I fY%aKsfha fyo ks<OdrSka i|yd

ld¾hCIu;d lvbï úNd.h

fmdÿ l<ukdlrKh
fmdÿ fyolu
 fmdÿ l<ukdlrKh

• jsIhh wka;¾.;h

- fyo id;a;= ie,iqu

- ld¾h uKav, iqmrSCIKh

- j.lSula iys; ld¾h mejrSu

- kdhl;ajh

- udkj iusm;a l<ukdlrKh

 • l<uKdlrkh yd jdÜgq l<uKdlrkh

“hï ixúOdkhl wruqKq fj; M,odhsj <Õdùu i|yd ixúOdkfha

mj;sk ish¿ iïm;a Wmßu ld¾hCIu;djhlska hq;=j m%fhdackhg

.ksñka isÿlrk fufyhqus l%shdj,sh l<uKdlrkh f,i ye¢kafõ'”

 • jdÜgq l<ukdlrKfha wruqKq

- fiajd,dNSkag by< .=Kd;aul fiajdjla ,nd§u

- fiajd,dNSkag wk;=re j,ska f;dr msßisÿ fiajd mßirhla ilia lsrSu

- fiajd,dNSka wdidOk" wk;=re yd ndysr Wmøjj,ska wdrCId lsÍu

- ld¾h uKav,hg Wiia fiajd ;Dma;shla <Õd lr .ekSug iydh ùu

- fiajd,dNSka yd ifydaor ld¾h uKav,fha wjYH;d imqrd .eksfï

myiqlï ie,iSu
 • wruqKq bgqlr .ekSfï §
• ^1& ie,iqï lsÍu

• ^2& ixúOdkh lsÍu

• ^3& uQ,sl;ajh .ksñka fufyhùu

• ^4& md,kh

• ^5& iqmrSCIKh

hk l%shdj,ska imqrd .ekSu wjYH fõ'

 l<ukdlrK l%shdj,sh
• ie,iqï lsÍu
• ixúOdkhla úiska ;uka isÿlsrSug woyia lrk ls%hdjka ms<sn| meyeos,s
tlÕ;djla we;slr.ekSfuka miq tys wjika m%:sM,h tkï wruqK ilia
lr.kS.
• wruqKla hkq wjidkfha oS ,Õdlr .ekSug wfmaCIs; ;;a;ajh fõ. wruqKq
fláld,Sk yd os.=ld,Sk f,i j¾. lrhs.
• ixúOdkhl os.=ld,Sk wruqK hkq ;j;a wdldrhlska oelau f,i o
ye|skaúh yel
• os.=ld,Sk wruqK ,Õdlr .ekSu fjkqfjka fláld,Sk wruqKq ilialr
.kakd w;r tajd fufyjr f,i o ye|skaúh yel
• fyo l<ukdlrK l%shdj,sh wruqKq lr.kq ,nkafka fiajd ,dNSkag id;a;=
fiajdj ie,iSu, frda. ksjdrkh, fi!LH wNsj¾Okh yd mqkre;a:dmkh
hk wruqKq fõ.

• fulS wruqKq bgqlr .ekSu i|yd wod, jk ls%hdud¾. fyo l<ukdlre

úiska ie,iqï l<hq;= w;r ta fjkqfjka wkq.ukh lrk iEu wruqKla
ms<sn|j fyo l<ukdlre b;d fyd|ska oek isàu w;HdjYH fõ.
 • ixúOdkh lsÍu
• id;a;=fiajd i,ik tallfha wruqKq ,Õdlr .ekSu fjkqfjka isÿlrk
fjkialï fus hg;g .efka.
- wruqKq fjkqfjka tla tla jHdmD;s ie,iqï lsrSu
- jHdmD;s j, oS isÿl, hq;= ld¾hhka yªkd.ekSu
- fï ms<sn| ld¾hh uKav,h oekqj;a lr Tjqkaf.a woyia yd iyfhda.h
,nd .ekSu
- isÿl, hq;= ld¾hhka ld¾hh uKav,h w;r fnod .ksñka rdcldrs isÿ
lsrSu
- jHdmD;s i|yd wjYH ish¿ há;, myiqlï fukau fN!;sl yd udkj
iïm;a kshñ; fõ,djg imhd .ekSu
jeks lghq;= ixúOdkh lsÍu hg;g .efka
 • uQ,sl;ajh .ksñka fufyhùu

• wruqKq ,Õdlr .ekSu fjkqfjka ish¿ fN!;sl yd udkj iïm;a Wmrsu

ld¾hCIu;djfhka hq;=j fufyhùu hs

- ;u tallfha ld¾h uKav,hg tlsfkldf.a j.lSu meyeos,s lsrSu

- wNsfma%rKh lrñka Tjqkf.ka Wmrsu lemùula we;slr .ekSu
- Tjqkg wjYH mqyqKqj ,nd oSu
- Tjqkf.a W!K;d yªkdf.k tajd ksjeros lr.ekSu i|yd u. fmkaùu
- Tjqkf.a oCI;d i|yd ksis we.hqï isÿlsrSu
 • md,kh
• ish¿ fN!;sl yd udkj iïm;a Wmrsu ld¾hCIu;djfhka hq;=j
fufyhùfï oS tys hï m%udohka fyda fjk;a ´kEu wld¾hCIu;djla
ksjeros lsrSug l<ukdlrefjla f,i isÿlrk ueosy;a ùu

• fï hgf;a fyo l<ukdlre ksjeros iqmrSCIKhla Supervision mj;ajd

.; hq;= fõ

• tu.ska fyo ld¾h uKav,fha fukau wfkl=;a ld¾h uKav,hka ys

j.lSu yd j.ùu ksis mrsos isÿjkafka o hkak ;lafiare lr.; yels h
• ta yryd mj;sk W!K;d wjulr .ekSfï jvd fyd| hdka;%Khla
fyo l<ukdlreg ilialr.; yels jkq we;

