapy, chemotherapy).

◾    Family planning interventions.

◾    Scientific research.

◾    The hospital has a system for informing patients and their families about available services and how to obtain them.

◾    The hospital has a system in place to inform patients and their families of any expected costs.

9      The availability of a policy that specifies the hospital’s responsibilities towards the patient’s belongings, including at least the following:

◾    Who is responsible?

◾    When does responsibility for these belongings begin?

◾    How to protect belongings

10    A defined process is available to inform patients and families of the results of care and treatment

11    The availability of policies and procedures that specify how the hospital informs patients and their families about how to donate organs and other tissues.

12    The availability of policies and procedures that define the autopsy process and document the results of this process rights of nursing staff

◾   To be respected and appreciated by the institution in which they work and the health team with whom they deal.

◾   To obtain all their moral and material rights while practicing the profession, which are determined by the applicable laws and regulations.

◾    That they can participate in a continuous training project that develops their profession and performance.

◾   That they have the right to seek the assistance of union authority when any moral or material damage occurs.

◾   To refuse any work requested of them that is considered a violation of the laws and ethics of the profession.

◾    To practice home nursing care in accordance with legislated laws.

◾   Nomination for the position of captain, membership, or participation in committees if the conditions are met, in accordance with Article 17 of Law No. 479/2002 and the general conditions for elections and nominations.

◾    Send a topic or request for discussion to the union council.

◾    Enjoy the necessary protection from occupational hazards and work accidents.

Duties of nursing staff towards their patients

·      To keep in mind that healing the patient and maintaining his health is their primary goal, without any other considerations such as religion, color, gender, or politics.

·      To be the place of trust placed by the patient in terms of his recovery.

·      To be kind-hearted in their treatment, to act wisely and accurately towards their patients, to give the patient hope for recovery, whether physical or psychological, to maintain absolute confidentiality of everything you know about the patient, and to participate with the patient in making some decisions related to his treatment.

·      They should be responsible for health education for the patient and providing him with complete information regarding his illness, how to cope with it, and what are the means of avoiding complications resulting from it, and not just giving him medication.

- Ethics and ethics of the nursing profession

introduction

God Almighty has granted the nursing staff the honor of the nursing profession, which transcends all considerations and rises to the level of a human being, providing comprehensive nursing care to him in cases of health and illness in his capacity as a human being, with justice and honesty.

The nursing profession is based on a scientific and ethical foundation. The human being, in cases of illness in particular, deserves to be provided with nursing care at the best levels and the noblest methods of human interaction. The ethics of the nursing profession are an essential part of nursing care, treating patients, enhancing the health of individuals and communities, and relationships with members of the health team. The responsibilities of ethical nursing care. It is a duty for everyone involved in it to be a suitable environment for the work of nursing staff members

And the nursing staff members are the basis for encouraging all concerned to provide ethical professional conditions for their work and to provide nursing care. The Egyptian nursing profession’s charter of ethics is the agreement and consensus of all Egyptian nursing and health leaders, nursing staff unions, and members of the Arab Nursing Staff Union, who look up to all members of the Arab nursing staff. And Al-Masry for commitment and awareness of it in order to achieve ethical, scientific nursing care and achieve satisfaction among patients and members of society wherever nursing care is provided and satisfaction among service providers with the nursing service provided.

The General Syndicate of Egyptian Nursing and the Central Nursing Administration at the Ministry of Health and Population were keen to bring nursing professional concepts closer together between service providers and recipients, achieve progress in all fields of the profession, advance its sciences and services with the highest possible degree of unification, and benefit from the diversity and multiplicity of levels of progress that the Arab Republic of Egypt is expected to witness towards the nursing profession. In order for Egypt to be a producer of scientific nursing knowledge towards universal benefit, based on the belief of the Egyptian Nursing Authority that science should be reflected in the service of man wherever he is and to whatever nationality or religion he belongs to, cooperation began with the issuance of the Charter of Ethics for the Egyptian Nursing Profession, to be the first charter issued by the General Syndicate of Nursing, and its basic reference is the Charter. Arab Nursing Federation, emphasizing the importance of professional ethics at work

The Egyptian Charter of Ethics for the Nursing Profession is of great importance, and the General Nursing Syndicate hopes that this Charter will receive the great attention of the Egyptian Nursing Authority, governments, health sectors, and all medical professionals throughout the country, and to emphasize adherence to it, disseminate it to all concerned, and encourage its use wherever necessary. It will be a permanent reference in work, planning, and education, and it will receive attention and be a subject of criticism and scientific research.

The most important provisions of this constitution are the following:

·      Respecting life, alleviating suffering, and working to alleviate pain and raise the level of health.

Providing the highest level of nursing service and professional behavior.

·      They must be prepared to practice the profession only and work to acquire information and skills

·      Respect the patient’s religious beliefs.

·      Keep all information she obtains through her work and do not disclose it except in accordance with the law.

·      Do not prescribe or give medical treatment without a doctor’s orders, except in emergency cases and notifying the doctor immediately

·      They are committed to carrying out the doctor’s orders intelligently and obediently and refuse to contribute to any unethical actions.

·      Gain the trust of the doctor and members of the health team.

·      Not allowing their names to be used in advertising products or in any form of personal advertising

·      Cooperating with members of other professions and with her nursing colleagues

·      Adhering to the standards of personal etiquette in her private life.

·      Participate with citizens and members of other health professions in their efforts to meet the health needs of the local, national and global community.

Thus, nursing staff members have many responsibilities and duties towards the patient, themselves, their colleagues, their workplace, society, and their profession in which they work.

Ethical responsibilities of nursing staff towards their patients:

Among the most important duties of nursing staff towards their patients are:

·      To keep in mind that healing the patient and maintaining his health is their first goal without any other considerations such as religion, color, gender, or politics.

·      To be the object of trust placed in them by the patient.

·      That they be kind-hearted in their treatment,

·       And to act wisely and carefully towards their patients,

·      To give the patient hope for recovery, whether physical or psychological, and to maintain absolute confidentiality of everything you know about the patient, and to participate with the patient in making some decisions related to his treatment.

Responsibility of nursing staff towards themselves:

·      Nursing staff members must work to improve their scientific level by constantly being informed of everything new in the general natural sciences and special nursing sciences.

·       Complete studies to obtain available academic degrees such as a specialized diploma, master’s and doctorate.

·      Attending seminars, scientific conferences and seminars organized by medical and nursing societies and participating in scientific research that helps advance the nursing and health care profession.

·      That they be fully convinced of the nursing profession and that they should bear in mind that this profession has its own respect, dignity and dignity, and that they should be of good conduct and behavior in their public and private lives.

Responsibilities of nursing staff towards their colleagues at work:

·      Sincere cooperation with members of the health team, which helps provide health care to citizens.

·      They treat their co-workers as they would like to be treated, and avoid bad talk about them or any comment or remark that would detract from the skill or opinion of any co-worker.

·      Fully prepared to teach recent graduate colleagues all the foundations and concepts of modern nursing.

Responsibility of nursing staff towards the institution in which they work:

·      Respect the organization’s work laws and rules.

·      Respect all employees of the organization and cooperate with its superiors.

·      Respect the full uniform while working.

·      Proper use and preservation of work tools, and reporting in the event of loss or damage to any of the  devices and tools

·      Admitting the mistake and reporting it to those concerned.

Responsibility of nursing staff towards society:

·      To be good citizens who respect the traditions and customs of society.

·      Not participating in work that affects the honor and dignity of citizens.

·      They must be sufficiently familiar with the laws and legislation of the state.

Responsibility of nursing staff towards the nursing profession:

·      Paying attention to their appearance and adhering to their dress, cleanliness and grooming.

·      Stay away from any action that raises suspicions around them and be of good conduct and behavior.

·      That they be convinced of the profession and that it is a humane work that is respected.

·      Raising the level of the scientific profession through scientific research while delivering information to other groups.

·      Working to improve the material, economic and social conditions of workers in the profession

·      Improving the level of performance of nursing services in their workplace, as well as improving the selection of workers.

The following are the most important qualities necessary for nursing staff members:

Nursing staff members must possess the most beautiful qualities that qualify them to carry out their tasks in the best way, such as:

1- A healthy body and mind.

2- Mature in thinking and behavior.

3- They have basic information about the profession as well as general information.

4- They have skills specific to the nursing profession.

5- They have the ability to gain the trust of others and teach others.

6- They have the right attitudes towards her profession.

