TRAINING MANUAL

INTRODUCTION
This document has been developed by the HR Department of Harley Street Hospital in
order to familiarize trainees with basic Health’s rules and regulations. In addition to
the Common Trainee Policy and Procedure Manual, program specific manuals
highlight standards for a hospital to maintain all the operations successfully. In this
training manual, we are entitled to well-defined rights, privileges and goals of the
program you have selected. This manual is a guidebook to the goals, regulations, and
policies of the training program. The goal of our training programs is to provide high
quality training that gives each trainee a foundation for future medical training. we
believe our organization has developed a curriculum that meets the goals and
objectives of a successful training and provides a comprehensive base for future
medical training.

WELCOME
Welcome to Harley Street Hospital. We are happy to have you as a new member of our
family!

OUR MISSION

OUR VISION

ORIENTATION SCHEDULE
Trainee orientation is structured to help the individual become familiar with their roles,
responsibilities and institutional aspects of the organization. We understand that the
orientation schedule provides a great deal of information, remember – we encourage
you to ask questions and to refer to your manual and seek assistance from your
assigned heads.

CHANGES IN POLICIES
This manual supersedes all previous trainee manuals and memos. While every effort is
made to keep the contents of this document current, Harley Street Hospital reserves the
rights to modify, suspend, or terminate any of the policies, procedures, and/or benefits
described in the manual with or without prior notice to trainees & employees.

OPERATIONAL POLICIES
STRUCTURE
The training program is structured to provide trainees with the fundamental knowledge
and essential principles requisite for the application of pre-doctoral knowledge to
clinical decision-making and skills. The basic techniques of physical examination, the
necessary skills for performing clinical procedures, and the capability to communicate
clearly with patients, their families and other members of the health care team are
stressed in our training program(s).
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EMPLOYMENT POLICIES

o EQUAL EMPLOYMENT OPPORTUNITY/DIVERSITY

Harley Street Hospital is committed to diversity that will build on the strengths of our
current workforce and continually enhance the diversity of our organization. Harley
Street Hospital is an equal opportunity employer and does not discriminate on race,
color, citizenship status, national origin, ancestry, gender, sexual orientation, age,
weight, religion, creed, physical or mental disability, marital status, veteran status,
political affiliation, handicapped persons who, with reasonable accommodation, can
perform the essential functions of the job or any other factor protected by law.

o EMPLOYEE BACKGROUND CHECK

Prior to making an offer of employment, Harley Street Hospital may conduct a job-
related background check. A comprehensive background check may consist of prior
employment verification, professional reference checks, education confirmation, and
criminal check.

o PRE-EMPLOYMENT EVALUATION
Record of immunizations and other health information will be maintained in the
Employee Health Record. Harley Street Hospital is commitment to the health and
safety of its employees, as well as its patients. This includes the assurance of a drug
and alcohol-free work environment. The Hospital has, therefore, implemented a
substance abuse policy that applies to all Harley Street Hospital employees, making
mandatory drug screening a regular part of the pre-employment physical. Any refusal
of an employee to complete, or failure to satisfactorily pass this screening will be
turned over to the Committee of Impaired Physicians for review.

o CRIMINAL RECORDS
When appropriate, a criminal record check is performed to protect Harley Street
Hospital’s interest and that of its employees and clients.
All Harley Street Hospital’s entities conduct criminal background checks on all final
candidates for employment. The results of criminal background checks may take
several weeks to be processed. Employees are permitted to begin work before the
results are received. In the event that a disqualifying conviction is returned on an
employee, the employee will be subject to separation from the Hospital and terminated
from the training program. This separation will occur even if the employee has
successfully completed some period of the training program before the results are
received. The employee’s contract will then become Null and Void.

o SAFETY
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Harley Street Hospital strives to provide its employees, patients, and visitors with a
safe and healthy environment. Should conditions or hazards be identified that pose an
immediate threat to life, health or safety, the situation must be immediately and
appropriately addressed and report to the Safety Officer.

o CHANGE OF PERSONAL DATA

It is the responsibility of each employee to report any changes in name, address or
phone number to the Concerned Department.

o CHAIN OF COMMUNICATION
Employees shall follow the “Chain of Communication” policy of Harley Street
Hospital. When necessary, the CEO presides over all areas and is the final step in the
chain of command. When issues and or problems occur, the employees should contact
and speak with:
1. Attending Physician
2. Program Director or Associate Program Director
3. Director of Medical Education
4. Vice President of Medical Education
5. CEO
 But you should speak to your line manager first.

