Nursing Made Easy by Shruti Bhagwat

Nursing Made Easy

By Shruti Bhagwat

‘Nursing Made Easy’ Original text, Design and illustration by Shruti Bhagwat Set in Avenir LT Std and Adobe Caslon Pro. Printed by: Print Express

Copyright © Srishti Insititute of Art, Design and Technology 2015. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without the prior written permission of Srishti Institute of Art,Design and Technology.

Preface The time an individual arrives at a health care premises seeking clinical care, to the time they get attended by an appropriate medical health practitioner, a perception of the healthcare environment on the part of patient/ their families have a potential to affect a sense of the quality of care. Thus the brand experience becomes critical. The one of the key stakeholders in the healthcare system is a Nurse.The nurses are involved in many activities and a majority of their time is supposed to be dedicated to a patient’s health care. They are involved in administering food and nutrition, Mother and Child Care, scheduling and implementing (neo natal care) perinatal care, Immunization in the health care premises etc. they are also sought to be partners in day to day administration viz. billing, discharge summary, etc. The critical point to be noted from the above is that a patient’s well-being is hinged and pivoted on a nurse’s work life balance. A stressed eco system can adversely impact the professional acumen that the nurses are expected to bring forth. There is Lack of empathy for the person the person who’s expected to provide empathy. This project is about empowering the nurse. This project used a multi-disciplinary approach of design to achieve work life balance of a nurse and change the perception about a nurse and nursing.

Contents

Chapter 1. The Client and Client Brief Chapter 2. It’s all about health care • Interpreting health and health Care • Sensitizing to the context Health care • Health care and hospitals Chapter 3. Experiencing health care scenarios in India • Field Visits • PESTE ,SWOT Analysis • Interviews and critical observations on Field • Inspirations and Insights • Developing Notional Business Ideas through Insights drawn Chapter 4: Need & Gap analysis • Inter and intra hospitals • Key Design Intervention Area • Project Proposal Chapter 5: Contextual setting for Eksa – An Ortho. Clinic

• Vision and mission • Brand essence, attributes • Voice and tone

Chapter 6: Nurses: A contextual subject matter • Introducing Nurses & Nursing • Expectation in a 8 hr shift Chapter 7: The Analytical Phase • Shift handover • Shifts • Current scenario in Nursing Career • Prevailing KRA /KPI • Core and Non-Core Activities • Overlap of Nurse’s journey and Patient’s • Understanding the pain points and touch points Chapter 8: Envisaging work life balance for the Eksa nurse. • Organization Chart • KRAs and KPIs recommendations • Core and Non- Core activity break up recommendations • Arriving at key Design intervention areas • Projected Outcomes

Chapter 9: Proposed solutions • Conceptualization • Digital Solution • Story Board • User Flow • Site Map • UX Road map

• Wire Frame • Visual representation Redefining visual identity of Eksa Nurses • History & Evolution • Validation and Analysis • Concepts • Iterations • Projected Outcome Chapter 10: Reflections Chapter 11: Acknowledgements Chapter 12: Bibliography

engaging a highly motivated and empowered workforce. ” Values of Tata Elxsi

The Client, Tata Elxsi is a design company that blends technology, creativity and engineering to help customers transform ideas into worldclass products and solutions. A part of the Tata group, Tata Elxsi addresses the communications, consumer products, defence, healthcare, media & entertainment, semiconductor and transportation sectors. This is supported by a network of design studios, development centres and offices worldwide. Their Key services include embedded product design, industrial design, animation & visual effects and systems integration. Tata Elxsi is a listed company.

The Client And Client Brief

Values form the foundation of business management, providing justification of behaviour and influencing how we conduct our business. Values do not drive the business; they drive the people within the business. The five values that constitute the acronym BRISK, express our understanding of what we believe, how we aim to behave, and what we aspire to be as an organization, in today’s business environment. B - Benchmark to become the best R - Recognize contribution fairly and transparently I - Improve collaboration across teams to scale together

Mission of Tata Elxsi

S - Satisfy customer needs, both external and internal

“We will become the preferred partner for our customers by creating worldclass products & differentiated solutions through innovation and leading edge technology. We will be an employer of choice,

K - Keep pace with changes in the environment.

The Brief Settings: Urban How can one research the health care scenario and ‘measure’ the connection between ‘experiential’ elements and “perceived” quality of healthcare? How can one, then, articulate, formulate, integrate and design these plethora’s of experiential elements that one is likely to have in hospitals, and S.M.A.R.T ly transform it into one unique experience. The overall project would thus be innovative individual projects interspersed in the experiential spaces of: Product Design & Interface Design Process Interface & Information Design Floor & Space design Visual Communication & Branding

points leading to judgements about health care quality, would be under one overarching identity and hence interlinked to one another. While some of these touch points and customer experiential areas may appear frivolous, a seemingly irate experience in any of these spheres can create a negative impact on the overall hospital experience of the medical attention seeker and/or their families.

and outcomes shall be mentored by design professionals from Tata Elxsi. Interpretation of the design brief From the time an individual arrives

Project Challenge Cohesively creating a design brief that sensitively justifies, chooses one area of design intervention and then explores it in greater depth, breaking it into different components. It would be required to understand and address the last level of detail in experience design, towards delivering satisfying customer experience as a brand and predict the impact.

And/ or A completely new perspective, Wherein health care (preventive/ critical) is made available to the seekers at their doorsteps.

These requires a thorough understanding and addressing till the last level of details in the experience design towards delivering satisfying customer experience as a brand and thereby predict its impact.

All the above innovative individual projects based on experiential touch

The project has a live interface with the industry wherein the design process

at a health care premises seeking clinical care, to the time they get attended by an appropriate medical health practitioner, a perception of the healthcare environment on the part of patient/ their families have a potential to affect a sense of the quality of care. The experiential outlay becomes critical wherein the perceptions inferred from the healthcare environment seen and interactions at “Key experiential areas” have directly connected with sense of quality care. The more hospital can control and modulate the experience, the greater the impact on the perception of the quality of the care and the health care brand. In an urban setting, medium sized 109

20 bed hospitals, how can the patients/ consumerâ&#x20AC;&#x2122;s experience be improved by making alterations in the existing system.

Interpreting health and health Care What Is Health? The word health means different things to different people, depending on the situation. For Instance: If somebody says “I was worried about my Granny’s health when she was travelling “, it is clear that the person was referring to her physical health, due to old age or any other reason. On the other hand, when people say “With all high pressure jobs and the deadlines it comes with which requires long working hours and sleepless nights, they wonder will be its effect on their health,” most likely the word “health” refers more to their mental health than physical health (although the two are often linked).

It’s All About Health Care

The words “health” or “healthy” can also be used in non-medical contexts. The English word “health” comes from the Old English word hale, meaning “wholeness, being whole, sound or well,”.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Definition by World Health Organization’s (WHO’s) The most famous modern definition of health was created during a, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States and entered into force on 7 April 1948. Four Aspects to Health The Concept of health can be further divided into four broad aspects • Physical or biomedical health • Psychological or mental health • Ecological health • Holistic Health Bio-Medical Health Or Physical Health Physical health it generally referred to physical wellbeing. Physical wellbeing can be achieved by developing all health-related activities of his/her lifestyle. Generally people’s response to “How’s your health”, is about anything concerning to the human body as physical entities. Physical health has been the basis for active living 11

campaigns and the many nutrition drives that have swept the industrialized world. Psychological Or Mental Health

health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

Ecological Health Ecological concept views health as a dynamic equilibrium between human beings & their environment. Human’s ecological & cultural adaptations determine the occurrences of disease. The ecological concept arises due to two issues. • Imperfect Human Being • Imperfect environment. It also depends on biotic conditions, landscape conditions, natural disturbances, hydrology, chemical processes and ecological processes. For example, If your water is clean and safe, the air you breathe is pure, your workplace is healthy, your house is comfortable and safe, you are more likely to enjoy good Health. A study carried out by researchers at Zuyd University, The Netherlands; found that just an hour of sniffing car exhaust fumes induces a stress response in the brain’s activity.

Mental health refers to people’s cognitive and emotional well-being. A simple understanding could be “Sound mind in a sound body in the sound family. According to W.H.O., mental

No matter how many definitions people try to come up with regarding mental health, its assessment is still a subjective one. People have always found it easier to explain what mental illness is, rather than mental health.

Holistic Health Another way of looking at health is by taking a ‘holistic’ view, which takes a more integrated approach. This takes into account the interaction of

biological, psychological and Eco social factors and also views the person as a ‘whole’ rather than a sum of their ‘parts’. Holistic notions of health may be seen as taking into account mind; body and spirit. The difference between the Eco social and a holistic approach to health is that the holistic approach tends to focus on the individual rather than social structures that influence the individual. A holistic approach underpins many, complementary or alternative, approaches to health. While strength of a holistic approach is that it takes spiritual health into consideration and holistic approach is also about prevention and protection of health. Determinants of Health The health of individual people and their communities are affected by a wide range of factors. People’s good or bad health is determined by their environment and situations. As per W.H.O. following factors probably have a bigger impact on our health • Where we live • The state of our environment • Genetics • Our income • Our education level

• Access and use of health care services.

Locally available resources – materials and man power – should be used

Major Health Issues in India

• Inter-sectorial coordination : Different sectors like agriculture, education and public works should work together to bring about improvements in healthcare.

o Communicable Diseases o Nutritional Issues o Environmental Sanitation Issues o Medical Care Issues o Pollution Issues o Disability and Disorders issues o Physical Accidents o Chronical Diseases Where There Is Health, Health Care Comes With It. Health care is prevention, treatment and management of illness and the preservation of mental, physical wellbeing through the services offered by medical and allied health professionals.