• md,kh hkq ld¾h uKav, idudcslhka mSvkhg m;a lrñka Tjqka

wiSudka;slj fjfyig m;alsrSula fkdjk nj fyo l<ukdlre
jgyd .; hq;= fõ fï i|yd fyo l<ukdlre my; l=i,;d
we;slr .ekSu w;HdjYH h
 • l<ukdlrK olaI;d

• M,odhS ikaksfõokh
• kdhl;ajh
• ksjeros f,i ;SrK .ekSu
• wNsfm%arKh
• ks¾udKd;aul Ñka;kh
• .eg¿ úi£fï yelshdj
• .egqï ksrdlrKh lsÍfï yelshdj
• ueÈy;aùu
• ie,iqïlrKh yd ld,h l<uKdlrkh
• j.lSï fnÞyÞ .ekSu
• iajhx ÈYdk; ùu
• ld,dkqrEm ùu
l<ukdlrK uQ,O¾u
• ld¾hhka fnod .ksuska lghq;= lsrSu
• j.lSu yd wêldrS;ajh w;r iu;=,s; njla we;slr .ekSu
• úkh
• ;Srk j, tald.% nj
• b,lal yd ta i|yd .kakd ls%hdud¾. j, tald.% nj
• mqoa.,sl reÑl;ajfha iy fmdÿ reÑl;ajh w;r ifudaOdksl nj
• m%udKj;a f.ùus
• uOH.; nj
• Oqrdj,sh mj;ajd .ekSu

• ms<sfj,

• tald.% nj

• tlu lKavdhula os.= l,la fiajfha fhoùu

• kj woyia i|yd bv ie,iSu

• ld¾h uKav,fha Ñ;a; ffO¾hh j¾Okh lsrSu

( Henri Fayol - Father of Modern Management Theory)

• olaI;d l%shdfõ fhdojk wjia:d

tallfha
ld¾h
uKav,h

frdayf,a fiajd
ld¾h ,dNSka yd
uKav,h {d;’ka
udkj
in|;d

iafõÉpd Ndysr
fiajlhka md¾Yj
• ld¾h uKav,fha olaI;d y÷kd .ekSu

• ffoksl" udisl ld, igykla$jev ie,eiaula b,lal o iys;j ilia

lsÍu

• ld¾h uKav,h fj; ld¾hNdrhka yd j.lSï fnÞ §u iy tu j.lSï bgq

lsÍug Wmfoia ,nd §u yd lKsIaG ks<Odßka wkqia:dmkh lsÍu

• ld¾h uKav, l<uKdlrkh yd wëCIKh

• fiajd,dNSka" YsIHhska" ld¾h uKav,hg wOHdmkh ,nd§u
(Clinical Teaching)

• ld¾h uKav,h úêu;aj we.hSu

• fiajd uqr igyka l%udKql+,j ilia lsÍu

• jÜfgdare NdKav yd iemhqï l<uKdlrkh

 fyo id;a;= ie,iqu

• fyÈhf.a kHdhd;aul ±kqu ;=<ska frda.S id;a;=fõ § y÷kd .kakd

frda.Skaf.a wjYH;d úYaf,aIKh lr, we;s lr .kakd úksYaphka u; ,

Ñls;aiSh ms<sfj;a isÿ lsßu u.ska , frda.shd Wmßu ufkda iudÔh

l%shdldß;ajhlg f.k tAu i|yd isÿlrk úoHd;aul l%shdj,shls'

 • fyo id;a;= ie,iqfus jdis

- mqoa., noaO id;a;= fiajdjla iemhsh yelsùu

- fiajd,dNshdf.a il%Sh Þhl;ajh ,nd.; yelsùu
- id;a;= fiajdfjs wLKav nj /lsh yelsùu
- fiajd,dNSka yd fiajd imhkakka w;r ukd iïnkaOhla mj;ajd.;
yelsùu
- wjYH;d u; id;a;= fiajdfõ fjkialï l< yelsùu
 • fyo id;a;= ie,iqfus mshjr

• 1) ;lafiare lsrSu Assessment

• 2) fyo jsksYaph Nursing Diagnosis

• 3) ie,iqus lsrSu Planning

• 4) ls%hd;aul lsrSu Implementation

• 5) we.hqu Evaluation
 • ;lafiare lsrSu Assessment
• fiajd ,dNshd iusnkaO YdrSrsl , udkisl , idudchSh o;a; tla/ialsrSu yd
thska frda. ;;a;ajhg Rcqj wod, jk f;dr;=re yªkd .ekSu jk w;r
frda. b;sydih ms<sn| f;dr;=re o fuhg wh;a fjs.
 • m%d:ñl uQ,dY%

- fiajd,dNshd yd Tyqf.a mjqf,a idudðlhkaf.ka ,efnk f;dr;=re

• oaú;Sl uQ,dY%

- frda. b;sydih" mÍCIK o;a;" fi!LH lKavdhfï idudðlhkaf.ka

,efnk f;dr;=re o ie,ls,a,g .; hq;= h.
• ;lafiare lsrSfus oS fiajd ,dNshd jsiska imhd fok f;dr;=re Subjective
Data ( wd;auSh o;a; ) f,i;a ta wkqj fyosh jsiska imhd ,kq ,nk
f;dr;=re Objective Data ( jdia;jsl o;a; ) f,i;a yªkd.kS

• fuu f;dr;=re Inspection , Palpation , Osculation and Percussion hk l%u

u.ska fyosh jsiska tl;= lrKq ,nhs.
• fyoshf.a j.lSu jkafka Subjective Data i|yd jgskdlula we;sjk
mrsos Objective Data u.ska fulS Subjective Data ;yjqre lr .ekSuhs.
 • fyo úksYaph Nursing Diagnosis
• fiajd,dNSkaf.A .eg¿j,g m%;spdr olajkafka flfiao hkak ksremkh
flfrk m%ldYKh

• tla/ia lr.;a o;a; úYaf,aIKh lrñka fiajd,dNShdf.a .eg¿ w¾:

ksrEmkh isÿ lrhs'
• tla/ialr .;a o;a; wdY%fhka fï fudfydf;a mj;sk .eg¿
( Actual Nursing Diagnosis )

• kqÿre wkd.;fha oS u;=ùfï wjOdku we;s .eg¿

( Possible Nursing Diagnosis )

• hymeje;aug wÞ, úh yels .eg¿ ( Potential Nursing Diagnosis )

• fyo úksYaphka wjYH;d wkqms<sfj, wkqj f.dvk.kq ,nhs

• fiajd,dNshdg fï fudfydf;a n,mdk .eg¿j,g wÞ, úksYaphka
Actual Nursing Diagnosis fõ. ta w;rska Ôú; wjÞkï iy.; nj
y÷kd.kakd úksYaphg m<uq m%uqL;ajh ,nd osh hq;= h.