7- Set a role model for their cleanliness and good appearance.

8- They are keen on observation and intelligent.

9- They must be firm.

10- Conscientious and cooperative.

- Communication methods

Definition Of Communication

Communication

It is the process of exchanging ideas, information and trends verbally and non-verbally between individuals to achieve public or private purposes.

Communication

A circular process, not a one-sided conversation, meaning that the sender is at times a receiver and the receiver is at times a sender.

The importance of communication:

•       Forming relationships between community members.

•       Exchange information, ideas and experiences.

•       Conviction to change positive knowledge, attitude and behavior among individuals and groups

•       Clarifying ideas, removing confusion, and correcting concepts.

•       Increase culture.

•       Influencing others through guidance and guidance.

•       Transferring information, data, statistics and concepts through various channels to contribute to decision-making.

•       A purposeful means of ensuring interaction and mutual exchange of the various activities of the organization.

•       A way to motivate employees.

•       Communication helps achieve goals.

Components of the communication process

1.         The sender

2.         The message

3.         Communication channel

4.         The future

5.         Feedback

6.         Environment

Types of communication:

1.    Verbal

2.    Non-verbal.

There are two types of communication:

First: Verbal communication:

(talk - printed material to read - watching a television or radio program)

Second: - Non-verbal communication:

(body and hand movement - sitting - facial expressions such as joy and sadness - eye movement...etc.)

Communication skill:

1.     Listening skill.

2.     Speaking skill.

3.     Persuasion skill.

4.     The skill of asking questions.

5.     The skill of managing dialogue.

6.     Skill in dealing with others.

7.     The skill of using body language.

1.   Listening skill

It is focusing attention on the opinions, thoughts, feelings, and linguistic and physical expressions of others. Not relying on the content of the words, but trying to reach the speaker's directions.

The difference between listening and listening

-       Listening is limited to receiving the message organically through the ear.

-      Listening is using the mind with its full capacity in everything that has been received by mentally processing the received message with interpretation.

Types of listening:

Good listening is often accompanied by good thinking

Why don't we listen?

◾Their inability to concentrate for any reason.

◾The extent of their preoccupation with themselves.

◾They are very preoccupied with what they will say later.

◾Their lack of confidence in what they are listening to and the reasons why they are listening to it.

◾They do not have the ability to follow the points that the speaker is talking about.

◾They do not care about what is said to them.

◾We think seven times faster than we speak, and this makes us preoccupied with our judgments about the speaker’s speech?

◾Our desire to express ourselves instead of listening (I want the opportunity to speak).

◾Distraction due to side conversations or noise.

The importance of good listening

Good listening is the appropriate path for a leader or individual with strong relationships with others

It saves a lot of time and effort in managing problems and conflicts, achieving goals, and negotiating with those around them, as listening leads to:

◾It affects the validity and accuracy of the decision

◾It makes the relationship mature and strong between individuals

◾Generates the ability to innovate and create

◾It makes the individual able to face problems and crises

◾Makes the criteria for evaluating others fairer

◾Listening means a permanent addition to a person’s ability to speak forcefully

◾It reduces error and represents the key to safety for the individual’s intellectual growth.

How to become an effective listener?

◾Look for the content of the topic and ignore the speaker’s manner or mistakes in speaking.

◾Arrange the information you hear logically in your mind.

◾Do not rush to judge.... Rather, let the speaker finish his speech.

◾Do not turn your face away from the interlocutor (the eye sometimes listens).

◾Ask your interlocutor if the conversation is not clear.

◾Create an appropriate environment for yourself from the beginning that prevents you from focusing on things other than listening to the speaker.

◾Make your place in the session suitable for following the speaker with your eyes and ears, and try to eliminate the factors that could hinder this, such as sunlight falling on you or the presence of some devices in front of you.

1.   Speaking skill

How do you prepare yourself before starting the conversation?

◾Determine the purpose and benefit of the communication

◾Tailor your message to suit your listeners

◾Good preparation of the topic of the conversation...it is the best source of trust.

◾Get an idea in advance about the person you will be speaking to.

◾Prepare supporting materials to support your talk.

◾Mental and muscle relaxation.

To be a good speaker

◾Avoid inexpressive faces - exaggerated expressions - distressed expressions.

◾Avoid sharp glances or direct close-up looks.

◾Avoid repetitive movements as a result of excessive nervousness (movement such as a pendulum, for example).

◾Avoid inappropriate or excessive clothing.

◾Avoid stuttering - low voice - continuing on one tone.

◾Expand your circle of thinking and fully understand the information

◾Use the recipient’s language to convey the message clearly

◾Ask questions and then let the speaker confirm that what you have understood is in fact correct

◾Do not say lightly: I do not know: many of us know very little about the world in which we live, and pretending to answer or fabricating it only doubles the problems.

◾          Give your full attention to those you talk to: If you set aside time to communicate with someone, give them attention and attention. Join the conversation and participate in it when you see that it is of interest to the communication process.

2.   Persuasion skill

It is one of the skills necessary for the communication process, and it is used in personal interviews, group discussions, and talking with leaders. Definition: Enticement through reason, logic, and knowledge to make others accept changes in their opinions, attitudes, or behaviors.

Stages of the persuasion process:-

Attention stage: The individual is attracted to the new idea and shows enthusiasm for this idea.

Interest stage: A stage in which the individual wants to know details about the idea and has a desire to analyze facts and collect information.

Evaluation or mental comparison stage: In this journey, the individual performs a process of self-evaluation and comparison between the old and the new.

Experimentation stage: In this journey, the individual tries to get rid of tension and attraction, so he experiments and applies the pleasure of the idea on a small scale.

Adopting the idea/complete conviction: In this journey, the person is completely convinced of the idea and decides to continue implementing it.

3.   The skill of asking questions

To keep the dialogue going, there must be a reaction from the other party that includes indicators that support that it received the message and helps the first party determine how to continue the dialogue. These indicators can be obtained through the optimal use of questions. The questions may be positive or negative. If they are positive, they explain the other party’s way of thinking and feeling, but if they are negative, they make him feel tense and embarrassed and push him to take a defensive position.

Therefore, the following must be taken into account:

1.       The goal of questions should be to reach agreement and not to get into personal matters.

2.       It is important not to ask questions that cause the other party to become anxious or stressed.

3.       Questions should help both parties, not be used as maneuvering.

4.       Questions should aim to establish an atmosphere of cooperation by motivating the other party to respond frankly.

5.       Make sure that the questions are not deceptive, contrived, evasive, shameful, or worthless.

6.       Questions should be appropriate to the situation.

7.       The questions should also be appropriate to the other party’s personality and general aptitudes.

8.       The purpose of questions should be to achieve a goal and not simply to elicit a response.

9.       The necessity of a connection between the questions.

10.      Finally, it is required and usual that questions be characterized by tact and respect for the other party.

Specifications of successful communication:-

◾            Both the sender and the receiver must believe and be interested in the message

◾            Mutual respect between sender and receiver

◾            The subject of the message is clear to both parties

◾            Use appropriate means for the sender, the recipient, the subject of the message, and the place where it is presented

◾            Communication is two-way, meaning there is interaction between the sender and the receiver

◾           Use verbal and non-verbal communication equally efficiently, as they complement each other

◾            The more senses we use, the more efficient the communication process becomes

◾            The message must be correct, accurate, clear, specific and short

◾            Do not be a continuous sender or receiver

◾            Set a clear goal for the communication process

◾            Choose the appropriate circumstance from an environmental, social and psychological perspective.

◾            The language of communication must be appropriate for both parties

Specifications of successful communication

1- Both the sender and the receiver must believe and be interested in the message

2- Mutual respect between sender and receiver

3- The subject of the message is clear to both parties

4- Use appropriate means for the sender, the recipient, the subject of the message, and the place where it is presented

5- Communication is two-way, meaning there is interaction between the sender and the receiver

6- Use verbal and non-verbal communication equally efficiently as they complement each other

7- The more senses we use, the more efficient the communication process becomes

8- The message must be correct, accurate, clear, specific and short

9- Do not be a constant sender or receiver

10- Set a clear goal for the communication process

11- Choose the appropriate circumstance from an environmental, social and psychological perspective

12- The language of communication must be appropriate for both parties 

Basic principles: Communicate clearly

In order for people to hear, see and understand the message you want to deliver to them, you must:

◾    Choose words that are easy and simple to understand.

◾    To avoid scientific and medical terminology.

