NIGHTINGALE INSTITUTE OF NURSING

A REPORT

ON

SUMMER FIELD EXPERIENCE AT

ESIC HOSPITAL,

NEWDELHI

CHAUDHARY CHARAN SINGH UNIVERSITY

MEERUT (U.P)

Ms DIVYA THOMAS

M.Sc. NURSING II YEAR

ROLL NO:

8
SUMMER FIELD STUDY REPORT

PRACTICAL RECORD FILE

NAME OF THE STUDENT : MS. DIVYA THOMAS

ROLL NO :

BATCH : 10th Batch 2019-2020

INSTITUTE : NIGHTINGALE INSTITUTE

OF NURSING

ADDRESS : C-23, SECTOR-62, NOIDA

8
 ACKNOWLEDGEMENT

I would like to thank all persons who have been instrumental in successful completion of
this project report.

I would like to express my deepest sense of gratitude to Mr Ashok Jain sir, Director
Nightingale Institute of Nursing and the management for providing the administrative
support for the summer field experience.

My sincere thanks to Prof. Mrs. Lavanya Nandan mam, Principal Nightingale Institute of
Nursing Noida for her valuable help in providing timely support and guiding us for the
summer field experience.

I owe my sincere thanks to Mrs. Kapeelta Devi mam, Associate Professor and M.Sc
Coordinator , Nightingale Institute of Nursing Noida for the noble guidance and invaluable
suggestion, and encouragement throughout the project.

I extent my heartfelt thanks to Ms Glory mam,head of the department, psychiatric

nursing ,Nightingale Institute of Nursing, Noida for the advice and guidance throughout the
project

I would like to take this opportunity to thank all the HOD of various department of
Nightingale of institute of nursing and heartfelt appreciation also goes to all the non-
teaching faculty of the institution.

Appreciation is expressed to the ESI hospital staff for granting the permission and
providing necessary help throughout the project.

I am indebted to offer my gratitude to them all who had been with their exceptional
consideration and constant assistance rendered to me, for giving final shape to this report, It
is a great honour and privilege to be guided by them.

Above all I express my deep sense of gratitude to almighty God who was a guiding force
behind all my efforts with their invisible presence.

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ESIC HOSPITAL, NOIDA

8
 INDEX

S.NO CONTENT PAGE NO

1 SECTION 1

 INTRODUCTION AND OBJECTIVES

 INSTITUTIONAL PROFILE
 PHYSICAL LAYOUT

2 SECTION 2

 ADVANCED COMPETENCIES GAINED IN

NURSING PRACTICE

3 SECTION 3

 FURTHER ABILITIES IN MANAGEMENT AND

SUPERVISION IN CLINICAL AREAS.

4 SECTION 4

 PROBLEM SOLVING ABILITIES.

 ANALYSIS AND INTERPRETATION OF
FINDINGS

5 SUMMARY AND CONCLUSION

Signature of the HOD Signature of the Principal

8
 INTRODUCTION

Summer filed experience report is a brief report on activities carried out as a requirement of
the M.Sc 2nd year in the area of mental health and psychiatric nursing speciality. The
experience carried out under the eminent guidance of the nursing experts of respective field,
at ESI hospital which is located at Noida.

People are the vulnerable to many health problems in India. The medical science is
advanced day by day. For early detection of complication and treatment of those various
diseases, need more research and current knowledge of medical science as well as use of
modern equipments. Hospitals in any of the area provides good preventive, curative and
promotive care to the people and ESI hospital , Noida is one of the equipped hospital with the
advanced diagnostic and curative facilities. The recent progress by the government of India is
the preventive, promotive and curative approach by running various types of programmed for
the eradicating the various types of diseases. According to W.H.O the health is a complete
mental physical and social well being and not merely the absence of any infirmity.

The hospital is providing better care to the people with having well equipped articles and the
personnels. They are taking parts in various programmed run by central government and ESI
hospital.

Objectives of the summer field posting-

After completing the experience the student will be able to-

1. Gain knowledge regarding the organizational setup and functioning of the unit .

2. Gain advanced competence in nursing practices in the area of specialization.

3. Develop further abilities in management and supervision in clinical area.

4. Develop problem solving ability in clinical area to improve nursing care practice and
management of care.

5. Gain competencies in report writing.

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S. NO GENERAL SPECIFIC PLAN OF ACTION RESOURCES
OBJECTIVES OBJECTIVES

1. Discuss the • To learn about the Identify the source of  Medical

institutional historical information about the Superintendent
profile background of the organization.
organization.
• Introduce self to the  Nursing
• To explain about head of the institution. Superintendent
philosophy and
objectives of the • Discuss the  Matron
organization. objectives of summer
field experience
• To get oriented to  Sister In
various department • Enquire the Charge
in the organization. historical background
and development of
• To explore institution.
organizational set up
of the institution • Draw the
organizational chart. •
Enquire about the
services offered by the
institution.

8
2. Gain advanced • To select an area Select an area from • Doctors
competence in for specialization Pediatric unit • Staff Nurses
nursing skillfully and • Assess the patients
practices in the competently. admitted in the
area of specialty unit.
specialization • To provide
comprehensive • Identify the various
nursing care to the type of Neonatal
patients in the unit. pediatric cases.

• Observe the work of

nursing staffs as well
as other health care
team members.

• Take up clinical
topic related to patient
care

3. Develop further • To know about the • Assess the  Nursing

abilities in working pattern of supervision provide by Superintendent
supervision and staff nurses of the nursing  Sister in charge
management in respective wards. superintendent.  Doctors
clinical area. • Observe the  Staff nurses
• To learn about the supervision and
formulation of duty managerial work done
roster. by the sister in charge.
• Observe their
• To know and learn competency of nurses
about the in the particular unit.
maintainance of the • Find out various
records and reports. protocol and
standards.
• Assess care provided
to the patients.
• Enquire the staffing
pattern of each unit.
• Assess the
management of the

8
 department.

• Assess the
management of the
personnel.
• Assist the nursing
superintendent in her
work.
• Observe the work
done by various grade
of nursing personnel.

• Observe the pattern

of shifting duty.
4. Develop • To identify the • Assess the existing  Nursing
problem existing problem. problem from the Superintendent
solving in different wards of the  Assistant
clinical area to • To find out the Pediatric Department. Nursing
improve problem solving Superintendent
nursing care. approach in the • Identify the  Sister In
management of the alternative solutions Charge.
existing problem. for the problem.  Staff Nurse.

• Take permission
from the authorities.

• assess the knowledge

regarding existing
problem.

• Analyze and
interpret the result.

5. Develop To organize the • Prepare a brief report  Nursing

competency in available material in of field experience. Superintendent
report writing writing and  Assistant
reporting. • Write report of Nusrsing
problem solving Superintendent
approach.  Matron
 Staff Nurse
• Present a brief report
in classroom.

• ask for the comments

and suggestion from

8
 faculty and
classmates.

• submit the final

report to respective
teacher.

8
 Section –I

INSTITUTIONAL
PROFILE

SECTION 1

Contents

1 Employees State Insurance Scheme Of India 4

8
 Introduction,Vision ,Missions

2 ESIC Hospital, Noida 13

Underneath it all

3 Committees 20

4 Departments 24

5 Medical Care 25

6 Budget Planning 29

7 Purchase Of Materials 30

8 Kitchen Department 33

9 Training 35

10 Common problems 36

11 Observations & Suggestions 38

12 Physical layout 40

Employees State Insurance scheme of India

Introduction

VISION: To be a role model in providing Social Security coverage to workforce in the

organized sector

MISSION: To provide specified Social Security coverage to workers in organized sector

8
OBJECTIVES: • To expand the network of ESI Scheme (New implementation) and to
implement the 
provisions of ESI Act, 1948 (Compliance) 
• To create fund and ensure its utilization/deployment for sound financial health of the 
scheme 
• To create adequate infrastructure for providing medical services 
• To encourage State Govt. for providing proper medical care services at ESIS Hospitals & 
Dispensaries 
• Framing Budget showing the probable receipt and expenditure 
• Improve Compliance with the Financial Accountability Framework 
• Enhanced Transparency/Improved Service Delivery of Department (Service Level 
Benchmark / Evaluation of ESIC Hospitals) 
• Awareness of ESI Scheme to the stakeholders FUNCTIONS: • Enhancing efficiency in
collection of contribution 
• Arrange Medical Care Services to the ESI beneficiaries 
• Disburse Cash Benefit to IPs/Dependents under different benefits 
• Implementing ESI Scheme to new areas 
• Surveys and Inspections of factories/establishments 
• Recruiting manpower 
• Organizing Awareness Program among the stakeholders 
• Organizing Training for its personnel 
• Implement Information Technology 
• Public Grievances Redressal 
• Construction of Dispensaries/Hospitals etc. 
• Internal Audit Inspections 
• Annual valuation of assets and liabilities

8
STATEMENT

To provide for certain benefits to Employees in case of sickness, maternity and employment
injury and to make provisions for related matters.

INTRODUCTION:

Employees State Insurance scheme of India is an integrated social security scheme tailor to
provide protection to workers in the organized sector and their dependents in the organized
sector and their dependents in contingencies, such as, sickness, maternity or death and
disablement due to an employment injury or occupational disease. Towards this objective the
scheme of health insurance provides full medical facilities to insured the person and their
dependent, as well as, cash benefit to compensate for any loss of wages or earning capacity in
times of physical distress.

APPLICABILITY OF THE ESI ACT:

The ESI Act, (1948) applies to the following categories of factories and establishments in the
implemented areas:-

 Non-seasonal factories using power and employing ten(10) or more persons

 Non-seasonal and non-power using factories and establishments employing twenty

(20) or more persons.

The “appropriate Government” State or Central is empowered to extend the provisions of the
ESI Act to various classes of establishments, industrial, commercial, agricultural or otherwise
in nature. Under these enabling provisions most of the State Governments have extended the
ESI Act to certain specific classes of establishments, such as, shop, hotels, restaurants,
cinemas, preview theatres, motor transport undertakings, news paper and advertising
establishment etc., employing 20 or more persons.

ORGANISATION:

8
As provided under ESI Act, the Scheme is administered by a duly constituted corporate body
called the Employees State Insurance Corporation (ESIC). It comprises members
representing Central and State Governments, Employers, Employees, Parliament and the
medical profession, Union Minister of Labour functions as Chairman of Corporation where
as the Director General, as its chief executive, discharges the duty of running the day-to-day
administration.

A Standing Committee representing all stake holders is elected from the body corporate for
managing the affairs of the scheme and monitoring the progress of implementation of various
corporate decisions and policies etc. from time to time.

The Medical Benefit Council, a statutory body advises the corporation on matters related to
administration of medical benefit under the ESI scheme.

INFRASTRUCTURE

The central headquarters of the Corporation is located at New Delhi. For purpose of
coverage, revenue collection, extension of the scheme to new classes of establishments,
implementation of the scheme in new areas, coordination’s the Corporation has established
Regional and Divisional Offices across the country mostly located in the state capitals.

Given the huge number of beneficiaries- about 354 lakhs now the Corporation has set up a
wide spread network of service outlet for prompt delivery of benefits in cash kind that
includes full medical care.

