Learn about counselling, its types, processes, tools, techniques, and the qualities of a good counselor. Explore the role of health education in effective counselling strategies.

COUNSELLING

Introduction

• Definition: Counselling is a helping process aimed at assisting clients in identifying solutions, managing stress, and improving interpersonal relationships.
• Purpose:
  • Address normal developmental problems in adolescents.
  • Assist individuals during temporary crises.
  • Early identification of disturbed or problematic behavior.
  • Refer cases requiring specialist treatment.
  • Facilitate communication between nursing schools, homes, communities, and resources.
  • Support tutors needing guidance and reassurance.

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Principles of Counselling

• Tailored to individual needs.
• Encourages collaborative thinking with the client.
• Avoids a dictatorial approach.
• Builds trust and confidence with the client.
• Prioritizes the client’s needs.
• Includes family and significant others in the process.
• Demonstrates warmth, friendliness, openness, and empathy.
• Active listening and objective responses.
• Encourages voluntary, informed decisions by the client.
• Respects the dignity of the individual.

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Scope of Counselling

• Covers various aspects of life as challenges grow more complex.
• Educational Guidance:
  • Course selection and study habits improvement.
  • Career planning and higher education advice.
• Personal and Social Support:
  • Mental health maintenance.
  • Family, moral, marital, and financial problem resolution.
• Vocational and Developmental:
  • Job placement and vocational objectives selection.
  • Addressing discipline and interpersonal issues.
• Includes advising on students’ activities and program planning.

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TYPES OF COUNSELLING

1.Directive Counselling (Counsellor-Centered):

• Counsellor plays a major role in solving problems and guiding the client.
• Advantages:
  • Effective for anxious clients, young children, or disturbed individuals.
  • Less time-consuming.
• Limitations:
  • Limits the client’s self-insight.
  • Not suitable for all clients.

2. Non-Directive Counselling (Client-Centered):

• Client takes the lead; the counsellor offers support and guidance.
• Advantages:
  • Promotes client’s self-insight and decision-making skills.
• Limitations:
  • Time-consuming and may irritate some clients.
  • Not suitable for low IQ or severely disturbed individuals.

3. Eclectic Counselling:

Combines directive and non-directive approaches for a collaborative effort.

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1. Educational Counselling:
   • Guides in course selection, study habits, specialization, and higher education.
   • Supports clinical learning and career planning.
2. Vocational Counselling:
   • Assists in understanding abilities, values, and career goals.
   • Provides information about occupations, scholarships, and skill development.
3. Health and Living Counselling:
   • Promotes health awareness, hygiene, and proper living conditions.
   • Includes sex education and recreational activities.
4. Personal Counselling:
   • Helps in self-acceptance, interpersonal skills, and appearance improvement.
   • Provides guidance for personal problems.
5. Moral and Social Counselling:
   • Encourages ethical conduct and social values.
   • Trains in prioritizing values for societal benefit.
6. Leisure Counselling:
   • Guides creative use of free time.

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4. Short-Term Counselling:

• Addresses situational crises or immediate concerns.

5. Long-Term Counselling:

• Focuses on developmental crises (e.g., menopause, breastfeeding).
• May involve group support.

6. Clinical Counselling:

• Diagnoses and treats maladjustments through face-to-face interaction.

7. Psychological Counselling:

• Relies on conversation to address repressed emotions and mental challenges.

8. Psychotherapeutic Counselling:

• Facilitates emotional and personality reorganization for personal growth.

9. Student Counselling:

• Assists in educational and vocational planning, study methods, and adjustment.

10. Placement Counselling:

• Matches clients with suitable jobs based on skills and interests.

11. Marriage Counselling:

• Resolves marital issues and enhances understanding between partners.

12. Vocational Counselling:

• Focuses on career preparation, problem-solving, and skill enhancement.

13. Individual Counselling:

• One-on-one sessions to boost personal growth and effective skill utilization.