◾    To make sure that everyone present sees and hears what you are saying.

◾    To display a message as short as possible without disturbing the content of the message.

◾    Long messages lead to the attendees being distracted and not focusing on what you are saying and presenting. It also leads to them not remembering the message shortly after your talk. You must talk to them about one topic at a time.

- Quality and improving the work environment

Introduction:

There are multiple definitions of quality, and some or all of these definitions may apply to many topics or services. Each person’s expectations about the expected quality of the service or product depend on several factors such as his individual needs, personal experiences, and the influences of others on him. These factors help to form a set of characteristics that On the basis of which the quality of services provided to him is evaluated.

The perspective and judgment of quality may differ from the perspective of the patient, provider, hospital administration, and community.

Quality is the basis of providing health services, and to confirm the meaning of doing the right thing the right way the first time, we must ensure that things are done in a better way every day, ensure that we obtain the best clinical result for the patient, satisfy all our customers, maintain distinguished workers, and finally ensure the optimal use of available capabilities.

Definitions of quality

•       Quality is conformity with needs and specifications.

•       It is doing the right thing right the first time.

Quality and health services

•       Making sure things are done better every day.

•       Ensuring the best clinical result is obtained.

•       Ensuring the satisfaction of all our customers.

•       Ensuring we retain outstanding employees.

•       Ensure optimal use of available capabilities.

Quality and cost

introduction:

The means and methods of providing high-quality health services vary, starting from working in a method of observation and discovering the problems that occur during the application of the system, then eliminating these problems and planning to develop systems that achieve high quality in the service provided, in a way that ensures reducing expenses and saving resources, and even increasing income and returns, through... Eliminate unnecessary and harmful procedures and improve efficiency.

The relationship between quality and cost

Methods and approaches to providing high-quality health services vary as follows:

1.    The method of observing and discovering problems that occur during the implementation of the system and then eliminating these problems during work (leads to raising the level of service).

2.    The method of taking preventive measures during the implementation of the system to identify the systems that lead to reduced quality and then work to develop these systems (leading to reducing service expenses).

3.    The method of advance planning to establish systems that achieve high quality in the service provided, ensuring reduced expenses, saving resources, and even increasing income and returns. From the above it is clear that ensuring quality leads to:

•       Eliminate unnecessary procedures.

•       Eliminate harmful actions.

•       Improving efficiency. (It achieves increased income and resources and reduced expenses).

Quality assurance

The four characteristics of quality assurance:

•       Awareness of meeting the needs and expectations of the patient and society.

•       Focus on systems and chains of procedures.

•       Using data to analyze health service provision chains.

•       Encouraging teamwork to solve problems and develop and improve quality.

Quality assurance

The quality assurance division consists of three stages that include ten steps:

The ten steps to ensure quality

Characteristics based on which the starting point is determined:

Most frequent cases:

•       These are activities that will affect a large number of people or their incidence will increase.

Conditions accompanied by problems:

•       These are cases in which problems occur repeatedly, whether for workers or patients.

Cases most at risk:

•       These are the activities that make the patient more exposed to danger:

1.    Failure to provide health services.

2.    Not providing the service when it is needed.

3.    Providing an unnecessary service.

Standard

What is the standard:

•       A standard is a statement that defines expected quality.

Why standard standards:

•       Defining and defining quality “How are activities carried out?”

•       Quality assessment “How well were the activities implemented?”

What is the standards section in determining quality?

•       Identify important inputs.

•       Identify the series of actions necessary to achieve the desired results.

•       Describe the desired outcomes.

Types of standards

•       Clinical work manual.

•       Administrative work rules.

•       Specifications.

•       Performance Standards.

Standards sources

•       Standards previously prepared.

•       Local and internal standards.

•       International standards.

•       Educational bodies and institutions.

•       Educational institutes and institutions.

Standards published by:

•       Detailed explanation.

•       A clear plan for implementation.

•       Use of incentives.

Disseminate standards by:

•       Written letters.

•       Conferences and meetings.

•       Friendly meetings.

•       Work manual.

•       Training.

•       Monitoring and supervision.

Monitoring

It is the departmental process of collecting and analyzing data on specific indicators to help managers determine the extent to which the main activities are implemented according to the plan and the extent of their impact on the targeted sector of service beneficiaries.

To design a good monitoring program you must:

•       Focus on key indicators.

•       Collect only the required data.

•       Not exhausting workers.

•       Collecting data that can be collected, studied and inferred.

•       Feedback.

Division improves quality

Step five

Recognize the problem or improvement opportunity:

By knowing the types of data to be collected.

There are two types of data:

Quantitative data:

-       Surveillance system.

-       Surveys.

-       Evaluation results and assessment of the situation in special cases.

Qualitative data:

Step six

Definition of the problem in practice:

It expresses the difference and gap between the desired performance

And the current situation

Step seven

Determine who will work to solve the problem:

By choosing a team that has the following characteristics:

•       Who understand the problem.

•       Who can help.

•       Those who have technical experience.

Step eight

Analyze the problem to find out the root causes:

By using tools to analyze problems:

Illustration of the series of procedures (implementation steps):

Illustration of the relationship between cause and effect:

Step nine

Design and develop solutions:

By setting specifications for the solution and identifying the obstacles:

Choose the best solution based on criteria such as:

•       Ability to implement the solution.

•       The solution is free from a negative impact on other activities.

•       Workability of the solution.

•       Management support for the solution.

•       Community support.

•        ---------etc

Step ten

Apply solutions

Follow up on solution implementation:

•       Did the solution achieve the desired results?

•       Did the steps go correctly?

•       Are there steps that were difficult?

•       Did any problems arise during implementation?

•       Is there opposition from other parties and what is the reason for it?

Building a quality assurance program

•       Strengthening connection and loyalty to quality.

•       Implement an initial review process for quality-related activities.

•       Establishing a future vision and program objectives.

•       Determine the level and areas of activities.

•       Defining the responsibilities.

•       Resource allocation.

•       Strengthening important administrative skills and systems related to quality.

•       Prepare a written plan.

Common errors when implementing the program

•        Leaders’ lack of belonging.

•       Lack of patience among senior management.

•       Lack of specific strategy or methods.

•       Rushing into action before fully understanding.

Quality improvement story:

•       Telling the story of quality improvement is characterized by simplicity, clarity, and the use of sentences and diagrams. It helps to:

•       Visual documentation.

•       Strengthening the use of statistical methods.

•       Strengthening communications and reducing duplication.

•       Preparing presentations and reports.

•       Strengthening the use of the surveillance system.

•       Help the team understand the differences between procedures and tools.

•       Providing a unified approach.

•       Report on quality improvement activities

Monthly report on quality activities

Quality improvement activities	Activity start date	Head of improvement team	Notes (type of problem - opportunity for improvement - solutions - developments)	Expected date of completion of work

Definition of Kaizen philosophy:

It is a compound word of two parts that means “change for the better.” It is a primary means for achieving continuous improvement. It includes many of the improvement tools used in management, and one of these tools is 5S.

Five S?

5S is the philosophy of taking care of the workplace by organizing and cleaning it. It consists of five basic steps, and each step is called in Japanese with a word that begins with the letter S, hence the name 5S. This philosophy became known worldwide by this name, so much so that these five Japanese words were translated into English words starting with the letter S in order for the name to be valid. We can translate these five words into Arabic words that begin with the letter T, which are classification, organization, cleaning, standardization, and stabilization.

The five elements of this philosophy:

Five T consists of five elements:

1- Sorting classification, which is in Japanese: Seiri:

Taking care of the workplace begins with classifying everything in it.

Meaning of classification: Classification here means that we classify things into things that are necessary for work at the present time and things that are not necessary for work. After that, we get rid of the things that are not needed for work and keep those that are necessary for work. Such as: tools, files, materials, waste, papers, and equipment.

The classification process is the first step in this process

2- Set in Order, which is in Japanese: Seiton:

After that comes the organization process, which aims to preserve the things that we decided to keep in an organized way that helps us perform the work efficiently. The organization process does not only include arranging tools or files on the shelves, but it also leads to reconsidering the general plan of the workplace itself. We have to think about the most appropriate way to organize the workplace based on our current work.

3- Cleaning or polishing (Shining) in Japanese: Seiso:

The goal is a very clean work environment. This process is a process that is carried out in sections every shift or every day. There are things that must be cleaned by the person who uses them or handles them, such as work tools, including keys, tools, and supplies that he uses.