• Appropriate technology : • The technology applied should be scientifically appropriate • Adaptable to local needs socially acceptable to the people who implement it and those who use it can be maintained using the locally available resources Sensitizing To the Context of Health Care Study of Indian Health Care

• Equitable distribution :Healthcare should be available to all people irrespective of financial and social status

India is a multi-lingual country with rich cultural diversity. In India, for the last 10 years considerable work has been undertaken related to health and hospital sector reforms, which has involved various governments, worldwide multilateral agencies and other stakeholder’s participation.

• Community participation :The community should be involved in the planning, implementation and maintenance of health programs and

Delivering appropriate health care to India’s billion plus population presents enormous challenges and opportunities for the medical fraternity.

Principles of Health Care

Health Care Delivery System

policy making, planning, guiding, assisting, evaluating and coordinating the work of the State Health Ministries.

India is a union of 29 states and 7 union territories. States are largely independent in matters relating

The health care system in India is universal. That being said, there is great discrepancy in the quality and

of the poorer states, more often, have less access to adequate healthcare than residents of relatively affluent states. Health care systems can be categorised in multiple ways viz. by the ownership of the healthcare unit, level of health care services provided by the unit. Categories As Per Ownership Of Health Care Unit • Public Sector: o Primary health care, Primary health centres, sub‐centres o Hospitals/Health centres Community health centres Rural hospitals District hospital/health centre Specialist hospitals Teaching hospitals o Health Insurances schemes Employees state insurance Central Govt. Health Scheme o Other agencies: Defence services Railways

to the delivery of health care to its people. Each state has developed its own system of health care delivery, independent of the Central Government .The Central Government’s responsibilities comprises mainly of

coverage of medical treatment in India. Healthcare between states, rural and urban areas can be vastly different. Rural areas often suffer from physician shortages, this along with disparities between states means that residents

• Private Sector: o Private Hospitals, polyclinics, Nursing homes and Dispensaries. o General practitioners and clinics • Indigenous system of Medicine o Ayurveda, Siddi, Unani and Tibbi, Homeopathy • Voluntary Health Agencies • National Health Programmes

The lack of adequate coverage by the health care system in India often forces people turn to private healthcare providers, though this is an option generally unaffordable to the poor. To help pay for healthcare costs, insurance is available, often provided by employers, but most Indians lack health insurance, and out-of-pocket costs make up a large portion of the spending on medical treatments in India. However, private hospitals in India offer world class quality health care at a fraction of the price charged by their counterparts in developed countries. This aspect of health care in India makes it a popular destination for medical tourists. India also is a top destination for medical tourists seeking alternative treatments, such as Ayurvedic medicine. India is also a popular destination for students of alternative medicine. Categories as per level of the health care • Primary health care • Secondary health care • Tertiary health care • Primary health care o The “first” level of contact between the individual and the health

system. o Essential health care (PHC) is provided. o A majority of prevailing health problems can be satisfactorily managed. o The closest to the people. o Provided by the primary health centers. • Secondary health care o More complex problems are dealt with. o Comprises curative services o Provided by the district hospitals o The 1st referral level • Tertiary health care o Offers super-specialist care o Provided by regional/central level institution. o Provide training programs Needs of Health Care System in India o Education concerned to prevailing health problems & methods of preventing & controlling them. o Promotion of food supply & proper nutrition. o Adequate supply of safe drinking water & basic sanitation. o Maternal & child health care, including family planning.

o Immunization against major infectious diseases. o Prevention & control of locally endemic disease. o Appropriate treatment of common diseases & injuries. o Provision of essential drugs. Issues in Health Care Delivery System in India As per assessment of health status & health problems to design health services the following components are the indicators decisive of health problems. o Morbidity & mortality statistics o Demographic conditions of the population o Environmental factors influencing health o Socio – Economic factors influencing health o Culture & its components o Medical & Health services available o Other services availability Study of the Global Scenario After understanding Indian health care structure and problems related to it, in 15

order to address these problems it is imperative to compare it with the health care systems abroad. So we looked at health care addressed globally. We took most powerful countries like USA, few countries from Europe to understand health care systems facilities and policies. We looked at health care system of United States of America in detail as a class exercise. After brain storming and discussions we summarized the study as follows General Information about Health Care System in USA • Most health cares are largely owned by the private sector businesses. • 80% of hospitals are non-profit. 2% government owned. 18% are for profit. • Most population under 67 is insured by their or a family members employer. • 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses and 43% are forced to mortgage or sell their primary residence. Facilities The U.S constitutes 3 types of hospitals, • Non-profit hospitals • Privately owned for profit hospitals

• Government owned hospitals Health care spending in the U.S. is characterized as being the most costly per person as compared to all other countries. They provide welfare systems for the aged (above 65 years old) called Medicare and for the poor, blind and disabled called Medicare. While most Americans in the middle to upper class have little to worry about since they probably have medical insurance, it is those of the lower classes that are tossed to the side, if they are not insured with Medicaid. Efficiency and Equity In United States health services are paid through insurance. Insurance companies have high premiums and lot of processes and paper work followed. As an effect it is seen that majority of deaths are due to lack of insurance and unaffordable premiums. In Primary care Facilities doctors are often the point of entry for most patients needing care, but in the fragmented health care system of the U.S., many patients and their families experience problems with care coordination. Uninsured Americans are less likely to have regular health care and use preventive services. They are more

likely to delay seeking care, resulting in more medical crises, which are more expensive than ongoing treatment for such conditions such as diabetes and high blood pressure. Paying by insurance can distort the incentives of consumers since the consumer pays only a portion of the ultimate cost directly. The lack of price information on medical services also distorts incentives. The insurance which pays on behalf of insured is negotiated with medical providers, sometimes using government-established prices such as Medicaid billing rates as a reference point. Depending on demographics the services and the premium change, which make people reluctant to avail health services on time. Mental illness is not covered under many insurance plans. Even some of them have water tight eligibility criteria which makes citizens under insured. Few states have covered plans only for children. We learnt that USA’s insurance system and more process oriented health care structure becomes very expensive affair. Patient withdraws themselves from availing services until they reach to the medical crisis. Health and Health Care – Perceptions

Understanding health care theoretically wasn’t enough to bring sensitivity about the context. We ran through few more interesting exercises. We were given an exercise to tabulate our perceptions about “Health” and “Health Care”. The perceptions and feel about health and health care by means of all body senses. Exercise 1 If a person/you is/are suffering with symptoms of Dengue • What kind of experience he/she/ you would have? • How will your body react? • What kind of thinking pattern you will have? Exercise 2 When you visit hospital with sick friend (Image answers) • What kind of visual you have? • How you react to your surroundings? • Thought patterns? Hospitals as a part of Health Care The project talks about creating a 10 to 20 bed hospital in metro city. Hospitals

are not new health care units to us. We must have visited hospital for someone or may be got admitted as a patient. As class we were been given few exercises related to our recall values of hospitals. Recall Values about Hospital My First Visit to Hospital Exercise I had to make story board to describe my first hospital visit. • When was my first visit to hospital? • How was my first experience in the hospital? • Did it have long impact on me? I visited hospital first time when I was 3 years old. My mother was hospitalized for her delivery. I had gone to hospital to meet a new family member and to bring my sister home. As I was just 3 my feelings were not about anything more than about my sister. I was very curious about her appearance, whether it is similar to us or not. I was also panicking about all attention she would be getting from my parents. It was very happy visit as we had gone to bring new member to the family, so it did not have any negative impact on me. But I learnt that if you need new member to

play with you then you go to this place called hospital and bring them. My Customer journey Map Exercise: To create a customer journey map being customer of a hospital yourself. Starting from the point of development of symptoms of sickness to getting discharged from the hospital a complete journey experience. Understanding the stakeholders A stakeholder is anybody who can affect or is affected by an organisation, strategy or project. They can be internal or external and they can be at senior as well as junior levels. Stakeholders are those who have the power to impact an organisation or project in some way. Stakeholders are crucial to the success of your project. Exercise Create a list of hospital stakeholders. List them as per primary, secondary and tertiary stakeholders. (Image of stake holder mapping)

Evolved Customer journey Map Learning about stake holders gave me a clear understanding of the system. I overlapped my first customer journey map and stake holder in the stakeholder map to create evolved customer journey. I added points like ATL and BTL activities, identification of touch points, pain points in the system. This helped to find out critical observation through the process. The outcome helped me to view first blue print of my customer mapping.

Stakeholders Map:

After the theoretical study was done, it was time to go on the field and get to know the real scenario of health care. With the college’s assistance, we planned hospital visits to collect the first hand information. We prepared a questionnaire, with the help of previously collected information, to understand and observe the processes in those hospitals. Questionnaire

Experiencing Health Care Scenarios In India

In order to understand the design intervention area for the project, we needed to explore these hospitals in different perspectives. For that needed answers to the following questions: • Basic information about the hospital • Location of the hospital • Type of Hospital, Bed size • Vision, Mission, Values • What is work area or unit in particular hospital? • Which are the specialities? • What is the Avg. footfall?

• Which are the more selling specialities? • What kind of customer segment visits them? What kind of technology do they offer? • What kind of advertisements they do? • What are the other facilities and amenities? • What are the kinds of finance services the offer? • Waiting time • Doctors and Nurse’s work hours, shifts, Stays • And other questions 3.2 Field Visits

Baptist Bangalore Baptist Hospital (BBH) was started as an outpatient clinic in a makeshift building, for rural Bangalore, in 1973. Today it is a 300 bed multispecialty mission hospital serving all socio-economic strata of the society and leading the way in quality healthcare in the country. BBH is the first mission hospital in India to be accredited with NABH and NABL To enable quality healthcare, the hospital conducts many medical, nursing and allied health services educational programs at undergraduate and post-graduate levels. The hospital is 21

governed by Christian Medical College, Vellore, since 1989.

Vision Healing and Wholeness in the spirit of

To provide quality, holistic care to all people and train others to do the same, sharing the love of Jesus Christ, drawing people to him and growing together into a mature community. Departments and Specialities

and preventive and Wellness Unit.