Medical facilities are provided through a network of 1422 ESI Dispensaries, over 2000 Panel
Clinics, 307 diagnostic centers besides 144 ESI hospitals and 42 hospital annexes with over
28000 beds. For providing super-specialty medical care the Corporation has tie up
arrangement with advanced medical institution in the country, both in the public and private
sector. The medical benefit is administered with the active cooperation of the State
Governments.

The payment of cash benefit is made at the grass roots level through as many as 825 Branch
Offices and Pay Offices that function under the direct control of the corporation.

CONTRIBUTION

8
The ESI Scheme is mainly financed by contributions raised from employees covered under
the scheme and their employers, as a fixed percentage of wages. As of now, the rates of
contribution are:-

I. Employee’s Contribution : 1.75 percent of wages

II. Employer’s Contribution : 4.75 percent of wages

 Employees earning up to Rs. 50/- a day as wages are exempted from payment of their
part of contribution.

 The State Government bear one-eighth share of expenditure on Medical Benefit

within the per capita ceiling of Rs. 900/- per annum and any additional expenditure
beyond the ceiling.

WAGE CEILING

Employees of covered units and establishments drawing wages upto Rs. 10.000/- per month
come under the purview of the ESI Act, 1948 for multi-dimensional social security benefits.

AREAS COVERED

The ESI Scheme is being implemented area-wise by stages. The Scheme has already been
implemented in different areas in the following States/Union Territories

STATES
All the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and Mizoram.

UNION TERRITORIES 
Delhi, Chandigarh and Pondicherry

BENEFITS PROVIDED BY ESI

Medical Benefit:

8
An insured person and his dependent family member become eligible t claim medical
facilities under the E.S.I. Scheme from day one of entering insurable employment.

For availing the medical facility for self or any of the declared dependents an insured person
has to produce the temporary identification certificate issued by the E.S.I.C Branch Office on
taking insurable employment. This temporary identity certificate is thereafter replaced with a
family photo identify card that caries the photographs and other particulars of the family
member and the insured person. Failure to obtain the permanent card or its non production at
dispensary/hospital can result in deprivation of medical care.

It is also to be born in mind that dispensary is the base point for availing medical facilities.
The reference for specialist treatment of diagnostic investigations is made by the ESI
dispensary itself to the concerned hospital. It is only in extreme emergency or at odd hours
when the dispensary is closed that the insured person can report at the emergency dept of an
ESI hospital directly but should not fail to produce his/her photo identity card.

All medicines are issued free of cost by the dispensary to which an ISP is attached. However,
in case of non-availability of prescribed drugs at the hospital an insured person can purchase
the medicines from local market if so advised and submit such claim to the dispensary for
reimbursement.

Sickness Benefit:

A claim for sickness benefit can be made only on the basis of Medical Certificate issued by
the authorized doctors under the Scheme. In exceptional cases alternative evidence of
sickness or temporary disablement is accepted by the Corporation.

1. An insured person is required to deposit his medical certificate in the box provided at
the dispensary. Or he should ensure that the certificate is presented to the branch
office within 3 days of its issue.

2. He/She should fill-up claim form from sickness benefit printed on the certificate
itself, when she/he goes to branch office for collecting payment or while submitting
the certificate at the pay office, as the case may be.

3. Branch office staff will assist in the filing the claims if so required. In case of pay
offices, Dispensary staff will assist in filing the claims.

8
 4. If the claim is accepted, the same shall be paid immediately by the branch office and
if not found eligible a regret slip will be issued in ESI-15. In case of Pay-offices the
cashier visits the pay office on an appointed day and disburses the payment. Insured
person can also get payments through money order if they do desire and send a
written request to the Branch Office.

Extended Sickness Benefit:

Same procedure is to be followed as is applicable for claiming Sickness Benefit. However, in

this case the insured person is supposed to appear before the medical referee when referred
by the Branch Officer Manager for the purpose of confirmation of the examination for
allowing Extended Sickness Benefit from 124 to 309 days. Further an insured person is
required t appear before the Board for deciding the case beyond 400 days but upto a
maximum period of 2 years:

Temporary Disablement Benefit:

1. Procedure regarding submission or Regulation Certificate and claiming the benefit

remains the same as shown above against sickness Benefit.

2. In addition, an insured person who sustains employment injury to give a notice to such
injury to the employer immediately either in writing or orally and also ensure that the
employer has given the accident report to the concerned Branch Office will in time in
the prescribed form-16.

Permanent Disablement Benefit:

1. An Insured person should submit an application for reference to the Medical Board on
plain paper to the branch office manager after the termination of temporary disablement
benefit. This may be done at the time of submitting the final certificate or within 12
months from the termination of temporary disablement.

8
 2. He should ensure that he also gives his age proof to the Branch Office Manager along
with the application.

3. Form B.11 (a) indicating residual incapacity will be issued by the I.M.O./I.M.I. at the
time of final certificate. It is required to be submitted along with an application for
appearing before a Medical Board. If it has not been obtained at the time of issue of
final certificate it should be obtained at the time of applying for Medical Board.

4. The Medical Board sends its decisions to the ESIC Regional Office directly or through
branch office as the case may be and the regional office issues the sanction for
periodically payments of P.D.B. One copy of the sanction order is endorsed to the
insured person also. After receipt of this sanction the insured person should submit the
claims form in the branch office for payment of P.D.B. This payment will be made to
him every month as long as he is alive.

5. In case his rate of P.D.B. is Rs.5/- per day or less an insured person can apply for lump
sum communication of the payment provided that the total commuted value does not
exceed Rs.3000

6. An Insured Person should apply for commutation within a period of 6 months from the
date of possible option. Then only branch office manager shall be able to send the
request to regional office immediately. Otherwise the insured person will be referred to
the medical referee for certifying normal expectancy of life, and only after such
certifying is obtained, the insured person’s case will be processed for sanction of
communication.

7. The original sanction order of communication is send to the insured person with a copy
to the branch office. The insured person should produce the original copy at the branch
office at the time of payment.

Dependent Benefit:

1. Dependents of a deceased insured person should contact the branch office for
claiming the dependents benefit. The claim clerk will receive them and supply them
necessary forms and furnish all information needed by them. He will also assist them
in filing the claim form-18

8
 Dependents are required to submit:

a) The evidence of death of the insured person having occurred due to an

employment injury.
b) Evidence that claimants are dependent.
c) Evidence of age of claimant.
d) Evidence that female dependent (widows/daughters) has/have not remarried or
married after the death of an insured person.

1. These claims after scrutiny are forwarded to the regional office and the Regional
Officer communicates its decision to all the persons who claim the Dependent Benefit. To
those who are not found entitled, a letter in form ESIC-146 will explain why their claim
has been rejected. The letter in form ESIC-147 will indicate the daily rate of benefit of
each dependent. For minor dependent the information is sent through the guardian.

2. The dependents should approach the Branch Office with the letter (ESIC-147) for
claiming the first payment.

3. Subsequently they can collect dependents Benefit on first of each month either in
person or by money order by submitting claims in form-18 A.

4. If dependants are staying in far off places, they can opt for payment from the nearest
Branch Office. The Branch Office Manager will transfer all the records to the concerned
Branch Office from where payment has been desired to be made by the beneficiary.

5. At the time of claiming Dependent Benefit for the month of June and December
every, the claimant should submit a declaration in form-27 duly attested by the authorities
mentioned there in.

Maternity Benefit:

8
An Insured woman claiming Maternity Benefit during the employment is to submit
following documents either personally or by post:

a) A certificate of expected confinement form-21. Issued by an authorized doctor.

b) A benefit claim in form-22 duly completed.
c) In addition to above, she has also to submit a certificate of confinement in form-
23 within 30 days of date of confinement.

In case of claiming payment after confinement insured women has to submit a certificate
in form-23 along with the claim form in form-22.

In case of miscarriage she has to submit a certificate of miscarriage along with claim in
form-22. Certificate of miscarriage has to be submitted within 30 days. Insured woman
can draw Maternity Benefit on weekly basis. At the time of final payment she should
submit form-28 duly completed by her employer which will be issued by the Branch
Office Manager.

Funeral Expenses:

Claim in form 25 (A), duly attested by the competent authority as mentioned in the claim
form itself, be submitted to the branch office along with the death certificate for claiming
the funeral expenses on the expenses up to a maximum of Rs.2500/- is admissible.

Other Benefits:

a) Unemployment Allowance payable for up to 6 months to those insured persons, who

face involuntary unemployment due to closure of factory/establishment, retrenchment
or permanent invalidity arising out of non-employment for last 5 years.
b) Old age medical care for self and spouse at a nominal contribution of Rs.120/- per
annum.
c) Physical rehabilitation with free supply of artificial appliances.
d) Vocational rehabilitation on permanent disablement.
e) Immunization, family welfare services besides pre-natal and post-natal care in respect
of female beneficiaries.

8
 Employees State Insurance hospital, NOIDA
Underneath it all

ESI Hospital, Andheri, was constructed by ESI Corporation as a 600 bedded hospital and
commission by State Government of Maharashtra on 1.5.1977. It was later reduced down to
400 beds and again on recommendation of review committee to 300 beds w.e.f. 1.10.07. As a
matter of policy of taking over 1 hospital from each State to run as a model hospital, this
hospital was taken over by ESI Corporation on 14.4.08, in presence of Honorable Chief
Minister of Maharashtra, honorable Union Minister of State for Labour and employment and
officers of ESI Corporation and State Government. The hospital has been upgraded to 500
beds.

Specialist Services:

This hospital caters OPD Services in General Specialties viz. General Medicine, General
Surgery, Orthopedic, Gynaecology, and Obstetrics, Pediatrics, Ophthalmology and ENT.
Medical Officers with Post Graduate Qualification run the Pediatric and Gynaecology
Department. Appointment will be done in August 2008. One Dentist is also posted.

The Specialties other then in OPD Service are Pathology, Anaesthesia (PG Qualifies Resident
Anaesthetist) and Radiology (Medical Officer with PG Qualification) SR. Specialists in this
Departments will be appointed in August 2008. For super specialty treatment, tie-up
arrangement is available with J.J. Hospital, KEM Hospital, Nair Hospital, Sion Hospital and
Tata Cancer Hospital.

8
The hospital has a Counseling Center for HIV/AIDS with a Counsellor from MDACS. A
DOTS Centre is also functioning. There are no Skin, Psychiatry and Chest Department at
present.

Daily attendance in OPD is approximately 300 patients. OPD services are catered during
working hours of 9.00 a.m. to 4.00 p.m.

Emergency Services:

Round the clock services are available in Casualty, Indoors, Pathology, X-Ray, and O.T.
Casualty medical officers are posted in casualty along with another staff compromising staff
nurse, ward boy, Sweepers, Barber etc. Medical officers are also posted in shifts for indoors.
Specialists remain on call to attain any emergency either in casualty or in wards. Technicians
are posited in shift duties in X-Ray and Pathology Department.

The maintenance agency has provided man power round the clock to run Central AC and
package unit of kitchen.