o PERSONAL PROPERTY
Harley Street Hospital assumes no risk for any loss or damage to personal property and
recommends that all employees have personal insurance policies covering the loss of
personal property left in any of its premises.

o PROFESSIONAL ACTIVITIES OUTSIDE THE PROGRAM

Employees may be required to attend educational programs based on the hospital
training program’s requirements. The Head department or any qualifying supervisor
officer will alert staff of such activities and will notify employees & Staff.

o VISITORS IN THE WORKPLACE

For safety, insurance, and other business considerations, only authorized visitors are
allowed in the workplace. When making arrangements for visitors, employees should
request that visitors enter through the main reception area and sign in. The hours and
regulations for visiting are published and given to all patients. Recommendations for
individual exceptions to the regulations should be made to the Nursing Supervisor.
Information concerning a patient is privileged and confidential and should not be
divulged to anyone except individuals specifically designated by the patient. Non-
designated friends, relatives and visitors are not entitled to such information, but their
inquiries must be handled in a friendly and tactful manner.

ETHICAL POLICIES

o HARASSMENT POLICY
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Harley Street Hospital does not tolerate workplace harassment. Workplace harassment
can take many forms. It may be, but is not limited to, words, signs, offensive jokes,
cartoons, pictures, posters, e-mail jokes or statements, pranks, intimidation, physical
assaults or contact, or violence. Refer to Human Resources Policy and Procedure
Manual.

o SEXUAL HARASSMENT POLICY

It is the policy of Harley Street Hospital to provide an employment environment free
of sexual harassment. Unwelcome sexual advances, requests for sexual favors, and
other verbal or physical conduct of a sexual nature are violations of our policy. If you
believe you have been subjected to sexual harassment, you should report it
immediately in writing to the HR Department and the director of human resources. All
complaints of sexual harassment will be promptly and confidentially investigated. Any
employee/staff who violates this policy will be subject to corrective action, based on
the severity of the violation, up to and including termination. Any other form of
repeated behavior, which the employee/staff perceives as harassment, should be
reported to the HR Department.

o VIOLENCE IN THE WORKPLACE

Harley Street Hospital has adopted a policy prohibiting workplace violence. Consistent
with this policy, acts or threats of physical violence, including intimidation,
harassment, and/or coercion, which involve or affect Harley Street Hospital or which
occur on the premises of Harley Street Hospital or client property, will not be
tolerated. Refer to Human Resources Policy and Procedure Manual.

o CONFIDENTIAL INFORMATION AND NONDISCLOSURE

The confidential nature of medical information and the patient's right to privacy are
well established. All hospital personnel are expected to treat patient-related
information in a confidential manner, sharing it only with those who have a need to
know, whether in written, oral, electronic, or any other format. Hospitals and
physicians can be held liable for the improper or unauthorized disclosure of medical
information. As such, discussion of patient-related information should be conducted
only in appropriate settings, and especially not in elevators or other public areas. At the
start of your training at Harley Street Hospital, you will be asked to sign a
Confidentiality and Non-Disclosure Agreement, documenting your acceptance of this
policy. Harley Street Hospital and its employees and business associates to protect the
privacy and security of patient health information. As all Harley Street Hospital
employees are affected by HIPAA and subject to its penalties for noncompliance, it is
important that everyone keep abreast of new developments and understands the overall
impact and intent of the legislation. Refer to Human Resources Policy and Procedure
Manual.

o ETHICAL STANDARDS
Employees are required to comply with Harley Street Hospital’s Code of Conduct.
Harley Street Hospital insists on the highest ethical standards in conducting its
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business. Doing the right thing and acting with integrity are the two driving forces
behind Harley Street Hospital’s great success story. When faced with ethical issues,
employees are expected to make the right professional decision consistent with Harley
Street Hospital’s principles and standards. If a trainee cannot determine the correct
decision, the trainee should contact their respective program director and or the
Department of Medical Education.

o USE OF EQUIPMENT
Harley Street Hospital will provide employees with the equipment needed to do their
job. None of this equipment should be used for personal use, nor removed from the
physical confines of Harley Street Hospital unless it is approved for a job that
specifically requires use of company equipment outside the physical facility.

o USE OF COMPUTER, PHONE, AND MAIL

Harley Street Hospital’s property, including computers, phones, electronic mail, and
voice mail, should be used only for conducting company business. Incidental and
occasional personal use of company computers, phones, or electronic mail and voice
mail systems is permitted, but information and messages stored in these systems will
be treated no differently from other business-related information and messages.

