20 September 2011NCM 107: Nursing ManagementRey Ramirez

ORGANIZATION • What is an organization?

social entity (involves people) goal directed structured and coordinated activity system linked to the external environment open system

• Why organize? Man is a social animal

it is inherent in man (even nomads organize to get food)

no man is an island (early man form tribes to survive)

KEY ELEMENTS OF AN ORGANIZATIONInvolves people interacting with one another

People People

People

IMPORTANCE OF ORGANIZATIONSResource Management

to combine resources to make the desired goals and outcomes

4Ms/1T Money Machine Manpower Materials Time

Produce goods and services efficiently Facilitate innovation

Use modern manufacturing and computer-based technology

Adapt to the influence on changing environmentCreate value for owners, customersAccommodate ongoing challenges of diversity, ethics,

career patterns; and the motivation and coordination of people

CHARACTERISTICS OF AN ORGANIZATIONA purpose

People using Interacting knowledge and in groups and techniques

Working together in patterned relationships

5 BASIC PARTS OF AN ORGANIZATIONTop ManagerTechnical Support StaffMiddle ManagerAdministration Support StaffTechnical Core

Top Manager

Technical Middle Administration Support Staff Manager Support Staff

Technical Core

ORGANIZATIONAL EVOLUTIONEvolution:

One-man operation Father-son/assistant type Functional organization Functional organization plus a central headquarters Multi-diversonal firm Conglomerate

Tends toward increase in the ff: complexity size of organizations accelerating scientific knowledge and technological

developments government role customer needs new paradigms

*warranted the need for ORGANIZATIONAL THEORY

1//carengreyes

ORGANIZATIONAL THEORYa way to see and analyze organizations more accurately

and deeply HOW?

based on patterns and regularities in organizational design and behavior

insights into organization functioningSIGNIFICANCE:

makes managers more competent and more influential (with theoretical background)

endless people will see and understand things other people around cannot see/understand

provide an appreciation of understanding of what is happening in organization

PRINCIPLES OF ORGANIZATIONCOMMUNICATION

formal; vertical; horizontalUNITY OF COMMAND

line of command; one superior; vertical lineSPAN OF CONTROL

number of subordinates that a supervisor can supervise effectively

DELEGATION OF AUTHORITY centralized; decentralized, delegate to competent

staff responsibility; accountability SIMILAR ASSIGNMENTS

departmentalization; specializationUNITY OF PURPOSE

all areas work towards a single purpose to achieve success

ORGANIZATION THAT THRIVE IN DYNAMIC ENVIRONMENTFLEXIBLE

Fast Speed Empowered Open in its communication Innovation Learning-oriented

DEVELOPMENT-FOCUSED Learn Energized Team-oriented Performance-based

VALUE-DRIVEN

ORGANIZATIONAL FUNCTIONSOperations ManagementAdministrationProduction ManagementMarketingSupplies ManagementHuman ResourcesSalesResearch and DevelopmentFinanceInformation Technology

ORGANIZATIONAL CLIMATEHealthy Unhealthy- Open and free- Seek help- Take risks- Challenged by job

- Frustrated- Threatened- Reluctant- Excuses for shortcomings

TYPES OF ORGANIZATIONUNITARY

DIVISIONALYZED (+) flexible (+) quick to respond to changes (+) innovative (-) duplication of resources (-) limit exchange of knowledge

CENTRALIZED Chief

Administrative division Investigative division Support service division Uniform division

DECENTRALIZEDMATRIX

(+) to combine functional and divisional (-) have 2 bosses (-) not easily to implement (-) ideal for multicompanies

PROCESS-BASED ORGANIZATION

ORGANIZATIONAL CHART

2//carengreyes

ADVANTAGES map lines of decision-making authority helps people understand their assignments and

those of their co-workers reveals to managers and new personnel now they fit

into the organization contributes to sound organizational structures shows formal lines of organizations

LIMITATIONS shows only formal relationship does not indicate degrees of authority may show things as they are supposed to be/used to

be rather than as they are possibility exists of confusing authority with status

MAJOR CHARACTERISTICS THAT DIFFERENTIATE HEALTH CARE ORGANIZATIONservices offeredlength of direct service provisionownershipfinancial provisionteaching statusgeographical locationaccreditation and licensure status

