FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Learning objective
 Introduction
 Operational standards
 Implementation Guidance
 Assessment checklist
 Indicators

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 At the end of this presentation the participant will able to
◦ Explain Concepts and principles of nursing/midwifery
service organization and management
◦ Identify resources and infrastructure needed for
nursing/midwifry service management
◦ Identify tools and methods used to measure nursing service
◦ Describe the development of SOPs and quality improvement
projects for implementation of nursing service standards

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 Nursing and midwifery services are expected to provide the public
with competent, safe and ethical nursing and midwifery care.
 Nurses and midwives are fully accountable and responsible for their
entire practice.
 Nurses and midwives are professionals who are committed to the
development and implementation of practice standards through
ongoing acquisition, application and evaluation of relevant
knowledge, skills, attitudes and judgment.
 The services are an essential part of the hospital system in improving
the health outcomes of individuals, families and communities
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 The hospital has established nursing/midwifery service
management structures
 The hospital has a nursing and midwifery workforce plan that
addresses nurse /midwife staffing requirements and sets
minimum nurse /midwife to patient ratios in each service area

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 The hospital has written policies describing the
responsibilities of nurses and midwives for the
nursing/midwifery process including the admission
assessment, planning, implementation and evaluation of
nursing/midwifery care.
 All admitted and emergency patients/clients have a
nursing/midwifery care plan that describes holistic
nursing/midwifery interventions to address their needs

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 All hospital nurses/midwives comply with the professional
code of conduct and ethics which governs their professional
practice.
 The hospital has established guidelines for verbal and written
communication about patient/client care

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 The hospital has standardized procedures for the safe and
proper administration of medications.
 The hospital has established a system for nursing/midwifery
care practice audit programme, including the documentation
of completed audits and resulting practice improvements.

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 The hospital implements regular nursing/midwifery eight
hours’ shift rounds.
 The hospital has a centralized nursing/midwifery station set-
up in each ward with adequate space, equipment and
consumables.

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 Organizational Structure for Nursing/Midwifery service
◦ Nursing/Midwife Director is a member of the senior management team
(SMT) and responsible for the overall function of nursing and midwifery
activities in the hospital.
◦ Head nurses/midwives are responsible for the overall function of nursing
and midwifery activities in each ward and accountable to the
Nursing/Midwifery Director.
◦ Supervisor Nurses: are responsible for the overall function of nursing and
midwifery activities in the hospital on duty and are accountable to the
Nursing/Midwifery Director.

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 Nursing practice requires teamwork, :
◦ Collaborate with the patient and their caregivers,
◦ Work with colleagues in the formulation of overall goals,
plans and decisions related to patients,
◦ Work with other members of the multidisciplinary team in
caring for patients,
◦ Consult with other health care providers on patient care, as
appropriate,
◦ Make referrals, including provisions for continuity of care, as
appropriate,
◦ Lead an organized Health Development Army, and
◦ Nurses/midwives should assume responsibility for monitoring,
evaluating and reporting of their activities

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 Supervision and Delegation
Clinical supervision is “a formal process of professional support
and learning which enables individual practitioners to develop
knowledge and competence
Senior nurses will lead the clinical supervision activities like
nursing shift rounds, nursing case discussion program, nursing
service audit program and etc
Nurses/midwives may delegate tasks and responsibilities to junior
nurses/midwives, student nurses/midwives or parallel position

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 Work force plan
◦ Inappropriate distribution of available staff adversely affects the quality
of patient care.
◦ Staff ratio the following factors to be considered include:
◦ The severity of the clinical condition of patients,
◦ The intensity of nursing/midwifery care needed, for example the
frequency of nursing interventions such as observations, medication
administration, wound care, stoma care, bathing etc.,
◦ The number of admissions and discharges,

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 Resources
 Hospitals should ensure that nurses/midwives have access to and
are trained on how to use resources (including equipment and
consumables) correctly and cost-effectively.
 Nurses/midwives are responsible for forecasting stock-outs of
nursing/midwifery formats and other consumables on the ward,
and should inform the appropriate party of the need for additional
resources to prevent stock out

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 Admission assessment
◦ A nurse/midwife collects and documents data regarding
patient/client health status. In the nursing assessment, the
nurse gathers and examines both Subjective and Objective
data.
 Subjective data are what the patient/client actually states (e.g. "I'm
tired"). These are his/her feelings and perceptions.
 Objective data are concrete, observable information and
investigation.