Sakra The SAKRA World Hospital is committed to advanced medical care through innovative and efficient services, creating an environment of continued quality improvement and expertise of the best physicians. They utilise the most recent medical technologies, advanced clinical methods and develop protocols to improve our outcomes ensuring the good health of the community around.

Vision We commit to medical care that enhances the quality of human life.

Mission

Jesus Christ.

Mission

They have general surgery, dentistry, dermatology, dietetics, General medicine. Their speciality is paediatric surgery, Heart Surgery, palliative care, personal care, sports medicine, therapy

Providing high quality medical care, through cutting edge technology and highly skilled manpower. Caring beyond the treatment, which includes complete after-care. Being responsible for the patientâ&#x20AC;&#x2122;s well-being and continuous enhancement of quality of life.

Specialities and Departments

Sakraâ&#x20AC;&#x2122;s Specialities are Cancer and blood disorder, ENT and Head Neck surgery, Internal Medicine, Ophthalmology, Neurology , Cardiac Centre, Respiratory medicine.

Victoria

of India. The facilities available includes departments of Medicine, Surgery, Orthopaedics, Dermatology, Psychiatry, Radiology and Radiotherapy, physiotherapy, Forensic Medicine super specialities include Plastic Surgery, Surgical and Medical Gastro

departments.

Entomology, Neurology, Neurosurgery, Cardiology and Urology. The Hospital provides prompt and high quality emergency and elective services in all

proprietary concern. They have all kinds of latest equipment for treatment which enables it to continuously rise on the growth chart and set very high quality standards. Their strict emphasis on quality of service is combined with the

Acura Acura Speciality Hospital specialises in all kinds of diseases. Mr.Tanveer Ahmed started this hospital as a sole

The foundation stone of Victoria Hospital, the century old premier Medical Institutions of India was laid on 22nd June 1897 by her highness Kempananjammani Avaru, the erstwhile maharani regent of Mysore to commemorate the completion of 60 years of reign of Queen Victoria. The Hospital was then formally inaugurated on 8th December 1900 by Lord Curzon the then Viceroy of India. It started as a health centre with 140 bed strength which is now the second largest Hospital in India accommodating more than 1000 patients at a time. It is located in the hub of the city and is easily accessible.

Departments and Specialities This is a teaching hospital and is attached to Bangalore Medical College and Research Institute, which is one of the premier Medical Colleges

latest technology to offer the patients a competitive edge. Since its inception, the company has established a reputation for itself as a supplier of quality service. PESTE, SWOT Analysis

Interviews and critical observations on Field

Interview with Dr. Dayaprasad Kulkarni Dr. Dayaprasad runs Aarogyaseva a non-profit organization. Dr Daya had very different take on today’s medicine and education. He mentioned in the interview that health care and education should not be for Sale anywhere. He took us through his journey. He told us about his experience with the people who were affected by the tsunami of 2004, helping HIV patients and sex workers through their problems, drug abuse community problems, providing services to Naxalites, helping African communities through their problems. He found the need to teach medical students “humanity” as a subject to sensitize them and to teach them to have empathy for the patients. He himself, always, provided medical services pro-bono.

Some points About Aarogyaseva Aarogyaseva is an international, humanitarian volunteer organization that is dedicated to providing quality healthcare services to affected

communities worldwide.

Vision

with us and told us about Fortis hospital and development of their chains across India.

To install the spirit of seva in doctors and the medical fraternity

There are 2 things you need to consider while building any business entity to provide better services.

To provide a structured platform for medical and non-medical professionals, to volunteer their time and skills, and strengthen the healthcare system.

Objective Build a global network of medical and non-medical volunteers. Provide meaningful volunteering opportunities in the health space Create models within the healthcare ecosystem that will demonstrate and showcase the effects of an organized network.

Interview with Mr. Anurag Kashayap Mr Anurag kashayap is the marketing head in Sakra Hospital. Meeting him gave us different perceptive about hospital and hospital business. He shared his previous work experience

1. Consumer 2. Customer Here, in hospital business consumer is the patient who is availing all the facilities and customer is the family of the patient. In any business you need to know the need of the customer or you need to create need to buy in the customer. This later gets converted into Greed or necessity to have. In hospital business Cosmetic is a sector where need is created for Good looks. He gave us example of the buttock surgeries and lip jobs. “Is hospital business easy? “He asked us a question. He explained how they classify hospitals as per need. When you look at it as a business what are possible bottle necks. • No Exchange of Happiness: It’s a first bottle neck. The expenses are very high. In country like India only 27% have access to insurance. In that 22% have mandatory insurances by the Employer

and rest 5% take up the insurances. • Brand Ambassador: Due to act of confidentiality it’s very difficult to have brand ambassador for the hospital for promotion and advertisements. • Superior Customers: Hospitals generally channelize their business through the primary health care groups or doctors. So here the business is B2B. In this customer is superior with better knowledge about the field which becomes a bottle neck for the sales person to sell the hospital to the customer. • MCI and other state Government Guidelines: Following all the acts and laws is very difficult when it comes to micro level. It becomes 4th bottle neck in the business. There is lack of satisfaction to the customer in the industry. Mr. Kashayap also mentioned about studies where 1 out of 20 patients communicates good comments or experiences to people about hospital to others. But 19 people out of 20 badmouth about the hospital to its target audience. From the interview he also explained us what kind of promotional activities hospitals do, viz. Above the line and below the line activities. Lack of mortality and morbidity understanding creates more complexities to run the hospital. 25

Critical Observations and thoughts from interviews

for employees so our nursing students try to fly abroad and we help them.” – Nursing College Principle

“Only Doctors are important part of health care system. “ By Doctor form Victoria Hospital

“We have been funded by government to the tune of 200 crores but we haven’t got time to implement new changes” – Victoria Hospital Staff

“We still are using same papers since the time we have joined the organization” – Nurse age 57 from Victoria Hospital “If student can visualize the studies they go under It will help them to retain it for longer, they could be better doctors” – Dr. Anand from Victoria Hospital “Love is very expensive and so is empathy” “Patients complain about nurses talking and making lot of noise during the shift change.” – Acura Manager “Doctor Moves cheese around the hospitals” – Mr Kashayap “Doctor’s respected us once upon a time” – Retired Nurse Chhaya “Nurse’s don’t have class-1 official ranks” -All India Nursing Portal “Abroad health care has better facilities

“Waiting makes patient move to another hospital” – Baptist Admin Staff

intervention area.

Insights for Business Idea • Cardiac Care • Geriatric Care ( Complete Geriatric Care, My business Idea) • Sports Medicine • Paediatric Care • Others

“Commercialization is need” – Sakra Staff

Insights for the project Ideas

“Personalizing and customizing as per patient’s need brings in lot of business” – Sakra and Acura Hospital

How to pick a clinic or hospital if you are new in town?

Inspirations and Insights As the research progressed there were some initial Ideas and insights developed. They were purely on the basis of critical observations through the hospitals. As a class we looked at the bigger insights which could help to us to build business idea. We pooled in couple of ideas for the business. We drew some more for individual project progress to reach to design

Where is exchange of happiness in Hospitals? What is better medicine or listening to patient? Where is the empathy for the system? Developing Notional Business Ideas through Insights drawn • Concept of Bachpan after Pachpan • Vision , Mission , Attributes • Personas • Brand Personality • Identity

Need

Vision

As one grows older they are treated as added responsibility or added expense to the family. Taking care of them becomes a major deal with growing expenses and busy work schedules. The nuclear families find it hard to accommodate their parents in their family.

“Our vision is to take care of the older adults in their golden years.”

Mission “At Bachpan After Pachpan, we strive to give the seniors a happy and healthy life in their golden years. We will challenge our skills and abilities and work towards

Statistics of World Health Organization says “There are over 700 million people above the age 55 – 60 and 13% among them are age 80+ “. While I was doing the gap analysis for Bangalore region there is only 1 dedicated hospital for geriatric care in Bangalore and that too not completely equipped. Some hospitals have geriatric care ward but they have not thought through the positioning of the ward which makes it very inconvenient. The hospitals need differently trained staff for geriatric ward. Through this need I proposed a business idea to open a geriatric hospital which comes with palliative care as well as a sustainable old age home which will help them to empower their life and live it with dignity. This was the seed proposed for concept of “Bachpan After Pachpan”.

providing excellent medical services to the older adults.”

Attributes of Brand I wanted my hospital brand to be very comfortable for elderly people. It shouldn’t make elderly people feel unwanted in the society. The hospital should be well equipped to take good care of senior citizens. My hospital staff should be considerate and respectful in their every act.

Personas I looked at different possible personas for my brand. Some of them I have listed in the image at end of this chapter.

Hospital Facility and Staff Requirement • 5 Floors building and basement (2 floors) • Institutional Facilities and activities • O.T rooms (2) • I.C.U ( Twin share (1))

• General Ward : (12- Bed (6 for Gents and 6 for ladies)) • Twin sharing (2 rooms (1 Gents and 1 Ladies) • Private Room (2 rooms) • Nursing staff 25 Nurses ( female nurse 18 and male nurse 7) • Labs, X ray • Ambulance(1 internal, 2 TP, Van to cemetery ) • Nurses room, Doctors room, Waste management rooms, Inventory stock rooms , admin room, Reception , recreation room • Consultations (5 rooms)

• 2- GPs and 2- Specialist • Specialist as per dedicated days. • Every G.P visits 3 days a week. (2 GPs) • Resident Doctor 1 GP

How Bachpan After Pachpan Functions • Orthopaedic , ENT, Cardiac , Respiratory , Gastric , Ophthalmology, Oncology Consultation • OT for Orthopaedic ( Dedicated ) • Old Age (20) and Rehabilitation(10) Home • Home Care • Palliative care • T.P. contract with Child Day Care This was a step towards more idea generation for our hospital. We learnt more details about generating ideas for the speciality or for the business. We needed to consider other things like business impacts, Staffing, speciality or super speciality, are we helping to any cause or its going to be totally commercial unit. It helped to progress with better understanding and finding loop holes in the analysis to generate better and deeper insights.