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Key Areas of Counselling

• Vocational
• Educational
• Health and Living Conditions
• Personal and Social Development
• Moral Guidance
• Leisure Activities

COUNSELING PROCESS: STEPS AND TECHNIQUES

Introduction

The counseling process involves interconnected and overlapping phases, much like the nursing process. These steps are flexible and can be adjusted based on the nature of the issue and the individual being counseled.

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Steps in the Counseling Process

1. Appointment and Establishing Relationship
   • A trusting relationship is key in counseling. The counselor schedules an appointment with the counselee at a mutually convenient time. Building rapport may take several sessions.
2. Assessment
   • This phase involves collecting and analyzing data. The counselor encourages the counselee to express their feelings and expectations while observing and clarifying the problem.
3. Diagnosis
   • The counselor identifies the core issues and determines the area of intervention based on the information collected.
4. Setting Goals
   • The counselor collaborates with the counselee to set short-term and long-term goals, providing direction and purpose to the process.
5. Intervention
   • Strategies are implemented to achieve the goals. The methods depend on the counselor’s approach, the problem, and the counselee’s needs.
6. Termination and Follow-up
   • Counseling concludes once the goals are achieved, with a phased-out process to ensure the counselee maintains progress. Follow-up sessions are scheduled as necessary.

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Tools and Techniques in Counseling

1. Standardized Tools and Techniques

These are objective and reliable tools developed by specialized agencies to evaluate various aspects of an individual:

• Intelligence Tests: Measure intellectual capacity.
• Achievement Tests: Assess performance in specific subjects.
• Aptitude Tests: Evaluate potential skills in particular fields.
• Interest Tests: Identify individual preferences and inclinations.
• Personality Tests: Analyze traits, interests, and behaviors.

2. Non-Standardized Techniques

These informal methods collect qualitative data and offer insights into personal characteristics:

• Autobiography: The counselee shares personal experiences through guided questions.
• Anecdotal Records: Document specific behaviors and their interpretation for action planning.
• Questionnaire: A structured set of questions about the individual’s background, habits, and aspirations.
• Interview: Face-to-face interaction for gathering direct information.
• Observation: Monitoring the individual’s natural behavior in various settings.
• Cumulative Record Chart: Detailed documentation of academic, health, and extracurricular activities.
• Case Study: Comprehensive analysis of an individual’s life, including family and development history.
• Rating Scales: Evaluate traits such as honesty, leadership, and reliability, though they can be subjective.
• Sociometric Techniques: Assess social dynamics and interpersonal relationships within a group.
• Informal Data Collection: Observing the individual during social and cultural events.

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QUALITIES OF A GOOD COUNSELLOR

Effective counselling requires a blend of interpersonal skills, personal maturity, educational expertise, and professional dedication. The qualities of a good counsellor can be grouped into the following key areas:

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1. Interpersonal Relationship Skills

• Friendly, approachable, and capable of building rapport.
• Displays sympathy, empathy, and sensitivity toward others’ attitudes.
• Exhibits fairness, sincerity, and tactfulness in interactions.
• Demonstrates patience and respects the client’s abilities and needs.
• Maintains confidentiality and communicates in the client’s language.
• Listens attentively, shows genuine concern, and responds in a facilitative manner.
• Inspires trust, tolerance, openness, and demonstrates a humanistic philosophy.

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2. Personal Adjustment

• Possesses mature behavior and an integrated personality.
• Maintains emotional stability, flexibility, and adaptability.
• Aware of personal limitations and demonstrates unbiased coping mechanisms.
• Shows self-respect, self-reliance, and confidence.
• Accepts criticism constructively and exhibits self-awareness.
• Has a sense of humor, personal magnetism, and tolerance for ambiguity.

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3. Scholastic Potential and Educational Background

• Possesses broad knowledge and efficient counselling skills.
• Motivated and committed to the counselling process.
• Understands community policies, beliefs, and misconceptions.
• Capable of effective problem-solving and decision-making.
• Possesses a Master’s Degree in counselling or related areas with training in:
  • Counselling process and understanding individuals.
  • Educational, occupational, and vocational guidance.
  • Behavioural sciences like psychology and sociology.
  • Research and evaluation methods.
• Experienced in teaching and follow-up services.