4-Standardization, which is called Seiketsu in Japanese:

After all this effort and experience in organizing and cleaning, specific rules should be established for what the workplace should be like. This includes defining the responsibilities of each individual, setting standard methods for the cleaning process, and announcing all of this so that each individual knows what duty he has in his department and how to perform it. This ensures that the situation will continue in this good manner and we will not return to old habits again.

5- Install Sustain, which is Shitsuke in Japanese:

We come to the final step, which is establishing systems to ensure the continuity of this entire process. For example, systems are put in place to review the cleanliness of places. An effective method is for one party to inspect another party, and a representative from one department inspects the process of filing files in another department or the cleanliness of the work site.

Five s benefits:

There are many benefits from it

1- Reducing time wasted searching for documents or tools

2- Reducing injuries due to the cleanliness of the floors, the absence of anything lying here and there, and the clarity of safe passage places

3- Reducing equipment malfunctions due to their early detection

4- Eliminate excess effort and unnecessary movements through a serious process of organization

5- Feeling a beautiful work environment as a result of the cleanliness and organization

6- Replace damaged tools as soon as they are damaged, instead of discovering it late and disrupting work

7- Easily discover lost things

8- Reducing the malfunctions that occurred after maintenance operations as a result of some dust entering the delicate components (and this has been mentioned in other fields)

9- Reducing quality problems that occurred due to pollution and dust.

- International and Egyptian standards and goals for patient safety and security

The Definition

A common goal that requires the process of coordinating the efforts of the health staff with the patient to protect him from injury. A process provided by the institution to make the health care provided more advanced, safe and secure. The process of preventing unexpected patient injuries.

Principles and standards of patient security and safety

Risk assessment: environment - patient

hazard identification : -

·      Develop a plan to protect the patient - how to act when an error occurs - recording and analyzing the incident -

·        Identify the cause – develop solutions to reduce reoccurrence

Who is responsible for the patient's security and safety?

Patient safety and security standards are the right of every patient and the responsibility of all employees of the medical institution

No employee is excluded, regardless of their administrative responsibilities:

Senior management    department managers         employees

Patient safety and security standards

1.     Introducing the patient in the correct way

2.     Improving good and effective communication methods

3.     The safety of using high-risk medications

4.     Ensure that the operation, the correct procedure, and the correct patient are concerned

5.     Reduce the risk of infection by washing hands

6.     Reduce patient falls to prevent injuries

7.     Preventing disconnection or misconnection of catheters or tubes

8.     Preventing bed sores

9.     Risk management and patient safety

10. Delivery and pickup policy

11- Restriction and isolation policy

The first criterion

1.   Introducing the patient in the correct way

Failure to introduce the patient in the correct manner leads to:

◾    Giving medication to another patient - Performing a procedure on another patient-

◾    Delaying giving treatment or performing a procedure –

◾   Giving an incorrect diagnosis –

◾    Delivery of the wrong patient to operations –

◾  Cancel an operation

Why does an error occur in the definition?

◾    Multiple interventions

◾    Multiple places to provide the service

◾   Multiple dealing individuals

◾    Some patients are unable to identify themselves

◾  Lack of a clear identification system

How do we avoid identification errors?

◾   Don’t be complacent - take the time

◾   Do not depend entirely on the patient

◾   Make sure that the information, stickers, and identification bracelet are correct

Do the following:

◾    Introduce the patient correctly upon admission

◾    Make sure the patient’s name is as it appears on the ID card

◾    Make sure that the identification data is correct before putting it on

◾    Put on a new bracelet if you lose the old one

◾    Ensure that the patient complies with the required procedure

◾    Ensure that the patient is properly matched before transporting him

◾   Apply the sample identification label immediately after taking the sample and before leaving the patient

Don't do the following

·      Do not tell the patient his name, but let him tell you his name

·      Do not take any sample before matching the patient with the data on the sample request form

·      Do not label the sample identification on the container  before taking the sample

·      Do not complete the work of the procedure remotely

◾    Understand and adhere to hospital policy:

◾    The hospital’s commitment to international goals for patient safety and security

◾    Patients are identified by their site of admission

◾    The hospital’s commitment to at least two definitions:

◾    The patient’s full name as on the identity card

◾    Its medical code

Both definitions are verified each time when:

◾     Giving medication

◾     Collection of samples

◾     Giving blood or its derivatives

◾     Do any tests

◾    Perform any other procedure

Second criterion:

Improving effective communication methods

The means of communication that most lead to errors:

◾     Verbal orders

◾     Telephone orders

◾     Receiving test results verbally or by telephone

Verbal orders:

It is administered face to face between sender and receiver

Telephone orders:

It is managed through the telephone between the sender and the receiver

Responsibility of the recipient of the message or order:

·       Writing the order or message while dictating orally or by telephone

·       Read the matter to the sender and wait for a response with a comment

·       If the matter is related to giving medicine, it must include the five basics

·       After reading the order, the receiver completes the order data by writing the date and time, the recipient’s name and position, the sender’s name and position, then signing.

·       In emergency situations, such as “cardiac arrest,” it is sufficient to repeat the matter to the sender and wait for a response with feedback

Responsibility of the sender or giver of the order:

·       Sign the order promptly

·       Spell the name of the medication if necessary

·       The numbers are dictated as they are pronounced, then each number is mentioned separately

·       Gives the command without using the abbreviation

·       Understanding and adhering to hospital policy:

·       The hospital accepts verbal and telephone orders within very limited limits when it is impossible to write them by the person responsible for them and if delaying them may affect the patient.

·       The sender and receiver must abide by their responsibility in this regard

·       The sender’s signature on the given order shall be made no later than 24 hours

Third criterion

Safety of using high-risk medications

Definition of high-risk medications:

·           They are those medications that, if used in an inaccurate and improper manner, may lead to serious injury to the patient or    death.

·           The most important of these medications:

·            Insulin - anesthetic drugs - anticoagulants - potassium chloride KCl and potassium phosphate -     sodium chloride solution more than 0.9

Why do errors occur and suggestions for preventing them?

Error prevention proposals	Reasons for the error to occur	Drug
[Develop and disseminate a bilateral review policy]	[Lack of bilateral review policy	[Insulin]
[Write “Unit” instead of U]	[Use the letter U to represent the number of units]
[They are placed in different and labeled shelves]	[Place the insulin container near the heparin container]
[Use self-programming or dual-review pumps]	[Incorrect programming of the solution pump]
[Coordination between them]	[Do not link insulin administration with meals]

[Error prevention proposals]	[Reasons for the error to occur]	[Drug]
[Limiting their presence to their designated places]	[Put them in the regular departments with the stock of other medicines]	[Drugs]  [And]  [Morphine]
[Develop and disseminate a narcotic drug policy]	[Lack of policy and procedure for its use]
[* Preparing printed medical orders explaining what is used in cases of mild to moderate pain]  [* It is necessary to have a doctor in case of severe pain]	[Using verbal or telephone orders]
[Use a pain assessment form]	[There is no way to evaluate pain]

[Error prevention proposals]	[Reasons for the error to occur]	[Medicine]
[Not to be placed in regular nursing departments]	[Presence in regular nursing departments]	[Potassium chloride]  [And]  [Potassium phosphate]
[Separate them in storage and preservation areas]	[Mixing the two medications]
[Unify focus]	[The preparation has not yet been labeled with the dosage and quantity]	[Anticoagulants]  [(heparin)]
[se single dose cntainers]	[Use multi-dose containers]
[Separation of the two medications]	[Confusion between heparin and insulin]
[Relating doses to laboratory results]	[Determine doses without relying on laboratory results]

[Error prevention proposals]	[Reasons for the error to occur]	[Medicine]
[Limiting his presence to care - operations - pharmacy]	[Its presence in regular nursing departments]	[Sodium chloride at a concentration of more than 0.9%]
[Develop and disseminate a bilateral review policy]	[Lack of bilateral review policy]

General instructions to reduce the risks of giving medications in general:

Read, understand and adhere to the hospital’s medication administration policy

General instructions to reduce the risks of giving medications in general:

·       Passing the “drug review” test, conditional on allowing treatment to be given

·       The presence of a pharmaceutical reference for some medications

·       Develop and circulate a bilateral review policy by two nurses

·       Linking the administration of some medications to laboratory results

·       Linking the administration of analgesics to pain assessment

·       Delete the presence of high-risk medications from the sections

·       Lack of medicines with similar packages and similar taste in one place

·       Place a clear label with the name in the place where each medication is kept and stored

·       Review the use of a two-way solution pump

·       After administering the treatment for the first time, the medication label is matched - according to the medical order - to the medication administration record sheet. When administration is repeated, the medication label is compared to the medication administration registration paper.

