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Indoor Services. S. Vivek Adhish Sanjay Arya. Indoor Services. Largest component of hospital. Account for approx. 35-50% of whole hospital complex. High Capital & operational cost. Ward or nursing unit ward include : Nursing Station Beds it serves &

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indoor services

Indoor Services

S. VivekAdhish Sanjay Arya

indoor services1
Indoor Services
  • Largest component of hospital.
  • Account for approx. 35-50% of whole hospital complex.
  • High Capital & operational cost

Ward or nursing unit ward include :

  • Nursing Station
  • Beds it serves &
  • Necessary services, work, storage & public areas needed to carry out the patients nursing care.
functions of ward
Functions of ward
  • To substitute for the home for regular eating, bathing, sleeping, etc;
  • To allow examination, treatment and cure of patients; and
  • To prepare patients to return to domestic life.
  • Learning centre
types of ward accommodation
Types of Ward Accommodation
  • Primary
  • Auxiliary
  • Sanitary
  • Ancillary
ward accommodation
Ward Accommodation…
  • Primary
    • Bed accommodation
    • Nursing station
    • Treatment Room
ward accommodation1
Ward Accommodation…
  • Auxiliary
    • Drs’ room
    • Nurses room
    • Stores
    • Clean Utility
  • For keeping linen & other supplies like cleaning materials.
  • Adjoining to the stores (but separately), a space may be provided for patients lockers for keeping their personal belongings.
clean utility room
Clean Utility Room
  • This room (100-200 sq. ft.) is used for clean storage e.g. IV sets & crystalloids, CSSD articles.
  • Used for packing dressing drums, setting up a treatment trolley etc.
  • This is sometimes combined with the treatment room.
ward accommodation2
Ward Accommodation…
  • Sanitary
    • Toilet block
    • Dirty Utility
    • Janitors’ room
bathrooms toilets
Bathrooms & Toilets*
  • WC - 1 for 8 beds
  • 1 Bathroom - 1 for 12 beds
  • 1 Wash basin - 1 for 10 beds
  • Urinal - 1 for 16 beds.

*These scales for toilets etc. are exclusive of WC, bath & washbasins provided for single/double room & staff toilets.

bathrooms toilets1
Bathrooms & Toilets
  • Toilet for an individual room (single or two-bedded) in a ward unit shall be 3.5 sq m comprising a bath, wash basin and WC.
  • A toilet common to two such rooms shall be 5.25 sq m comprising a bath, WC in a separate cubicle and a wash basin.
dirty utility room sluice room
Dirty Utility Room/Sluice Room
  • For cleaning bed pans, urinals, sputum mugs & storage of stool & urine specimens.
  • It should be fitted with bed pan washer and sink.
  • A large stainless board is provided for storing specimens.
janitor s room
Janitor’s room
  • A janitor’s room is required in each ward for keeping mops, brooms, cleaning materials & buckets.
  • It should have a large sink for cleaning buckets and other equipment with adequate supply of hot and cold water.
ward accommodation3
Ward Accommodation…
  • Ancillary
    • Ward Pantry
    • Day room
    • Conference room
    • Trolley Bay
    • Locker Room etc.
  • For temporary storage & distribution of meals and preparation of beverages.
  • It should be equipped with facilities for hot water, refrigerator, hot case & facilities for storage.
  • It should also have a large sink with drain for washing.
other areas
Other Areas
  • Wheel chair/trolley bay
  • Side lab
  • Staff rooms
  • Attendant room
  • Lockers
  • Seminar room
design of inpatient units factors
design of inpatientunits- Factors

Nursing unit characteristics and configuration

  • Work flow
  • Visibility of patient rooms
  • Walking distance for staff
design of inpatient units factors1
design of inpatientunits- Factors
    • Proximity of supplies & equipment.
    • Adequate storage space
  • Space requirements
  • Relationship with other departments
nightigle ward
  • Modified by Florence Nightingale in 1871
  • Self contained ward
  • Patients beds in two rows at right angles to the longitudinal walls
  • Accommodated 32 patients