o USE OF INTERNET
HSH reserves the right to monitor the way employees use & consume data &
information on their company issued devices. It is recommended to use only company
issued devices for official work only, otherwise strict action will be taken.
Employees are responsible for using the Internet in a manner that is ethical and lawful.
Use of the Internet must solely be for business purposes and must not interfere with
employee productivity. Harley Street Hospital encourages employee use of electronic
mail, the intranet and the Internet; it creates a more efficient work environment.
However, it should be clear that:
 Sending and receiving E-mail, Intranet or Internet messages regarding personal
matters are not permitted.
 Under no circumstances will the E-mail system, the Intranet or the Internet be
used as a forum for inappropriate, offensive or discriminatory comments.
 An employee should not consider the contents of his or her E-mail account
private.
 The password used to restrict access to employees’ E-mail accounts is a
mechanism for preventing an unauthorized person from gaining access to
Harley Street Hospital’s information rather than maintaining the privacy of
employees’ messages.
 The E-mail system, including the contents of messages and accounts, can be
monitored to,
 Evaluate the effectiveness and operation of the E-mail system.
 Find lost messages.
 Recover after system failure.
 Investigate suspected criminal acts or suspected breach of security.
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 Enforce other Harley Street Hospital policies. Employees, including trainees,

who use email, the intranet or the Internet improperly, will be subject to
disciplinary action according to policy the Human Resources Policy and
Procedure Manual. All Harley Street Hospital employees must sign a form
documenting that they understand the conditions under which an email account
may be used and what conduct is permitted.
Harley Street Hospital reserves the right to monitor the way employees use and
consume data and information on their company issued devices.
It is recommended to only use company issued devices for official work only
otherwise strict action will be taken.
o USE OF COMPUTER SOFTWARE
Harley Street Hospital does not condone the illegal duplication of software. The
copyright law is clear. The copyright holder is given certain exclusive rights, including
the right to make and distribute copies.

o SMOKING POLICY
To provide a healthier and safer environment for patients, visitors of its premises staff,
and employees, the hospital prohibits smoking and the use of tobacco products
anywhere in hospital and its premises. All employees are required to adhere to this
policy to ensure that Harley Street Hospital is a healthier and safer place in which to
work. To protect the health of our patients, medical staff, hospital employees, visitors
and volunteers, Harley Street Hospital has a Zero Tolerance Policy on smoking and the
use of tobacco products.

o ALCOHOL AND SUBSTANCE ABUSE

It is the policy of Harley Street Hospital that the workplace be free of illicit drugs and
alcoholic beverages, and free of their use. In addition to damage to respiratory and
immune systems, malnutrition, seizures, loss of brain function, liver damage, and
kidney damage, the abuse of drugs and alcohol has been proven to impair the
coordination, reaction time, emotional stability, and judgment of the user. This could
have tragic consequences where demanding or stressful work situations call for quick
and sound decisions to be made.

o CORPORATE COMMUNICATIONS
Because of your constant relationship with patients and their visitors, your role in
establishing a positive reputation for the Hospital is important. Patients are seldom
qualified to judge the technical quality of medical care they receive. To patients, the
most important thing is usually the personal concern of each individual they contact in
the Hospital. Patients are extremely conscious of the many little things that add up to
kindness, sympathy and understanding. Harley Street Hospital, through the
compassion and caring of its physicians, nurses, and support staff, has consistently
achieved excellent patient satisfaction ratings. Harley Street Hospital’s
Communications (Public Relations) Department is responsible for handling inquiries
and requests. During evening and night shifts, the Nursing Supervisor on duty may
release basic condition reports, as permitted by law, on public record cases.
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o CORPORATE COMPLIANCE
The compliance program at Harley Street Hospital is a comprehensive strategy to
ensure that employees and medical staff comply with applicable rules, regulations, and
laws. Refer to Corporate Compliance Policy Manual

o OBLIGATION TO TREAT
A primary mission of the hospital is to serve and heal all persons who need its help. In
addition to general legal and ethical requirements, hospitals participating in the
Medicare program are required to provide examinations and treatment to individuals
with emergency medical conditions, or women in labor, regardless of their ability to
pay.

o HOSPITAL PROPERTY
No x-ray films, instruments, drugs, scrub suits or other hospital property shall be taken
from the hospital unless permission has been granted by the HR Department.

o ACCIDENTS TO PATIENTS
The nursing staff of all accidents and incidents to patients will notify on service. They
will examine the patient immediately and report the follow up diagnostic and
therapeutic services as needed to the attending. They must record the findings on the
Occurrence Report Management system.