·       Identifying, recording, analyzing errors and finding out the reason is the way to improvement

·       The keys that help prevent errors when giving treatment:

·       Information about the patient

·       Information about the medication

·       Effective Communication

·       Labeling of drug packages: Medicines with similar packages or with a similar sound must be prepared when preparing their packages. Each package must be distinct so as not to confuse them (the presence of a single dose system is useful in solving this problem

·       Inventory: Providing the appropriate inventory in quantity and quality

·       Environmental factors: Having a system designed to administer medication contributes to reducing errors, for example, “good lighting - distance from noise and interruptions.”

·       Giving the patient appropriate instructions regarding treatment

·      Understanding and adhering to hospital policy:

·       Medicines are substances whose misuse may pose risks to patients

·       There is a group of medications that have been agreed upon as high-risk medications

·       These medications are not placed in regular nursing departments

·      When used, a double review is done before it is given

Fourth criterion

·      Ensure the operation - the correct procedure - the correct patient

·       Problems of the wrong patient - the wrong procedure and destination of the operation occur as a result of:

·       Ineffective or incomplete communications between health team members

·       Failure to involve the patient

·       Lack of policy

·       Patient assessment kit

·       Failure to review the patient’s file

·       Understanding and adhering to hospital policy:

·       The policy is consistent with international standards to prevent an error on the part of the operation, procedure, or patient, as follows

·       Determine the location of the operation

·       The mark is placed before the patient is anesthetized.

·       The mark will be visible throughout the procedure

·       The name of Maryam in triple and the medical number

·       The process and its destination

·       Signatures and dates completed

·      Pre-operation verification process:

·       Verify (the operation provider - the patient - the name of the operation...)

·       Verification is carried out by the department’s nursing staff members - the surgeon - the recovery nursing staff members - the anesthesiologist separately.

·       Verification is recorded in the special form and signature

·       Marked by the doctor or his assistant

·      Ensure the availability of supplies:

·       The surgeon must ensure with the operating nursing staff that:

·       Supplies

·       Safety of the devices used

·       Providing machinery

◾    Final verification  Time Out:

◾     It is done immediately before the procedure begins.

◾     It depends on team work and effective communication.

◾     The team consists of (surgeon - anesthesiologist - nursing staff members) whose purpose is to finally ensure that the correct procedure is carried out for the correct patient in the correct location.

Fifth standard

Reducing the risk of infection in hospitals

◾     The institution must establish a system that reduces the incidence of infection as a result of being in the hospital.

◾     The institution must adopt instructions and directives for hand hygiene.

◾     The organization must implement an effective hand care program

◾     Taking care of hand hygiene

◾     A simple, low-cost process that reduces hospital infection rates. Hand washing remains the best way to reduce the transmission of infection

◾     Hospitals’ obligation to wash hands is not applied effectively in all countries of the world, with variations.

Reasons for not adhering to hand cleaning:

◾     The number of employees is less than the usual ratios

◾    Allergy to the materials used in cleaning

◾     Insufficient information available to workers about the importance or method of cleaning and individuals’ behaviors towards protecting patients

◾    The following was noted regarding the commitment to clean hands:

◾     Doctors are less interested in cleaning hands

◾     Nursing assistants are the least concerned about cleaning hands

◾     Males are less committed

◾     Intensive care workers are less committed

◾     Workers with gloves are less observant

◾    From the employees’ questions, the following was learned: “Their statements”

◾    The materials used cause allergies

◾     Lack of sufficient sinks for washing hands

◾     Unavailability of soap

◾     Always busy

◾     Patients’ needs are more important

◾     We wear gloves

◾     There are no clear instructions

◾     The possibility of transmitting infection is small

◾     We don’t remember

◾   We did not see female trainers or supervisors doing this

Reducing the risk of infection in hospitals

What lives on the skin of the hands?

Colony microbes:

◾    It lives continuously on the skin and is usually not affected by regular washing, but it usually disappears when washed with disinfectants.

Temporary microbes:

◾     It sticks to the hands when dealing with patients, contaminated tools and devices, or the surrounding environment, and is often responsible for transmitting infections in hospitals and is usually removed by routine hand washing.

Ways to take care of hand hygiene

◾     Routine hand washing with soap and water

◾    Hands must be washed before and after:

◾       Performing any interventional procedure with the patient

◾        Dealing with any wounds

◾     Direct interaction “touching” the patient

◾     Routine hand washing with soap and water

◾    Removal of dirt – any organic materials

◾     Getting rid of temporary  microbes

◾     Hands must be washed before: - Serving any meal

◾     Leaving work - caring for patients with weak immune systems

How to wash hands?

◾     Remove any jewelry.  Turn on the faucet with your elbow or hand

◾     Wet hands with water, apply soap and distribute it on both hands

Follow the picture instructions. Rinse hands. Dry hands well with a single-use towel. Close the tap with the same towel. Reduce the risk of falling.

Sixth standard

Protection from fall risks

◾     A fall is a sudden and unexpected downward fall that may or may not lead to injury

◾     How can patients at risk of falling be identified?

◾     Evaluation is a process undertaken by nursing staff to collect data that helps identify the patient’s problems

◾     Evaluation is a procedure that involves several aspects, one of which is assessing the possibility of falling

◾     The purpose is to identify patients at risk of falling so that the necessary precautions can be taken

◾     The policy stipulates that all patients (departments - clinics) are evaluated for the possibility of falling

◾     You will use an evaluation form within an hour for department patients and within 10 minutes for clinic patients

◾     The evaluation is repeated once every 24 hours. Those with scores of 0: 44 are classified from simple to moderate, and the following precautions are applied to them:

◾     Familiarizing the patient with his surroundings - the suitability of what he wears on his feet - the bed in a low position

◾     Stabilize everything that is moving - good lighting - the patient’s personal needs are at his fingertips

◾    The nursing staff and telephone are working and in proper condition - the room is tidy and the floors are dry

Know the patient:

◾    How to call the nursing staff when needed - inform the nursing staff when feeling “dizziness - collapse.”

◾     Use any aid used by those who obtained 45 or more, as follows:

◾     Familiarizing the patient with his surroundings several times. Nursing staff are present to assist each time the patient is moved.

◾    The patient’s room is close to the nursing station - the bed is in the low position and good lighting stabilizes everything that is   moving

◾    Putting the patient’s needs at his fingertips

◾    The nursing staff pager and telephone are working and within his reach

◾     The room is tidy, the floors are dry, and there are no obstacles in the patient’s way

◾     The patient should not be left alone on a commode or wheelchair

◾     What is worn on the foot to prevent slipping

◾    The patient is asked every two hours during the day about his requests

◾    He is followed quietly while working

◾     The possibility of falls among nursing staff members is made verbally known when shifts are changed.

◾     This is written in the nursing notes

◾     The importance of these precautions is discussed with the patient’s family

◾     The patient is asked every two hours during the day about his requests

◾     He is followed quietly while working

◾     The possibility of falls among nursing staff members is made verbally known when shifts are changed.

◾    This is written in the nursing notes

◾     The importance of these precautions is discussed with the patient’s family

Seventh standard

Preventing disconnection or misconnection of catheters or tubes

◾    All connections are connected to the patient in the correct place.

◾     The name of the connection or catheter and the date of installation are written on it.

◾     The leads, catheters, and the insertion site are taken care of for signs of infection and other signs.

◾     The responsible nursing staff members place a sticky tape on which they write:

◾     The date the catheter or tube was installed

◾    Type of catheter or tube

◾    The size of the catheter or tube

◾     The person who installs the catheter or tube

◾    And evaluate the placement and connection of the catheter or tube according to its type and the purpose of its installation or  at ​​the beginning of work shifts and in the process of handing over and receiving.

Eighth standard

Preventing bed sores

Bedsores are one of the nursing problems that may occur in patients when they are not taken care of.

When the patient receives a new admission at the time of admission to the department and has bed sores, a declaration is written and signed by the patient or his companion stating that the patient has bed sores and of what degree they are.

The nursing staff responsible for the patient examines the patient at risk of developing bed sores and determines his degree of exposure to the occurrence of bed sores.

The treating physician and the responsible nursing staff determine the degree of the pressure ulcer in order to know the medical care plan required for the patient.