Sanitary Area


Nightingale Ward Plan


rigs pattern of ward
  • First made in Rigs hospital in 1910 in Copenhagen.
  • Small cubicles of three to four beds and single bed room.
  • Beds arranged parallel to the longitudinal wall.
  • Relative Privacy for patients
  • Possibility of isolation of infectious patients
  • Containment of hospital acquired infections
  • Enhanced flexibility as both sexes can be accommodated in the same ward
  • Patients are deprived of direct observation by the nurse
  • Difficulty of communication between the nurse and the patient
  • Wards become larger so the nurse has to walk more.
  • More number of nurses are required
  • Costly to build and maintain
physical planning
Physical Planning
  • Floor space for bed in multiple bed room: 7.0 m2 per bed
  • Single bed room: 14 m2 per bed
  • 2 bed room: 21.00 m2
  • The area per bed in the ICU is 12-14 m2 per bed.
physical planning1
Physical Planning
  • Ceiling height: 3.0 m
  • Width of corridors: 2.4 m
  • Windows: 20%of floor area
  • Doors: 1.2 m
  • Dado: 1.2 m
physical planning2
Physical Planning
  • The size of a hospital bed is 6’6” x 3’3” (2.2 m x 1.1 m)
  • Space at the head-end 0.25 m.
  • The space between two rows of beds is 5 ft.
  • The distance between two beds should be 3.5 to 4 ft.
physical planning3
Physical Planning
  • Water & electricity supplies
  • 300-500 liters for per bed.
  • Alternate source of light supply
  • One industrial switch for portable x-ray
  • At least two switches each of 15 amp. & 5 amp. in each cubicle.
nursing station
Nursing Station
  • Central with critical patients close by
  • Built in cupboard for storage of drugs , dressings & instruments
  • Closet for narcotics & dangerous drugs
  • Electric panel for nurses call station visible
treatment room
Treatment room
  • A treatment room is required for physical examination, dressings & certain procedures.
  • Should be equipped with examination table, spot light, cabinets and a dressing trolley.
  • Should have hand washing facilities.
duty room for doctors
Duty room for doctors
  • There should be a doctor’s duty room where doctors can work during day & take rest during night.
  • It should be equipped with a bed, chair, table & attached toilet.
space for different areas
Space for different areas
  • Sister’s duty room – 14 Sq M (Toilet 3.5 M2)
  • Clean Utility – 10 to 14 Sq M
  • Ward Store – 10-15 Sq M
  • Ward Pantry – 10.5 Sq M
  • Dirty Utility – 7 Sq M
  • MO’s duty room – 14 Sq M
norms for nursing staff
Norms for Nursing Staff
  • Chief Nursing Off: 1 per 500 beds
  • Nursing Supt: 1 per hospital
  • Dy. Nursing Supt: 1 up to 400 beds

& 200 addl. Beds

  • Asst. Nursing Supt: 1 for 100-150 beds

or 3-4 wards

norms for nursing staff1
Norms for Nursing Staff
  • Ward Sisters: 25-30 beds/ Ward
  • Teaching Hospital: 1 nurse for 3 beds *
  • Non-teaching : 1 nurse for 5 beds *

* For 24 hr.

norms for nursing staff2
Norms for Nursing Staff
  • For ICU / CCU: 1 nurse for 1 bed
  • Extra nursing staff to be provided for Depts. & research functions.
  • For each 250 beds: 1 infection control nurse.
nursing methods
Nursing Methods
  • Case Method
  • Functional method
  • Team method.
case method
Case Method
  • A nurse is assigned to the care of a number of patients.
  • She is responsible to give complete nursing care.
  • It provides more individualised care to the patients
  • Patients feel sense of belongingness to nurse.
  • It provides more incentives to personnel to improve the quality of their care.
  • Professionally most satisfying
functional method
Functional method
  • Nurses are assigned to specific functions for all the patients in the ward
  • One person becomes expert in one particular job, which enables to do the same in less time
  • Less equipment is required
  • Better maintenance of the equipment as handed by a particular person.
  • Care of the patient becomes mechanical as the nurse knows little of the overall care of the patient.
  • The patient feels insecure as care is provided by many people and the nurse-patient relationship disappears.
  • Least satisfying to nurse as well as patients.
team method
Team method
  • Several staff members of all categories under leadership of a professional nurse are assigned to a group of patients.
  • The team leader is responsible for assigning, supervising and instructing her team members.
team method1
Team method
  • This is very good & desirable method of assignments but requires good team building & supervision.
  • Useful, where we plan to use auxiliary nurses along with staff nurse.
progressive patient care
Progressive Patient Care
  • The basis for PPC system is orienting wards on the basis of nursing needs of patients.
  • Nursing Care required is linked to criticality & degree of dependence of the patients on nurse because of underlying disease.
  • Wards are manned & equipped accordingly.
progressive patient care1
Progressive Patient Care
  • Intensive Care
  • Intermediate care
  • Self care
  • Long term care
intensive care
Intensive care
  • Critically ill patients
  • Totally dependant on nurse & are even unable to communicate needs
  • Requires continuous observation & intensive nursing care.
intermediate care
Intermediate care
  • Moderately ill patients.
  • Require moderate amount of nursing care.
self care
Self care
  • Patients are ambulatory.
  • Able to look after themselves.
  • Minimal nursing care required.
long term care
Long Term care
  • Prolonged nursing care.
  • Partially dependant


  • Services not available at home
good ward management
Good Ward Management
  • Participative approach in formulating ward policies
    • Maintenance of high morale amongst all members of the staff
  • Good inter-personal relationship within the ward & other associates
  • Delegation of responsibility
good ward management1
Good Ward Management
  • A conducive work environment
  • Establishment of ward routines
  • A planned program for each day’s work
  • Beginning the day on time
  • Preventing interruptions
good ward management2
Good Ward Management
  • Provision of supplies & equipment.
  • Proper record keeping
  • System of carrying out doctor’s orders.