• jvd blaukska ueÈy;aùula wjYH úksYaphka i|yd ó,Õ m%uqL;ajh

,nd osh hq;= h

• WodyrK - fiajd ,dNshdg Yajik wmyiqj yd fõokdj .eg¿ f,i

mj;sk úg Yajik wmyiq;dj úi|Sug m<uq m%uqL;ajh ,nd oS fõokdj
iukh i|yd fojk m%uqL;ajh ,nd osh hq;= h
• Ôú; wjOdkï fï fudfydf;a ke;;a tu.ska fi!LHhg ;¾ck
we;slrjk .eg¿ m%uqL .eg¿ yd ne÷Kq tksid ks¾udKh jQ iy
fjñka mj;sk .eg¿ Possible Nursing Diagnosis f,i yªkajhs

• WodyrK f,i Y,H ;=jd,hla fya;=fjka we;súh yels mq;Sh m%ydrh

(Septic Shock)
 • ie,iqï lsÍu
• ;lafiarej yd fyo úksYAph wkqj fiajd ,dNshdf.a wjYH;d wruqKq bgq
lsÍu fjkqfjka fyo id;a;=j ie,iqï lsÍu
• fuys§ zudiaf,daZ f.a wjYH;d wkqms<sfj, fhdÞ .; hq;=h
5 wd;au YdCId;alrKh
5 m%cdj ms<sn| we;s myka yeÕSu

4 wd;au wNsudkh
4 wd;au ;uka ms<sn| wNsudkh
wNsudkh

3 wdorh yd 3 wdorh yd wfmaCIK;ajh

wfmaCIK;ajh wfkfll=f.a wjOdkhg yd
wdorhg md;%ùu
2 wdrCIK
wjYH;d 2 wdrCIK wjYH;d
cSú; wdrCIdj
1 fN!;fõoSh wjYH;d 1 fN!;fõoSh wjYH;d
wdydr, weªï , ksjdi…
 • ie,iqï lsÍfï wruqKq

• ie,iqï lsÍu fiajd,dNshd flakaø lr .ksñka ^Client Centered& isÿ

l< hq;=h
• fiajd,dNshdf.a id;a;=j fufyhùu

• id;a;=fõ wLKav;dj wdrCId lsÍu

• id;a;=j ie,iSfï lemùula we;s lrúu

• úëu;a ,sÅ;lrKh
 fiajd ,dNSkaf.a wjYH;d wkqms<sfj,

• YajikfhaoS fiajd,dNshdg iydh ùu

• wdydrmdk .ekSug fiajd ,dNshdg iydh ùu
• nysi%djh wmyiqjlska f;drj isoqlr .ekSug i|yd iydh ùu
• iqÿiq bßhjq mj;ajd .eksug yd bßhjq udre lr .ekSug iydh ùu
• úfõlh yd m%udKj;a kskao i|yd wdOdr lsÍu
• YdÍßl WIaK;ajh idudkH ;;a;ajfha mj;ajd .ekSug iydh ùu
• YdÍßl mú;%;dj$ iajia:;dj by, ugsguska mj;ajd .ekSug iydh
ùu
• iqÿiq we÷ï f;dard .eksug weÕ,Sug yd udre lr .ekSug iydh ùu
• mdßißl WmÞj j,ska wdrlaId ùug iydh ùu
• woyia m%ldY lsÍug iydh ùu
• ksjerÈ f;dr;=re ±k .ekSug iydh ùu

• wOHd;añl wjYH;d imqrd .eksug iydh ùu

• M,ÞhS ld¾hhl ksr;ùug iydh ùu

• udkisl iunr;dj we;sjk úfkdaÞiajdoh ,efnk l%shdjkays

ksr;ùug iydhùu

• bf.kSug iydh ùu

(Virginia Henderson )
 • l%shd;aul lsÍu
• ie,iqï l< ms<sfj; l%shdfõ fhoùuhs' fuysoS ie,iqus l,
wkqms<sfj,skau id;a;=j ,nd oSu wfmaCId fkdlrK w;r wjYH;dfjs
iajNdjh u; by, ugsgfus ie,iqula l,ska ls%hd;aul l, yel. Bg
wÞ, ksjerÈj ,sÅ;lrkh isÿ lsÍu b;d jeo.;a h
• we.hqu

• fuys § frda.shdf.a ;;a;ajfha fjkialï' p¾hd;aul fjkialï"

id;a;=j M,ÞhS ù o" ;lafiarefõ § y÷kd.;a fjkialï idudkH
;;ajhg m;aù o" wfmaCIs; wruqKq fj; ,Õdù o ke;skus ie,iqu
fjkia l< hq;=o hk ;SrK .ekSu ms<sn| we.hqï flf¾'
 iqmrSCIKh fyj;a wëCIKh

• wëCIK l<ukdlreg Rcqj j.lSfuka ne|S isgsk ld¾h uKav,

idudcslhkaf.a oCI;d by, kexùug wjYH Wmfoia ,ndfouska oCI;d
w.hñka, ixúsOdkh Wmrsu ld¾hCIu;djlska hq;=j b,lal yd wruqKq
fj; M,odhsj <`.dùu i|yd lghq;= lrùSu fjkqfjka l<ukdlre
úsiska isoq lrk ish¿u ld¾hhka iqmrSCIKh kus fõ
 • wëCIKh isÿlrk wdldr