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 Diagnosis/ Problem Identification
 Diagnosis is a clinical judgment about an individual, family or community,
response to actual or potential health problems.
 The most commonly selected nursing/midwifery diagnoses compiled and
categorized by NANDA.
 It is important to remember that nursing diagnoses differs from the
physician’s diagnosis as illustrated as

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 Physician vs Nursing Diagnosis
Physician diagnosis is disease focused, for example:
“Ato Yidnek has pain and swelling in all his joints. Diagnostic
studies indicate that he has rheumatoid arthritis. Anti-
inflammatory drugs will be prescribed to treat the rheumatoid
arthritis”
Nursing diagnosis is holistic, considering both the problem and
its effect on the patient and family, for example:
‘Ato Yidnek has pain and swelling in all his joints making it
difficult to feed and dress himself. He states that he feels
worthless when he cannot even feed himself’.

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 Care plan
◦ The care plan is a record of interventions that will address the
identified problems. It should be based on the problem
identification and the diagnoses, and should be individualized .
◦ Assigning priorities to the nursing/midwifery diagnoses and
collaborative problems.
◦ Specifying expected outcomes.
◦ Specifying the immediate, intermediate, and long-term goals of
nursing action.

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 Care plan
◦ Identifying specific nursing/midwifery interventions
appropriate for attaining the outcomes.
◦ Identifying interdependent interventions.
◦ Documenting the nursing/midwifery diagnoses,
collaborative problems, expected outcomes, nursing goals,
and nursing/midwifery interventions on the plan of nursing
care.
◦ Communicating to appropriate personnel any assessment
data that point to health needs that can best be met by other
members of the health care team

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 Care plan
◦ The following aspects of nursing care should be considered
when developing and implementing a nursing care plan:
◦ Therapeutic relationship
◦ Counselling
◦ Promoting self-care/group
◦ Activities Psychosocial interventions

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 Implementation of the Plan
The care plan should be implemented by all nurses/midwives
who care for patients/clients. Hence, all staff should be familiar
with the care plan and should ensure that the activities
described in the care plan are carried out during each shift.
Designed to promote, maintain, and restore mental and
physical health.

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 The interventions should be:
◦ For each admitted patient, the nursing/midwifery process
form should be attached and the assessment should be
completed immediately after admission.
◦ Based on current knowledge and principles of relevant
preventive and therapeutic modalities.
◦ Selected based on the needs and /or desires of the individual
or community.
◦ Selected according to the nurse’s level of practice,
education and certification.

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 The interventions should be:
◦ Implemented within the established plan of care.
◦ Performed in a safe, ethical and appropriate manner.
◦ Adapted to changing patient needs and situations.
◦ Reviewed in order to recognise the progress or lack of progress, and,
reassignment of priorities is required towards identified goals.
◦ Nurses/midwives should document progress reports at the end of each
shift which should consist of nursing/midwifery interventions,
patient/client responses, patients/clients emotional adjustment and
rendered patient/client education.

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Evaluation of the plan
◦ Evaluation is the process of determining the extent to which the set
goals have been achieved. The nurse/midwife must evaluate the results
to determine whether the interventions were effective The care plan
should be regularly reviewed and modified as necessary and should
consider the following questions:
◦ Have the goals of the care plan been achieved?
◦ If not, why not? Were the goals realistic?
◦ Was the client/patient committed to the goals?
◦ Was there enough time to achieve the goals?
◦

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 Evaluation of the plan
◦ Did other problems arise that impeded progress?
◦ Which interventions were consistently performed as
prescribed?
◦ Have any new problems developed that have not addressed?
◦ Could more have been achieved than originally hoped?
◦ Should new goals be set?
◦ The action plan should be checked at intervals, randomly by
the nurse supervisors/head nurses and should be
documented

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 Accountability and Responsibility
 The nurse/midwife remains accountable for his/her own practice as well as
for the delivery of the care plan and for ensuring that the overall objectives
are met.
 Nurses/Midwives’ Continuous Professional Development
 Professional development /education contain the following four steps to
improve the quality of care:
 Self-Assessment of your learning needs,
 Planning your learning goals,
 Implementation of your plan, and

 Self-Evaluation of what you have achieved.