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4. Health and Personal Appearance

• Has a pleasing voice and appearance, with freedom from annoying mannerisms.
• Maintains poise, neatness, vitality, and endurance.

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5. Leadership Skills

• Ability to stimulate and lead others.
• Reinforces key information and directs counselees toward solutions.
• Guides counselees to make independent decisions in a voluntary manner.

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6. Philosophy of Life

• Demonstrates good character and a wholesome outlook on life.
• Respects human values, civic sense, and exhibits an integrated personality.
• Holds spiritual and religious values while respecting universal principles.

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7. Professional Dedication

• Strong vocational interest and commitment to guidance work.
• Displays a professional attitude, loyalty, and enthusiasm.
• Maintains professional ethics and a focus on growth and research.
• Willing to work beyond expectations to provide support.
• Uses psychotherapy when needed and fosters a helping relationship.

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8. Spiritual Faith and Universal Principles

• Holds a belief in the spiritual quality of the world.
• Respects universal principles of religion and exhibits moral conviction.

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9. High Sense of Morality

• Upholds moral values and maintains integrity in all professional and personal endeavors.

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Difference Between Health Education and Counseling

Aspect	Health Education	Counseling
Scope	Related to groups or individuals.	Primarily focuses on one-on-one interactions.
Interaction	Often delivered in group settings, though it can be individual.	Always involves face-to-face interaction between counselor and client.
Focus	Emphasizes increasing awareness of health risks and promoting protective behaviors.	Helps individuals solve personal problems through mutual discussion.
Nature	Research-based, theory-driven, and provides functional health knowledge.	A learning-oriented process aiming to remove barriers to personal growth.
Purpose	Provides information to support informed health decisions.	Encourages self-reflection and personal problem-solving.
Environment	Can be conducted in various settings like schools, clinics, or community centers.	Requires a cooperative and supportive environment for effective engagement.
Outcome	Enhances general awareness and promotes collective health behavior change.	Empowers individuals to make decisions and solve problems independently.
Process	Focuses on delivering health messages and information.	Aims to help individuals explore and resolve personal challenges.

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Role of Nurses in Counseling

Nurses play a vital role in counseling, encompassing several functions critical to patient care and support:

1. Caregiver:
   • Provides physical and psychological assistance while preserving the client’s dignity.
   • Offers full, partial, or supportive-educative care based on client needs.
2. Communicator:
   • Identifies client problems and communicates effectively with the health care team.
   • Ensures clear and accurate communication to meet client needs.
3. Teacher:
   • Educates clients about health conditions and procedures to restore or maintain health.
   • Assesses learning needs, sets goals, and measures progress.
4. Client Advocate:
   • Protects client rights and communicates their needs to other health professionals.
   • Helps clients exercise autonomy and speak up for themselves.
5. Counselor:
   • Supports clients in coping with psychological and social stressors.
   • Encourages new attitudes, feelings, and behaviors for personal growth.
   • Promotes decision-making and problem-solving through reflection.
6. Change Agent:
   • Helps clients modify behaviors and facilitates systemic changes in health care.
7. Leader:
   • Guides individuals or groups toward achieving specific health goals.
   • Utilizes interpersonal and motivational skills to influence positive outcomes.
8. Manager:
   • Coordinates nursing care for individuals, families, and communities.
   • Delegates, supervises, and evaluates care delivery.
9. Case Manager:
   • Collaborates with multidisciplinary teams to ensure client-centered and cost-effective care.
   • Oversees care plans and monitors outcomes.
10. Research Consumer:
    • Engages in research to improve client care.
    • Identifies significant problems, protects rights, and applies findings effectively.
11. Expanded Career Roles:
    • Functions in advanced roles like Nurse Practitioner, Nurse Educator, and Clinical Nurse Specialist.
    • Contributes to specialized care and greater autonomy in health care delivery.