• mrsmd,kuh Administrative

• idhksl Clinical

• iyfhda.S Supportive
 wëCIK uQ<O¾u

• j.lSus fnod yerSfus oS ta i|yd lKavdhus idudcslhkaf.a yelshdj

ms<sn| mQ¾j we.hqula isoqlsrSu
• iqmrSCIKh lKavdhus idudcslhkaf.a rdcldrs iSudjka ;=, isoqlsrSu
• ixjsOdk.; wruqKq iys; yd ms<s.;a iqmrSCIK l%ufjso iys; ld<
rduqjlg wkq.; ls%hdj,shla ùu
• lKavdhus idudcslhka uQ,sl lr.;a ls%hdj,shla jskd m%:st, b,lal
lr.;a;la fkdùu
• wLKAv ls%hdj,shla ùu
 • wëCIK fuj,ï

• - iDcq wOSCIKh - Observation ( Ex; Ward Rounds )

• - iusuqL mrSCIK yd m%Yakdj,s i|yd ms<s’=;=re ,nd .ekSu
• - ;ks mqoa., yd lKavdhus idlÉPd
• - iqmrSCIK oskfmd;la Ndjs;h
• - oCI;d we.hqu ( Wod - ld¾h idOk we.hqu )
• - ,sLs; yd jdÑl jd¾;d
• - wkqia:dmkh yd WmfoaYkh
• - w;afmd;a yd ks¾kdhl Ndjs;h
• - fiajdia: wOHdmkh
• - wLKav wOHdmkh
 wëCIK l<uKdlrejl= i;=úh hq;= l=i,;d

• ikaksfõok yelshdj
• wNsfma%rKh
• ;SrK .ekSu yd .eg`: úi§u
• .egqï ksrdlrkh
• ie,iqïlrKh yd ld,h l<ukdlrKh
• wmCImd;S yd idOdrK jSu
j.lSula iys; ld¾hh mejrSu - Deligation

• ksjerosj yÿkd.;a ld¾huKav, idudðlhka w;r j.lSï yd wêldß;ajh fnod .ksñka

lghq;= lsrSu fuhska woyia flf¾'

• fuu.ska
• ld,h iy iïm;a b;srs lr ld¾hCIu;dj by, kxjhs
• lKavdhfus idudcslhka n,.ekajSu isoqlrhs
• Tjqkf.a mj;sk oCI;d by, kxjhs
• ld¾h uKav,fha bÉPdNx.;ajh wju lrhs
• ld¾h uKav,fha Wkkaoqj jeä lrhs
• lKavdhfus idudcslhkaf.a ;SrK .ekSfus yelshdj jevsoshqKq lrhs
 j.lSï fnod .ekSfï oS

• l<ukdlre jsiska ld¾h mejrSu isoql, hq;=h

• iqoqiq ld¾hhka muKla mejrSu i|yd lghq;= l, hq;=h

• ld¾hh l, hq;= iSudj ksYaÑ;j y|qkajdosh hq;= h

• iqoqiq yd yelshdjla we;s njg iEySulg m;ajsh yels ld¾h uKav,hg

muKla j.lSula iys; ld¾h mejrSu isoq l, hq;= h

• wfmaCIs; ld¾hh yd b,lal meyeos,s l, hq;= h

• ld¾hh bgql, hq;= ld, rduqj ms<sn| tlÕ;d we;slr.; hq;= h

• ld¾hh bgqlsrSu iïnkaOj Tjqkf.a j.lSu meyeos,s l, hq;= h

• wjYH iEu úglu iydh oelaúh hq;= h

• .eg¿ u;=jk wjia:d j, oS ld¾h uKav, idudcslhka fjkqfjka

fmkS isgsh hq;= h

• ld¾hh bgqlsrSu yd oCI;d iïnkaOj ksis we.hqula isoql, hq;= h

• ld¾h uKav, idudcslhkag md,kh lr.; fkdyels lreKq

fya;=fjka we;sjk m%udo fodaI l<ukdlre úiska ord.; hq;= h
 kdhl;ajh - Leadership

lKavdhul idudcslhkaf.a iajNdjh y|qkd .ksñka Tjqka wNsfm%arKh

lrñka lKavdhfï fmdoq wruqK fj; ,Õdlrùfus ls%hdj,sh
kdhl;ajhhs
 • kdhl;aj ,CIK
• n,h mj;ajd .ekSu
• lKavdhus idudcslhkaf.a oCI;d y|qkd .ekSu yd Tjqka
wNsfma%rKh lsrSu
• ixjsOdk yelshdj
• iyfhda.fhka lghq;= lsrSfus yelshdj
• ks¾udKYS,S;ajh
• fm!reIh
• wmCImd;S jSu
• ksis ;SrK .ekSu yd ld,dkqrEmj ls%hd;aul jSu
• bosrsh mqfrdal:kh lsrSfus yelshdj
• wdo¾Yj;a nj
• wd;au jsYajdih
• lemjSu
• ord .ekSfus yelshdj
• oq¾j,;d yd ydks ord .ekSu yd wju lr .ekSug lghq;= lsrSu
• wkau; bjiSu
• wdrusNl Yla;sh
• ikaksfjsok yelshdj
 kdhl;aj j¾.
• Participative or democratic - m%cd;ka;%jdoS
wjika j.lSus ;uka oruska j.lSus iys; ld¾h mejrSula wkqj nyq;rhf.a
u;h wkqj ;SrK .ekSu