ROLE OF ORGANIZATION Knowledge x Skill = Ability

Attitude x Situation = MotivationAbility x Motivation = Potential Human PerformanceHuman Performance x Resources = Organizational Productivity

MAJOR FORCES INFLUENCING PERSONALITY:

3 PERSPECTIVES OF EFFECTIVENESS Individual Group Organizational

CAUSES OF EFFECTIVENESS: Individual

effectivenessGroup

effectivenessOrganizational effectiveness

Causes:- ability- skill- knowledge- attitude- motivation- stress

Causes:- cohesiveness- leadership- structure- status- roles- norms

Causes:- environment- technologies- strategic choices- structures- processes- culture

SOURCES OF POWERCOERCIVE POWER – is the opposite of reward power and

is based on fear of punishment if one fails to confirmCONNECTION POWER – comes from formal or informal

coalition and interpersonal relations and links to prestigious and influential people within and outside the organization

REWARD POWER – something given in recompenseLEGITIMATE POWER – gives the leader or manager the

right to influence and the staff member an obligation to accept the influence

REFERENT POWER – is based on identification with a leader and what the leader symbolizes

INFORMATION POWER – comes from knowledge, access to information, and the sharing of information

EXPERT POWER– skillful, having knowledge and training

THE NURSE MANAGER INTRODUCTION TO MANAGEMENT

Definition of Management: deciding what to do doing through the effective use of resources coordination and integration of resources through:

P lanning O rganizing L eading C ontrolling

*to accomplish specific goals and objectives within an organization

science and art; a process involving mix of rational leading problem solving decision-making activities intuitive judgment

KEY PURPOSES OF MANAGEMENT AND LEADERSHIP: to provide direction to facilitate change to achieve results through the use of resources

(effective, responsible, creative)

MANAGEMENT THEORIESDIFFERENT THEORIES:

Scientific Management (F. Taylor, M. Weber) Administrative Management (H. Fayol) Human Relations (E. Mayo) Behavioral Science (A. Maslow, D. McGregor) Contemporary Management Theories (Ouchi)

TRADITIONAL MANAGEMENT METHOD: mid-19th century in pre-industrial times apprenticeship cottage industries Laissez-faire economies

SCIENTIFIC MANAGEMENT Taylor, Frederick

Father of Scientific Management frustrated with what he called, “systematic

soldiering”

3//carengreyes

Principles: traditional “rule of thumb” means organizing

work must be replaced with scientific methods scientific personnel system must be established

so workers can be hired, trained, and promoted based on technical competencies and abilities

workers should be able to view how they “fit” into the organization and how they contribute to overall organizational

Nursing Implications: Work specialization Nurse staffing Staffing needs Supervisory tasks Departmentalization

BUREAUCRATIC ORGANIZATION Max Weber, a well-known German sociologist,

proposed bureaucracy as organization designed the need for legalized, formal authority and

consistent rules and regulations for personnel Characteristics of Bureaucracies:

there must be a clear division of labor a well-defined hierarchy of authority there must be impersonal rules and impersonality

of interpersonal relationships a system of procedures for dealing with work

situations must exist a system of rules covering rights and duties of

each position must be in place selection for employment and promotion is based

on technical competenceMANAGEMENT PROCESS THEORY

constitutes the body of knowledge that describes how managers conduct activities to keep the organization

why study? a theory provides criteria for determining what is

relevant provides stable focus for undertaking what

we experience enable us to communicate efficiently challenge us to keep learning about our

world Henri Fayol first identified the management

functions of: Planning

prevoyance (think ahead) examine the future and draw up plans of

action Organization

to organize build with the structure, material, and

human of the undertaking Command

to command (to direct) maintain activity among the personnel

Coordination to coordinate bind together, unify and harmonize activity

and effort Control

to control

see that everything occurs in conformity with policy

Fayol’s 14 Principles Specialization/Division of Labor

a principle of work allocation and specialization in order to concentrate activities to enable specialization of skills and understanding, more work focus, and efficiency