o NURSING SERVICE
You are expected to extend professional courtesy, assistance, and cooperation to the
nursing personnel. They are respected members of a health service team whose reason
for being here is the same as your own, to provide the best service possible. From a
truly fine nurse, you stand to learn much. Should any problems arise with the nursing
service, do not take it upon yourself to correct the situation, but discuss it with the HR
Department.

o PROFESSIONAL CARE OF HOSPITAL PERSONNEL

Members of the hospital staff shall not render any professional service to hospital
personnel or dependents, except under the provisions of the employee health service
plan of the hospital or with the supervision of an attending staff physician. Trainees
will please address all employees by their surnames, prefaced by Miss, Mrs. or Mr., as
that case may be, or their title, e.g., Nurse.
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STANDARDS OF CONDUCT

o MORNING REPORT
Morning report occurs from 7:30 a.m. – 8:15 a.m. on working days.

o WORK SCHEDULE
In-hospital rotations service hours are from 7:00 a.m. to 7:00 p.m. every day.
Employees in an office setting rotation will be responsible for being in the office
setting during the teaching attending’s office hours. Scheduled times will be subject to
shift workload of attending physician and the attending physician may assign,
schedule, or adjust scheduling as appropriate to the service.

o GENERAL GUIDELINES
All employees are urged to become familiar with Harley Street Hospital rules and
standards of conduct. It is expected that all individuals will follow these rules and
standards faithfully in doing their own jobs and conducting the company’s business.
o DRESS CODE
Dress, grooming, and an overall professional appearance are important aspects of
patients' expectations, and project an image of quality healthcare. When scrubs are
worn outside of clinical areas, a white coat or similar cover-up should be worn.
Employees must appear neat and clean at all times. The uniform for floor duty during
the day is a long white clinical coat. Coats should be worn at all times. Socks and
closed toe appropriate footwear must be worn at all times. Male and Female medical
staff is required to wear professional business attire under the white clinical coat.

o WEATHER-RELATED AND EMERGENCY-RELATED CLOSINGS

At times, emergencies such as severe weather, fires, or power failures can disrupt
company operations. In such instances, Executive Staff will decide on the closure and
Harley Street Hospital will provide the official notification to the employees.
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LEAVES AND ABSENTS POLICIES

o ABSENCES
The employee will not be permitted to leave the hospital premises other than during
off-duty hours without the permission of the Head or Administrative Director. If it
becomes necessary for an employee to leave the premises during duty hours,
permission must be first obtained as stated above, arrange for another employee to
cover the service, notify the switchboard and nursing station involved that you will be
off the premises, and the name of the trainee covering the service. Upon returning to
the hospital, the employee is to notify the switchboard, the Administration Department
and the nursing station, that you are back on duty. If employee is unable to report to
duty due to illness, he/she is to notify the attending physician.

o UNAUTHORIZED/UNSCHEDULED ABSENCES
An unauthorized absence from duty will result in disciplinary action. Any
unauthorized absence of three or more consecutive business days without any notice,
will result in strict actions from management.

o VACATION TIME
Vacations are granted and scheduled at the discretion of the department to which the
employee is assigned. Vacation allowance is 20-days per academic year.

o FAMILY MEDICAL LEAVE

In accordance with the “Family and Medical Leave Act,” Harley Street Hospital’s
unpaid leave-of-absence policy supports up to twelve workweeks of leave during a 12-
month period for the following:
 Pregnancy/birth of a child
 Placement with an employee of a child for adoption or foster care
 Caring for a spouse, child, or parent with a “serious health condition”
 The employee’s own “serious health condition”
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The 12-month period is measured forward from the date your first FMLA leave begins.
To be eligible for FMLA, you must first have been employed at Harley Street Hospital
for at least twelve months and have worked 1,250 recorded hours in the 12 months
preceding the leave. You must apply for this leave and Human Resources must
approve it. The forms are available in the Human Resources office. If eligible for
FMLA, it must be applied for concurrently with any leave due to maternity or
paternity, short or long-term disability, and leave pursuant to “Extended Leave of
Absence” in the Trainee Manual. Leave under this provision only protects your job,
i.e., job security. It does not provide any income guarantee or entitlement. Time taken
off for leave may extend the training period as necessary to comply with the
appropriate accreditation guidelines. While on FMLA, trainees are entitled to up to
twelve weeks of Harley Street Hospital subsidized benefits only (see “Benefits While
on Leave”). See Human Resources Policy and Procedure Manual.