Ambulance Services are available round the clock. A tie up arrangement has been made for
super specialty investigations and purchase of medicines, which are not available in the
hospital.

Indoor Services:

There are 300 beds distributed for different departments viz. Medicine 90, Surgery 60,
Gynaecology and Obstetric 60, Paediatrics 30, Orthopaedics 30, Casualty 5, Pooled beds 15
and 5 beds each for Eye and ENT. Pooled beds can be utilized later for other departments to
be established viz. Skin, Chest, Dental, Psychiatry, ICU/ICCU etc. The present occupancy of
the hospital ranges between 180 to 190.

Diagnostic Services:

These services are catered through Pathology and X-Ray Department. A full time Pathologist
is posted a Semi Autonalyser, Cell Counter, Centrifuge, Hot Air Oven, Incubator, Auto
pipettes, Blood Storage Refrigerator are available in Pathology Department. All routine

8
investigations are done here. Since there is no tissue processor, tissue blocks and slides are
got prepared through a tie-up arrangement.

X-ray Departments has won 725 MA X-Ray machine, One Portable, 60 MA Machine and
One Ultrasonograph. Medical Officer with PG Qualification is looking after X-Ray
Department. Both Pathology and X-Ray Department function round the clock.

Operation Theatre:

There are two Operation Theatre complexes in the hospital viz. on 2 nd and 3rd floor. However,
only the one on 2nd floor was in use and has been closed for repairs. A minor O.T. on ground
floor is converted to Major O.T. as a makeshift arrangement. All major and minor Operations
of all departments are done here. There are two Resident Anaesthetists posted here. The
equipments available are Boyles Apparatus, Suction Machine, Cardiac Monitor with
Defibrillant, Pulse Oximeter, Multipara Monitor, Operating Microscope (Ophth.) etc.
Number of operations performed is annexed.

Kitchen:
Through Kitchen diet as required for various patients is provided as per ESIC Norms.
Morning breakfast, Lunch and Dinner are provided. Diet Committee makes the planning of
diet. Apart from Steward, Head Cook and Cook mates, a Dietician is posted here. One
Medical Officer is the in charge.

CSSD:

There are two High Pressure Horizontal Sterilizers in the department out of which one is
working and other needs repairs. Suppliers of Sterile material is made from here to OPD,
Indoor, Pathology, X-ray and other department. One Medical Officer is incharge of the
department, apart from Staff Nurses and other Staff.

Linen Department:

This department has a staff including Linen Keeper, Tailor and group D Employees. There is
sufficient stock of blankets, bed covers/sheets, and other surgical linen. Procurement was
done through PSU Textile Industry.

8
Labour Ward:

This section runs round the clock with Staff Nurses and Group D Employees. Medical
Officers with PG Degree in Gynaecology and Obstetrics remain on call. Deliveries conducted
in the past are annexed.

Maintenance of the Buildings:

The hospital building is on ground and five floors and there are 324 Staff quarters in the
Premises. The maintenance at present is being done through Private Contractors. Hospital
Building and Residential Quarters are undergoing special repair works. However, there is a
proposal to renovate the hospital completely and provide modern facilities with Central Air-
Conditioning.

Family Welfare Activities:

There is a family Welfare Section run by the State Government with a Staff of a Medical
Officer, Staff Nurse, One Clerk and Group D Employees. This Department conducts
Antenatal Checkups, vaccination and distribution of Contraceptives. Operative part is looked
after looked after by the hospital.

Future Plans:

1. A Dialysis unit will be started soon.

2. ICU/ICCU units will be opened.
3. New equipments will be purchased for all the departments.
4. ESI Corporation has already floated global tender for installation of CT Scan/MRI
machine in ESI Hospital Andheri.
5. Hospital building is being completely renovated, refurnished and centrally air
conditioned. New construction of building after demolition of old nurses hostel and
on the vacant plot a PG hostel will be constructed.
6. There is a plan to start an Evening OPD.
7. There will be regular CME and training programmes for doctor and paramedical staff.
8. Procedure for starting of blood Bank will be taken soon.

8
Composition:

Person In charge:

Sl. No. Name / Designation Address Tele / Mob. / VOIP No / Email Address
Fax No.

1 Dr. Anish Singhal Directorat 0120- ms-noida[at]esic[dot]nic[dot]in

Director(Medical) e 2970355
(Medical) 9818411331
Noida

2 Dr. Balraj Bhandar Directorat 0120- dr.balraj.bhander@esic.nic.in

Deputy Medical Suptd. e 4506586
(Medical) 9871471316
Noida

3 Shri Chitranjan Kumar Directorat 0120- ck.das@esic.nic.in

Das e 2970320
Deputy Director (Admin) (Medical) 8368185855
Noida

4 Shri Anurag Kumar Directorat 0120- anurag.kumar@esic.nic.in

Deputy Director (Finance) e 2970326
(Medical) 9899334122
Noida

5 Shri Harminder Pal Directorat 0120- harminder.pal@esic.nic.in

Assistant Director (Cash) e 2970334
(Medical) 9868846544
Noida

The medical superintendant is directly appointed by the government. The deputy medical
superintendant and the deputy director, finance is recruited from the UPSC (Union Public
Service Commission) based on their qualifications.
The minimum qualification for the medical superintendant is M.B.B.S degree.
There is no fixed tenure for the officers. They can be transferred from one location to another
location periodically as per the requirement.
Organization chart

8
8
 1

Committees

has been decided to constitute committees for various purposes for smooth functioning of the
hospital, ensure supply of drugs, diet, stationary and other articles and also see for
implementation of new proposals to update the hospital services. Such committees will work
out annual requirement on the basis of consumption of last 3 years and taking into
consideration future planning and development. After sanction from the medical
Superintendent limited/open tenders, as the case may be, shall be limited and finalized in
consultation with accounts and approval of the medical superintendent. Emergency
requirement may be fulfilled by local purchases from hospital contract for drugs and
dressings and Kendriya Bhandar/NCCF for stationery and other articles. Dietary articles if
required may be purchased by inviting limited tenders. Linen and liveries should be
purchased from government agencies. It should be ensured by all committees that adequate
stock is kept at hand before placing the orders.
The committees are as follows:
1. Medical scrutiny committee:

After the tender is passed this committee first checks the quality of the
medicine and then it uses for the patients. This committee mainly looks
after the quality of drugs and medicines supplied in the hospital.
Composition:
 Deputy Medical Superintendent
 Medical Officer Purchase
 Representatives of 3 Departments
 Deputy Director Finance
 2 Pharmacists

2. Tender/Purchase committees for Non-Medical equipments:

In this committee, all the suppliers get a chance to quote their price in a sealed
envelope and then all the tenders are opened in front of all the committee
members and the tender with lowest quotation is finalized.
Composition:
 Deputy Medical Superintendent
 Medical Officer Purchase
 Representative of user department

8
  Joint director (Administration) / Deputy Director (Administration)
 Deputy Director (finance)
 Care taker of hospital

3. Technical Evaluation Committee for Equipments:

This committee evaluates the equipments that are brought into the hospital.
Composition:
 Deputy Medical Superintendent
 Medical Officer Purchase
 Representative of user department

4. Committee of General/Stationery Purchase:

This committee looks after the stationary items that are used in the hospital.
Composition:
 Deputy Medical Superintendent
 Joint director (Administration) / Deputy Director (Administration)
 Deputy Director (finance)
 Representative of nursing staff.
 Medical Officer Purchases.

5. Technical Committee (purchase of medical equipments):

This committee purchases medical equipments like X-Ray machines, C T Scan

machine, and Ultra Sound machine.

Composition:
 Deputy medical Superintendent
 Specialist of concerned department
 Doctor (may or may not be from the same department)
 Medical Officer (Purchase)
 Deputy Director Finance (For all committees)

6. Committee of Dietary and Grocery items:

This committee looks after the food items for the patients. The quality and
quantity of food items is decided by this committee.
Composition:
 Deputy medical Superintendent

8
  Joint director (Administration) / Deputy Director (Administration)
 Deputy Director (finance)
 Dietician
 Store in charge

7. Committee of Linen Purchase:

This committee looks after the uniforms of the patients as well as bed sheets,
napkins, pillow covers.
Composition:
 Deputy medical Superintendent
 Joint director (Administration) / Deputy Director (Administration)
 Deputy Director (finance)
 Representative of nursing staff
 Medical Officer (Purchase)
 Linen keeper

8. Committee of Purchases of Liveries:

This committee looks after the uniforms of the staff. Every year three uniforms
are provided to each staff member.
Composition:
 Deputy medical Superintendent
 Joint director (Administration) / Deputy Director (Administration)
 Deputy Director (finance)
 Store Keeper
 Union Representative

DEPARTMENTS

i. Medical

8
 ii. Surgery

iii. Gynaecology

iv. Orthopaedics

v. ENT (Eyes ,Nose and Throat)

vi. Ophthalmic

vii. Psychiatrist

viii. Pathology and X-Ray

ix. Anesthesia

Medical Care

The hospital takes care of its patients in three different ways. They are:

1. Primary care
2. Secondary care
3. Tertiary care

 Primary care :- The doctors (Insured Medical Practitioners) give the primary
treatment
to the patients at the various dispensaries of ESI Hospital . They examine them
by holding check ups and treat them for minor injuries.

8
  Secondary care: - The IMPs’ at their dispensaries diagnose the severity of the disease
and accordingly advise them for further treatment in the ESI hospital. The patients are
advised to visit the hospital for blood testing, urine and stool testing, and other
prescribed tests such as Ultra sound Sonography, Eco-cardio gram (ECG), Magnetic
Resonance Imaging (MRI), Computed Tomography (CT) scan and thereby provide
the reports to the patients for their further treatment.

 Tertiary care: - The tertiary care includes the super specialty treatment which is given
by the doctors to their patients. Any major surgery or a transplant which has to be
performed on the patient comes under this category.

The tertiary facilities given in this case includes the knee joint replacement, the hip
joint replacement and such other replacements or transplants. There are various tied
up hospitals viz. Balaji hospital at Byculla, Sion hospital, JJ hospital, and KEM which
provide the tertiary treatment to the insured patients.

Budget Planning
For the smooth functioning of the hospital there has to be smooth flow of funds for the
various expenditures for the purchase of drugs, medical and non medical equipments, food
for the in -house patients and also for improving the infrastructure and administrative affairs
of the hospital. For this purpose, the budget is sanctioned every year by the central
government. The budget allocated by the government for the fiscal year 08-09 is 25 crores.
However, the Deputy Director, Finance has proposed a budget of 52 crores.

The funds allocated for the medicines and treatment of the insured employees is the collective
contribution of the employers (4.75%) and the employees (1.75%).

The budget can be invariably sanctioned by the Deputy Director, Finance as and when there
arises a requisition for drugs, medical/non medical equipments, stationeries, groceries, etc.

8
 5

Purchase of materials

The ESI Hospital purchases drugs , equipments (medical/non medical), diet, stationery &
printing, linen & liveries as per the requirements of various departments.

The committees responsible for the purchase of their respective materials, meet as per their
need in the presence of the Deputy Medical Superintendent and Deputy Director , Finance
and Medical Officer Purchase to take collective decisions regarding the floating of the
tenders. These tender notices can be given as global or local tender notice.