Inter and Intra Hospital

Looking at system being part of system “Where is the empathy for the system?” Dr. Daya’s statement made me take a reverse approach on my research I started dissecting the system and stakeholders map.Evaluation of all this information lead to a very important question, “Who is with patient for 90% of the time?” And answer was “A NURSE”. I looked into nursing sector in more details. For that, I interviewed a few nurses.

Few Interview questions for the nurses (All of these must be in indirect form)

Need & Gap Analysis

• Basic details: Name, Age, Education • How long have you been in nursing? • Reason to become a Nurse

• Do you consider nursing a profession or a job? • Their Speciality within Nursing Position in the hospital (Designation) Speciality related questions • Beds • Patient Details • Patient Ratio • Do they feel necessity of mentorship or more education? • Challenges faced in the job Have things improved/changed over time or just the same since they started? • Do they feel the need to make the Nursing field more appealing to others?

Addressed issues were, • The responsibility of making, life and death, decision for 7 people based on a 5 mins shift report • Getting reprimanded by doctors, for a missing one step in the process, while never being appreciated for doing all other steps correctly • The nauseating feeling of thinking what to eat for lunch, while cleaning an emesis basis or a bedpan? • Keeping updated on the knowledge of aetiology, classification, dosage, side effects, contraindications, 31

and compatibility for 18,000 different medications • The need to know the significance of obscure lab results and to decide if it is necessary to consult the doctor in the middle of the night because of it • The need to obtain a physician’s order to give a patient a Tylenol but have the authority to float a Swan-Ganz catheter through a patient’s heart to measure central venous pressure and pulmonary artery pressure • Spending 12 hours on your feet, at a stretch, only to be told by their personal physician that you need to get more exercise • Owning and maintaining 20 sets of nurse’s scrubs and own zero sets without stains on them • Having to adapt to new corporate computer systems, in the rear end of their careers, when they are not really acquainted to using a computer • Memorizing the menus and phone numbers of every local restaurant that will deliver in the middle of the night • Finding and Selecting a personal physician based on how he treats nurses

• Working in bizarre shifts, where in the shift starts while its dark outside and ends only when it gets dark again • Backfilling for experienced nurses, in some unacquainted departments of hospitals, and being expected to not drop the a ball, with the either limited or zero exposure to the procedures and protocols of that department • Is a chair at th¬e nurse’s station something worth fighting for? • Keeping a track of patients by their diagnosis and/ or room numbers rather than their names • Learning to read blood pressure, manually, in 15 seconds flat • Handling the instances, where in they couldn’t find the patients charts, while it being called up for, by the doctor • The sense of guilty conscious towards their patients the leave them, even for a 30 min meal breaks • Deciphering the physicians handwriting While I was reading through online nursing blogs I found letters and

advices for people about joining nursing sector. The nursing sector once used to stand for serving people, helping the ill and making people’s life better or saving people’s life, but now it has lost it glory. One of the letter I found left me startled!

I Hate Nursing “I hate nursing and I need to get out of nursing. I discourage everyone from entering the field. I know of no nurses who like their job. The patient’s families are impossible, and require more attention than the patients. I constantly have to clean up poop, deal with demented patients who fall on the floor, have no support from management, and God forbid anyone goes badly. It is up to nursing to monitor and correct mistakes made by every other department from dietary to pharmacy. If something goes wrong it will ALWAYS be blamed on the nurse. How do you take care of the low quality papers more when you have critical patients around? I am tired of missing weekends and holidays with my family only to spend them cleaning up excrement and being berated by patients and family members. DO not EVER become a nurse.”

A Role of nurse Reading and finding these short falls in nursing created a need to understand the role of nurse. I used all information from the interviews and online blogs and nursing officials help to understand role of a nurse. The nurses are involved in many activities and a majority of their time is supposed to be dedicated to a patient’s health care. They are involved in administering food and nutrition, Mother and Child Care, scheduling and implementing (neo natal care) perinatal care, Immunization in the health care premises etc. they are also sought to be partners in day to day administration viz. billing, discharge summary, etc. Critical point to be noted from the above is that a patient’s well-being is hinged and pivoted on a nurse’s work life balance. A stressed eco system can adversely impact the professional acumen that the nurses are expected to bring forth. The nursing community is also expected to participate in the government and hospital driven awareness programs viz., Water and sanitation awareness and education, Educating community programmes Prevention initiatives etc. Their assistance is sought in devising necessary precautionary measures at

a local level, primordial prevention strategies, and specific preventive measures to promote the health of the community. Problem Identification There is a Lack of empathy for the person who is expected to provide empathy. I divided nursing sector issues into 2 Broad categories.

• Workflow o The boards, papers and files the work is majorly on these medium where its possibility of data loss with the time. o Finding information is much tedious and slower process. o Patient Tracking becomes very difficult when patient is transferred form one speciality to other or one war to other ward. o When nurses change their shift there is process called Shift Hand Overs. It consumes lot of their time pre and post duty. o The system has no provision to see information at one glance. It is very

difficult to swift through pile of papers and files. o Data is maintained on the white board or black board where the board is dragged everywhere for discussion or 10 people touching the board all time. Causes loss of data. o When wards are changed the patient data entry is made again. There is redundancy in this process and information. This is done manually which takes time and effort of the nurse. o Carrying patients for different tests and labs check-ups consumes lot of time due to queuing system. No Prior appointment or intimation is made so that nurse could save on her time.

• Social o There are so many strikes in the country called by the nursing sector. Their payments are very low in commensuration to their work hours. o There is lack of awareness about the nursing jobs in the society and also the rules and particular Job descriptions are not followed. o It is predominantly a women oriented work domain. The women are exposed to lot of physical contact

during their jobs. There are case nurses being harassed by co-workers and even male patients. o There is loss of respect for the profession. As it is very difficult for them to find groom for marriage or high paid well respected job. They do not classify as class -1 employee. Need for Intervention • What makes streamlining a patients’ journey through the hospital so challenging is the number of people involved in delivery of care and the need for awareness around what tasks have been completed and which ones still remain. • Paper-based systems and scheduled meetings were the only way for staff to communicate this information to one another. • In practice, this means that information vital to patient care is infrequently communicated between team members, is recorded in different places and in different ways, and is heavily reliant on care providers seeking out, in a demanding work environment, the information they need to perform effectively in their role. My project proposal

Insights developed from analysis and research

• Chaos in the workflow o Paper-based systems o Invisibility in the Patient’s journey o Lack of centralization of patient’s data

• Avoid redundancy in the data by Introducing disciplined patient journey tracking and organization of data centrally. • Improvising on transparency of the patient’s journey to enhance nurse’s autonomy. • To facilitates easy mobility of essentials for a patient, with nurses .

• Job profile of the nurse is not motivating anymore

These can lead to a better scope of work definition for nurses

o Lack of respect for the profession o Below standard salary levels

Self-Positioning

• Sense of security in workspace environment is needed o Sexual Harassment o Lack of work ethics and etiquettes o Awareness of job description at a societal level o Over all well-being

Design Intervention areas In 10 to 20 bed hospital, • To reduce stress levels at work and which will lead to better services to the consumer.

The designer can play an important role in the health care system. Logical thinking will enable the analysis and problem identification of existing system. Problem identification will lead to unique design solution for system improvement which will help nurses to achieve a better work life balance. The transparency in the patient’s journey will help these nurses to take decisions in difficult situations. The respect to this profession and standards for the same could be restored through appropriate programmes and /or awareness materials.

Scope of Project

In 10-20 bed hospital, the scope of this project could be in the area of information design, graphics design or based on digital platform that aims to bring about an integrated and holistic approach to nursing. This could lead to better work-operation-life balance, thus can have an impact on the quality of health care delivered. The scope of the project would hence be multi-disciplinary in the/through area of product interface design, information design, and graphic design and can also tend to apparel design. The idea is to arrive at a design solution that could control chaos in a nurseâ&#x20AC;&#x2122;s workflow in a pilot context. Post user testing, necessary suggestions could be adapted and the resultant model could be scaled up to larger size hospitals.

Methods o Stakeholders interviews o Target Audience interviews o Field visit o Participatory Design Methodologies o Market research o Video / audio documentation o Design Challenges

Tools for Analysis o Fishbone Technique o SWOT analysis o 5Whys o Questionnaire o Mind mapping o A day in life of o Fly on the wall o Workflow blue print

Resources

field

o Hospitals, clinics, etc. o Newspapers o Web Recourses o Research papers o NGOâ&#x20AC;&#x2122;s, Unions in the nursing

o Other projects and other initiatives by people to work in enhancing work-life balance

Learning Goals o To demonstrate skills in the area of system communication and planning, design aesthetics, role as facilitator and use of communication tools. o To be sensitive and aware of the issues of the nursing sector. o To be able to communicate the message in an effective and appropriate manner. o To explore different mediums, their forms and the use of appropriate technology. o Understanding the social

and economic context of the target audience and the beliefs and values that they follow. o To use the design methodologies and principles effectively. o To explore my role as a designer in the area of development.

Time Line of My Project

With help of this technique I found out there is need for Oncology Hospitals Orthopaedics hospitals (dedicated) Geriatrics Hospitals

Origin of Idea for Orthopaedics Hospital I chose to work for nursing vertical as a whole. After the proposal was approved for each individual projects we had to find out one bigger umbrella to align our individual project under that. We had to do independent research and analysis to pool in ideas for bigger picture. I started my exercise by putting all hospitals in Bangalore on the map. I found out all the hospitals and their specialities through search engine online as well as on phone. All hospitals ranging from 10 to 15 beds to 500 bed multi-speciality.