• Task-oriented and relationship-oriented

hus b,lalhla ,Õdlr .ekSug lKAvdhu fufyhjk kdhlhd

• Autocratic taldOsm;s
n,h yd wOsldrS;ajh ;SrK .ekSu ish,a,u kdhl;ajh isoqlrhs

• Narcissistic kdisjdoS
kdhlhdf.a leue;a; u; muKla ish,a, isoq fjs
• Laissez-faire ks¾NdO
ish¿ j.lSus idudcslhka fj; h. Tjqkf.a wNsu;h mrsos lghq;=
lsrSug wjia:dj ie,fia
• Bureaucratic - ks,OdrS;ka;%
• Charismatic - wdl¾Ykh lr.kakd / m%;dmj;a
• People / Relationship oriented - uyck in|;d u; ks¾udKh jQ
• Transformational - úm¾hldrl
• Situational - wjia:dkql+,j f.dvkef.k
 udkj iusm;a l<ukdlrKh

• ixjsOdkhl wruqKq yd mrud¾: Wmrsu whqrska ,Õdlr .ekSu Wfoid

jvd fhda.H yd ;Dma;su;a udkj iusm;a cks; lrjd .ekSu;a Tjqka
ld¾hCIu yd M,odhS f,i Wmfhda.S lr .ekSu;a hk Wmdhud¾.sl yd
jsOsu;a ls%hdj,sh udkj iusm;a l<ukdlrKhhs
 udkj iusm;a l<ukdlrKfha mrud¾:
• m%Odk mrud¾:

• ixjsOdkfha ld¾hCIu;dj yd M,odhs;dj j¾Okh lsrSu;a iudc

iqNisoaOsh fjkqfjka b;du ;Dma;su;a yd fhda.H fiajl msrsila cks;
lrjSu
• WmdhYS,s mrud¾:

- fiajdodhl M,odhs;dj j¾Okh

- fiajdodhl ixj¾Okh
- ld¾h uKav,fha /lshd cSjs;fha .=Kd;aul nj j¾Okh lsrSu
- rch jsiska mkjd we;s kS;Hdkql+, ;;a;ajhka wkqj wdh;kfha udkj
iusm; Wmfhda.S lr.kakd nj iy;sl lsrSu
 • wfkl=;a mrud¾:

• - fiajd kshqla;s msrsjeh wju lsrSu

• - fiajd odhlhd wNsfm%rKh lsrSu
• Intermission
 fmdoq fyolu
• fuu jsIhh fCI;%h hg;g
• - m%d:usl fi!LH ixrCIKh
• - frda. ksjdrKh yd fi!LH wNsj¾Okh
• - wOHdmk jsoHd uQ,O¾u
• - fyo m¾fhaIK uQ,O¾u
• - jdgsgq mrsmd,kh
• - ikaksfjsokh
• - lKavdhus ixl,amh
• - ld¾h uKav, ixj¾Okh
 m%d:usl fi!LH ixrCIKh

• m%cdfjs cSj;a jk mqoa.,hkag mjq,g yd m%cdjg myiqfjka ,Õdlr.;

yels yd w;HdjYH fukau jsoHd;aul mokula u; ilia jQ iudch jsiska
wkqu; lrk id;a;= myiqlus m%d:usl fi!LH ixrCIKh f,i y÷kajhs

• Primary health care is the care that which is essential to people, care
which is practical, scientifically sound, using methods and technology
which are socially acceptable, and made available to all individuals and
families in the community
• m%d:usl fi!LH ixrCIKh ,Õd lr .ekSu i|yd YS% ,xldj jsiska
wkq.ukh lrk ,o Wmdhud¾.sl lreKq 17

• 1 ksis m%udKj;a fmdaIKh ie,iSu

• 2 wdrCIs; c,h

• 3 uQ,sl ikSmdrCIdj

• 4 ud;D fi!LH

• 5 mjq,a ie,iqus

• 6 <ore <ud iy fmr mdi,a orejkaf.a fi!LH fiajd

• 7 m%;sYla;SlrKh

• 8 iq,N fndajk frda. md,kh yd je,elajSu

( oekqusosh hq;= frda. , w;Sidrh yd mdpk frda. , uef,arshd , nrjd , ,doqre
TB , STD )

• 9 iq,N fnda fkdjk frda. md,kh yd je,elajSu

( CVS Diseases , Accidents , Malignancies )

• 10 iq,N yosis wk;=re yd fi!LHhg ;¾ckhla jk tosfkod isoqjSus

l<ukdlrKh i|yd jsOsu;a l%ufjsohla ilia lsrSu
• 11 mqkre;a:dmkh

• 12 udkisl fi!LH myiqlus ie,iSu

• 13 oDIaGs jsIu;d iy wkaO Ndjh j,lajd .ekSu

• 14 jD;a;Sh fi!LH

• 14 mdi,a fi!LH jevigyka

• 15 fi!LH wOHdmkh yd m%d:usl fi!LH ixrCIKh i|yd m%cdj ixjsOdkh lsrSu

• 16 uqL fi!LHh yd o;a osrdhdu j,lajd .ekSu

• 17 wdndOs; jQjka i|yd fi!LH myiqlus ie,iSu

• ta wkqj jir 2000 oS ieug iqjfi; ixl,amh ,Õdlr .ekSug fuu jevigyk ls%hd;aul
jsh
 frda. je,elajSu iy fi!LH wNsj¾Okh

• 1 m%;sYla;SlrK jevigyk yd thska wdjrKh flfrk frda. ;;a;aj

fukau m%;sYla;SlrK ie,iqu ms<sn| oekqu
• 2 mdi,a fi!LH yd mdi,a oka; fi!LH jevigyk
• 3 fndajk frda. j,lajd .ekSu i|yd wkq.ukh lrK jevigyka
• 4 fndafkdjk frda. j,lajd .ekSu i|yd wkq.ukh lrK jevigyka
• 5 fi!LH wOHdmk jevigyka
• 6 m%d:usl oajS;Sl iy ;D;Sl j,lajd .ekSus i|yd wkq.ukh lrK
mshjr
• mQ¾j uQ,sl frda. je,elajSu Primordial Prevention
• - frda. we;sjSu j,lajd .ekSfus wruqKska hq;=j kshus; fi!LH mqreoq
wkq.ukh lruska wdfmaCIs; fi!LH ugsgu mj;ajd .ekSu;a wjOdkus
idol j,lajd .ekSu;a fus hg;g .efka