Sealed bids are invited and finally the committees meet up again for finalizing the quotations.
The least biding parties are selected for the purchase of their required materials.

Purchase of drugs:

Purchase of drugs and dressings is done under the E.S.I. Corporation centralized rate contract
no.130 for additional drugs. A copy of the Centralized rate contract for additional drugs
finalized for supply of drugs and dressings under the ESI Scheme in the country is sent to the
director general of E.S.I. Corporation (ESIS-ALL STATES AND Medical superintendent
ESIC Model Hospitals). All the medicines, drugs, dressings come under the rate contract.

Purchase of equipments (Medical/non medical):

For the purpose of purchase of equipments the hospital has a committee known as technical
committee. This committee looks after the purchase of the medical as well as non medical
equipments. They often meet as and when the need arises and decides upon the further
actions to be taken regarding the purchase of the materials.

The purchase of the equipments usually occurs due to the following reasons:

8
 1. Purchase against the contamination

2. Purchase of new equipment.

Procedure for purchase of equipments:

 Advertisement is given in news papers in the form of tenders with specifications.

 The tender with the lowest quotation which meets the requirements and standards is
then finalized.

 After the finalization of the tender, order is passed to that particular agency.

 The supply of the material is done within 3-4 days (for emergency within 24 hours)

 The hospital receives the equipments and checks for the quality of the material
supplied.

 After the quality checking of the material, it is approved for installation.

 As and when the installation is finished payment is made (90% of the payment is
made before the supply and the remaining 10% is done after the installation )

Purchase of raw materials:

The purchase of the raw materials for the kitchen is managed by the committee of Dietary
and Grocery items. This committee meets up to decide upon yearly purchase of the raw
materials.

In meetings, the dietician and the along with other members involved decide upon the quality
of the raw materials to be purchased. Once the specifications are decided upon, the committee
members float the tenders in the newspapers stating the required specifications.

The tender is passed for the supplier whose quotation is the lowest. And after the complete
quality checking and approval form the dietician the payment is done.

8
 6

Kitchen department

 The kitchen department comprises of 6 persons working in a general shift from 9 am

– 5 p.m out of which 3 persons work as cook, assistant cook, 1 Dietician & 1
Assistant Dietician .

 The raw materials & the food grains is purchased for the 15 days & is brought from
the tender in Vashi. This contract is maintained for 1 year & it keeps on changing
according to the need.

 The rate of entire meal for per patient is Rs. 17.95 paise/day & Rs. 38.86
paise/monthly. Thus the entire budget of the meal comes at around 1 lakh 42,000
monthly.

 There is a provision of a refrigerator for storing the food items & the store room in
case of an emergency.

 The Diet Sheet is prepared one day in advance according to the patients need & the
scaling is done by the Dietician for proper measurement of nutrition in the food.

 The meal comprises of: BREAKFAST- 1 Glass of Milk, 2 Bananas;

 LUNCH/ DINNER- As per prescribed & it consists of 1 vegetable which could be

repeated twice a week for sedimentary workers.

 The following terminology is used for the diet sheet as mentioned below :-

 AD - FULL DIET
 LD - LIGHT DIET
 MD/BMD - MILK & SUGAR

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 ADD - DIABETIC VEG -DIET
 AFD - PEDIATRIC DIET ( SMALL)
 BFD - NON –VEG FULL DIET
 BMD - BUTTER MILK DIET
 BREAD - 60 GRMS - 2 SLICES/ PATIENT
 MILK - 70 ML MILK IS CUT FOR MAKING TEA

Training

The Medical Superintendent of the ESI Hospital firmly believed in the power of Karma and
satisfying his customers who are in the form of patients. Hence in order to avoid hindrance in
the smooth functioning of the hospital, conducts training for his staffs. These training are
mostly for improving the behavioral aspects of his staffs and nurses.

The staffs and nurses who are employed in the hospital are underprivileged. Thus they tend to
aggravate at times while serving their patients. This will in turn escalate a sense of
dissatisfaction among the patients.

Thus to instill a sense of tranquility within these class III and class IV employees, he holds
training where he advocate about means by which patients can be served and satisfied. The
staff tends to believe in spirituality. And hence he explains the sacredness involved in helping
and serving people by way of treating them.

There are no external training conducted as of now. But, they have future plans to give
external training in technical as well as behavioral areas.

**********

8
Common problems

8
 The Medical Superintendent of the ESI Hospital firmly believed in the power of Karma and
satisfying his customers who are in the form of patients. Hence in order to avoid hindrance in
the smooth functioning of the hospital, conducts training for his staffs. These training are
mostly for improving the behavioral aspects of his staffs and nurses.
The staffs and nurses who are employed in the hospital are underprivileged. Thus, they tend
to aggravate at times while serving their patients. This will lead to unsatisfied customers.
Thus to calm these people he holds training where he preach about ‘satisfying one patient
also, will satisfy god. And if a patient is not served properly or not attended proper manner
will be punished by god.’
Nevertheless, he also believes that there is no organization which doesn’t have problems.
Even in this hospital there are certain problems which do occur among the patients, the staffs,
the nurses and the doctors.
The common problems, which occur among them, are as follows:
Patients
 There are no equipments for major surgery viz. angioplasty, heart operations, and
kidney transplantations available in the hospital. Hence asked to go to other hospitals
which are tied up with ESIC.
 The out going patients have to wait for long hours for the doctors which in turn results
in hypertension and anxiety among them.
 The doctors being from the state government tends to become proud and arrogant at
times with the patients. Due to their arrogant behavior they at times delay or avoid
operating the patients.
 No doctors for lifestyle diseases like depression and heart ailments.
 Over-crowded wards.

Staffs
 No proper laundry facilities provided for nurses and staffs
 Adequate number of uniforms not provided to them with no proper stitching facilities
provided.
 Canteen is not in a proper hygienic condition with very few seating arrangement.
 Confusion in the minds of the state government staffs after the take over of the
corporation as to whose policies to follow.
Doctors

 Doctors are less in numbers hence; they have to attend more patients at a time.
 No adequate equipments available for super specialty treatment.
 The state government doctors have a fear of loosing their jobs due to the take over of
corporation.
9

8
 Observations & suggestions

Observations
1. The officials were very co operative as well as helpful, and provided as much
information as they could.

2. The Hospital building is under renovation for the purpose of constructing a “Model
Hospital”.

3. All the wards were clean and well ventilated.

4. New equipments with the latest technology such as Incubator, X-ray machine and
USG machine were newly introduced.

Suggestions
 The procedure of filling the forms for getting the patients admitted can be simplified,
as it is time consuming and difficult for the patients and their relatives to understand
as they are less educated.

 Seating arrangements for the visitors of the patients needs more attention as some of
the visitors were found to be sitting on the floor due to less inadequate space.

 The stretchers used to carry the patients need to be in good working conditions as the
backrest of the stretcher was found to be slight curved and the stretcher was rusted.

 The complaint box must be kept in an isolated place so that the patients are able make
use of this facility freely, without any hesitation or any fear.

 Rest room for the staff should be adequately furnished.

 The staff canteen needs has to have a good infrastructure and has to be hygienic.

8
  The area around the doctors’ residential quarters within the premises needs
maintenance as the area was found to be littered.

PHYSICAL SETUP/LAYOUT

PHYSICAL SETUP/LAYOUT OF NEUROLOGY

UNIT, E.S.I HOSPITAL, NOIDA

Nurses
Changing
room Doctors duty Room Staff Washroom Isolation and Patient Washroom

Pvt. rooms

Pantry
Xray,
examination And Store
and
procedure
area

NEUROLOGY Hand
Emergency GENERAL WARD washing
Medications (Patient beds ) area
and equipments

NURSING Dressing
ENTRY

STATION area

8
SECTION-2

ADVANCED
COMPETENCIES
GAINED IN
8
 NURSING
PRACTICE

S.NO ACTIVITIES COMPETANCIES GAINED

PERFORMED

1. Planned one month Competencies gained in planning self-activities by preparing one

activities according to month action plan
the objectives .

2.. Orientation and Critical viewing of physical layout of different units.

observation of whole
hospital

3 Worked , nuero  Observation of physical layout of nuero ward, I.C.U ,.

ward ,wards along with  Observe and assess the various needs of the patients
senior staff nurses and during hospitalization
doctors  Reviewed the records to know the problem.
 Planned, implemented & evaluated the nursing care based
upon the diagnosis & need of the patients.
 Preparation of patients for various diagnostic and
therapeutic procedures.
 Care of the patients after the therapeutic procedures.
 Understanding steps of procedures by interacting with the
consultants performing various procedures.
 Immediate care of patients after procedures by
participating in care given.
 Writing report and keeping records by writing reports
under supervision of senior staff nurses.
 Performed procedures on patients such as checking vitals,
helping in doing routine work etc.
 Assisting patient in complimentary therapies.

8
4. Gain skills and  Introducing self to the HOD, in-charge, ward sisters.
proficiency by  Explaining the objectives of the visit to the ward.
witnessing the advanced  Arranged structured teaching for staff in wards.
procedures. Preparation of patients for administering medication.

4. Gain skills and  Giving introduction about self to the manager , team leaders,
proficiency by ward sister.
witnessing the advanced  Explaining the objectives of the visit to wards and I.C.U.
procedure.  Observing the various procedures

INTRODUCTION The Mini-Mental Status Examination offers a quick and simple way to
quantify cognitive function and screen for cognitive loss. It is used mainly in dementia and
Alzheimer’s disease
DIFINITION: It is a brief 10 minutes standardized, reliable screening instrument used to
assess for cognitive impairment. It is a shortened version of the more comprehensive mental
status examination

COMPONANTS
 Orientation
 Registration
 Attention
 Calculation
 Recall and language

SCORING OF MMSE
Maximum score is 30
25-30 considered normal
18-24 mild to moderate impairment
17 or less than 17 indicates severe impairment
FORMAT FOR MINI-MENTAL STATUS EXAMINATION(MMSE) FORMAT

1. Orientation
 What is the year?

8
  Season?
 Date?
 Day?
 Month?
 Which is our state?
 Country?
 Town or city?
 Hospital?
 Floor?

Total score is 10 ,each question carries 1 point

2. Attention and Calculation (total points -5)
Spell “world” backwards give 1 point for each letter that is in the right
place(Forexample,DLROW =5,DLORW=3).Alternatively, do serial 7s(ask the person to
count backwards from 100 in block of 7,i.e. 93,8679,72,65).stop after five substractions.give
one point for each correct answer.

3.Registration (total poit-3)

Name three objects (for example, apple table, pen) taking one second to say each one. Then
ask the individual to repeat the name of all three objects. Give one point for each correct
answer. Repeat the object names until all three are learned.