Contextual setting for Eksa – An Ortho. Clinic

Plotting them on the map of Bangalore and putting their specialities I could see the place and the need according to the locality. I located residential areas, IT areas, Commercial Areas, Other prime localities. (Image of Map and layers)

Individual research on the opportunities in the healthcare scenario in Bangalore :

Others Idea to the pool • Palliative care • Blood bank + transfusion medicine • Psychiatry hospitals We went back to the business ideas we had earlier and picked out the large ideas that we resonated with. • Rehabilitation and fitness • Health for kids • Wellness of the body and mind • Healthcare away from the hospital We then looked at specialities and departments that fit two or more of these larger ideas. • Geriatric care Orthopaedic care • Oncology Rehabilitative services • Pain management • Psychological therapy • Palliative care • Occupational therapy Our two final ideas from a need based perspective which covered a large

realm of services and facilities were • A super speciality space dedicated to oncology • A multi-speciality space with rehabilitation services Our research and immersion led us to a speciality approach where we decided to look at a larger umbrella of orthopaedic services. A healthcare space that is dedicated to providing every kind of remedy for orthopaedic pain. Next few steps we were for developing the back bone of our hospital that is developing vision mission and voice and tone of the hospital and brand evolution of the hospital. After lot of brainstorming all us agreed on name Eksa suggested by Pallavi. We worked on initial brand development together as class activity. Initially we developed personas and other attributes of the brand. Brain storming sessions for mission and vision

Brand Persona Excluding emergency cases nearby who are brought to the hospital for first contact care

• Educated • Open minded • Middle and higher • Income group

Persona 1 • Young working professional • 27 years old • Works at a managerial level • Drives a two wheeler to work and back • Reasonably hectic schedule • Occasionally goes to the gym • Conscious about their diet • Medically insured • Would prefer a comfortable, quick treatment in case an unforeseen injury occurs

Persona 2 • Corporate professional • 50 years of age • Nine to five job • Head of family of four • Not very fit and has a tendency of putting on weight • Has a history of orthopaedic problems • Eager to find a constant reliable source he can keep referring to • Does not get time for much exercise • Visits a physiotherapist when the pain gets too extreme.

Persona 3 • Sixteen year old • Passionate about dancing • Wants to take up dancing as a career professionally • Often needs an orthopaedic physician every time she injures herself during practice • Parents are both working • Looking for a space where they would be comfortable sending their daughter for physical therapy when they are not around.

Persona 4 • Sixty year old • Lives with spouse • Retired professional • Restricted movement • Have Medicare • Children are settled in different parts of the country • Travels infrequently only to buy groceries and durables for the house • Prefer a service where they don’t have to be dependent on their children when the need for medical attention arises.

Persona 5 • Thirty six year old • Practicing orthopaedic surgeon, pain management specialist 39

• Believes in the brand’s philosophy of patient centricity • Believes that every patient is different and may need a different kind of treatment • Well connected to bigger corporate hospitals for instant referrals • Comfortable in a smaller space • Open to new kinds of treatment, solutions for pain. • Fitness enthusiast

Brand Genesis Eksa Orthopaedic Care was a result of our collective effort to create a healthcare space that breaks away from the negative, gloomy picture a hospital or a clinic paints in a consumer’s head. To create a brand that is synonymous with empathy, addressing the consumer’s needs and making the journey of relief, treatment and cure, easier and more comfortable. We seek to be unique, different from all the larger corporate spaces that exist in the urban pockets of the city. A smaller, familiar speciality space that empowers its customers and stakeholders through knowledge, systems and assistance. Thus the name

‘Eksa’- one of a kind.

Vision To revive, retain and promote good health.

Mission To provide reliable systems and services that care for the quality of life.

Core values • Attentive • Relieving • Reassuring • Empowering

Essence To Enable through relief and recovery.

Voice and tone • Familiar • Positive • Guiding

Unique Selling Proposition Eksa is not just about offering medical services. It is about delivering those in the quickest, most efficient way possible with empathy and care.

Attentive to every aspect of your pain and determined to help you overcome it. With all these efforts we established our brand Eksa. Further development of log and branding is done by pallavi and rest of us started working on our individual context in detail.

Logo and Meaning

the functioning of an organization, it is important to study its organization structure.

6.1 Introducing Nurses and Nursing As given In chapter 4th the research and interviews helped me to understand responsibilities of a nurse and her role in the health care. The study also helped me to understand issues at work flow level and at social level. To get to the grass root level of understanding about nursing I felt the need to know about the different organizational structures, hierarchies, job roles, recruitments, education background they come from, financial structure, government involvement, laws and acts.

Organization Structure

Nurses: A Contextual Subject Matter

Organizational structure means the formal structure of authority to define, distribute and provide for the coordination of tasks and contributions to the whole which is very essential for fulfilling the objectives of an organization. In order to understand

The hospital is an integral part of the social and medical organization, the function of which is to provide for the population, complete health care, both ‘curative’ and ‘preventive’ and whose outpatient services reach out to the family and its environment. Hospitals can be classified as per ownership/ control, clinical basis, length of stay of patients and teaching or non-teaching status. As per ownership basis the hospitals can be public, voluntary, private and corporate hospitals. The public hospitals can be further classified as Central Government Hospitals and State Government Hospitals. The hospital works through many departments, which deal with different kinds of services like medical, nursing, pharmacy, laboratory services etc. Among all these services the nursing service is that part of the hospital which aims to satisfy the nursing needs of the patient and community. The nursing service is closest to the patients 24 hours of the day and seven days of the week. Nursing personnel also usually constitute the largest proportion of the hospital staff. Planning, organizing, directing and coordinating the individualized care of hospitalised

patient is the most important function of a hospital nursing service. All other nursing functions and activities are related to it.

generally driven by your experience in the field. This is a field where hierarchy structure is followed and evidently seen in the work culture.

As per the ownership three types of state hospitals I looked at • Autonomous Hospital • A private Hospital • A State Government hospital

Job and Classification

Organizational structure of Nursing Department of all three hospitals is depicted in the organization chart of nursing services of these hospitals as shown in Diagrams. Having a closer look at these charts, it can be observed that the Director is the overall in-charge of the hospital, and the Medical Superintendent is overall in-charge of the Hospital under whose supervision the Nursing Department works. (Nursing and Midwifery Research Journal) I looked at hospitals like Bombay Hospital, Hinduja Hospital, and Acura Hospital for their hierarchy Structure. They are non-teaching hospitals ranging from 300 beds to 25 beds. The hierarchy in the nursing sector is driven by experience. Education qualification helps to reach to higher ranks in private hospitals. In this hierarchy structure your post is

The purpose of a classification scheme is to categorize and rank different positions so that the type and level of each rank can be used as a mean of securing equal pay in commensuration for work. The class or position include those that is sufficiently similar in the content of work, in the level of difficulty and in the responsibility and qualification requirement of the work as to warrant similar treatment in personnel and pay administration.

Facilities and salary standards in the nursing sector In my research, I read in the news regarding nurse’s strike. The strike was for salary growth. Majority of hospitals pay very low wages to nurses. They are ranging from Rs.1800 to Rs. 8000 only. In India the Class of employee is determined by the post of job he/she works for. The nurses do not qualify to be Class I employees. Pay scales of Nursing Staff of select hospitals are depicted in Table.

Educational and Eligibility Background As per Indian Nursing Council guidelines licencing is required to join as register nurse in the hospital. For the licencing one needs to qualify below listed education qualification. Eligibility Criteria Nursing Programs Revised from 2012-13 Academic year

A. N. M. • The minimum age for admission shall be 17 years on or before 31st December of the year in which admission is sought. • The maximum age for admission shall be 35 years. • The minimum educational requirements shall be 10 + 2 in Arts (Mathematics, Physics, Chemistry, Biology, Biotechnology, Economics, Political Science, History, Geography, Business Studies, Accountancy, Home Science, Sociology, Psychology, and Philosophy) and English Core/English Elective or Science or Health care Science - Vocational stream ONLY passing out from recognized Board. • Student shall be medically fit. • Students qualified in 10+2 Arts 43

or Science examination conducted by National Institute of Open School. • Student shall be admitted once in a year.

conducted by National Institute of Open School with 40% marks. • Student shall be admitted once in a year.

G. N. M.

B. Sc. (N)

• Minimum and Maximum age for admission will be 17 and 35 years. There is no age bar for ANM/LHV. • Minimum education: o 10+2 class passed preferably Science (PCB) & English with aggregate of 40% marks. o 10+2 in Arts (Mathematics, Biotechnology, Economics, Political Science, History, Geography, Business Studies, Accountancy, Home Science, Sociology, Psychology, Philosophy) and English Core/English Elective or Health care Science - Vocational stream ONLY, passing out from recognized Board under AISSCE/CBSE/ICSE/SSCE/HSCE or other equivalent Board with 40% marks. o 10+2 vocational ANM under CBSE Board or other equivalent board from the school and recognized by Indian Nursing Council with 40% marks. o Registered as ANM with State Nursing Registration Council. • Student shall be medically fit. • Students qualified in 10+2 Arts or Science examination or Health care Science - Vocational stream ONLY

• The minimum age for admission shall be 17 years on 31st December of the year in which admission is sought. • Minimum education: o 10+2 class passed with Science (PCB) & English Core/English Elective with aggregate of 45% marks from recognized board under AISSCE/CBSE/ ICSE/SSCE/HSCE or other equivalent Board. • Student shall be medically fit. • Students appearing in 10+2 examination in Science conducted by National Institute of Open School with 45% marks. • Student shall be admitted once in a year.

Post Basic B. Sc. (N) • Passed the Higher Secondary or Senior Secondary or Intermediate or 10+2 or an equivalent examination recognized by the university for this purpose. Those who have done 10+1 in or before 1986, will be eligible for admission.