o EXTENDED LEAVE OF ABSENCE

Depends on how many months completed.
Employees with extraordinary and long-term personal or family tragedies may be
granted extended leave without pay and without loss of previously accepted residency
position or status for periods of up to one year in the following circumstances:
 Terminal illness.
 Permanent disability
 Complications of pregnancy that threaten maternal or fetal life.
 Other “devastating conditions” or personal tragedies from which eventual
recovery and/or return to regular employment may be reasonably expected.
If extended leave is requested, the residency Program Director will provide the trainee
written information regarding its potential impact on:
 Requirements for successful program completion.
 Requirements for board eligibility.
The Program Director will also provide written information regarding availability of
alternative accommodations, such as reduced hours, night-call accommodations,
modified rotation schedules and part-time scheduling. Eligibility for extended leave
will be determined on a case-by-case basis by the Residency Program Directors and/or
Committee for that department. In case of a dispute, a panel consisting of three
Program Directors and two Chief Residents of other departments shall be convened by
the DME to hear arguments on both sides and make a final determination.

o SICK LEAVE
Full-time employees who become incapacitated due to illness, injury or other forms of
medial disabilities, may be granted a Medical Leave, not to exceed one (1) year. After
one (1) year of Medical Leave of Absence status access to health and other elected
insurance plans is terminated. The employee is removed from the active payroll, and
Human Resources will notify the employee of his/her post employment rights. The
employee requesting medical leave must submit a certification of health care provider,
identifying the reason for the medical leave, with prognosis and expected return to
work date. This certification must be returned within ten (10) days of Harley Street
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Hospital giving notice that certification is required. Going beyond ten (10) days will
cause Harley Street Hospital to make a decision on the leave status without the
information on the certification or to even deny the leave request. If circumstances
exist where even a diligent, good faith effort on the part of the employee will not
produce the certification in that time frame, then the employee should notify his/her
Department Director as soon as he/she becomes aware of the delay. Harley Street
Hospital reserves the right to request a second opinion (at no cost to the employee) on
any request for Medical Leave. Every effort will be made to retain an employee’s
original position while on Medical Leave. However, it may be necessary to fill the
position with a full-time employee before the leave terminates. In these instances,
Harley Street Hospital will make every attempt to place the employee in a similar
position on the same shift, with the same rate of pay, as before the leave commenced,
and in accordance with any federal or state laws, regulations or statutes that contain
return to work compliance requirements. Refer to Human Resources Policy and
Procedures for complete details.

o PROFESSIONAL LEAVE OF ABSENCE

Unpaid professional leave of absence is granted at the discretion of the Program
Director of each residency program. Time taken off for leave may extend the training
periods as necessary to comply with appropriate accreditation guidelines. Note: Efforts
will be made on a case-by-case basis to give appropriate time off while assuring
program compliance upheld. Depending on situation, additional training may be
required.

o ADDITIONAL BENEFIT & LEAVE CONSIDERATIONS

Effect of Leave for Satisfying Completion of Program: Time taken off for any leave
may extend the training period, as necessary, to comply with appropriate accreditation
guidelines. Trainees should check with their Program Director to make sure they are
not in jeopardy of needing to extend their training and, therefore, changing plans for a
job or fellowship opportunity. Trainees are not automatically guaranteed re-entry into
the training program and therefore should discuss future arrangements with their
Program Director prior to commencing a leave of absence. An employee remains
eligible for health benefits during the time he/she is on unpaid leave. During the time
the employee is not receiving pay, the usual payroll deduction obviously cannot be
made. The employee, therefore, is responsible for direct payment of benefits costs. The
Benefits Office must receive a check or the appropriate amount before the 15th of each
month to assure uninterrupted coverage. An employee requiring further leave after
FMLA has expired, or an employee exercising any of the other forms of unpaid leave,
assumes full cost of any insurance coverage. Any leave of any kind must be
coordinated through Human Resources and notification to the Department of Medical
Education is required.
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MEDICAL STAFF BEST PRACTICES GUIDELINES

o GENERAL OBJECTIVES
During training, you should attain a level of competence that will qualify you to
continue your postdoctoral training. Satisfactory levels of accomplishment must be
demonstrated in the cognitive, psychomotor, and affective aspects of patient
management. Upon satisfactory completion of training, you should be able to:
 Obtain patient information accurately, comprehensively, and systematically; obtain
a thorough and accurate personal and family history; perform a complete history
and physical examination; maintain appropriate report of the patient
 Present a clear clinical picture, verbally and in writing, of the history, physical
examination, chief complaint, diagnostic testing, etc., confidently by organizing
and recording data in a concise, legible format; accurately record information
shortly after completing an examination – write clearly and legibly to ensure that
the members of the health care team can interpret the information.
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 Differentiate between important; less important; and/or, unimportant information to