• - YrSr ialkaO o¾Ylh kshus; w.fha mj;ajd .ekSu yd Bg .e,fmk

wdydr jHdhdu jeks fi!LH mqreoq wkq.ukh uSg WodyrK f,i
fmkajd osh yel
• m%d:usl frda. je,elajSu Primary Prevention
- oekg frda. ;;a;ajhla ke;;a wjOdkus lKavdhulg wh;a wfhl= f.a
tu wjOdkus idol ksrka;r mrSCIdjg ,lalruska yd wjYH;dj u;
m%:sldr isoqlsrSu fus hg;g .efka

• oajS;Ssl frda. je,elajSu Secondary Prevention

- frda.hla uq,a wjOsfha oS y|qkd .ekSu iy Bg lvskuska m%:sldr lr ;S%j%
;;a;ajhg m;ajSu md,kh lr.ekSu i|yd wkq.ukh lrk l%ufjs o fjs

• ;D;Sl frda. je,elajSu Tertiary Prevention

- frda.hla ;S%j% wjOshg m;ajSfuka miq ;joqrg;a ld,Skj thska jshyels
wjOdku wju lr .ekSu i|yd wkq.ukh lrk ls%hdud¾. fjs
• fi!LH wNsj¾Okh hgf;a YS% ,xldfjs ud;D fi!LH myiqlus uQ,sl lr.;a
ls%hdud¾.

- jsjdy jSug iqoqiq jhfia miqjk hqj, ,shdmosxÑh

- mQ¾j jsjdy WmfoaYkh yd cdkuh in|;d ms<sn| fidhd ne,Su fukau iqoqiq
WmfoAYk ls%hdud¾. .ekSu. tfiau ore m%iQ;sh i|yd iQodkus jk ujlg f*da,sla
wus,h .ekSug Wmfoia oSu isoqfl¾
- mQ¾j m%ij idhk yd tysoS ukaofmdaYKh kSrla;sh jeks ;;a;ajhka j,lajdf.k
wdrCIs; ore m%iQ;shla i|yd iQodkus lsrSu
- orejdf.a iy ujf.a .ensKs iufha wjYH fjkialus isoqjkafka o hkak wLKavj
yd l%udKql+,j fidhd ne,Sfus idhk
- ore m%iQ;s b;d l,d;=rlska yer myiqlus iys; frday,l isoq lsrSu
- m%iQ;sfhka miq wksjd¾h m%;sYla;SlrK jevigykg we;=,a lsrSu
- m%iQ;sfhka miq miq m%ij idhk u.ska wLkavj ksrSCIKh lsrSu
• - jrska jr u;=jk fndajk frda. i|yd wjYH;dj u; m%;sYla;SlrKh
,nd oSu

• - iq,N fnda fkdjk frda. y|qkd .ekSu i|yd idhk wjia:d isoqlsrSu

• - jevsysgs ldka;djkaf.a wd¾;jyrKh iu. we;sjk .eg¿ wju lr

.ekSug iqjkdrS idhk isoqlsrSu
 fyo m¾fhaIK uq,O¾u

• m¾fhaIKhla hkq ms<s.;a Ys,amSh l%u wkqj .eg¿ jsi|Sug fyda m%Yak
i|yd ms<s;=re fijSug wkq.ukh lrk jsoHd;aul l%ufjsohls

• m¾fhaIK j¾.
• 1 m%udKd;aul - Quantitative
• 2 .=Kd;aul - Qualitative
 • fyo m¾fhaIKhl mshjr
• m¾fhaIK .eg¿j y÷kd .ekSu
– (What is the general problem, is the problem evidence of significant ?,
research ability ?,feasibility ?, interest to research ?)

• m¾fhaIK .eg¿jg wod, jsp,Hhka ilialr .ekSu

– (Dependent or independent)

• l,ams;h ks¾udkh lsrSu

• wod, wdYs%; m¾fhaIK jd¾;d wOHhkh

-(does review provide systematic foundation for study)
• m¾fhaYk ieleiau fyda ie,iqu ilia lsrSu
– (how study is being proceeding, strengths & weaknesses,
accountability to ethical consideration, respect human dignity)
• wod, ck.ykh yd idusm,h y÷kd .ekSu
– (who will be involving, target and accessible population, sampling
procedures, what extent can study result be generalize)
• o;a; tla/ia lsrSu
– (Using methods, strengths and weaknesses, supportive factors)
• o;a; jsYaf,aIKh
(data analysis procedures, )
• wjika ks.ukh
 • fyo m¾fhaIKhka ys jeo.;alu

• mj;sk id;a;= m%:sldr j, .=Kd;aul nj by, kexùu

• kj oekqu yd l%ufõo id;a;= m%:sldr fj; wkq.; lr.ekSu
• tla tla ;;a;ajhkag jvd iqÿiq id;a;= m%:sldr l%ufjso ms<sn|
we.hqula we;slr .ekSu
• fiajd ,dNSka id;a;= m%:sldr ms<s.kakd wdldrh ms<sn| ;lafiarejla
we;slr .ekSu
• .=Kd;aul yd iliqrejï id;a;= m%:sldr l%u y÷kd.ekSu yd ;srir
Ndú;h
 jdgsgq mrsmd,kh