• Obtained a certificate in General Nursing and Midwifery and registered as R.N.R.M. with the State Nurses Registration Council. A male nurse, trained before the implementation of the new integrated course besides being registered as a nurse with State Nurses Registration Council, shall produce evidence of training approved by Indian Nursing Council for a similar duration in lieu of midwifery in any one of the following areas: o O.T. Techniques o Ophthalmic Nursing o Leprosy Nursing o TB Nursing o Psychiatric Nursing o Neurological and Neuro surgical Nursing o Community Health Nursing o Cancer Nursing o Orthopaedic Nursing • Candidates shall be medically fit. • Students shall be admitted once in a year. M. Sc. (N) • The candidate should be a Registered Nurse and Registered midwife of equivalent with any State Nursing Registration Council. • The Minimum education requirements shall be the passing of:

B.Sc. Nursing/B.Sc. Hons. Nursing/Post Basic B.Sc. Nursing with minimum of 55% aggregate marks. • The candidate should have undergone in B.Sc. Nursing / B.Sc. Hons. Nursing / Post Basic B.Sc. Nursing in an institution which is recognized by Indian Nursing Council. • Minimum one year of work experience after Basic B.Sc. Nursing. • Minimum one year of work experience prior or after Post Basic B.Sc. Nursing. Indian Nursing Council (INC) is a statutory body established by the Act of Parliament in 1947. The INC lays down standards of nursing education throughout the country besides recommending the optimum nurse-patient ratio and education requirements for various positions of the nursing staff. Apart from it Government of India had set up various committees from time to time to lay down standards for nursing practice.

6.1.4 Nursing council’s definition of nursing Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities,

sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy.

6.1.5 Job description today Staff nurses The Staff nurse is responsible for the complete nursing care of the patient assigned to her. The following duties would be shared with nursing students, if any and auxiliary staff such as nursing orderlies wards boys, ayas, and sweepers as the situation warrants. • Admission and discharge of patient. • Assistance and instructions to patient and their relations. • Bathing patients including daily care of mouth, nails and pressure points. • Four hourly or more frequent attentions to pressure points. • Giving and removing of bed pans and urine pots. • Giving and removing of hot water bottle. • Bed making. • Feeding of patients. • Distribution of diets, milk etc.

• Preparation of special feeds, eggs, milk etc. • Technical nursing care of patients. • Administration of medicine. • Administration of injections. • Assistance in administration of I/u injection. • Preparation of injections and clearing up. • Recording of medicines & injection given. • Rounds with doctor. • Technical procedure e.g. Enema catheterization, dressings irrigations O2 therapy, preparing for and clearing up after procedure. • Preparation for and assistance in clinical tests and medical procedure. • Pre and postoperative care. • Urine testing. • Collecting labelling and dispatching of specimens. • Escorting patients to and from departments. • Giving and receiving reports.

Ward management a. Handing over and taking charge of shift. b. Keeping the ward clean and tidy. c. Preparation of surgical supplies, bandage, splint. d. Routine care and cleaning of dressing trolleys, cupboards, apparatus, computer etc. 45

e. Care of clean and soiled linens. f. Disinfections of linen, beds, floor and bed pans.

General a. Demonstration and guidance to student nurses and domestic staff. b. Supervision of domestic staff. c. Assistance in orientation of new staff nurses. d. Participation in staff education and staff meeting. e. Participation in professional activities. f. Any other duty that may be assigned from time to time. g. Duties of Officers

Nursing Superintendent • Recruitment and training of nursing staff. • Regular rounds in hospital wards & departments, daily visits to seriously ill patients and surprise night round. • Rub mission of daily reports regarding admission, discharges and deaths completed by night sisters. • Assigning Nursing staff to various wards and departments. • Organising and conducting staff meetings of the nursing staff. • Matters relating to nursing school. • Matters related to nurses hostel. • Deployment of nursing personnel’s

& vacancy. • Grievances of nursing staff. • Any other duty that may be assigned by Medical Superintendent from time to time.

mechanism for transferring information, primary responsibility, and authority from one or a set of caregivers, to oncoming staff”. It is to be performed within complex organizational systems and cultures that impact patient safety. Shift Handovers The detailed day in a life of nurse introduced me to a very important process called “Hand Over” or “Hand Off”. There are a number of terms used to describe the handoff process, such as handover, sign-out, sign-over, crosscoverage and shift report. The transfer of essential information and the responsibility of patient’s care, from one health care provider to another is an integral component of communication in health care. This critical transfer point is known as a handoff. An effective handoff supports the transition of critical information and continuity of care and treatment.

The Analytical Phase

The concept of a handoff is complex and “includes communication between the change of shift, communication between care providers about patient care, handoff, records, and information tools to assist in communication between care providers about patient care”. The handoff is also “a

Why Is There a Problem With Handoffs Today? Ineffective handoffs can contribute to gaps in patient care Ineffective handoffs are failures and gaps in patient safety, including medication errors, wrong-site surgery and patient deaths. Clinical environments are dynamic and complex, presenting many challenges for effective communication among health care providers, patients, and families. Nursing department deals with multiple transfers, discharges, new admission on daily basis. This creates possibility of errors like, • Missing allergy and weight • Incorrect medication information • Incomplete or missing information.

The handover process is majorly dependent on • Potential gaps in communication among health care providers transferring information about care and treatment.

• Level of Caregiver’s knowledge and experience • Variability in quality, omission of essential information • Lack of structure how handovers occur • No hand over procedure thought in nursing school • Communication barriers between Physicians and Nurses due to different communication methods. • Status of Physical work environment (noisy, prone to interruptions) • Difficulties with data access (documentation is illegible, or not transferred)

Different types of Hand Over • From one health care provider to another • Department change • The transition of information and responsibility during the handoff between shifts on the same unit • Interdisciplinary handoffs occur between nurses and physicians • Nurses and diagnostic personnel • Intra disciplinary handoffs occur between physicians • Between nurses Inter facility handoffs occur between hospitals • Among multiple organizations • Including home health agencies

• Hospices • Extended-care facilities Handovers may involve use of specialized technology (e.g., audio recorders, pagers, hand-held devices, and computerized records), fax, written documents, and oral communication. Each type and location of handoff presents similar as well as unique challenges. The importance of handovers and aforementioned dependencies’ I came up with few questions, they are as follows: • What could be best strategy for handoffs in various scenarios? • What are the most effective strategies, instruments, and tools to employ to assure maximum transfer of and receipt of accurate, relevant, up-todate information? • How digital/electronic technologies could help to achieve more accuracy and help prevent loss of data? • What are the effective ways for assuring, that, critical information is forwarded with any omission or negligence? • What are the critical data elements that should be transferred by type of service, specialty, profession, and

setting? Shifts Nursing is a 24 hours job. The care is provided across the day with same attention to details throughout the day. They generally work in 3 shifts. • Morning • Evening • Night The official working hours are 8 for morning and evening shift. For night shift is generally 10 hours a shift. Due to lack of employment of nurses in reality they work for more than 8 hours or they work double shifts. This creates possibility of making more errors. The hand over process extended shift hours before joining on a shift and exiting from shift. Working in shift has added few disadvantages, for e.g. they have to travel alone when the shift gets over in the mid-night and late evenings. Different hospitals have different shift structures. Current scenario in Nursing Career

Core and Non-Core Activities As per current scenarios after close look at the day in a life of nurse the time consumed by each activity is divided in percentages. The pie chart shows the shift work distribution. As per the 51

observations and understanding I categorized the time spent per activity and as per given importance to those activities. I made existing list of KRAs and KPIs

Prevailing KRA /KPI Overlap of Nurse’s journey and Patient’s To understand complexity of the nursing job I looked at the correlation between the patient’s journey map and nurse’s day in a life. It gave me 24 hours in hospital journey. (end of this chapter)

Understanding the pain points and touch points Service Blue print The service blueprint is a technique used for service innovation. The technique was first described by Lynn Shostack, a bank executive, in the Harvard Business Review in 1984. A map that displays all the touchpoints of the consumer with your brand, as well as the key internal processes involved in it. It is Useful to visualize the path followed by consumers across multiple channels and how you could improve the flow. The blueprint shows processes within

an organization, divided into different components which are separated by lines. Here is the service blue print of Eksa nursing services derived from the customer’s journey, A day in a life of a nurse and overlap. (Detailed image of service blue print is provided in the CD ) When the blue print was ready I could see the possible spots of intervention in an organization. This completed analytical phase for my project. I enlarged the work areas needed improvement and compared them placing parallel with insights and problem identified in previous chapter to arrive at definite intervention areas and project outcomes explained in the next chapter.

After the Research phase and Analytical phase I reached to the solution phase of the project. Making an organizational structure was the best approach to start working on the nursing vertical. These lead to making KRA and KPI’s of an individual and deciding job description for posts. To arrive at design intervention areas I divided all the activities into core and non-core. Organization Chart

Envisaging Work Life Balance For The Eksa Nurse

• Reduced medical and medication errors • Decrease in patient complications • Decrease in mortality • Improved patient satisfaction, • Reduced nurse fatigue and burnout • Improved nurse retention and job satisfaction Few Patients to Nurse Ratios: One of the articles gave formula for the patient and nurses ratio. • Nurses/Patient = (Productive Nursing Hours) /(Patient days * 24) Nursing council states that nurse interns and patient ratio has to be 1:5 to 1:3 Nurse to patient: 1:3 or 1: 4 ICU / Critical Care: 1:1 or 1:2 Surgical Ward: Minimum 1 Register Nurse If its orthopaedic Speciality : 1 (licenced) Recovery Unit: 1:2 Emergency Care: 1: 4 or fewer On Call: 1 has to be assigned for 24*7 Trauma and Critical Care: only licenced nurses should be assigned. Trauma Care: 1:1 Post-operative Care: 1:3

Building something for community always has constraints and set of requirements by governing body. Patient safety issues are an ongoing concern, There is a strong relationship between adequate nurse-to-patient ratios and safe patient outcomes. Indian nursing council and Nursing Act has set few ratio requirements. Every speciality The Eksa hospital has IPD ward, or every health care unit has to follow a OPD ward, Ambulance Department, particular nurse to patient ratio. Casualty, Operation Theatre, Physiotherapy Rehabilitation. Eksa is 20 Importance of Patient Ratio: Having an bed sized hospital. As per single and adequate staffing helps to achieve twin sharing rooms and ratio structure