4. Recall( total point-3)

Ask for the three objects repeated above (for example: apple ,table, pen)give one point for
each correct object

5.Language(total point -9)

Point to a pencil and ask the person to name this object(1point)

Do the same thing with a wrist watch(1 Point)

Ask the person to repeat the following .No ‘ifs’ and/ or ‘buts’(1 Point)
Give the person a piece of blank white paper and ask them to follow a three stage
command. Take a paper in your right hand ,fold in half and put it on the floor (1 Point
for each part that is correctly followed)

8
 Write ‘CLOSE YOUR EYES’ in large letters and show it to the patient. Ask him or
her to read the message and do what it says (Give 1 point if they actually close their
eyes.)
Ask the individual to write a sentence of his choice on a blank piece of paper. The
sentence must contain a subject and a verb, and must make sense. Spelling punctuation
and grammar are not important.( 1 Point)
Show the person a drawing of two pentagons which intersect to form a quadrangle.
Each side should be about 1.5 cm. Ask them to copy the design exactly as it is (1
point). All 10 angles need to be present and two shapes must intersect to score 1
point .Tremor and rotation ate ignored.

LIMITATION OF MMSE

 Sometimes there will be difficulty in recording changes in cases of severe dementia.

Furthermore, age, education, cultural and socioeconomic background can cause a

considerable bias in the MMSE's scores
CONCLUSION:
The minimental status examination is a cognitive test used to screen for the presence of
cognitive impairment
ALZEMER’S DISEASE:Alzheimer’s disease is an irreversible disease marked by
progressive impairment of cognitive functioning ,memory and personality
INCIDENCE:Dementia occur more commonly in the elderly than in the middle age ..1% in
those below 60 years of age and 15-20 % in those who are 80 years of age
Etiology. The exact cause of AD is unknown. Several hypotheses have been supported by
varying amounts and quality of data. These hypotheses include:
1. Acetylcholine Alterations. Research has indicated that in the brains of AD clients, the
enzyme required to produce acetylcholine is dramatically reduced. The reduction seems to be
greatest in the nucleus basalis of the inferior medial forebrain area (Cummings & Mega,
2003). This decrease in production of acetylcholine reduces the amount of the
neurotransmitter that is released to cells in the cortex and hippocampus, resulting in a
disruption of the cognitive processes. Other neurotransmitters implicated in the pathology and
clinical symptoms of AD include norepinephrine, serotonin, dopamine, and the amino acid

8
glutamate. It has been proposed that in dementia, excess glutamate leads to overstimulation
of the N-methyl-D-aspartate (NMDA) receptors, leading to increased intracellular calcium,
and subsequent neuronal degeneration and cell death.
2. Plaques and Tangles.. The plaques are made of a protein called amyloid beta (Aβ), which
are fragments of a larger protein called amyloid precursor protein (APP; Alzheimer’s Disease
Education & Referral Center [ADEAR], 2003). Plaques are formed when these fragments
clump together and mix with molecules and other cellular matter. Tangles are formed from a
special kind of cellular protein called tau protein, whose function it is to provide stability to
the neuron. In AD, the tau protein is chemically altered (ADEAR, 2003). Strands of the
protein become tangled together, interfering with the neuronal transport system. It is not
known whether the plaques and tangles cause AD or are a consequence of the AD process. It
is thought that the plaques and tangles contribute to the destruction and death of neurons,
leading to memory failure, personality changes, inability to carry out ADLs, and other
features of the disease
3. Head Trauma. The etiology of AD has been associated with serious head trauma (Munoz
& Feldman, 2000). Studies have shown that some individuals who had experienced head
trauma had subsequently (after years) developed AD. This hypothesis is being investigated as
a possible cause. Munoz and Feldman (2000) report an increased risk for AD in individuals
who are both genetically predisposed and who experience traumatic head injury.
4. Genetic Factors. There is clearly a familial pattern with some forms of AD. Some
families exhibit a pattern of inheritance that suggests possible autosomaldominant gene
transmission (Sadock & Sadock, 2007). Some studies indicate that early-onset cases are more
likely to be familial than late-onset cases, and that from one third to one half of all cases may
be of the genetic form. Some researchers believe that there is a link between AD and the
alteration of a gene found on chromosome 21 (Munoz & Feldman, 2000; Saunders, 2001).
People with Down syndrome, who carry an extra copy of chromosome 21, have been found
to be unusually susceptible to AD (Lott & Head, 2005). Some studies have linked the
apolipoprotein E epsilon 4 (ApoE ε4) gene, found on chromosome 19, to an increased risk of
late-onset AD (Poduslo & Yin, 2001). The presenilin 1 (PS-1) gene on chromosome 14 and
the presenilin 2 (PS-2) gene on chromosome 1 have been associated with the onset of AD
before age 65 years (Saunders, 2001)
.
STAGES OF ALZHEIMER’S DISEASE:
Stage 1. No Apparent Symptoms. In the first stage of the illness, there is no apparent decline
in memory
Stage 2. Forgetfulness. The individual begins to lose things or forget names of people. Losses
in short-term memory are common. The individual is aware of the intellectual decline and
may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptom.
Maintaining organization with lists and a structured routine provide some compensation.
These symptoms often are not observed by others.
Stage 3. Mild Cognitive Decline. In this stage, there is interference with work performance,
which becomes noticeable to coworkers. The individual may get lost when driving his or her

8
car. Concentration may be interrupted. There is difficulty recalling names or words, which
becomes noticeable to family and close associates. A decline occurs in the ability to plan or
organize.
Stage 4. Mild-to-Moderate Cognitive Decline; Confusion. At this stage, the individual may
forget major events in personal history, such as his or her own child’s birthday; experience
declining ability to perform tasks, such as shopping and managing personal finances; or be
unable to understand current news events. He or she may deny that a problem exists by
covering up memory loss with confabulation (creating imaginary events to fill in memory
gaps). Depression and social withdrawal are common.
Stage 5. Moderate Cognitive Decline; Early Dementia. In the early stages of dementia,
individuals lose the ability to perform some activities of daily living (ADLs) independently,
such as hygiene, dressing, and grooming, and require some assistance to manage these on an
ongoing basis. They may forget addresses, phone numbers, and names of close relatives.
They may become disoriented about place and time, but they maintain knowledge about
themselves. Frustration, withdrawal, and self-absorption are common.
Stage 6. Moderate-to-Severe Cognitive Decline; Middle Dementia. At this stage, the
individual may be unable to recall recent major life events or even the name of his or her
spouse. Disorientation to surroundings is common, and the person may be unable to recall the
day, season, or year. The person is unable to manage ADLs without assistance. Urinary and
fecal incontinence are common. Sleeping becomes a problem. Psychomotor symptoms
include wandering, obsessiveness, agitation, and aggression. Symptoms seem to worsen in
the late afternoon and evening—a phenomenon termed sundowning. Communication
becomes more difficult, with increasing loss of language skills. Institutional care is usually
required at this stage.
Stage 7. Severe Cognitive Decline; Late Dementia. In the end stages of AD, the individual is
unable to recognize family members. He or she most commonly is bedfast and aphasic.
Problems of immobility, such as decubiti and contractures, may occur.
CLINICAL FEATRURES
• Personality changes: lack of interest in day to-
day activities, easy mental fatiguability,self centered,
withdrawn, decreased self-care
• Memory impairment: recent memory is prominently
affected
• Cognitive impairment: disorientation, poor
judgment, difficulty in abstraction, decreased
attention span
• Affective impairment: labile mood, irritableness,
depression

8
• Behavioural impairment: stereotyped behaviour,
alteration in sexual drives and activities,
neurotic/psychotic behaviour
• Neurological impairment: aphasia, apraxia,agnosia, seizures, headache
• Catastrophic reaction: agitation, attempt to compensate for defects by using strategies to
avoid demonstrating failures in intellectual performances, such as changing the subject,
cracking jokes or otherwise diverting the
interviewer
• Sundowner syndrome: It is characterized by drowsiness, confusion, ataxia; accidental falls
may occur at night when external stimuli such as light and interpersonal
DIAGNOSTIC MEASURES
DIAGNOSIS:
 MMSE-Shows cognitive impairment
 Nurological examination

 Magnetic resonance image of the brain shows structural and neurologic changes
 Spinal fluid analysis shows increased beta amyloid deposits
 Functional dementia scale(to indicate degree of dementia)

Treatment for Mild to Moderate Alzheimer’s

Medications called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer’s
disease. These drugs may help reduce some symptoms and help control some behavioral
symptoms. The medications are Razadyne® (galantamine), Exelon® (rivastigmine), and
Aricept® (donepezil).
Medication Classification For treatment Daily dsosage Side effects
of
(mg)

Donepezil (Aricept) Cholinesteras Cognitive 5-10 Insomnia, dizziness,

e inhibitors impairement GI upset, headache

Rivastigmine Cholinesteras Cognitive 6-12

(Exelon) e inhibitors impairement Fatigue, dizziness,
GI upset, headache

Galantamine Cholinesteras Cognitive

8
 (Razadyne) e inhibitors impairement 8-24 dizziness, GI upset,
headache

Memantine NMDA Cognitive 5-20 Dizziness,headache,

(Namenda) receptor impairement constipation
antagonist

OTHER MEDICATIONS INCLUDE

-Anti depressants like sertraline may be used in case of depression
-diazepam ,lorazepam is used for relieving anxiety
-Zolpidem,ramelteon is used for sleep disturbance
-Atypical antipsychotic like risperidone,olanzapine is used for aggression,agitation and
hallucination

Nursing Interventions
Daily Routine
Maintaining a daily routine includes drawing up a fixed timetable for the patient for waking
up in the morning, toilet, exercise and meals. This gives the patient a sense of security.
Patients often deteriorate after dark, a phenomenon known as 'sun downing'. Additional
careMust be taken during the evening and at night. Orient the patient to reality in order to
decrease confusion;clock with large face said in orientation to time. Use calendar with large
writing and a separate page for each day. Provide newspapers which stimulate interest in
current events.Orientation of place, person and time should begiven before approaching the
patient.
Nutrition and Body Weight
Patient should be provided a well-balanced diet, rich in protein, high in fibre, with adequate
amount of calories. Allow plenty of time for meals. Tell the patient which meal it is and what
is there to eat; food served should be neither too hot nor too cold. Many patients have sugar
craving. Care should be taken that such patients do not gain weight. The diet should take into
account other medical illnesses which require diet modification, such as diabetes or high
blood pressure. Semisolid diet is the safest while liquids are the most dangerous as these can
be easily aspirated into the lungs.

8
Personal Hygiene
Particular care should be taken about the patient's personal hygiene including brushing of
teeth, bathing, keeping the skin clean and dry, particularly in areas prone to perspiration, such
as the armpits and groin. Caustic substances such as spirit or antiseptic solutions should not
be used routinely on the skin. Remember to check fingerand toe nails regularly, cut them if
the person cannot do it by himself. People with dementia may have problem withthe lock on
the bathroom door; if this happens it is advisable to remove the lock. Compliment the patient
when he/ she look good.