The doctor records the evaluation result in the patient's medical record

The patient exposed to bed sores is evaluated as follows

First degree:

Redness in the area prone to ulcers compared to normal skin color

Cover and protect the exposed area

Second degree:

Loss of the surface layer of the skin and the presence of a scarlet-red ulcer with the presence of white or yellow fluid sometimes.

Cover/protect the skin/moisturize and heal the area

Third degree:

The presence of a deep ulcer that includes the superficial layer of the skin and what lies beneath it / there is a white, gray or yellow fluid / there is an edge to the ulcer / there is a purulent discharge

Covering the skin/protecting it/moisturizing and healing ulcers/removing dead tissue/cleaning and treating infections/aiding healing

Fourth degree:

The presence of a deep ulcer that reaches from the surface layer of the skin to the muscles and bones / There is a foul odor / There is a brown or black secretion / There is a purulent secretion

Covering the skin / protecting it / moisturizing and healing ulcers / removing dead tissue / cleaning and treating infections / helping healing / filling the gap

Precautions to be taken to prevent bed sores

◾   If the patient is bedridden, he must use an air-filled mattress (air mattress).

◾  Use pillows between the joints (knees, elbows)

◾    Use soft, clean and dry furniture

◾   Avoid creating folds in the bedding under the patient

◾    Continuously monitor the skin (dryness, wetness, redness)

◾    Dry the body well after washing

◾    Eat a balanced diet.

◾    Consult a physical therapist regarding appropriate exercises to improve blood count.

Ninth standard

Risk management and patient safety

◾    Risk management is the other side of the patient’s safety and security. The risks that the patient may be exposed to in the hospital are identified, an analysis is made of them, and a method is developed for how to deal with them, solve them, and prevent them from occurring again.

◾    There are risks from people

◾    Risks resulting from interventions to which patients are exposed

◾    Risks from hospital infrastructure

◾    Risks arising from incorrect work system

The tenth standard

Delivery and pickup policy

the purpose:

◾    Communicating important information about patient care from one doctor to another, from one nursing staff member to another, or from one person to another during the patient’s medical service shift.

Politics:

◾    The commitment of the medical service providers during the work shift to provide and exchange general information about the patient while providing medical care to him. The head of the department develops a form for delivery and receipt that contains the important information that is exchanged between the medical service providers in his department. The medical service providers deliver and exchange medical information in Between them during the work shift, according to the relevant evidence and forms, information is exchanged between service providers during the exchange of work departments, with sufficient time to discuss information about the patient and provide answers to inquiries about the care or service required to be provided to the patient. The head of the department ensures the continuous implementation of the handover and receipt process in case Transferring the patient: Medical service providers exchange important information about the patient and provide answers to inquiries about the patient’s condition during the handover and handover process. The information that must be conveyed orally or through handover and handover forms is: the patient’s name, age, date of birth, and address. Diagnosis. History. Patients. Allergies. Medications/food/fluids. Tests. / Tests, previous and planned operations, the patient’s health care plan within 24 hours, the tests and analyzes required to be performed, the procedures required before the patient is discharged.

The eleventh standard

Isolation and restriction policy

·       The Patient Care Law guarantees the patient his right to enjoy his freedom and not be restricted or isolated in accordance with Article (36) of the law unless the emergency situation requires it. Isolation or restriction is considered an exceptional situation that the treatment team does not resort to as part of the treatment plan because the principle is to avoid and use them. After exhausting the means that least restrict the patient's freedom.

·       The patient’s emergency situation is represented by the emergence of aggressive behavior or disturbed behavior that threatens his safety or the safety of others around him and constitutes an imminent danger that cannot be controlled or contained by means that are less restrictive of his freedom (such as reassuring the patient, using positive reinforcement, or modifying the environment surrounding him).

·       Isolation and restraint procedures are not applied except by direct order from the responsible physician or his representative within the facility who has experience in applying these procedures.

·       The therapeutic team performing the isolation or restraint must be professionally trained in both procedures and possess the skills that qualify it to carry out them, taking into account the application of internationally approved standards.

·       Isolation or restraint procedures must be carried out according to methods that are psychologically and physically safe and preserve the patient’s dignity.

·       Isolation or restriction measures must not be a means of coercion, discipline, comfort or retaliation on the part of the treatment team.

·       Isolation or restraint procedures shall be carried out for a specific time and must be terminated immediately when the reasons that necessitated their application have ended, provided that the period of isolation or restraint for adults does not exceed 8 continuous hours in accordance with the provisions of Article (36) of the executive regulations of the law, subject to renewal, but after another debate and a new examination. For the patient through the responsible physician or his representative. Renewal requires the continuation of the emergency situation, and it is preferable that the time specified for the isolation or restriction procedure be in accordance with international standards as follows: -

◾      4 hours for adults (18 years or older)

◾      2 hours for teenagers (9-17 years old)

◾     One hour for children under 9 years old

·       A patient subject to restraint or isolation reserves the right to see an official of the Patient Rights Committee and also has the right to file a complaint.

Insulation:-

It is detaining the patient against his will in a room or area designated for that purpose, isolated from others, so that he cannot leave it, provided that the place conforms to all internationally approved specifications for isolation rooms.

Restriction:-

It is limiting the patient's movement and its types:

Manual restriction:-

Manually or physically, the patient is contained with the least amount of force by stabilizing his arms and legs, avoiding pressure on his back and neck, and keeping his position lying on his back as much as possible.

Mechanical restraint:-

What is meant is the use of tools or devices to limit the patient’s movement so that they are close to his body to such an extent that he cannot easily escape from them, and also allow him little freedom of movement. They are safe and provide the patient with physical and psychological protection. They protect the patient from falling. They are easy to adjust and do not waste the patient’s dignity. They do not require In fixing it until surgical intervention, it allows for quick termination when an emergency occurs in the patient's surroundings.

·      When restraining, one person is required on each limb and another for the patient’s head. The patient is placed lying on his back in the bed, and each ankle and wrist are tied so that he is tied to the bed from four sides. Soft restraints are used such as gauze, leather restraints, or medical belts according to the desired degree of immobilization and the patient’s condition, and they are not used. Apply restraints to the chest, neck and head.

To apply isolation or restriction procedures, the following steps must be followed:

·       Observation of the patient by the therapeutic team present with him in terms of behavior and actions and the speed of predicting the presence of an imminent danger as a result of his behavior.

·       The treatment team (usually the department’s nursing staff) monitors any aggressive behavior in the patient or severe agitation that threatens his safety or the safety of others around him and evaluates it professionally, not personally, towards the patient.

·       Attempting to use the least restrictive means of the patient’s freedom, and after exhausting them and being unable to control the emergency situation, the treatment team resorts to containing the patient and trying to control his movement with physical restraint only. It is not permissible to isolate the patient or restrain him chemically or mechanically except by direct order from the responsible physician or his representative. about him.

·       Fill out the paragraph related to the nursing staff member’s report on the emergency case in the isolation and restraint form

·       Call the responsible doctor or his representative immediately to discuss the case and do the following:

◾      Examine the patient clinically (psychologically and physically)

◾      Evaluate the extent of the risk and whether it requires the application of isolation or restraint measures, and attempts to control it by means that least restrict the patient’s freedom.

◾      Informing the patient of the reasons that necessitated isolation or restriction measures, the danger of his behavior to himself and others, and quickly ending the procedure if the reasons necessitating it do not exist.

·       The responsible physician or his representative must complete the form for isolation and restraint, which includes:

◾      Clinical examination of the patient, psychological and physical

◾      Risk aspects and severity

◾      Less restrictive means that have been exhausted

◾      The specified period of isolation or restriction

◾      The type of procedure that will be decided for the patient

◾     Description of the prescribed method of isolation or restraint, for example (the place of isolation is the patient’s room or another room - the mechanical restraint, the nature of the tools used in the procedure and how they are used and distributed among the parts of the body)

◾      Determine the start and end times of the procedure in isolation or restraint

◾      Pointing out the necessity of observing critically ill patients such that their condition requires special care, for example: patients with respiratory system diseases, heart diseases, and obese and overweight patients.

◾      The responsible physician or his representative must state his name, signature, and the date of the procedure

◾      The procedure is carried out under the direct supervision of the responsible or on-duty physician and in the presence of one of them

◾      Identifying the cases and circumstances that require the treatment team to terminate the procedure

◾      The responsible physician or his representative must review the patient’s treatment plan and update it according to the patient’s clinical condition and the circumstances surrounding him to avoid a recurrence of the emergency.