I formulated my Org Chart as well as Referring to the research to understand the organization structure (Chapter 6). As per architecture of the Eksa’s Room Allocations Second Floor: 12 beds: 4 twin sharing and 4 single rooms Fourth Floor: 6 single rooms and 2 suits The organization chart I derived has combination of male and female nurses plus I have divided general responsibilities and speciality responsibilities between 2 nurse incharges. In one of my interview manager of the hospital said not many people chose to be in the nursing. Boys graduate from the nursing school and due to lack of opportunity in our country they tend to look for opportunities abroad. Therefore there is possibility of employing male in the field and we do have male population unemployed in spite of good education. This is orthopaedic speciality hospital where nurses need to have physical strength also as patients could be dependent on nurses for mobility. Advantages of men nurse: • Eksa can be pioneer for this project • Comfort to male patient • Majority population can be given

employment. (this is broader level solution/insight ,which is possible to implement across the country to bigger hospitals also) For Speciality like rehab and Operation Theatre the nurse should be qualified for the specialization (Ortho. nurse). Recruitment for Nurses Department A successful, managerially oriented, recruitment program is aimed at procuring the most efficient and effective employees. Quality nursing care is a cornerstone for running a hospital efficiently. Hence in order to have efficient nurses it is important to have a good recruitment policy. In order to have a sound recruitment system three aspects are important • Balance between number of people recruited and management’s current expectation to recruitment needs in the near future. • Promises made during recruitment should not oversell the institute or job. • Recruitment procedures should be well adapted to relevant differences in the kind of employees to be recruited. Recruitment procedures include the process and the methods by which vacancies are notified, post are advertised, applications are handled and screened, interviews are conducted and appointments are 59

Organization Hierarchy

Organization Chart

made. Recruitment covers both the filling of new posts both from internal, i.e. already employed or from external candidates. It may however be pointed out that the lower level positions may be recruited through direct recruitment; for middle level positions it could be direct recruitment combined with a liberal system of promotions; and top level positions should go by well-designed system of promotion . Direct recruitment method works on the principle of democracy. It provides equal opportunities to all and it ensures continuous supply of fresh employees with ability and competence, while other ensures that the people who are appointed at higher positions have sufficient experience of work and administration. It provides the employees the ample opportunity for advancement. But in the meantime it narrows down the area of selection. It puts premium on experience and neglects the brilliant fresh candidatures. KRA and KPIs Recommendation This was fairly new concept to derive core competency for this sector. While making this, Gayatree Nair, nursing manger from one of the reputed

hospital, provided me guidance to draw the KRA and KPI help to define core competency at every level. Identifying KRAs helps individuals: • Clarify their roles • Align their roles to the organisation’s business or strategic plan • Focus on results rather than activities • Communicate their role’s purposes to others • Set goals and objectives • Prioritize their activities, and therefore improve their time/work management • Make value-added decisions

KRA KPI for Staff nurse Core and non-Core Activities In business unit it is necessary to derive core and non-core activities to enhance the productivity and gather more focus on important and core activities. Referring to Nursing Council’s definition of nursing (Chapter 7) Patient care, Hygiene and communication are very important activities of the nurses due to charting, documenting and other paper or process work they cannot give majority of their work time to patient care( pie chart in chapter 7) In ideal scenarios their time distribution should be

Core activities • Patient Care • Maintaining Hygiene • Integrity and ownership of Work • Communication Non-Core Activities • Paper work of reports • Hand Over Process • Ensure Business results • Patients Flow and planning • Development of the sub-ordinates • Continuous knowledge enhancement Reducing complexities and redundancy from their non-core activities they will be able to spend more time in patient care. This will help to achieve work life balance by reducing stress they go through. This will lead to better patient care.

Arriving at key Design intervention areas Looking at our core and non-core activities I decided to reduce time spent on non-core activities by helping with solutions they can give more quality time to patient care. Ideation and Brain storming phase Looking at issues in the workflow and non-core activities column I saw a link .Due to flaws in the work flow the time consumed in documentation, taking readings etc. along with keeping abreast was a bit of difficult task.

To solve these issues I started ideating with different solutions ranging from making small changes in working hours, Shift solutions to finding digital solutions to ease work load and helping them to achieve accuracy.

Project Outcomes: Ideation phase lead me to figure out my final projects outcome. They are as follows. Digital solutions for Patient care and Ward Work: Closely looking at hospitals and interviewing lot of nurses in my research helped me understand type of work nurses do. I divided it primarily into patient care and ward work. With help of this digital solution hospital can achieve following, • Reducing paper work: due to use of tablets or smart phones or computers we can reduce paper work. This will lead to help nurses to move around swiftly rather than carry files for 10 patients. • Accuracy in making patient’s records and files: Data will be entered digitally and the graphs will be generated digitally so there won’t be any wrong inputs on the graphs. The readings will be accurate. • Patient tracking: The information will be handled centrally which will eliminate redundancy in data when

departments/wards of patient is changed, It will also give treatment tracking and next steps visualization in one glance. • Retrieval of archives: Hospitals have to store patient’s data for IPD 10 years and OPD 5 years. With use of paper there will be piles of files which makes retrieval of old records very difficult. This will help nurses to access patient’s records faster as well as storage will not take much of space. • Taking appointments: Taking appointment for further processes like doctor consult, Labs, Tests consumes lot of time due to not prior appointment. Nurse has to go back and forth for the same. This will be eliminated as they will be able to take direct appointment. • People Development: Nurse’s will have their own learning portal where they can upload their study and cases.

solutions: While looking at providing safe environment inside and outside of the hospital. I designed their shifts keeping in my mind their hectic working hours, having more staff at time when needed. Pick up and drops services, health insurances, security funds, etc. Prototyping and Conceptualization process in further discussed in the next chapter with help of Flow charts, User Scenarios, User flows, Site maps, Wire Frames.

Redefining visual identity of Eksa Nurses: Empowerment is one the major aspect and value of brand Eksa. To give back the respect to the nursing field, there is need to re define the identity of the nurse •Branding of nurse: Apparel Design for Eksa. Shift hour calculations and other small 65

• Task Analysis • Taxonomy • Site map • Sketches • Wire Frame • Visuals This chapter talks about all the Conceptualization phase. Conceptualization Phase Before finalizing on digital solution I looked the information flow in the hospital. How it works in the present scenario. In hospitals, there is no specified path which is followed by the customer. The information centralization is necessary as all the departments function independently but data which flows throughout needs to be exchanged whenever it is needed.

Proposed solutions

Story Boards A comic strip that illustrates the series of actions that consumers need to take while using the product, translates functionalities into real-life situations, helping designers create empathy with the consumer while having a first look at the product scope. User Flow

Structure of information flow in the hospital

A visual representation of the user’s flow to complete tasks within the product. It’s the user perspective of the site organization, making it easier to identify which steps could be improved or redesigned.

UX UI Solution

Task Analysis

To develop digital solution I created multiple scenarios considering intervention areas from blue print. The steps I followed were: • influence board • Story board • User Flow

What Is Hierarchical Task Analysis? “A hierarchical task analysis provides an understanding of the tasks; the users need to perform to achieve certain goals.” A structured, objective approach to describing user’s performance of tasks,

hierarchical task analysis originated in human factors. You can break down these tasks into multiple levels of subtasks. Here in conceptualization use of hierarchical task analysis is to describe the interactions between a user and a software system. When designing a new system, hierarchical task analysis lets you explore various possible approaches to completing the same task. When analysing an existing system, it can help you to optimize particular interactions. Applying Hierarchical Task Analysis to User Experience Hierarchical task analysis requires a detailed understanding of users’ tasks. You can achieve this understanding by • identifying user’s primary goals • detailing the steps users must perform to accomplish their goals • optimizing these procedures Taxonomy An exploration around multiple ways to categorize content and data: topics in a news site, product categories in an ecommerce etc. assists designers in defining the content structure to support the user’s and the organization’s goals. Site Map

One of the most iconic deliverables consists of a diagram of the website’s pages organized hierarchically. It makes it easy to visualize the basic structure and navigation of a website. Sketches Paper sketches

nursing uniforms has changed now, with nurses wearing scrub sets and other flexible clothing. Still, it’s the everlasting image of the perfect nurse in her pristine, starched white uniform that remains with us. The final Execution was done on muse.

Wire Frames • Influences • Initial Iterations • Final Wireframe Visual Development • Iterations • Final Redefining Visual Identity of Eksa nurse When you think of a nurse, what image comes immediately to mind? A lady in a crisp white frock, with a starched white cloth apron in her hair, wearing white rubber shoes, white socks and white belt; the quintessential image of standard nursing uniform for nurses worldwide. However, the concept of 67

Data Flow

Influences

Story Board Decteting Problem

Story board of product use

User Flow for Wire Frames

Skecthes Of WireFrame

Digital Iterations of Wire Frame

Finalized Wire Frame

Visual Frame

Final Visuals

History & Evolution

Nursing Uniforms in 19th Century Nurses in this era wore servant’s uniforms, which consisted of a full black or printed gown with a white gathered or banded cap and a white apron. Nursing was still a street profession, though some nurses worked as private health caretakers for wealthy households. People started feeling a greater need for nurses around 1840 and nursing as a career started gaining more respect. Nurses were trained to some extent and made to work at city or local health board. These nurses did not wear servant’s uniforms; rather, they wore ladylike gowns with white aprons and caps to indicate that they were nurses. The starched white cap became synonymous with the nursing profession at about this time. Florence Nightingale paved the way for the ultimate recognition of nursing as a superior, compassionate profession. Nursing in the post Nightingale era turned into a more respectable job, with schooling systems and uniforms for nurses. Nurses had to wear a hat and band to distinguish themselves as nurses and display their nursing rank.

Fresh nurse students would wear ribbon bands of pink, blue, or other pastel colours. Senior nurses and nursing teachers would wear black ribbon bands to indicate seniority.