be recorded on the patient’s medical record; maintain adequate and up-to-date
medical records.
 Diagnose and treat the most commonly encountered diseases in primary care
practice; recognize, diagnose and treat the acute, life-threatening conditions
encountered by the primary care physician; differentiate less common disease
entities for diagnosis; recognize conditions which require referral and or
consultation.
 Determine the need to perform tests for the purpose of diagnosis and treatment of
the patient’s current problem; interpret the results of investigative tests as they
apply to a patient’s condition and/or disease.
 Develop a comprehensive, therapeutic health care plan based upon identified
disease(s), disorder(s), and defined patient needs; identify appropriate length of
stay (LOS) for each patient problem, taking into consideration diagnosis related
groups (DRGs).
 Demonstrate logical decision making and clinical problem solving relative to case
management; develop a patient problem list and demonstrate the proper use of
problem oriented medical record (POMR) for recording progress notes and
physician orders (information written in the physician’s orders must illustrate a
logical association with the information written in the problem list and the progress
note).
 Determine and prescribe medications; be familiar with the pharmacology of all
agents used, including indications, contraindications, appropriate dosage, possible
interactions, and proper routes of administration.
 Select and consult with appropriate allied health professionals (e.g., dieticians,
physical therapists, occupational therapists, etc.) to assist in patient care (e.g.,
nutrition, rehabilitation, activities of daily living, etc.) and propose immediate,
necessary steps in the medical management of the patient.
 Interpret statistical data in literature as it applies to patient situations; utilize current
medical literature to gain insights into the care of the patient and continuously
update medical knowledge and medical practice skills.
 Recognize the value of evidence-based medicine in the practice of medicine,
literature searches, patient care and education, scholarly writing, research, etc.
 Provide health care for acute problems in the initial contact with an assessment of
the patient as well as on-going treatment of chronic problems; follow the patient at
appropriate intervals, both in the hospital and on an ambulatory basis, modifying
the original patient management plan when necessary; determine the approximate
time for discharging hospitalized patients and necessary post-discharge care.
 Demonstrate the psychosocial skills needed to develop trusting relationships with
individual patients and their family members; establish and maintain a therapeutic
and support rapport with the patient.
 Promote positive interrelationships with health professionals in the community.
 Understand how family dynamics and interpersonal relationships affect the health
and illness of a patient; provide that support of family therapy when required.
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 Deliver medical care to the family unit by recognizing and allaying the fears and
anxieties of the patient and family members, and attempt to understand the impact
of the patient’s background and environment on his/her wellness.
 Understand the impact that illness of any member of the nuclear or extended family
has on the function of the family unit.
 Identify preventive health measures and demonstrate appropriate teaching
techniques to the patient and the patient’s family; serve as an educator who
instructs patients in preventive medicine, responsibility for personal health care and
community medicine.
 Provide care and rehabilitative programs for the chronically ill, permanently
disabled, and physically challenged and or geriatric patient; determine and
prescribe the degree of physical activity for the optimum functioning of the patient.
 Demonstrate osteopathic philosophy integrating anatomical, physiological, and
psychological considerations; identify and demonstrate appropriate use of
osteopathic manipulative medicine (OMM).
 Maintain confidentiality and the uniqueness of the patient as a person.
 Participate in community preventive medicine, health screening programs,
epidemiology, community health resources, rehabilitative centers and care for
geriatric patients.
 Exhibit high ethical standards for medical practice; identify, analyze, and respond
effectively to ethical problems/issues that arise frequently in the practice of
medicine.
 Assess one’s own medical competence; understand legal rules and principles that
impact the practice of medicine
 Understand basic practice management principles and procedures such as billing,
scheduling, record keeping, etc.
 Understand the impact of evolving managed health care environment on the
practice of medicine.
 Develop an understanding of the seven core competencies and how they apply to
patient care.

NURSING STAFF TRAINING

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NURSING PROCESS DEFINITION:

It is a tool or method for organizing and delivering care or a deliberate intellectual
activity whereby the practice of nursing is approached in an orderly systematic
manner. It is a series of planned steps and actions directed towards meeting the need
and solving of problems of the clients.
PURPOSE OF NURSING PROCESS:
 To identify client's health care needs.
 To establish nursing care plans so as to meet those needs.
 To complete the nursing intervention designed to meet the needs.
 To provide individualized core.

Nursing process has 6 main steps.

