Managing the patients in case of non-availability of facilities

Nearly 51 per cent of the staff feel that the patients have suffered due to non- availability of material in the ward and the hospital. Comparing the staff nurses and the sister incharges opinions on the issue of the negative effect of non-availability of physical facilities on patient treatment it is evident that while nearly 50 per cent of the staff nurses state that patient care suffered due to the non-availability of material, only 43 per cent of sister incharges feel the patient care was affected by the non-availability of physical facilities. Overall, 49 per cent of the nursing staff have reported that patient care suffered due to the lack of availability of material in the hospitals.

Table 2.3

Impact of lack of facilities on patient care

Do you have an experience in the past where due to non availability of material the patient care was suffered irrespective all your efforts?

Present designation

Total Staff Nurse Sister

incharges

No 133 (50.4) 30 (56.6) 163 (51.4) Yes 131 (49.6) 23 (43.4) 154 (48.6) Total 264 (100) 53 (100) 317 (100)

(Figures in brackets indicate the percentage of nursing staff) N=317

Since the nursing staff are in direct contact with the patients and they have the responsibility to provide facilities, guidance and support to the patients during the course of their entire stay at the hospital, it becomes necessary for the staff to take some steps to improve the conditions in case the material supply is inadequate or there is a complete lack of the same in the ward. The nursing staff’s experiences of managing patients in case there are no medicines or linen or any other facility available in the ward is shown in Table 2.4.

Table 2.4

Management of patients incase of non-availability facilities

Sl. No. Nursing staff action against non availability of facilities Percentage 1 To follow as per the direction of supervisors/doctors 34 2 Ask the patients or relatives to bring items (medicines, surgical _{items etc) incase of shortage and they buy from outside} 63 3 Only inform superiors and they shall manage 21 4 Incase of need for equipments shall be taken from wards 15 5 Transfer the patient if no service available or higher level of _{treatment is required to other hospital as per doctor’s instruction} 49 6 Give prescriptions to the patients and referring to medical social _{worker for any other support} 76 7 To maintain some material for emergency and take it from other _ward 35

In case some of the facilities are not available in the ward or in the hospitals, the nursing staff ask the patient or their relatives to get such material from outside. If the facility are complex such as a higher level of treatment , the patients will be shifted to medical college hospitals because peripheral hospitals are not tertiary care centers and hence, these hospitals have only limited facilities. It is to be noted that

in the study hospitals, facilities like ICU, blood bank, emergency care, diagnostic equipments like CT Scan, MRI, etc. are not available as per regulatory standards. 2.3 Additional facilities needed for Nursing staff and Patients

Facilities needed for Patients

The nursing staff is of the opinion that there is a need for adequate material supply for the patients. As indicated earlier, a large number of staff feel that the material supply is inadequate in the hospitals. Nursing staff feel that some material like linen, medicines, good diet, disposables, advanced technological machines; number of beds, antibiotics should be available adequately. Apart from this, the staff also feel that there is a need for additional services like blood bank, X-ray facilities and lab services at night, CT scan, MRI, ECG facilities, ICU services, dressing rooms, drinking water, stationery, blood investigations injections, clean place, proper educational means and methods for the patients, channels to provide emotional support to the patients are essential. In addition to the above, free treatment for poor patients and adequate security guards to control overcrowding in the hospitals should be provided.

Facilities need for nursing staff

The nursing staff feel that the primary requirement is adequate staff as per staff nursing council norms (better staff-patient ratio), safe drinking water facilities with purified aquaguard water, baby-sitting support, bank concession for 2 hours (to do personal banking work), card swiping instead of manual logging in of arrival and departure, training and educational facilities for the staff, educational and loan support for the staff’s children, adequate bathroom and toilet facilities, canteen facilities, removal of double duty, changing room, locker facilities, common room, concession on medical treatment, dining room at one or two locations (inpatient or outpatient areas), official lunch break, rooms for the staff to rest in between their duty, staff quarters, good salary, additional staff as relievers, more support from class IV staff, good management, increase in uniform allowance, cabin or locker for the staff, sick rooms (specialty), time bound promotions, proper nursing stations, adequate stationeries, suitable duty hours, patient-safety material, staff learning opportunities, schools of nursing, safety and security for staff particularly from

alcoholics, respect for the staff, presence of adequate Class IV staff, free tea, dinner and breakfast for the night staff and reasonable work hours for those on afternoon and night In addition to the above, the nursing staff expect to be given authority to discharge (after getting doctor’s discharge instructions) the poor patients (subject to confirm with proper records as their poor status) in case they are unable to pay at any time.