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COURSES

GNM

BSC NURSING

Learn how standing orders guide community health nurses in managing minor ailments like fever and diarrhea. Explore their role in MCH care, referrals, and health education.

Standing Orders for Treatment of Minor Ailments

1. Fever:

• Record vital signs (temperature, pulse, respiration, BP).
• Identify accompanying symptoms (e.g., headache, nausea, shivering).
• Provide rest, light meals, and hydration.
• Administer paracetamol for high fever and perform cold sponging if >39°C.
• Prepare blood slide for malaria parasite test.
• Refer for severe symptoms (delirium, convulsions, unconsciousness).

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2. Heat Stroke:

• Place patient in a shaded, ventilated area; wrap in a wet sheet.
• Monitor temperature; give salted cool water if conscious.
• Refer to the hospital once stabilized.

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3. Diarrhea:

• Monitor dehydration signs.
• Provide ORS, coconut water, lemon juice, or light meals.
• Refer severe dehydration cases to the hospital.
• Ensure proper hygiene, and report epidemic cases promptly.

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4. Burns:

• Cool the burn with water; do not touch blisters.
• Cover with a clean cloth, and remove tight items like rings or belts.
• Administer analgesics if needed and refer for severe cases.

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5. Drowning:

• Clear lungs by laying the person on the abdomen.
• Perform resuscitation and refer to the hospital.

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6. Dog Bite:

• Wash the wound thoroughly with soap and running water.
• Apply antiseptics (betadine/tincture iodine).
• Administer tetanus toxoid and refer for ARV therapy.

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7. Snake Bite:

• Immobilize the patient and tie a tourniquet above the bite (loosen every 30 mins).
• Suction the venom carefully or use a vacuum syringe.
• Clean with saline; provide fluids like tea/coffee and refer for ASV therapy.

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8. Scorpion Bite:

• Remove sting, apply ice, and clean thoroughly.
• Use tourniquet and give analgesics or sweetened milk.

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9. Fainting:

• Lay the person down with feet elevated.
• Ensure fresh air; help them take deep breaths upon regaining consciousness.
• Refer if unconsciousness persists.

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10. Injuries and Fractures:

• Clean wound with soap and antiseptic; apply sterile dressing.
• Immobilize fractured parts with a splint.
• Administer analgesics and tetanus toxoid, and refer for further care.

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11. Wounds:

• Wash with clean water and antiseptic.
• Remove foreign bodies and apply sterile bandage with betadine.
• Administer tetanus toxoid and manage bleeding.
• Refer large or severe wounds for sutures.

Standing Orders for Maternal and Child Health (MCH) Care

Maternal Care

• Provide tablets for morning sickness during early pregnancy.
• For pregnancy-induced toxaemia:
• Advise restricted salt intake and complete rest.
• Refer to the hospital immediately if edema develops.
• In cases of Antepartum Hemorrhage (APH) or Postpartum Hemorrhage (PPH), refer the mother to a hospital.
• Manage fever post-delivery with antipyretics and refer for further treatment if necessary.
• Support mothers with perineal care, excess breast milk, or stillbirth issues, and guide them for further treatment.

Newborn Care

• Observe for abnormalities and refer if needed.
• Ensure the newborn is kept warm.
• Initiate breastfeeding as early as possible.

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Common Pediatric Issues

Convulsions in Children

• Place the child safely on a bed and loosen tight clothing.
• Clear mouth secretions to ensure proper breathing.
• Use cold sponging if fever is present.
• Identify possible causes and refer for treatment.

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Emergency Conditions

Hemorrhage

• Lie the patient flat on their back.
• Press a pad on the bleeding site until it stops, then bandage.
• Monitor for shock and provide liquids.
• Refer to the hospital if bleeding or shock persists.