• jdgsgqjl we;s jgsfgdare.; NdKav wekjqus lsrSu, yd wdrCId lsrSu

wmyrKh lsrSu
• T!IO yd Y,H o%jH wekjqus lsrSu , wdrCId lsrSu yd, wmyrKh lsrSu
• fiajd wjYH;d wkqj ld¾h uKav, fhojSu yd lD;H f,aLK ieliSu
• .eg¿ jsi|Su yd .egqï ksrdlrkh
ms<sn| oekqu
 jdgsgq mrsmd,k ls%hdldrlï
• ld¾h uKav,h fiajfha fhoùu iy fiajduqr igyka ieliSu
• fus i|yd;
1 jdÜgqfõ yd fiajd ,dNSkaf.a wjYH;d wkqj ffoksl lghq;= ie,iqï lsrSu
2 tla tla wjYH;d bgqlsrSug m%udKj;a wju ld¾h uKav, idudcslhka
m%udKh ksYaph lr.ksñka Tjqka ffoksl lghq;= j, fhoùu
3 fuys oS úfYaI oCI;d iy mqyqKq iys; ks<OdrSka ta fjkqfjka jk fiajdjka
j,g fhoùfï oS m%uqL;dj ,nd oSug wjOdkh fhduq lsrSu jeo.;a h
4 jrska jr fiajfha fhdok wxY idOdrK f,i udre lsrSu jeo.;a h
5 ld¾h uKav, idudcslhkaf.a wjYH;djka bgqlr .ekSug yelsjk mrsos iy
Tjqkg m%udKj;a mrsos úfõlh ie,fik wdldrhg fiajfha fhoùu
• jgsfgdare.; NdKav ( Inventory ) wekjqus lsrSu yd mrsyrKh

• ;u tallfha jd¾Ysl NdKav wjYH;dj weia;fïka;= lr ta ms<sn| úêu;a

mrsos ,sÅ;j b,a,qïlsrSu
• fi!LH 500 Wmm;s%ld fmd; u.ska wdh;k m%Odkshdf.a wkque;sfhka
miqj .nvdj yryd ;u tallhg ,nd.ekSu
• ,nd.;a NdKavh jgsfgdare.; NdKav f,aLKfha f,aLK.; lrjd.ekSu
• wod, l=ú;dkais yd j.lSï iy;sl wdrCIs;j ;nd.ekSu
• NdKavh mrsyrKhg ,nd oSu yd tys ls%hdldrS;ajh ms<sn| ld¾h uKav,h
oekqj;a lsrSu
• NdKavh ksismrsos mrsyrKh lrkafka o hkak wëCIKh
• jgsfgdare.; NdKav wmyrKh lsrSu( Condaming of Inventory )

• Ndú;d l, fkdyels NdKav fi!LH 503 Wmm;s%ld fmd; u.ska wmyrK

.nvdjg Ndr oSu
• wlS%h úÿ,s WmlrK ls%hd úrys; njg ;dCIKsl we.hSï jd¾;djla
• wlS%h Y,H WmlrK ms<sn| wdh;k m%Odkshdf.a wkque;sh iys; fi!LH
m;s%ldj u.ska ;yjqrejla fyda ls%hd úrys; njg ;dCIKsl we.hSï
jd¾;djla bosrsm;a l< hq;= h
• fuu NdKav wmyrK ióCIK uKav,hla u.ska wmyrKh lrjd
ks¾foaYs; wjika mshjr .ekSfuka miq jgsfgdare.; NdKav f,aLKfhka
wvq lrjd .ekSug lghq;= l, hq;= fõ
 frda.S id;a;= l<ukdlrKh - Patient Care
Management

• 1) m%udKj;a mßÈ ld¾h uKav,h fh§u

• 2) tA whg jev ie,iqï ie,iSu
• 3) wjYH iïm;a ,nd§u
• 4) ld¾h uKav,hg ukd m%;sfmdaIKhla ,nd§u yd we.hSu
• 5) ld¾h uKav,hg iajdëkj lghq;= lsÍug bv ie,iSu
• 6) ld¾h uKav,fha wd;;sh l<uKdlrKh
 frda.S id;a;=j i,ik wdlD;s
Care Delivery Models
• idïm%odhsl l%ufõo
• - Case Method
merKs;u l%ufjsohhs frda.shd fjkqfjka fyo id;a;= ie,iqula wkqj mQ¾K
id;a;=jla wLKvj ie,iSu fuu.ska woyia lrhs
• - Functional Method
- hï ksYaÑ; ld¾hhla fjkqfjka muKla fyo ks<OdrSka w;r j.lSï fnod
yod .ksñka fyo id;a;=j ,nd oSu fuys oS isÿlrhs Wod ; Drug Nurse, Dressing
Nurse…
- fuu.ska tallfha ld¾hhka wjika Wjo fiajd ,dNSkag mAQ¾K fyo
id;a;=jla ie,iSu ms<sn| j.lSula ke;
- flfia kuq;a fyo ks<OdrSka w;r úfYaI m%d.=KH Specific Nursing Skills
we;s ùug fuh fya;= fõ
• Team Method
- fyo ks<OdrSka lKavdhula tlaj ir, wjia:djkays isg ixlS¾K wjia:d olajd
id;a;=j ie,iSu jk w;r jev fnod .ekSu o oelsh yel w;aoelSus o fnod .ekSug
wjia:djla ,efnk nejska mQ¾K id;a;=jla ,nd oSug bv ie,fia
• - Moduler Method
- id;a;=j ie,iSfus oS tys tla tla fldgia id;a;=j i,ik wx. f,i ie,ls,a,g
f.k ta i|yd tla m%Odk fyo ks<Odrsfhl=f.a uQ,sl;ajfhka wfkl=;a wh iu.
tlaj id;a;=j ie,iSuhs
- tla tla id;a;=j i,ik wx. i|yd fjk fjku fyo lKavdhus fhduql, hq;=
fjs
• - Primary Nursing Method
- fiajd ,dNshdf.a ish¿ fi!LH wjYH;d wLKavj iusnkaOSlrKfhka hq;=j
i,iuska tla fyo ks<Odrsfhla jsiska tla frda.sfhl=g jk mrsos id;a;= myiqlus
ie,iSu
• kQ;k l%ufõo
• - Case management
• fiajd ,dNshdf.a frda. ;;a;ajh jsksYaph lrk wjia:dfjs isg frday,a.;
j m%:sldr lr mqkre;a:dmkfhka miq kej; iudc.; jk ;;a;ajh olajd
jk Okd;aul ;;a;ajh j¾Okh jk mrsos iusmQ¾K isoaOs wOHhkhkhla
f,i isoqlrK id;a;= ie,iSuhs