1. ASSESSMENT
Collects Client Health Data.

2. NURSING DIAGNOSIS
Analyzes Assessment Data to Determine Diagnoses.

3. OUTCOME IDENTIFICATION
Identifies Expected Outcomes of Client for Nursing Diagnoses.

4. PLANNING
Develops Plan of Care and Prescribes Interventions to Attain Expected Outcomes.

5. IMPLEMENTATION
Implements the Interventions in the Plan of Core.

6. EVALUATION
Evaluates Client's Attainment of Outcomes

DETAILING OF NURSING PROCESS

o ASSESSMENT:
The systematic collection of data to determine the patient's health status and to identify
any actual or potential health problems. The best sources of information about the
client are the client and the family. Health professionals, previous client records act as
information sources.

Data collection falls into two categories:

 Objective Data include all the measurable and observable pieces of information
about the client and his/her overall state of health. The term objective means that
only precise and accurate information or clear descriptions are used.
 Subjective Data consists of the client's opinions, feelings about what is happening.
Only the client can tell you that he she is having point. Sometimes the client can
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communicate through body language: gestures, facial expressions and body posture.
To get subjective data you need sharp interviewing, listening, and observation skills.
Method of Data collection:
 Observation is an assessment tool that relies on the use of the five senses (sight,
touch, hearing, smell and taste) to discover information about client.
 Health interview - the health interview may also be called a history taking.

o DIAGNOSIS:
Identification of the following two types of patient problems.
 Nursing diagnosis - actual or potential health problems that can be managed by
independent nursing interventions. Purposes of the Nursing Diagnosis - the nursing
diagnosis serves the following purposes:
 Identifies Nursing Priorities.
 Directs nursing interventions to meet the client's high priority needs.
 Provides a common language and forms a basis for communication and
understanding between nursing professionals and health care team.
 Guides the formulation of expected outcomes for quality assurance requirements of
third-party payer.
 Provides a basis for evaluation to determine if nursing care was beneficial to the
client and cost effective.
 Is of help in making staff assignment.

Diagnostic Statement.
The client may present with more than one problem. Therefore, the nursing diagnosis
may be made up of multiple diagnostic statements. Each diagnostic statement has two
or three parts depending on the healthcare facility.
o PLANNING
development of gools and a plan of care designed to assist the patient in resolving the
diagnosed problems. Setting priorities, establishing expected outcomes, and selecting
nursing interventions result in plan of nursing care.

Setting priorities
Nursing diagnosis is ranked in order of importance. Survival needs or imminent life-
threatening situations takes the highest priority. For e.g., the need for air, water and
food are survival needs. Nursing diagnostic categories that reflect these high priorities
needs include Ineffective Airway Clearance and deficient fluid volume.
Establishing Expected Outcomes An expected outcome is a measurable client behavior
that indicates whether the person has achieved the expected benefit of nursing care. It
may also be called a goal or objective.
An expected outcome has the following characteristics:
 Client oriented
 Specific
 Reasonable
 Measurable.
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Selecting Nursing Intervention

Nursing intervention is also called Nursing Orders or nursing actions, they are
activities that will most likely produce the desired outcomes (short term or long term).
To achieve this outcome, one should select nursing interventions such as the following
examples:

 Offering fluids frequently

 Positioning frequently
 Teaching deep breathing exercises
 Monitoring vital signs
 Administering Oxygen, etc. accordingly.

o IMPLEMENTATION
Actualization of the plan of care through nursing interventions

o EVALUATION
Determination of the patient's responses to, the nursing intervention and the extent to
which the goals have been achieved.

Critical Thinking
It is defined as an intellectually disciplined process of actively and skillfully
conceptualizing, applying, analyzing synthesizing, and or evaluating information
gathered from, or generated by observation experience, reflection, reasoning or
communication, as a guide to belief and action. The nurse process is considered to be
the specific critical thinking competency in nursing. Critical thinking skill helps the
nurse to look at all aspects of a situation and then at the conclusion.
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HOW TO MAINTAIN MEDICAL RECORDS

o MEDICAL RECORDS
The importance of complete and accurate medical records and an orderly and efficient
system of charts control (to assure accessibility) cannot be overemphasized. At the
beginning of the trainee’s service, personal instructions in the use of dictation
equipment and the policies of the Hospital will be given by Medical Records. If a
problem arises in connection with medical records, the staff will be glad to assist you.

