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The In-patient context
Feb 2009
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Learning outcomes
Define the term inpatient and identify different types ofinpatient settings and the services provided
Describe the structure and function of an inpatientsetting/ward/unit
Identify and discuss the roles of key personnel within
an inpatient setting/ward/unit
Discuss the operational systems and processes of aninpatient setting/ward/unit
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Who is described as anIn -patient?
A person who has been admitted to a hospital as aregistered bed patient and is receiving services under the
direction of a physician for at least 24 hours
A patient admitted to a Hospital or other facility for bedoccupancy to receive services consisting of active medical
and nursing care to treat conditions requiring continuousnursing intervention of such an intensity that it cannot
be safely or effectively provided in any other setting
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Counties Manukau District HealthBoard
DHB Objectives include:to improve, promote, and protect thehealth of people and communities;to promote the integration of healthservices, especially primary andsecondary health services;Hospital and Specialist serviceswww.cmdhb.org.nz
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Middlemore Hospital
91,000 patientsadmitted per year354,000 day-patient/outpatientattendances
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Types of In-patient settings
RuralSmall country hospitals
UrbanCity base hospitals
PublicPublicly funded
PrivateFee paying service
Pukekohe hospital
Middlemore hospital
Middlemore hospital
Mercy Ascot hospital
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Types of inpatient settingsDay stay/Short stay
Elective surgery orprocedures
Long stay elderly care
Secondary careSpecialist , diagnosticand treatment services
TertiarySpecialised services
Manukau Surgery Centre
Franklin Hospital
Howick Baptist Hospital
Middlemore Hospital
Burns and plastic surgery,
orthopaedics, renal dialysis
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Key CMDHB inpatient services
Kidz First and WomensHealth
Medical and surgicalinpatient care for
children
Gynaecology service
Ante Natal, Post Nataland delivery care
Newborn special care
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Key CMDHB inpatient services
Medicine, Acute Care andClinical Support
Cardiology, Respiratory,Palliative Care, InfectiousDiseases, CerebrovascularAccident(Stroke), HaematologyEmergency care/Intensive careRadiologyPhysiotherapyOccupational TherapySocial Work, DieteticsSpeech LanguagePharmacy
LaboratoryClinical records
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Key CMDHB inpatient services
Surgical and ambulatory careOperating theatreGeneral surgeryPlastic surgeryBurnsDental surgeryAnaestheticsOtorhinolayryngology (ORL)
OpthalmologyUrologyBreast service
Orthopaedics
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Key CMDHB inpatient services
Mental Health andintermediary care
Mental health inpatientand rehabilitation
Assessment andtreatmentRehabilitationMental healthservice for theelderly
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Who are the key personnel?
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Key personnelNurses
Medical staff
Allied health staff
Other clinical staff
Health care assistants
Support staff
Volunteers
Security
Administration
Management
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Structure, processes and
functions of a ward or unit
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Structure, processes andfunctions of a ward or unit
Types of wards or units
Key staff - roles
Ward routine a typical day
Nurse patient ratios
RosteringAdmissions and discharges
Family/visitors/public
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Structure, processes andfunctions of a ward or unit
Policies, procedures, documentation
Equipment and supplies
Budgets
Technology and communication
Safety and security
Privacy, confidentiality and release of information
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Roles and effective teamwork
Learning outcomes
Identify the roles and teams within the inpatient setting
Discuss the role of the nurse within the team
Identify any barriers to effective team work
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Case study-Roles and teamwork
Barry is a 44 year old bus driver who experienced centralchest pain whilst
driving his car. He also experienced dizziness and nausea.He stopped his car and called 111 on his cell phone.He was transported to the emergency department byambulance.
The ambulance staff gave him oxygen andinserted a cannula in his left arm.
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Case study-Roles and teamwork
On arrival at the emergency department Barry was admittedto the monitoring area.The registered nurse from the emergency departmentrecorded Barrys vital signs and took an ECG recording.Barry was attached to the cardiac monitor and given oxygen.Barrys family was informed of his admission
and are on their way to the hospital.
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Case study-Roles and teamwork
Barry is seen first by the by the Medical Registrar and aMedical Student.They examine Barry and order a number of tests;Electrocardiogram (ECG) , Chest X-ray (CXR),and a number of blood tests.Barry is given Morphine for pain relief.
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Case study-Roles and teamwork
The 3rd year (level 7) student nurse records the ECGand the Radiographer and Phlebotomist are called.
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Case study-Roles and teamwork
Barrys wife has arrived with her young son of 4.The Health Care Assistant brings them to Barrys bedside and offers them a drink.Barrys wife Tola does not speak English as a first language.The registered nurse assesses the situation and feels thatTola would benefit from having an interpreter present when
the doctor comes to speak with her and Barry.Other family members will be in later in theafternoon as they do not live locally.
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Case study-Roles and teamwork
When the test results are available an initial primary diagnosisof Angina is made.Barry is to be transferred to the Coronary Care Unit (CCU).An orderly comes with a trolley to transfer Barry to the unit.
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Case study-Roles and teamwork
When arriving at the CCU, Barry is transferred into a bed.A 2nd year student (level 6) is with the registered nurseand they settle Barry into the unit.Barrys wife Tola is shownto the waiting room by the ward clerk.
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Case study-Roles and teamwork
The Radiologist has reported on Barrys X -rayand contacted the Cardiologist as Barrys heart is enlarged.The charge nurse arranged for Barry and his wifeto be seen by the medical team.
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Case study-Roles and teamwork
Barry was in the unit for 5 days.He was found not to have had a myocardial infarction (MI)(Heart Attack)and was diagnosed with Angina.His heart was enlarged so he will return to the cardiologydepartment at a later date for further tests and
was discharged with a number of medications includingGlyceryl Trinitrate spray (GTN) and Aspirin. The ward pharmacist brought a number of informationleaflets for Barry and his wife to take home.
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Case study-Roles and teamwork
During his time in the unit he was seen by thecardiology nurse specialist who referred Barryto the physiotherapist , dietician and social worker .
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Case study-Roles and teamwork
There were a number of new registered nurseson the unit that week and the Clinical Nurse Educator was orientating them.The student nurses on the unit were visited by theMIT Lecturer
After Barry was discharged the nurses and ward cleaner cleaned the bed space and surrounding areas.
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What are the barriers to effectiveteamwork?
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