Toilet Habits and Incontinence

Toilet habits should be established as soon as possible and maintained as a rigid routine. This
includes conditioned behaviour such as going for bowel movement immediately after a cup
of tea. The patient should be taken to urinate at fixed interval, depending on the season and
amount of fluid intake. Prostate trouble common in elderly men leads to discomfort as it
causes urgency and frequency of urination particularly in winters. A doctor should check this
incontinence is very distressing to the patient and family. Once incontience sets in, the
undergarments pants of the patient and the house in general start reeking of foul smell. Toilet
habits,
When the first sign of incontinence appears doctor should check for an underlying cause if
any, such as urinary infection or urinary tract damage.
Constipation is a frequent cause of discomfort to the patient. The quantity of faeces passed
each morning should be checked to ensure that the patient is not constipated. Constipation
can be avoided by adding fibre supplements and roughage to the diet on a daily basis.
Accidents
Great care should be taken to avoid accidents caused by tripping over furniture, falling down
the stairs or slipping in the bathroom. The reasons for falling include loose and poorly fitting
footwear and wrinkled carpets. Ideally, patients should be made to wear soft slip-on shoes
withStraps which fit securely. Any floor covering mustbe firmly secured. Older people have
been driving for years and in modem cities many people are dependent on their personal cars
for transportation. Once early signs of the disease appear, patients should be gently persuaded
to stop driving as this can pose a hazard to them and others.Make sure that lights are bright
enough. Keep matches, bleach, and paints out of reach. Do not allow the patient to take
medication alone.
Fluid Management
The patients require as much fluid as normal people and this depends on the season. Ideally,
sufficient fluid should be given during the day and only the minimum essential amount of
fluid (some water with dinner) after 6pm. The last cup of tea should be given around 5 pm.
After that no beverages including tea, coffee, cocoa or any othercaffeine containing drinks
should be given, as all these promote urination. Proper fluid management will reduce bed-
wetting and also reduce the number of times the patient will need to get up during the night.

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Moods and Emotions
Some patients of Alzheimer's disease have abrupt change in their moods and emotions. These
changes can be unpredictable. Mood changes are best controlled by keeping a calm
environment with fixed daily routine. The patients should not be questioned repeatedly or
given too many choices, such as what they want to eat or what they want to wear. Mood
changes are also amenable to distraction, particularly if topics related to the past are
discussed or favourite pieces of music played. For example, if music that reminds the patients
of their childhood is played, the pleasant associations put them in a nostalgic mood. If patient
behaviour and emotions are distressing to the family members the doctor may prescribe some
medications to calm the patient.
Wandering
Patients of Alzheimer's disease often lose their geographic orientation and can get lost even
infamiliar surroundings. They may be found wandering aimlessly either in the neighbourhood
or far away. It is advisable to have some identification bracelet or card always in their
possession.
The doors of the house should be securely locked so that the patients cannot leave unnoticed.
The patient should always be accompanied while going for walks or for simple chores outside
the house.

Disturbed Sleep
Sleep disturbances are extremely distressing to the family. If the patient is restless at night or
wanders and talks at night, the entire family is disturbed. Sleep patterns must be maintained.
Napping during the day should be avoided. Sleeping pills are best avoided as their effect is
temporary and frequently unpredictable inpatients of Alzheimer's disease. Causes of
discomfort at night, such as pain, uncomfortable temperature or prostate trouble, should be
checked.

Interpersonal Relationship
Verbal communication should be clear and unhurried. Questions that require 'yes', or 'no'
answers are best. Reinforce socially acceptable skills. Give necessary information repeatedly.
Focus on things the person does well rather than on mistakes or failures. Try to make sure
that each day has something of interest for the patient - itmight be going for a walk, listening
to music; talkabout the day's activities. Try to involve him withold friends for a chat,
reminiscing about the past.
Family members should be aware of earlywarning signs which may suggest that one of the
older members may be on the verge of developing Alzheimer's disease. Early diagnosis and
early intervention can be beneficial both to the patient and the family. As the disease
progresses, the family remains the main pillar of support for the patient.

8
SECTION-3

DEVELOP FURTHER
ABILITIES IN
8
MANAGEMENT AND
SUPERVISION IN
CLINICAL AREAS

8
 DEVELOP FURTHER ABILITIES IN MANAGEMENT AND SUPERVISION IN
CLINICAL AREAS :

To gain and develop further abilities in management and supervision in clinical areas, we
worked with various ward sister in-charges, supervisors, discussed various issues regarding
nursing practices, administration and education with D.G.M and general manager and nurse-
educator
COMPETENCIES ACTIVITIES CARRIED OUT IN ORDER TO GAIN THE
GAINED COMPETENCIES

1. Learn about hospital  Developed communication skills

administration,  Got orientation of organization setup & policies of the institution
organization & policies  Gathering information regarding background, objectives,
organizational setup, staffing pattern, job description of various
office holder in nursing and other faculties, provision of continuing
education for the nurses in the form of various in-service education
programs, stability of the tenure in job, any special remuneration
for specialized nurses, selection of faculty and junior staffs and
various faculties provided to the employees.

2. Participated as a  Observed daily taking & handling over of duties & participated in
member of health team planning patient care.
 Observed the activities & type of care provided by staff nurses and
students.
3. Planning, organizing &  Learned to plan staff rotation plan
administration  Organized health teaching programmes
4. Supervision of  Observed cleanliness and smooth functioning of the unit by
cleanliness of the ward working with in-charges in supervising the work of Group D staff.

5. Gained knowledge  Discussed with team leaders about the system of intending.
about linen & drug  Help in indenting various items (consumable and non-consumable)
intend with Team Leader.
6.learnt the job description  Observed duties of General Manager, manager, senior team leader
of various categories of & ward sisters.
workers

7.learnt to maintain the  Observed the important records maintained in the wards
records  Maintained the records by computer and its retrieval system
8. Planning teaching  Areas of lacking knowledge identified.
programme for staff nurses  Demonstrations Conduction.

8
 SECTION- 4

PROBLEM SOLVING

8
INTRODUCTION: Human trafficking is a trade carried upon human beings. The offenders
traffic human beings, exploit them in various forms for financial earnings. Human trafficking
violates many human rights of the victims. The victims of human trafficking face many
consequences as they suffer long period of exploitation even after they come out from such
status.
Trafficking means a trade which is illegal. Human trafficking is carrying out a trade on
humans. Humans are trafficked for the purpose of sexual slavery, commercial sexual
exploitation, extraction of organs or tissues, forced marriage, forced labor or domestic
servitude.
STATEMENT OF THE PROBLEM
A PRE EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF
PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING HUMAN
TRAFFICKING AMONG MOTHER’S IN A SELECTED AREA OF DELHI
OBJECTIVES
 To assess the knowledge regarding human trafficking before and after administration
of planned teaching programme among mothers
 To evaluate the effectiveness of planned teaching programme on knowledge regarding
human trafficking among mothers.

SELECTION CRITERIA OF THE SAMPLES

The criterion for the sample selection was as follows:
 Mothers of various age group
 Who are willing to participate.
SAMPLE SIZE:-
10 mothers

SAMPLING TECHNIQUE:-
 Non-probability purposive sampling technique.

RESEARCH APPROACH
Experimental research approach
RESEARCH DESIGN:-
The research design used in this study is pre-experimental one group pre-test and post-test
design.
DATA COLLECTION TOOL:-
TOOL –I
Demographic variables –
1. Age

8
 2. Religion
3. Education
4. Occupation
5. Number of children
6. Family income
TOOL-II
Structured knowledge questionnaire having 10 Multiple Choice Questions.
.
ANALYSIS OF DATA

The data obtained was analyse as per the objectives of the study and is organized under

the following headings:

 Frequency and percentage distribution will be used to analyse the demographic data.

 Mean, mean difference, Standard deviation is used for assessing the knowledge scores.

 Fisher’s test is used to find out the association between the knowledge with selected

demographic variables. The significant findings will be experienced in tables, figures.

TABLE NO 1
FREQUENCY AND PERCENTAGE DISTRIBUTION OF DEMOGRAFIC DATA
DEMOGRAFIC DATA FREQUENCY PERCENTAGE
1) Age

8
 a) <25 years 2 20%
b) 26-30 2 20%
c) 31-35 5 50%
d) >36 years 1 10%
2) Relegion
a) Hindu 3 30%
b) Christian 5 50%
c)Muslim 1 10%
c) other 1 10%
3) Education
a. Primary 1 10%
b. Secondary 1 10%
c.Degree 7 70%
d.Post graduation 1 10%
4)Occupation
a. Unemployed 6 50%
b. Private 4 40%
c. Goverment 1 10%
5) Numberof chilren
a. One 6 60%
b. Two 2 20%
c. Three 1 10%
d. More than three 1 10%
6) Family income
a.1000-10000 5 50%
b.More than 10000 5 50%

RESULTS
 Data presented in table-1 revealed that majority (50%) mothers were in the age group of
31-35years, 2(20%) of mothers fell in th age group< 25 years and 25-30 years, and
1(10%) was in age group of >36 yrs.
 Half of the mothers are Christian (50%),30 % of them are hindu .and only 10%
mothers goes to muslim and other categoy
 Majority of mothers 70% completed their degree education,10% mothers completed
primary education,10% completed secondary education and10% completed post
graduation
 50% of the mothers are unemployed. Whereas mothers who work in government and
private stands at 40% and 10% respectively
 Maximum 60% of the mothers have one child 20% have two child,10% of mothers have
3 child,10% of mothers have 3 children
 50% of the mothers are have family income of 1000-10000 and the remaining 50%
have more than 10000

Data in Table 1 is also depicted in the form of Pie diagram

8
 AGE

10%
20% <25 years
26-30
31-35
>36 years
20%
50%

. Pie diagram showing percentage distribution of mothers according to relegion

10%

10% 30%
HINDU
CHRISTIAN
MUSLIM
OTHER

50%

Pie diagram showing % distribution of mothers according to education

8
 Education

10% 10%
Primary
10% secondary
Degree
Post graduation

70%

Pie diagram showing percentage distribution of mothers according to occupation

Occupation

10%
Unemployed
Private
50% Government
40%

Pie diagram showing percentage distribution according to the number of children

8
 number of chidren

10%
One
10% Two
Three
>3
20% 60%

Family income

1000-10000
50% 50% >10000

8
TABLE 2 FREQUENCIES AND PERCENTAGE DISTRIBUTION OF PRE-
TEST AND POST TEST OF KNOWLEDGE AND KNOWLEDGE SCORE.

N=10

Grading Grading Pre test Post-test

of of
Frequency Percentage Frequency Percentage
Scores knowledge (f) (%) (f) (%)
0-3 Poor 0 0% 0 0%

4-7 Good 10 100% 0 0%

8-10 Excellent 0 0% 10 100%

Data presented in the Table-2 shows that in pre-test maximum numbers of mothers
i,e.10(100%)were having good knowledge , and in post-test 10(100%) were having excellent
knowledge, which indicates an increase in knowledge score. Hence, the teaching programme
was effective.