o GUIDELINES FOR USE OF MEDICAL RECORDS

Medical records are privileged and confidential documents and must be safeguarded
according to Hospital Medical Records policies and procedures. The handling of
medical records shall be governed by the following guidelines:
 Medical records must be available to Medical Records personnel day or night.
They must,
a. Remain in specified patient care areas.
b. Be readily accessible in case of emergency.
 Medical records may be removed from the Medical Records Department only
for the following purposes:
a. For direct patient care, either for admission to the Hospital.
b. For case study or other uses by a department or individuals authorized to
requisition medical records. Trainee for use only within the Medical Records
Department may requisition medical records for study or dictation.
 Medical records may not be removed from the Hospital except for legal
purposes, and then only in the custody of authorized Medical Records
personnel.
 Medical records must be kept intact on in-patient floors and in the clinics, and
must not be taken apart or pages removed or rearranged.

o GUIDELINES FOR DOCUMENTATION IN THE MEDICAL RECORD

The Hospital maintains a “unit” record (containing all inpatient, outpatient, and
Emergency Department information). Trainees are reminded that medical records are
legal documents, and the physicians may at some future date be cross-examined in
court under oath on the notes he/she has written. Personal opinions, or non-medical
judgments, should not be expressed in the medical record on any matters except those
that pertain to the medical care of the patient.

o RULES FOR ENTRIES INTO THE MEDICAL RECORD

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ENTRIES MUST BE LEGIBLE.

 Entries must be signed, dated, and timed.
 Entries must be complete and accurate.
 If applicable, entries must be recorded only on officially approved Harley Street
Hospital forms that are provided on the divisions or in the clinics.
 Entries should be made chronologically with minimal blank spaces left between
entries to avoid bulky records.
 If applicable, chemical, abrasive or other erasures or alterations, that delete the
original entry, create an impression of a falsified record and render the record
valueless to the patient or to the Hospital in the event of litigation. Drawing a
SINGLE LINE through the part to be corrected and the new entry made in
proper sequence, or above or below the incorrect entry should make corrections.
The reason for the correction, if not obvious, should be noted in the margin. All
corrections should be signed, dated and timed by the individual making the
correction.
 Entries should not contain facetious, libelous, or otherwise inappropriate,
subjective remarks.
 Entries must be signed, not initialed. Your printed name, Department/Division,
PGY level and pager number should follow each signature.

o PROTECTED HEALTH INFORMATION

Medical records are considered Protected Health Information and are privileged and
confidential documents and the information must be safeguarded against unauthorized
release according to Hospital and Medical Records policies and procedures.
Information regarding a patient's care and treatment shall not be divulged without the
written consent of the patient, parents or guardians of minors, or executors of estates of
decreased individuals. The Medical Records Department will handle
 all medical correspondence:
 All insurance forms.
 Request for various medical certificates.
 Request for case summaries and other specified medical record information.
 Letters to schools, unions, or places of employment.
 Birth certificates/Proof of Birth letters.

o MEDICAL STAFF RULES & REGULATIONS

In addition to being familiar with the content of the Hospital's “Administrative Policy
and Procedure (AP&P)” Manuals, and the System Manual, trainees should review the
most current copy of the Rules and Regulations of the Medical Staff. These are
available in the Department of Medical Education and the Medical Staff Department.

o PHYSICIAN’S ORDERS
Orders must be written clearly, legibly and completely in permanent ink and signed by
the attending physician or trainee responsible for the patient's care. All orders written
must be done so on Physician's Order Sheet and must include the date and time
written, the physician’s or trainee’s signature. Supplemental verbal discussion of
 TRAINING MANUAL

orders between the physician and nurse or other professional is encouraged to provide
clarity. Orders must be specific for diagnostic or treatment procedure and include
generic name of medication. The time (when appropriate), frequency, duration, and
date to be carried out should be included. For medication orders will be in concert with
Pharmacy P&P Manual. Physician orders must be written on hospital approved
physician order forms according to medical staff bylaws. Any order discrepancy, or
clarification that is required, will be done by clinical staff with ordering physician in
accordance with medical staff bylaws and Harley Street Hospital Policy and
Procedures for medical orders.

o SERVICE TO IN-PATIENTS
Employees assigned to inpatients units must follow the guidelines of the Harley Street
Hospital’s Medical Staff Rules and Regulations. Specifically, trainees must evaluate
admissions or transfers to critical care areas based upon the patient’s condition and
within 24-hours in general care divisions. Trainees must evaluate inpatients and write
progress notes at least daily. When a patient is seen with an attending, the trainee
should chart that in the progress note. Employees should answer pages as soon as
possible, and respond to emergency consultations and Emergency Department requests
within 30 minutes. Employees are encouraged to consult with an attending or any time
he/she is uncertain about a patient care issue.