Unconsciousness

• Ensure the patient is in a well-ventilated position to support breathing.
• Remove dentures and loosen tight clothing.
• Clear mouth secretions and provide artificial respiration if needed.
• Refer to the hospital urgently.

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Minor Ailments

Sore Throat

• Inspect for redness or white patches and take swabs if needed.
• Advise saline gargles and fluid intake.
• Refer recurrent cases to the hospital.

Cough

• Determine duration and type; check for associated symptoms.
• Provide cough mixtures and steam inhalation as required.
• Collect sputum samples if tuberculosis is suspected.

Conjunctivitis

• Irrigate eyes with saline and clean with cotton.
• Apply drops/ointments and refer if severe.

Toothache

• Provide aspirin for pain relief.
• Refer to a dentist for further care.

Earache and Discharge

• Clean ears carefully without probing.
• Use hydrogen peroxide for discharge and administer ear drops.
• Refer complex cases to the hospital.

Foreign Bodies in Nose/Ears

• Avoid pouring water on seeds; refer immediately for removal.

Constipation

• Advise fluids, fruits, and leafy vegetables.
• Use mild laxatives as per protocol.

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Chronic Cases

Chronic Ulcers

• Clean with soap and water and apply prescribed ointments.

Pediculosis (Lice Infestation)

• Apply 5% DDT, Benzyl Benzoate, or kerosene-oil mixtures.
• Use fine-toothed combs for removal.

Scabies

• Scrub, bathe, and apply Benzyl Benzoate or neem-based treatments.
• Wash clothes in boiling water and dry in sunlight.
• Repeat treatment if required.

Role of a Community Health Nurse in Implementing Standing Orders

The Community Health Nurse (CHN) plays a pivotal role in executing standing orders effectively within the scope of their practice. Their responsibilities include the following:

Assessment and Data Collection

• Patient History: Collect comprehensive information about:
• General health status.
• Onset, intensity, and symptoms of the disease.
• Family history of illnesses.
• Past medical history and any prior treatments.
• Vital Signs: Measure and document temperature, pulse, respiration, and blood pressure. Conduct urine tests as necessary.
• Problem Identification: Recognize patient problems and determine personal needs.

Nursing Services

• Provide nursing care as outlined in the standing orders.
• Offer emotional support and reassurance to the patient and their family.

Referral and Follow-Up

• Referral System: Facilitate referrals to higher healthcare facilities when required.
• Health Education: Explain the causes of illness, possible complications, follow-up care, and preventive measures to the patient and their family.

Documentation and Review

• Assess the outcomes of nursing care provided.
• Regularly review and stay updated on standing orders and health manuals.
• Document and inform the health officer about communicable diseases promptly.

Communication and Advocacy

• Represent the nurse’s perspective during the review of standing orders.
• Clarify doubts about standing orders by gathering relevant information promptly.

Professional Conduct

• Be mindful of the scope of practice and maintain professional boundaries.
• Foster trust and collaboration with doctors and health administrators.

Environmental Safety

• Ensure a safe and healthy environment conducive to patient well-being.

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COURSES

GNM

BSC NURSING

(more…)

Learn about the introduction and principles of management. Discover the classification of minor ailments. This includes key standing instructions for effective community health nursing care.

Minor Ailments in Community Health Nursing

Introduction

• Community Health Nurses (CHNs) play a key role in providing primary health care in the community.
• One important aspect of primary health care is the treatment of minor ailments and managing smaller emergencies.
• CHNs should be capable of finding signs and symptoms of minor illnesses. They should treat them properly. This must be done while keeping within their limits and responsibilities.
• Minor ailments refer to slight illnesses or small-scale emergencies, which can be treated without major intervention.