Percentage of score in pretest and post test

100%
90%
80%
70%
60% 100 100
50%
40%
30%
20%
10%
0%
poor good excellentg

pretest post test

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TABLE 3 MEAN, MEAN DIFFERENCE, STANDARD DEVIATION AND ‘t’VALUE
OF KNOWLEDGE REGARDING HUMAN TRAFFICKING.
N=10

S.NO MEAN MEAN SD ‘t’ VALUE

DIFFERENCE

Pre test 6.1 2.7 .83 12.65

Post test 8.8

.74
Df(9) t=2.26 at 0.05 level of Significance
The Data presented in Table 3 Shows that the mean post-test knowledge score 8.8 is higher
than the mean pre-test knowledge score 6.1,with the mean difference is 2.7 The obtained
mean difference was found to be statistically significant Calculated’ value is 12.65 at 0.05
level of significance which is higher than the table value at df (9). Hence, it concludes that
the structured teaching program was effective in increasing the knowledge regarding human
trafficking among mothers.

TABLE: 4 FISHER EXACT TEST TO FIND ASSOCIATIONS BETWEEN POST-

TEST KNOWLEDGE SCORE REGARDING HUMAN TRAFFICKING WITH
DEMOGRAPHIC VARIABLES
Table 4 describes the finding of fisher’s test was used to describe the association between the
post-test practice score with selected demographic variables.
There is no significant association between post-test knowledge score amongmotherswith the
selected demographic variables at 0.05% of significance
S.NO CHARACTERISTICS KNOWLEDGE SCORES P- Value Significant/
Below Above Non –
Median Median Significant
1. AGE .80
<25 1 1 NONSIGNI
26-30 0 2 FICANT
31-35 3 2
>36 0 1

2 RELEGION .85

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 Hindu 2 1

Christian 2 3
NONSIGNI
Muslim 0 1 FICANT

Other 0 1

3 EDUCATION
Primary 0 1
.99
NON
Secondary 0 1
SIGNIFICA
NT
Degree 4 3

Post-graduation 1 0

4 OCCUPATION

Unemployed 2 3
NON
.99 SIGNIFICA
Private 2 2
NT

Government 0 1

5 NUMBER OF
CHILDREN
NON
One 2 4
0.80 SIGNIFICA
two 1 1
NT
three 1 0
More than 3 0 1

8
 6 INCOME
Between 1000- 2 3 1 NONSIGNIFICANT
10000
Above 10000 2 3

INTERPRETATION
The data represented in the table 4 revealed that the there is no association between the mean
post –test knowledge score with the selected demographic variables i.e., age , relegion,
educational level ,occupation ,number of children,and mothly family income with
demographic variable .

EVALUATION OF THE PROGARAMME

The problem solving program regarding human trafficking was successful in increasing the
knowledge which is evident from the post-test knowledge score and t value

CONCLUSION
.
The summer field experience in ESI was an enriched experience for me .It was an overall
good learning period as I could correlate my theoretical understanding with the practical and
apply it in the clinical field.

The visit was extremely and enlightening, we learned about various advanced policies and
procedures with high technologies equipped instruments .

The planned teaching program that I conducted was a learning experience for me through
conducting; I have developed leadership and problem solving abilities.

I am highly obliged and thankful to the Principal Madam and all faculty members of
Nightingale Institute of nursing for their valuable advices and encouragement for making this
experience possible and fruitful.

8
8
Questionnaire

1.Human trafficking include

a) Sex trafficking
b) forced labour
c) removal of organ
d) all of the above
2.Following statements are true regarding human trafficking except
a. A serious offence and a grave violation of human rights
b. Human trafficking is same as human smuggling
c. Human trafficking is the trade of humans for the purpose of exploitation
d. A crime that can occur within a country or trans-nationally
3.Human trafficking is
a) Recruitment, transportation, transfer, harboring, or receipt of persons for the purpose
of exploitation
b) Threat ,physical Force, coercion, abduction ,fraud deception, abuse of power ,abuse of
position for the purpose of exploitation
c) People in vulnerable and precarious situations are looking for a way out and, in their
desperation, can fall prey to human traffickers
d) All of the above
4 . Labour trafficking can be
a) Dept bondage
b) Child labor
c) Domestic servitude
d) All of the above
5.Stockholm syndreome is

8
 a) psychological response. when victims develop emotional bond with their captors or
abuser
b) Often seen as a result of physical injury
c) Seen among people who work overtime
d) is a cardiac complication

6.The Immoral Traffic (Prevention) Act, 1956 (ITPA) is the premier legislation for
prevention of
a) Trafficking for organ transport
b) Trafficking for forced labor
c) Trafficking for drug transport
d) trafficking for commercial sexual exploitation
7.Protection of Children from Sexual offences (POCSO) Act, 2012, is a special law to
protect children from sexual abuse and exploitation. which has come into effect from
a) Novemer 2, 2012
b) September 14, 2012
c) November 14, 2012
d) September 2,2012
8.Victim of human trafficking may show the sign of
a) malnourishment
b) physical injury
c) both a and b
d) obesity
9.Recruitment tactics used by traffickers can be false promises of
a. A good job
b. Educational oppertunity
c. Marriage
d. All of the above
10.These are the Central Government Initiatives to Combat Trafficking of Persons except

a) UJJAWALA
b) Anti-Trafficking Nodal Cell
c) Swadhar Program
d) Sukanya samrithy

ANSWER KEY FOR QUESTIONNAIRE

1.d 2..b 3.d 4.d 5.a

6.d 7.c 8.c 9.d 10.d

INTERVENTIONAL PACKAGE ON HUMAN TRAFFICKING

INTRODUCTION: Trafficking in persons is a serious crime and a grave violation of human
rights. Every year, thousands of men, women and children fall into the hands of traffickers, in
their own countries as well as abroad also. Almost every country in the world is affected by
trafficking, whether as a country of origin, transit or destination for victims. Human

8
trafficking can happen anywhere, as long as the environment contains vulnerable conditions.
Human trafficking varies from country to country, but it usually preys on vulnerable
situations. People in vulnerable and precarious situations are looking for a way out and, in
their desperation, can fall prey to human traffickers. Trafficking is a complex phenomenon
that is often driven or influenced by social, economic, cultural and other factors. Every year,
thousands of men, women and children fall into the hands of traffickers, in their own
countries and abroad
DEFINITION: Trafficking in persons can be defined as the recruitment, transportation,
transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms
of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of
vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a
person having control over another person, for the purpose of exploitation.
METHODS USED FOR HUMANTRAFFICKING: Threat or use of force, coercion,
abduction, fraud, deception, abuse of power or vulnerability, or giving payments or benefits to
a person in control of the victim for the purpose of exploitation
HUMAN TRAFFICKING AND HUMAN SMUGGLING: The terms "human trafficking"
and "human smuggling" are often used interchangeably, but they are not the same
thing Human smuggling involves an individual being brought into a country through illegal
means and is voluntary. The individual has provided some remuneration to another individual
or party to accomplish this goal 
CAUSES OF HUMAN TRAFFICKING

GLOBALIZATION
Human trafficking has been called one of the "darkest sides of globalization" . Globalization
is the term used to describe the interconnectedness of countries and nations, which facilitates
easy communication, exchange of ideas, and flow of goods, capital, and services . .
Furthermore, the ideals of Western capitalism may reinforce human trafficking as a business
or industry, with its emphasis on the free market and the flow of goods and services across
international borders .
Globalization has also created the need for cheaper labor . A study involving 160 countries
examined the effects of globalization and human trafficking trends . Researchers found a
positive relationship between globalization and trafficking for forced labor, prostitution, and
debt bondage.

POVERTY
Poverty and incessant economic stressors caused by civil wars, natural disasters, and
collapses of government systems all contribute to human trafficking . Families entrenched in
deep poverty may feel they have no other recourse but to sell a child or may be more easily
lured with promises of money and a better future . In one study, the odds of being trafficked
were nine times greater for those who felt extremely hopeless about upward mobility
compared with those with lower levels of hopelessness .

SOCIAL AND FAMILIAL DISORGANIZATION

8
Community factors (such as high social disorganization characterized by violence,
unemployment, and high crime) contribute to higher risk of trafficking . In addition, families
marked by instability (e.g., domestic violence, child abuse, continual unemployment) are also
at higher risk of having a member trafficked .

CORRUPTION
Human trafficking cannot occur without the existence of corruption within existing
infrastructures. Public officials, police officers, and local leaders in many developing
countries have been known to take bribes to provide protection to parties involved in various
aspects of human trafficking .

DIGITAL TECHNOLOGY
The rampant use of digital technology, such as the Internet, greatly facilitates sex trafficking.
The relative anonymity of online contact can empower traffickers to recruit or sell victims.
Graphic images of women and children engaged in sexual acts can be easily disseminated
over the Internet . Traffickers may employ the Internet for advertising, marketing to those
interested in making pornography . In addition, social media sites such as Facebook,
Craigslist, and Instagram have been used as a means of facilitating trafficking (e.g., by
connecting and grooming potential victims) . Newsgroups offer opportunities for those
interested in locating women and children for sexual exploitation.
In a 2013 qualitative study, smartphones were found to be integral in the business of
trafficking . Researchers indicated the phones were used "to maintain contact with each other,
in order to facilitate the business 'transactions' and stay in touch with transnational 'partners'
and other traffickers who remained in the country of origin" .

RACIALIZED SEXUAL STEREOTYPES

Race and ethnicity have been inextricably linked to sexual violence and victimization. Myths
regarding sexuality in certain cultures or racial fetishization may affect trafficking patterns.
For example, there is an over-representation of Asian women on American Internet
pornography sites in part due to popular myths sexualizing, eroticizing, and exoticizing Asian
women. This has translated into trafficking, as traffickers respond to the demand for young
Asian women and girls in part fueled by these stereotypes of exotic, docile, submissive, and
eager-to-please Asian women . These stereotypes devalue and dehumanize people, which is
the underlying core of human trafficking. This contributes to the acceptability of the
exploitation of individuals, particularly members of marginalized groups ..