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 Communication and documentation
◦ The hospital should establish clear guidelines for both verbal and written
forms of communication for in-patient, Emergency; Outpatient and Delivery
Case Teams.
 Written communication:
◦ This includes the written documentation of all findings, progress, care and
treatment provided to the client by the multidisciplinary team.
 Verbal communication:
◦ This entails the act of reporting and conversing with other members of the
health care team regarding the client’s progress and status.
◦ Verbal orders will only accepted in emergencies

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 Medical Record Documentation
◦ The following items are used by nurses/midwives to document a
patient’s course of treatment.
◦ It is the nurse’s/midwife’s responsibility to ensure that a patient’s
medical record is complete, containing all the necessary forms in the
proper sequence.

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 Inpatient Clinical forms include:
◦ Intravenous Fluid Administration Record, Routine
Observation Form, and Nursing Process forms Medication
Administration Record
◦ Family Folder for the individual/ family includes:
◦ Antenatal, post-natal and delivery ,Immunization card
Family Planning card and IMNCI chart

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 Patient education
 Nurses should give health education for all patients, also incorporate
family members and other caregivers who often play a strong role in
facilitating patient care in coordination with the medical staff
 Medication Management
 It is the nurse’s responsibility to safely administer the medications to a
patient as ordered by the physician. Nurses should be aware of the
desired outcome, dosage, preparation and side effects of each prescribed
medication.

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 Physician Order: A physician’s order is required for t
Standing order: To be carried out as specified until it is
canceled by another order (including PRN orders).
 Single order: To be carried out only once, as directed.
 Stat order: To be carried out immediately
 Verbal order: An order that has been communicated through
the phone or verbally. he administration of all medications.

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 the physician who issued the order should be called to
complete the order.
 Date and time:
 Full name of the medication:
 Dosage:
 Concentration:
 Duration
 Time and frequency:
 Route:
 Physician Signature:

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 Nursing/midwifery practice audit programme
 The nursing/midwifery practice audit programme
should be part of the overall hospital quality
improvement programme.

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 Purposes of Nursing Audit
 Evaluates nursing/midwifery care patients/clients
receive.
 Promotes quality improvement of nursing/midwifery
care.
 Improves quality of record keeping.
 Focuses on care provided and not on care provider.
 Contributes to research.

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 Audit type
 Retrospective Review - this refers to an in-depth
assessment of the quality of care after the patient
has been discharged. The patient’s chart is the
source of data.
 Concurrent Review - this refers to the
evaluations conducted on behalf of patients who
are still undergoing care. It includes assessing the
patient at the bedside in relation to a pre-
determined criterion; interviewing the staff
responsible for this care and reviewing the
patient’s record and care plan.
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Assessment Tool for Operational Standards
In order to determine if the Operational Standards of
Nursing /Midwifery care standards have been met
by the hospital an assessment tool has been
developed which describes criteria for the
attainment of a Standard and a method of
assessment

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Implementation Checklist
The following Table can be used as a tool to record
whether the main recommendations outlined above
have been implemented by the hospital. This tool is
not meant to measure attainment of each Operational
Standard, but rather to provide a checklist to record
implementation activities.

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 Criterria Yes no

1. There is a system for coordinating and managing

nursing staff.
2 A nursing workforce plan has been developed
3. The hospital’s nurse staff requirements are
defined in the nursing workforce plan
4. Nurse to patient ratios for each service area are
defined in the nursing workforce plan
5. There is a written policy for the nursing process
6. Nurses complete nursing admission assessments
for inpatients
7. Nurses complete a nursing care plan for
inpatients

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 Criterria Yes no

8. There are guidelines for nursing communication

9. There are written guidelines for medication
administration
10. There is an established nursing/midwifery care
practice audit programme
11. Nurses implement regular nursing/midwifery
hours (eight)’ shift
12. Nurses conduct nursing care hourly rounds
13. There is a centralized nursing/midwifery
station set-up in each ward
14. There is a central medication room or
cabinet

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THANK YOU!!!
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