Principles of Management

1. Safe Environment: Guarantee a safe and healthful environment for the patient.
2. Prompt Treatment: Treat promptly to prevent complications.
3. Infection Prevention: In case of infectious diseases, take precautions to prevent spread.
4. Observe Condition: Keep a continuous watch over the patient’s condition and vital signs.
5. Support Daily Living: Help the patient in activities of daily living (ADL) to guarantee quick recovery.
6. Health Education: Use every opportunity to give health education during patient care.
7. Respect Limitations: Always be aware of nursing limitations and follow physician instructions when necessary.
8. Support Family: Help family members cope and prepare them for home care.
9. Cultural Respect: Respect the patient’s beliefs, especially if they have used other therapies.
10. Prompt Referral: Refer promptly if the condition worsens or if the diagnosis is unclear.

Classification of Minor Ailments

1. General Minor Ailments:

• These include common accidents and emergencies that need immediate first aid.
• Examples:
  • Injuries and falls
  • Fractures
  • Burns
  • Dog bites
  • High fever
  • Heat stroke
  • Diarrhea
  • Fainting

1. Systemic Minor Ailments:

• These ailments affect different body systems and include smaller health issues. a. Eye:
  • Eye infections, foreign bodies, night blindness.
  b. Ear:
  • Earache, foreign bodies, otitis media, temporary deafness.
  c. Respiratory Tract:
  • Allergic rhinitis, sinusitis, sore throat, asthma attack.
  d. Cardiovascular System:
  • Hypertension, anemia, rheumatic heart disease.
  e. Digestive System:
  • Toothache, constipation, diarrhea, indigestion, vomiting.
  f. Urinary System:
  • Urinary infections, burning micturition, renal stones.
  g. Neuro-Muscular System:
  • Headache, backache, epileptic fits.
  h. Reproductive System:
  • Dysmenorrhea, heavy bleeding, breast lumps.
• Behavioral problems such as emotional disturbances or maladjustment may also be considered minor ailments.

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Management of Minor Ailments as per Standing Instructions/Orders

Management Steps for Minor Ailments

Managing minor ailments involves a systematic approach to ensure proper care and treatment. The general steps include:

1. Assessment:

• Taking History: Gather the patient’s history to understand the problem.
• Physical Examination: Do a quick physical examination to assess the condition.

1. Diagnosis and Care Planning:

• Find the cause of the ailment.
• Make a diagnosis and plan appropriate care.

1. Treatment and Nursing Care:

• Offer the necessary treatment based on the diagnosis.
• Offer nursing care to tackle the patient’s needs.

1. Evaluation:

• Evaluate the effectiveness of the care provided.
• If the patient improves, plan a follow-up.
• If the condition worsens or serious signs appear, refer the patient for further medical attention.

Standing Orders

Standing orders are pre-established instructions and directions. They allow nurses and health workers to manage treatment when a doctor is unavailable. This is especially useful in home settings, hospitals, or community health facilities.

• Objectives:
• To guarantee continuity of treatment.
• To protect and resuscitate patients in emergencies.
• To instill a sense of responsibility in the health team.
• Uses:
• Offer treatment during emergencies.
• Improve the quality of health services.
• Strengthen primary health care in communities.
• Decentralize health responsibilities.
• Enhance confidence and responsibility in nursing and health workers.
• Protect the public from unqualified practitioners (quacks).
• Build public trust in medical institutions and community health services.

Types of Standing Orders

Standing orders are often jointly created by authorized doctors and registered nurses. They guarantee that patient care continues smoothly when a doctor is unavailable.

1. Institutional Standing Orders:

• These are tailored based on the resources, staffing, and objectives of the institution.
• For example, standing orders for primary health centers may differ from those for district hospitals.

1. Specific Standing Orders:

• Designed for trained medical personnel, like nurses, requiring specific technical knowledge and skills (e.g., administering injections, oxygen therapy, or home nursing).
• These orders guarantee that nurses can make treatment decisions in the absence of a doctor, enhancing the quality of care.

1. General Standing Orders:

• These instructions are broad and aimed at the general public. They promote health awareness and simple treatments. This is especially important in large populations or areas with limited resources.
• Examples include instructions like taking Quinine for fever, Trimoxazole for pneumonia, and using ORS for dehydration.

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COURSES

GNM

BSC NURSING

(more…)