·       A member of the treatment team is assigned to observe the patient face to face around the clock throughout the specified period of isolation or restriction, and to follow up on him every 15 minutes and record the following: -

◾      Injuries that the patient may have suffered during the procedure

◾     Vital signs, respiratory rate, nutrition, skin color, behavior, and general condition

◾     The condition of the blood test in the places of registration (pulse, skin color)

◾      Frequency of movement, provided that restrictions are lifted every two hours for 10 minutes

◾      Provide him with fluids for two hours and record his intake

◾      The patient is given two hours of opportunity to excrete (urine, stool) when needed

◾     It allows the patient to sleep and provides him with protection and comfort during sleep

◾      Ensure that restrictions are placed in their correct places and amended when necessary

◾      Protecting the patient from harm by others (verbal and physical) during the procedure

◾      Observing the patient’s ability to understand the procedure, his ability to adapt to it, and the form of his behavioral response

◾      The name of the nursing staff member performing the procedure and observation must be recorded on the isolation and restraint form

·       The hospital is committed to creating a special record of isolation and restraint procedures, which records:

◾      Patient’s name, registration number, admission date

◾      Type of procedure, date, and duration

◾      Name of the responsible physician and nursing staff member performing the procedure and observation

·       The record is presented to the medical director daily, and the hospital administration is notified of this action as soon as it is taken during working hours or immediately the next morning when it is applied in the shift.

Reasons for ending isolation or restriction measures:

·       The signs of danger that necessitated applying the procedure have disappeared and the emergency situation has disappeared

·       The success of one of the least restrictive means of the patient’s freedom to control and modify the patient’s behavior

·       The appearance of signs of deterioration in the patient’s organic condition requires terminating the procedure

The occurrence of an emergency in the vicinity of the procedure that prevents its completion

Characteristics of good recording and reporting:

Accuracy, clarity and honesty in recording.

The data must be complete, correct, neatly arranged and objective.

Accuracy of timing when reporting certain important information, incidents, or disasters that cannot be postponed, as reporting must occur immediately and at the specified time.

The report must end with the signature of the informant or writer, the date, and sometimes also the time.

Reports:

A report is an oral or written message, the purpose of which is to convey information about a specific topic or incident for recording, reporting, or to take a specific action. Usually, reports are submitted from the subordinate to the superior on a regular basis and at specific times, with the exception of accidents and disasters, which are reported immediately upon their occurrence.

A good report is one that conveys information in a clear and precise manner, using simple sentences and without repetition - using clear words that do not have ambiguity or carry more than one meaning - avoiding the use of the passive voice - choosing appropriate words that clarify the purpose - while ensuring accuracy in writing.

Taking into account that there is sufficient time for drafting and review before signing, a copy of the report must be kept for reference when necessary.

The report usually consists of the following parts:

Name of the person or entity to whom the report is sent

Report title - It must be brief, clear, and indicative of the subject of the report

A simplified summary of the topic

The introduction includes a quick presentation of the history of the topic, its development, and the special circumstances surrounding it in terms of time, place, and people

The body of the report - or the main part of the report, which includes a complete presentation of the topic based on observations, interviews, and documents

The conclusion reached by the report writer and his personal opinion for treatment or solutions

Conclusion and recommendations

Signature and date

There are many types of reports:

Including printed and unified forms in all hospitals and units, such as statistical reports, reports attached to samples for laboratories, or a request to perform x-rays...etc.

There are also verbal reports, such as those reported by nursing staff members to their colleagues on the next shift, such as the condition of a specific patient or a special treatment that needs to be performed. It is preferable that this information be recorded in a written report as well for reference when necessary.

Methods of communication from the boss to the subordinate (from top to bottom) are in the form of administrative orders or instructions - a work manual - sections for the bulletin board - and sometimes they are in the form of verbal instructions.

Most written communications that go down from management to workers are issued in the form of administrative orders, work manuals, bulletin board sections.

As for written data and information that come from workers to the top, they may include statistical data and information about the quantity and type of services, and written reports from subordinates to superiors may affect service planning and decision-making to solve problems, resulting in the achievement of goals. Good management gives instructions and directions to workers about the quality of data. The statistical information that must be included in the report for each nursing department or unit.

As for the reports prepared by supervisors or head nurses and inspectors, they are usually related to solving problems, what has been done and what should be done, as well as an evaluation of current production and quality of care, along with presenting suggestions to solve problems that are outside their control and authority. Written reports can be kept as documents and a source that can be referred to if they contain Provides correct, accurate and real information.

Reports related to nursing services management:

1- Shift receipt and delivery report:

Necessary as a means of communication to transfer and follow up information from one group of nursing personnel to another group during daily work 24 hours a day. These written reports provide nursing staff with observations about patients and what happened to them during the period preceding their work. The importance of this report is that a large number of nursing personnel and members The health team meets with the head nurse to give the necessary data before writing the report, raise any questions, and reach clarifications and solutions to problems. The shift report makes the nursing staff aware of what happened.

2- Daily report:

This report is written by the hospital’s head nurse to the director to inform him about:

General condition of the hospital.

Statistics of patients who had changes or complications.

Cases of patients who have undergone changes or complications.

Patient cases that follow specific treatment or research.

Entry, exit, transfer and death cases.

critical cases .

The plan to be followed in the event of an emergency.

All cases with high fever, especially after birth.

Complaints from patients or service users.

There are many forms of this type of daily general report.

3- Patient census report:

It is the official number of patients in the inpatient department or in hospital departments at a specific time, usually at midnight. The nursing personnel who are awake are responsible for writing this report, and its purpose is to know the number of patients in the inpatient department at any time, the bed occupancy rate, and the number of empty beds.

4- Reports on work problems and the extent of progress in following the proposed solutions:

Writing reports on work problems and giving recommendations for solving them is an effective tool for obtaining facts and helping to direct discussion of a particular problem in meetings, as well as providing guidance for the follow-up system.

These reports also help other nursing personnel, all members of the health team, and superiors in knowing the real reasons behind these problems, so that they can confront similar problems that occur in the future and when evaluating progress in solving these problems and achieving the desired goals of the work.

The following must be followed when writing reports on work problems:

Definition of the problem and its size.

Giving an accurate statement of the errors and what needs to be fixed.

Analyze the reasons that led to these errors.

Remember the roots of the problem as the report writer sees it.

Proposed solutions to eliminate the causes of the problem, along with clarifying the people who will implement the solutions

5- Reports on accidents and emergency situations:

One of the responsibilities of the nursing staff is to maintain the safety and well-being of patients and users of health services in hospitals and health units

They are responsible for implementing and following up on the treatment and nursing plans for these patients, as well as for avoiding accidents and dangers that may occur in hospitals and health units. In order to provide insight and determine the duties of nursing staff members in the event of disasters or an emergency, they must be introduced to the hospital or unit system and how to inform their superiors. Work when internal disasters occur, as well as how to carry out their duties in response to them.

Therefore, one of the most important duties of the nursing services department in hospitals and health units is to follow a special system for reporting the occurrence of such errors and accidents as soon as they occur, and to alert and train nursing staff members when they take up work on the necessity of reporting these errors and accidents to those responsible. One of the most effective methods of reporting is writing reports on accidents and emergencies.

Reports of medication administration errors:

Such errors may occur from members of bodies that deal with issuing, preserving, or administering treatment to the patient, such as nursing staff, pharmacists, and technicians. This may indicate that they did not follow the necessary procedures of the hospital in giving and dispensing treatment. This may also be an indication that the doctor’s orders are necessary. It must be written accurately and clearly, and the pharmacy instructions written on the packaging must also be written accurately and clearly.

Analysis of reports on accidents that occur to patients during their stay in the hospital or their visit to health units shows a lack of accuracy on the part of those responsible for caring for the patients. For example, negligence in not following the instructions issued by the head nurse regarding the operating room, which must be followed by the nursing staff and doctors, such as counting the technician’s towels before closing the wound. During the operation, the shortage of these pads is discovered before the opportunity is too late, so that the hospital bears this responsibility alongside the doctors and nursing staff.

Likewise, accidents may occur for workers due to failure to follow the appropriate method and methods at work. For example, when linens are not checked before putting them in their container to be sent to the laundry, the laundry workers may be exposed to injury from quickly leaving scalpels or sharp tools in them.