Nursing Uniforms in 20th Century In the 1900s, nursing uniforms started looking distinctly different from servant uniforms. Nursing uniforms came with pockets for keeping things on hand, a button down style top and pointy collars that differentiated them from other clothing. A white bib covered the nurse’s torso till the waist, where the bib’s folds were gathered and let down as an apron. The nurse’s dress was made of solid colour fabric, and was tailored well. The tailoring, the style effects, the pockets and bib aprons ensured that the nurse would not be confused with a regular domestic servant. Nurses started wearing large hats in emulation of a nun’s starched high hat and veil. Emulating a nun’s uniform brought the nursing uniform a further semblance of borrowed respectability. Sometimes nuns used to operate as nurses and nurses opted to become nuns and serve in the nursing field. Therefore, many churches had trained nurses who would be asked to help during times of sickness and community diseases.

The First World War brought about great changes in the nursing uniform. Design aspects and distinction took a back seat, and functionality became the most important feature in a nurse’s uniform. Nurses had to be fast and provide quick care for the many casualties they had to tend during the war. Sleeves were rolled up for easier movement, bulky aprons were taken off and shirts shortened for convenience. After the First World War that nurses realized they needed a uniform that combined functionality with femininity. The resultant look is the precedent of the white nurse’s uniform that we know as the standard nursing image now. By the 1950s, paper hats and simple folded hats replaced the large, elaborate crown-like caps that were worn by nurses during the First World War. The simple paper hats were more comfortable. The policy to use hats to denote seniority level was abolished, since the morality of nurses was affected by the discrimination. Dresses also evolved, since no one has the time to launder elaborately tailored clothing anymore. Dresses became less form fitting and were easy to wash, iron and wear. The nursing hat disappeared completely in the US by the late 1970s. 79

Male nurses started wearing nursing scrubs, which soon became the new fashion trend. Nursing uniforms started to resemble regular clothing and nurses appreciated the informal and casual feel of the clothes.

Nursing Uniforms Today Nurse’s Uniforms are now designed as per comfort and trend. The paediatrics ward generally has multi coloured uniforms. Wearing cap has been almost gone out of field. Nurses are more aware of what uniform they are wearing. White uniform are replaced by brand colours of the hospital. This made washing and helped uniform looking clean. Uniforms are outfits of a specified material, colour, and design, usually provided by the hospital, for employees in an equivalent or similar position wear identical outfits. Providing uniforms for hospital staff is one way of ensuring proper grooming, thus reflecting the standard of hospital.

Talking to Nurses and finding need for Uniform Design Uniform style and historic changes A large proportion of nurses said they

would prefer to wear scrubs rather than tunics. Those who preferred dresses and tunics thought these were smarter. It has also been suggested that scrubs portray a competent and trustworthy image and command a certain level of respect as they are often associated with “prestigious” areas such as ICU, OT. Some discussed the perception that in the past nurses took a lot more pride and care in their appearance and had a stronger identity. They commented that nurses used to look smarter and therefore appeared more professional. All nurses thought uniform was an extremely important issue and that it directly affected practice and therefore needed attention. In order to retain staff and enhance nurse’s job performance, it is vital to improve their self-image and the public’s perception of nurses. Nurses also mentioned that a new image or identity for nurses would help to further remove old fashioned stereotypes and promote a more autonomous and professional image. However, they made clear that remembering nursing heritage and traditions is also important and a fundamental part of identity.

Uses or advantages of providing Nurses uniforms

• Hospital ensures a well- groomed appearance for staff. • They help to create an atmosphere. • They help identify the nurses and their position to the patients. • They help differentiate between levels or positions of the nurses. • If made in the right design for work, they provide comfort for the nurses. • They instil a feeling of belongingness and loyalty to an organization among the nurses. • They enhance the spirit of teamwork. • They allow nurses to save money on working clothes and costs of laundering. • It is easier for nurses to take up messy jobs when they know that their own clothes are not involved.

Designing of uniforms The following points should be kept in mind while designing uniforms –

• Comfort (size and stitching) Since uniforms have to be worn for long hours, they should be most comfortable. It should be loose enough to allow the nurses to perform all tasks efficiently without any barriers. Tight clothes restrict movement while causing

continuous irritation and physical discomfort and result in reduced output and poor job performance. Nurse’s job involves lot of movement and carrying medicines and lifting patients or stretching or pulling for the work which needs space or stretch room under the arms, across the back and around the waist and chest. • Practicality (usefulness of design features, pockets, etc.) Besides comfort, certain other points need to be kept in mind. Pockets, collars, belts or sash design should be carefully thought out. Nurses need pockets to be roomy enough for medicines, tablet phones etc. Straight pockets on the side, in jackets or trousers, are convenient since items do not crumple or break or spill out upon leaning or bending forward over a table or counter. Slanted pockets on the side seam are unsuitable for putting in paper, etc. easily. Collars and cuffs should be smooth, not too tight or stiff. Accessories should be avoided as far as possible since they make laundering difficult. They also have a tendency to get lost or misplaced creating an incomplete look appearing very shabby. Zips or elastics are more convenient than buttons and hooks. Trouser and shirt combinations work best for most strenuous jobs for both genders.

• Durability and ease of maintenance ( type of fabric used)

management staff. It is commonly used for restaurant hostesses, front office staff and housekeeping supervisors.

The type of fabric used will differ with the location of the employee. The requirements of a nurse working with patients 24*7 will be different from those of a front office assistant in the air- conditioned lobby. Various fabrics are available according to their launder- ability, comfort and ease of maintenance. I explored few materials like

Rayon Rayon is another popular fabric especially when blended with other fibres.

Cotton 100% cotton items are advisable for hot, uncomfortable areas especially hot areas or more stressed work areas, since they ‘breathe’ and are cooler. But pure cotton is difficult to maintain so unions or blends of cotton and synthetics can be used.

Terrycot Terrycot is most popular choice for uniforms as they have the advantages of both natural and synthetic fibres.

Wool Wool is a requirement in cooler temperatures (air conditioning) and is indicative of status. Blended or pure wool can be used for suiting. This needs dry-cleaning and is therefore expensive to maintain. These are frequently used only for management positions. SILK Silk is another fabric commonly used for the female supervisory and

Nylon Nylon has good wash ability but develops static, tending to stick to the body in hot areas as it allows no circulation of air.

• Suitability (with regard to individual appearance) The uniforms must be designed to suit the average individual rather than a specific body type. This means that the uniform should look equally attractive on a thin person, medium body type or a large proportioned individual. • Appearance / Aesthetics ( colours, design, styles ) The uniform must harmonize with the brand. The colour and style should coordinate with the ambience of the location or work area.

• Climate conditions of the place • Image and identity of the Hospital • Budget and value for money • Ease of availability of fabric Uniforms should be re-designed periodically. This is so because wearing the same uniform for a long time becomes boring and monotonous for the employees and also presents an unchanging monotonous environment for the customers as well.

Iterations

Nursing Today

Final Iteration with Measurements

Final Uniform for female

Final Uniform for male

This project has been a wonderful experience and I have seen myself grow in the field of service design and human cantered design. This One of the other important things I learnt during the course of this project was how important and valuable peer feedback is. You can really learn a lot by just asking for feedback from people around you. Every single person has some valuable inputs about your work and using that effectively can make a marked difference in your work. Empathy is the word for every problem and solution you want to solve or discover respectively. Wokring in the field of medicine working closely with nurses I interacted help me evolve as a better person. To think about bigger picture.

Reflections

expectation . The most gratifying part of the project was to see all the late nights and long hours result into something definite and productive. Putting so much effort into something and then witnessing the efforts turn into results that were even better than you expected is a different feeling altogether. Doing UI UX and attempting to do apparel design was big step. I learnt to push my self off limits to touch the impossibilities. I Learnt Crucial business aspects. In the flow of process I dint even realise even small things in the discussion I started protecting nurses. The sensitivity for human cantered design has become my core after this experience.

Golden circle was the most helpful theory which I had learnt in last project. You need to discover you â&#x20AC;&#x153;Whyâ&#x20AC;?; Why are you doing something and things will align itself like a solved mystery. It was glimpse of real world scenario. Where you have tight deadlines, lot of 87

Daya from Aarogyaseva for showing us selflessness inthe medical field with his admirable work.

It was initiation by Srishti institute and TATA Elxsi to create this platform for students to get industry experience. I would like to thank everyone from TATA Elxsi for this wonder opportunity. Specially to Mr. Narendra Ghate for guiding us through the process. This book was done as a part of my diploma project at the Srishti Institute of Art, Design and Technology, Bangalore. I would like to express my gratitude to my Facilitators and Jury members from all seminars â&#x20AC;&#x201C;VijayKumar J. Manasee Jog for being a great facilitator I am Thankful for their patient guidance, encouragement and useful critiques and feedback during each phase of this project. This project couldnâ&#x20AC;&#x2122;t have been better without you both being there. Urvashi Jalali, Janak and mary Jacob for their valuable feedback on the jury days.

Acknowledgements

I would like to thank hospitals like Baptost, Sakra, Victoria, Acura and their Dr.s Specially Mr. Anuraag from Sakra for sharing his experience with us. Dr.

A big thank you to all the nurses Specially Chhaya Bhagwat, Annie sister, Gayatry Sister, Madhumita Sister and many more. for providing me such valuable imformation and trusting with important data and for making this project seem like fun on most days. I would also like to extend my thanks to Vijaysarthy Krishnan a friend for all her help with content writing. Finally, I wish to thank my family and friends for their never-ending support, feedback and encouragement throughout my project, for easing the stressful times and for believing in me.

Home/Services/Nursing+Care/ Duties+of+Nursing+Staff http://uxdesign.cc/ux-methodsdeliverables/ http://www.indiannursingcouncil.org/ http://www.medinous.com/nursingmanagement-software.html nursingcenter.com/lnc/ pdf?AID=1401667&an=00152258201301000-00010&Journal_ID=&Issue_ ID= orthobasicpractices

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