CULTURE
Although many are careful in linking cultural factors to the etiology of human trafficking for
fear of imposing judgment on a particular culture, many maintain that cultural ideologies that
tolerate sexual trafficking, bonded labor, and child labor may be a stronger factor than
poverty in predicting trafficking rates . For example, some cultures emphasize collectivism
and prioritizing the needs of the family and group first before the needs of the individual.
Some children may feel they have to sacrifice themselves for their family when traffickers
promise money . Traffickers also know that they can threaten to hurt victims' families to keep
them from escaping .
Furthermore, in many cultures, boys are more highly valued than girls, and as a result, girls
are considered more dispensable . Sons are considered the family's social security, staying

8
with the family while daughters marry into other families. Therefore, girls may be more
likely to be sold into slavery than boys.
Child labor is also inextricably tied to cultural factors. In India, for example, child labor is
common because it is believed that children in the lower levels of caste system (i.e., the
"untouchables") should be socialized early to understand their positions in society . It has
been observed that when traditional cultural and societal norms about women's roles were
relaxed in some European countries and more women entered the labor force, child labor
decreased . Ultimately, it is difficult to unravel the effects of poverty and culture because the
pressures of poverty can lead families to use tradition as a justification to sacrifice young
men, women, and children .
Ultimately, the conversation about human trafficking is complex, and to attempt to isolate the
causes is beyond challenging. Multiple factors have been suggested as possibly predicting
human trafficking, including macroeconomic factors (e.g., gross domestic product per
capita), unemployment rates, female inequality, cultural oppression, and lack of protection of
women's rights . In one study, ease of land access to the destination country appeared to be a
powerful predictor in terms of the number of individuals trafficked 

TYPES OF HUMAN TRAFFICKING: `

1.Labour trafficking(forced labour)

Labour trafficking is the movement of persons for the purpose of forced labour and
services. It may involve bonded labour, involuntary servitude, domestic servitude, and child
labour. Labour trafficking happens most often within the domain of domestic
work, agriculture, construction, manufacturing and entertainment; and migrant workers and
indigenous people are especially at risk of becoming victims. People smuggling operations
are also known to traffic people for the exploitation of their labour, for example, as
transporters. Forced labour might also involve using a person as a drug mule — forcing them
to transport and deliver drugs
A.Bonded labour: also known as debt bondage a happens when people give themselves into
slavery as security against a loan or when they inherit a debt from a relative. It can be made
to look like an employment agreement but one where the worker starts with a debt to repay –
usually in brutal conditions – only to find that repayment of the loan is impossible. Then,
their enslavement becomes permanent

8
B.Domestic servitude refers to a category of domestic workers (usually female) who work in
forced labour as servants, housekeepers, maids, and/or caregivers, often in private homes. In
some cases, young women are lured with the promise of a good education and work, they are
exploited with little pay and long working hours.
C. Child labour: Employment of children in any work that deprives them of their childhood,
interferes with their schooling, and that is mentally, physically, socially or morally dangerous
and harmful

2.Forced marriage

A forced marriage is a marriage where one or both participants are married without their
freely given consent. Servile marriage is defined as a marriage involving a person being sold,
transferred or inherited into that marriage. , "Child trafficking for forced marriage is simply
another manifestation of trafficking and is not restricted to particular nationalities or
countries".
Forced marriage can be coupled with other forms of slavery. Children who are trafficked for
sex may also be sold into forced marriages. An adult who is forcibly married may then be
trafficked for labour or sex by and for the financial gain of his or her spouse.

3.Child trafficking:

 Commercial sexual exploitation of children can take many forms, including forcing a child
into prostitution or other forms of sexual activity or child pornography. Child exploitation
may also involve forced labour or services, slavery or practices similar to slavery, servitude,
the removal of organs, illicit international adoption, trafficking for early marriage,
recruitment as child soldiers, for use in begging or as athletes

8
Traffickers in children may take advantage of the parents' extreme poverty. Parents may sell
children to traffickers in order to pay off debts or gain income, or they may be deceived
concerning the prospects of training and a better life for their children. They may sell their
children into labour, sex trafficking, or illegal adoptions.

4.Organ trafficking
It a form of human trafficking. It can take different forms. In some cases, the victim is
compelled into giving up an organ. In other cases, the victim agrees to sell an organ in
exchange of money/goods, but is not paid (or paid less). Finally, the victim may have the
organ removed without the victim's knowledge (usually when the victim is treated for another
medical problem/illness – real or orchestrated problem/illness). Migrant workers, homeless
persons, and illiterate persons are particularly vulnerable to this form of exploitation.
Trafficking of organs is an organized crime, involving several offenders:

 the recruiter
 the transporter
 the medical staff
 the middlemen/contractors
 the buyers
Trafficking for organ trade often seeks kidneys. Trafficking in organs is a lucrative trade
because in many countries the waiting lists for patients who need transplants
5.Sex trafficking

8
Traffickers take advantage of young girls by luring them into the business through force and
coercion, but more often through false promises of love, security, and protection. This form
of coercion works to recruit and initiate the victim into the life of a sex worker
The goal of a trafficker is to turn a human being into a slave. To do this, perpetrators employ
tactics that can lead to the psychological consequence of learned helplessness for the victims,
where they sense that they no longer have any autonomy or control over their lives.
Traffickers may hold their victims captive, expose them to large amounts of alcohol or use
drugs, keep them in isolation, or withhold food or sleep. During this time the victim often
begins to feel the onset of depression, guilt and self-blame, anger and rage, and sleep
disturbances, PTSD, numbing, and extreme stress. Under these pressures, the victim can fall
into the hopeless mental state of learned helplessness. This form of coercion works to recruit
and initiate the victim into the life of a sex worker, while also reinforcing a "trauma bond",
also known as Stockholm syndrome. Stockholm syndrome is a psychological response where
the victim becomes attached to his or her perpetrator.[16
For victims specifically trafficked for the purpose of forced prostitution and sexual slavery,
initiation into the trade is almost always characterized by violence. Traffickers employ
practices of sexual abuse, torture, brainwashing, repeated rape and physical assault until the
victim submits to his or her fate as a sexual slave. Victims experience verbal threats, social
isolation, and intimidation before they accept their role as a prostitute.

SIGNS THAT A PERSON MIGHT BE TRAFFICKED

 Cannot leave their job to find another one

 Do not have control over their wages or money
 Work but do not get paid normal wages
 Have no choice about hours worked or other working conditions
 Work long hours, lives at a work site, or is picked up and driven to and from work
 Show signs of physical abuse or injury
 Are accompanied everywhere by someone who speaks for him/her
 Appear to be fearful of and or under the control of another person
 May have health issues that have not been attended to
 Owe money to their employer or another person who they feel honour bound to repay
 May describe moving or changing jobs suddenly and often
 Are unfamiliar with the neighbourhood where they live or work
 Are not working in the job originally promised to them
 Are travelling with minimal or inappropriate luggage/belongings

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  Lack identification, passport or other travel documents
 Are forced to provide sexual services in a strip club, massage parlour, brothel or other
locations
 May appear to be malnourished
CONSTITUTIONAL & LEGISLATIVE PROVITIONS FOR TRAFFICKING IN
INDIA

 Trafficking in Human Beings or Persons is prohibited under the Constitution of India

under Article 23 (1)
 The Immoral Traffic (Prevention) Act, 1956 (ITPA) is the premier legislation for
prevention of trafficking for commercial sexual exploitation.
 Criminal Law (amendment) Act 2013 has come into force wherein Section 370 of the
Indian Penal Code has been substituted with Section 370 and 370A IPC which provide for
comprehensive measures to counter the menace of human trafficking including trafficking
of children for exploitation in any form including physical exploitation or any form of
sexual exploitation, slavery, servitude, or the forced removal of organs.
 Protection of Children from Sexual offences (POCSO) Act, 2012, which has come into
effect from 14th November, 2012 is a special law to protect children from sexual abuse
and exploitation. It provides precise definitions for different forms of sexual abuse,
including penetrative and non-penetrative sexual assault, sexual harassment.
 There are other specific legislations enacted relating to trafficking in women and children
Prohibition of Child Marriage Act, 2006, Bonded Labour System (Abolition) Act, 1976,
Child Labour (Prohibition and Regulation) Act, 1986, Transplantation of Human Organs
Act, 1994, apart from specific Sections in the IPC, e.g. Sections 372 and 373 dealing with
selling and buying of girls for the purpose of prostitution.
 State Governments have also enacted specific legislations to deal with the issue. (e.g. The
Punjab Prevention of Human Smuggling Act, 2012)

Central Government Initiatives to Combat Trafficking of Persons

Integrated AntiHuman Trafficking Units (IAHTUs) • In 2008/2009, the Government

“allocated 832 million INR ($12.3 million) to the Ministry of Home Affairs to create 297
Anti-Human Trafficking units across the nation to train and sensitize law enforcement
officials

Anti-Trafficking Nodal Cell State Program • While its Central Government operation
remains under resourced (two-person department), the Ministry of Home Affairs (MHA) has
gained national support for the initiative. Every state has appointed Anti-Trafficking Nodal
Officers. .

Swadhar Program • The Ministry of Women and Child Development under Swadhar Greh
have increased the budget from 500 million INR ($7.37 million) to 900 million ($13.3
million)5 . The MWCD supports over 200 shelters for more than 15,000 women and girls
recused from a range of difficult circumstances, including sex trafficking. Currently, there are
551 Swadhar Greh homes with 16,530 beneficiaries (Annexure 3) across States/UTs. As per
the scheme, Swadhar Greh should be set up in every district with capacity of 30 women.

Ujjawala Program • Introduced by the MWCD in 2007, Ujjawala is a comprehensive scheme

for Prevention of Trafficking and Rescue, Rehabilitation and Re-Integration of victims of

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Trafficking for commercial sexual exploitation. • The Central government’s budget for the
Ujjawala program has increased from 180 million INR ($2.65 million) in 2015-2016 to 240
million INR ($3.54 millions) in 2016-176 . As on 21st Feb 2014, 273 projects including 151
Protective and Rehabilitative Homes have been supported under the scheme. There are 6350
beneficiaries under the scheme

Centrally Sponsored Plan Scheme for Rehabilitation of Bonded Labour The Ministry of
Labour & Employment (ML&E) on 17th May 2016 launched the scheme, which is a central
sector scheme where the state government is not required to pay any matching contribution for
the purpose of cash rehabilitation assistance

IMPACT OF HUMAN TRAFFICKING:

ECONOMIC IMPACT: Survivors/victims get excluded from the mainstream source of

livelihood. Due to low self-esteem, the survivors need external support to economically
sustain themselves.
SOCIAL IMPACT: Survivors find it difficult to deal with the social stigma when
rehabilitated back to their homes. They are unable to integrate back into their communities
HEALTH IMPACT:
The Physical Effects Sex trafficking is a complex problem because the victims experience
physical and psychological harm. The traffickers use physical violence to dominate and
control their victims. Some of the tactics include starvation, beatings, rape, and gang rape.
Victims also experience violence and harm from some of the people who are purchasing the
sex acts. Common injuries include broken bones, concussions, burns, and brain trauma.
Victims can also experience gynecologic health problems that stem from forced commercial
sex acts. They might suffer from sexually transmitted diseases, menstrual pain and
irregularities, miscarriages, and forced abortions, among other problems.
The Psychological Effects :The psychological impact of victimization may be more severe
than the physical violence (WHO, 2012). Victims who have been rescued from sexual
slavery, typically present with various psychological symptoms and mental illnesses,
including the following:
 Post-Traumatic Stress Disorder (PTSD)
 Depression
 Anxiety
 Panic disorder
 Suicidal ideation
 Stockholm Syndrome
 Substance abuse

CONCLUSION: Human trafficking is considered as major issue to resolve. Anti-trafficking

advocates argue that human trafficking exists because there is a demand for cheap goods and
labour and the provision of sexual services. They suggest that the most effective way to

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combat human trafficking is to eliminate the demand that fosters the exploitation of men,
women, and children.

BIBLIOGRAPHY
R Sreevani, a guide to mental health and psychiatric nursing, jaypee publishers, 3rd edition,
pg.no: 310-311,Page number.415 

 Townsend c Mary, text book on “Psychiatric Mental Health Nursing.” Jaypee publications.
5th edition, page 387-405
https://en.wikipedia.org/wiki/Human_trafficking
https://www.netce.com/studypoints.php?courseid=1866&printable=yes&page=printquestions
file:///C:/Users/hp/Downloads/TestKnowledge%20on%20human%20trfficking.PDF