For each of these examples, it appears that the members of the nursing staff have an important role in preventing accidents and mistakes that may result to patients and workers, which may happen to the patient while he is in the hospital. Therefore, reports on the patient’s physical and mental condition must be recorded in the patient’s file and notified to the head nurse and the doctor. Whoever is responsible at the time, such as the appearance of bed sores or lice infestation, as well as an unwanted reaction to a treatment such as the occurrence of chills (shivers) when giving intravenous solutions or injections, must be recorded and reported to the specialist as incidents and recorded in writing in a report.

The report of emergency incidents and treatment errors includes the following:

Patient's name and diagnosis.

Date of entry, frequency, or visit.

Time to notice and report the situation.

What was done to prevent the condition from occurring?

The circumstances of the situation, its dimensions, and the unusual factors that affected the environment at the time the situation occurred.

Steps taken to correct the situation and remedy the error.

Date, signature of individuals writing the report.

Suggestions from the head nurse to prevent such an error from occurring and are sent to the director of the hospital or health unit.

6- Reports on patient complaints:

The patient's complaint must be reported immediately to the head nurse, and it is important for both the nursing team leader and its members to become aware of the patients' complaint and their relatives from the beginning of the complaint so that it does not escalate and so that it facilitates the study and analysis of nursing plans to find appropriate solutions at the right time.

It is possible that complaints submitted by patients and their relatives regarding the quality of services provided constitute a kind of effective participation in directing these services in the interest of patients, workers, and the institution alike, by involving the patient in implementing the plan drawn up to care for him. Therefore, nursing staff members must consider the complaint objectively. The patient is assisted in accepting the necessary adaptation while he stays in the hospital, implementing his treatment, and accepting health instructions.

Such a report includes the following:

The content of the complaint and its justifications as stated by the patient.

Actions taken to resolve the complaint.

The result .

Date and signature.

7- Administrative reports:

Sometimes the executive authority and directors of hospitals and health units request writing and submission of monthly, quarterly, or annual reports from each department or unit of the institution or hospital. The Nursing Services Department may request written and departmental reports from the heads of nurses and nursing units in the hospital. Likewise, nursing inspectors often request monthly reports from Head nurses of health units.

Such a report includes the following:

A brief account of the unit’s activities, the type of nursing staff, the number of working hours and shifts, and statistics on births, admissions, discharges, deaths, and home visits.

Current capabilities of machines, tools and maintenance status.

Problems affecting nursing care in terms of manpower, environment, machines and tools.

A narration of the reasons for bringing about a change in the work pattern in terms of labor or resources and the result of this change, giving evidence and indicators that prove these changes and their results.

These reports must be taken seriously by the superiors and their results must be followed up until the required changes are made to raise the level of services in health units. If they are not taken seriously, these reports are considered a waste of time and energy and become unproductive...

- Records and Reports

The Definition

Records are an administrative tool used to preserve and arrange information and prevent its repetition. They contribute to achieving the goals of administration, the educational process, and conducting scientific research.

The following are the different types of records used in hospitals and nursing units:

1- Patient file:

It is the document that indicates the quality of health care given to patients or beneficiaries of health services. It includes information pertaining to the patient since his admission to the hospital or his first visit to the health unit, as well as his laboratory tests, observations, details of therapeutic procedures, as well as the patient’s reaction to the treatment and services provided to him.

It also contains records of consultations for treatment and surgical operations.

There are also separate papers to record treatment and medications.

They are not only records to collect information about the patient, but they are also considered a legal document used when necessary in judicial cases, and therefore the data contained in the patient’s file has a privacy character.

There are many efforts being made to raise the level of efficiency of using records as an administrative tool at all levels of health services.

The patient's record (file) is used for the following purposes:

Helping to reach diagnosis and treatment.

Recording the services provided to the patient.

Contributing to education and conducting research.

It is used as an important legal document in cases brought before the judiciary.

It is used in quantitative and qualitative analysis when evaluating services.

Responsibility of nursing personnel regarding patient files

Organizing and arranging the records of new patients and patients, provided that these files include the following:

Complete personal data for patients and visitors.

Forms for vital signs and observations of nursing staff.

Laboratory forms, x-rays, and other records for specialized departments.

Treatment papers.

Responsibility of the unit head nurse towards keeping patient records:

Records must be kept in a safe place away from tampering and loss.

Do not give records to others unless the patient is referred for study or to the treating physician.

Do not delete any paper from the patient’s or patient’s file for any reason.

No one, including relatives, friends or families of patients, is allowed to read the records except with written permission from the director of the hospital or unit.

Providing guidance and training to new nursing personnel on how to take complete and correct notes.

When the patient is discharged, you must ensure that the record is organized, correct, and complete before sending it to the office responsible for its preservation.

Patient records and reports must contain the patient’s progress from his admission until his exit from the unit, and the details must be sufficient so that it is easy to use in following up on the patient’s condition whenever necessary, as well as when conducting scientific research.

2- Records for recording nursing personnel’s notes:

This includes recording accurate observations about the patients’ condition and the nursing care given to them. It also includes special information related to medications, treatment, food, and health instructions, as well as recording notes about the patient’s physical and psychological condition, the patient’s reaction to treatment, the extent of his adaptation to the disease, and any change that may occur in his condition.

The purpose of this record:

·   There should be a unified record agreed upon by all employees in one hospital for writing notes by nursing personnel to facilitate the transfer of responsibility between nursing personnel during different working hours.

·   Facilitating the rapid review of the patient’s condition and the performance of nursing care.

·   Emphasize the importance of recording nurses’ notes.

3- Records of distribution of duties to members of the nursing team:

·  It includes the names of the nursing staff members working in the unit and the names of the patients assigned to their care, as well as the special duties assigned to each of them. There must be a unified form that is filled out daily by the head of the unit’s nursing staff, and this record must be placed in a clear and known place for everyone.

·  The duties distribution record includes the following:

·   Name of the responsible nursing personnel.

·   Patient name .

·   Diagnosis.

·   Needed nursing care or special treatment and research.

·   The type of duties that nursing staff members are responsible for, such as assisting the doctor in examining or giving treatment to patients.

·   As well as special duties such as preparing to give injections or preparing a dressing cart for wounds.

The purpose of this record:

·   Inform the nursing team members working in the nursing units in hospitals and health units in writing about their daily responsibilities.

·   Determine nursing responsibility for each patient.

·   A basis for evaluating the nursing care given to patients.

4- Shift tables:-

·   It is a record that is prepared weekly and daily and specifies the plan drawn up to cover the nursing and health unit with nursing staff over a 24-hour period and includes the following:

·   Names of the unit’s nursing staff.

·   The different levels of nursing staff members are in groups over the course of a week with a detailed 24-hour schedule on the number of shifts.

·   The name of the head nurse in each shift.

·   Rest days, sick leave, excuses and absences.

·   Meeting times, rest hours, and lunch.

The purpose of this record:

·   It explains the coverage of the units with the nursing workforce and the extent of its adequacy.

·   The presence and absence of nursing staff members in the unit is recorded daily.

·   It gives information about all nursing services in relation to the numbers and levels of the workforce

·   It also shows the number of working hours for all nursing personnel

- Custody inventory records:

·   Labeled records for all devices, furniture, tools and machines, identifying the quantity, specifications and condition of each.

The purpose of this record:

·   Providing the head nurse with information about tools that are missing, broken, or need to be repaired

·   Return the excess to its appropriate place, as well as the borrowed tools, before counting or inventorying the item.

Employee performance evaluation records:

·     These are records used to evaluate employees’ performance annually or every six months.

·     the purpose :

·   An objective basis on the basis of which employees are promoted and given rewards and incentives.

·   An incentive for employees’ professional advancement.

·   It explains the reasons for poor performance and gives recommendations for good work.

7- Time tables:

For routine and non-routine work.

The Purpose :

·     It shows the time when activities occur, which are daily, weekly and monthly.

·   Daily schedules show the times when the unit’s routine activities occur.

·   Monthly time sheets such as when to submit monthly reports and orders.

Types of records

·  Delivery and pick-up

·   Department records book

·   The custody book

·   A notebook of unexpected events

·   Maintenance book

·   Malfunction book

·   Entry and exit book

·   Work and tasks distribution book

·   Emergency vehicle delivery and delivery book.

·   Delivery and receipt book for sterilization.

·   Patient treatment notebook.

·   Medical report book.

·   Medication dispensing book from the pharmacy.

·   Radiology order book.

·   Furniture notebook.

·   Daily cash register.118