• - Critical Pathway
• ;Sj% wjia:d j,oS tu wjia:dfjs oS uqyqK oSug jk wmyiq;d wju jk mrsos
id;a;=j ie,iSfus l%ufjsohhs
• frda.S whs;sjdislï

• - ,ndfok id;a;= m%:sldr ms<sn| oek.ekSug we;s whs;sh

• - wjfndaê; leue;a; ms<sn| whs;sh

• - fm!oa.,sl;ajh wdrCId ùfï whs;sh

• - f;dr;=re j, ryiHNdjh wdrCId ùu

• - wLKavj id;a;= m%:sldr ,eîfï yd m%;slafYam lsrSfï whs;sh

• - m¾fhaIK j,ska wjYH wjia:d j, oS bj;aùfï whs;sh

• - ;u wd;auf.!rjh wdrCId ùu
 ikaksfjsokh Communication

• fofofkla fyda jevs msrsila w;r f;dr;=re woyia wdl,am yeÕSus

,sLs; fyda ,sLs; fkdjk l%ufjsohla u.ska yqjudre lr.ekSfus
l%ufjsoh ikaksfjsokhhs

• fï i|yd mKsúvh" hjkakd" udOHh" ,nkakd iy m%;sfmdaIKhla

;sìh hq;=h' ikaksfõokfha§ il%shj ijka§u o úfYaIfhka wjYHh'
 ikaksfjsokh j¾. lsrSu

ikaksfjsokh

in|;d u; .,dhdu u;
mokus jk yeÕSus u; mokus jk

1. Formal 1. Verbal 1.Upward

2. Informal 2. Non Verbal 2. Downward
3. Horizontal
 ikaksfjsok ixrpl - Elements

• ikaksfjsok m%Njh fyda mKsúvh hjkakd

• mKsjsvh fyda woyi
• mKsjsvh fla;kh lsrSu - Encoding
f;dr;=re fyda o;a; jpk ixLHd, ixfla; fyda mska;+r njg m;a lsrSu
• mKsúvh hjk udOHh
Wod - lgy~ , uqøs; yd jsoHq;a udOH ……
• mKsúvh ,nkakd
• mKsúvh ,nkakd tlS mKsjsvh we;=,;a fla;kh mKsjsvh njg m;alr
.ekSu
• m%;sfmdaIKh
 • M,odhS ikaksfjsokfha m%:sM,

• fi!LH ld¾h uKav, idudcslhka yd fiajd ,dNshd w;r wjfndaOh by,

hk nejSka id;a;= fiajdfjs .=Kd;aul nj by, hhs
• fiajd ,dNshdg id;a;=j ms<sn| w;HdjYH f;dr;=re ,efnk nejska Tyqf.a
whs;sjdislus wdrCId fjs
• ,sLs;lrKh ikaksfjsokh fuj,ula f,i wLKav yd ld¾hCIu id;a;=
fiajdjla ie,iSug Wmldr fjs
• fiajd ,dNshdf.a m%;sfmdaIKh .ek wjOdkh fhduq jSu ;=, id;a;=fjs
.=Kd;aul fjkialus isoql, yels jSu
• fi!LH ld¾h uKav, idudcslhka w;r id;a;=j mss<sn| wjfndaOh by,
hk nejska wvq ,qyq~qlus we;s jSug wjldYh wvq fjs
 • M,odhS ikaksfjsokhg we;s ndOd

• - wiusmQ¾K wmeyeos,s fyda ixlS¾K mKsjqv

• - fkd.e,fmk udOHhla Ndjs;h
• - mKsjsvh ,nkakdg th ksismrsos jgyd .ekSug fkdyels jSu
• - ,nkakdf.a udkisl ;;a;ajfha fjkialus
• - hjkakd ikaksfjsokh ms<Sn| we;s whym;a fyda wdlD;suh
(Steriotype) yeÕSu
• - m%;sfmdaIKh ms<sn| fkdie,lSu
 • Skills on convey Braking Bad news

- Advance Preparation
- Check clients perception
- Build a therapeutic environment or relationship
- Communicate well
- Respond with empathy
- Deal with patient and family reactions
- Encourage and validate emotions
- Establish a strategy for support
 lKavdhus ixl,amh - Team Concept

• fmdoq wruqKla ,Õdlr .ekSug tlg tla ù tlsfkld w;r

wka;¾ls%hd isÿlrk msrsila lKavdhuls
 • id¾:l lKavdhul ,CIK

• - wruqKla ;sfí
• - idudcslhka tlÕ jk kS;s wdpdrO¾u yd O¾u;d mj;S
• - kdhl;ajhla we;
• - idudcslhka iduQyslj lghq;= lrhs
• - iïm;a ld¾hCIuj Ndú;d lrhs
• - kdhlhdf.a yd idudcslhkaf.a j.lSu yd j.ùu b;d by,h
• - wid¾:l ùï wjuh
• - jeros iy wvqmdvq idOdrK úfõpk u.ska ksjerosa lr .kS
• - .egqï wju h
 • lKavdhus j¾.
• 1 Process Team
jHdmD;sfha iuia: ls%hdj,sh iusmQ¾Kfhka l<ukdlrKh lrhs
• 2 Self Manged Team
wOSCIKhlska f;drj wruqK fj; .uka lsrSug lghq;= lrk lKavdhu
• 3 Cross Functional Team
iqjsfYaIs wruqKla ,Õdlr ,ekSu fjkqfjka muKla lghq;= lrk lKavdhu
• 4 Quality Improvement Team / Problem Solving Team
hus jHmD;shl ;;a;ajh by, kexjSu fjkqfjka lem jk l=vd lKavdhuls
• 5 Virtual Team
tlsfkld w;r in|;dj wvq Wjo ;u ld¾hh ms<sn| by, ;dlaIKsl oekqula
yd oCI;djlska hq;= fjs
• ia;=;shs