Authority with Corresponding Responsibility managers must be able to give orders and

authority gives this right if responsibilities are allocated then the

post holder needs the requisite authority to carry these out including the right to require others in the area of responsibility to undertake duties

delegation process− the job holder is assigned to act as the

agent of the high authority to whom they report

− allocation and permission to use the necessary resources needed (budgets, assets, staff) to carry out the responsibilities

the R = A correspondence is important to understand

Discipline employees must obey and respect the rules

that govern the organization good discipline is the result of effective

leadership discipline is essential for the smooth

running Unity of Command

an employee should receive instructions from one superior only

even where we are involved with team and matrix structures which one involve reporting to more than one boss—or being accountable to several clients

Unity of Direction unity of command idea of having one head

(chief executive, cabinet consensus) with agree purposes and objectives and one plan for a group of activities must be clear

Subordination of Individual Interest to the General Interest Fayol’s line was that one employee’s on

interests or those of one group should not prevail over the organization as a whole

this would spark a lively debate about who decides that the interests of the organization as a whole are

ethical dilemmas and matters of corporate risk and the behavior of individual “chancers” are involved here

shared set of values by people in the organization

− a unitarianism where the reasons for organization/activities and decisions

4//carengreyes

are in some way neutral and reasonable

Renumeration of Staff price of services rendered general principle is that levels of

compensation should be “fair” and as far as possible afford satisfaction both to the staff and the firm (in terms of its cost structures and desire for profitability surplus)

Centralization process by which the act of an

organization, particularly regarding planning, decision –making, become concentrated within a particular location and/or group

decisions are made by the top executive/ on the basis of pre-set policies

difference between centralization and decentralization

− also called departmentalization

− there are: fewer ties in the organizational

structure wider span of control bottom to top flow of decision

making and flow of ideas Scalar Chain/Line of Authority

scalar chain of command of reporting relationship from top executive to the ordinary shop operative/driver needs to be sensible, clear and understood

straighten chain of command that extents unbroken from the ultimate officer to the lowest ranks

communication should follow this chain this chain creates delays

− cross communication can be allowed if agreed

Order people and materials should be in the right

place at the right time organization should provide an orderly

place policies, rules, instructions and activities

should be understandable one of the basic problem in management is

the balancing of an organization Equity

Fairness and sense of justice “should” pervade the organization in principle

Stability of Tenure

time is needed for the employee to adapt to his/her work and perform it effectively

stability and tenure promotes loyalty to the organization, it’s purposes and values

high employment is efficient if turnovers cannot be prevented,

management should provide orderly

personnel planning and ensure that replacement are available to fill vacancies

Initiative at all levels of the organizational structure,

zeal enthusiasm and energy enable people to have initiative

respect of employee empowerment employees who are allowed to originate

and carry out plans will exert high levels of effort

Espirit De Corps Need for building and maintaining of

harmony among the work force, teamwork and sand interpersonal relationships

This will also build unity within the organization

ACTIVITIES OF MANAGEMENT Luther Gulick expanded Fayol’s management

functions in his introduction of the 7 activities of management

PARTICIPATIVE MANAGEMENT Mary Parker Follet was one of the 1st theorist to

suggest basic principles of what they would be called “participative decision-making”

managers should have authority with rather than over employees

need for collective decision-makingHAWTHORNE MANAGEMENT

Elton Mayo discovered when the management paid special attention to workers, productivity was likely to increase, regardless of the environmental working conditions

“Hawthorne effect” indicated that people respond to the fact that they are being studied attempting

THEORY X AND Y Douglas McGregor, reinforced these ideas by

theorizing that managed vial attitudes about employees can be directly correlated with employee satisfaction

Theory X – lazy, needs constant supervision Theory Y – self-motivated and are willing to work

hard to meet personal and organizational goalsEMPLOYEE PARTICIPATION

Chris Argris self-esteem and independence not met to become

discouraged and trouble some

MANAGERIAL ROLESrole set is specific tasks a person performs because of the

position they holdroles are directed inside as well as outside the organizationTHREE BROAD ROLE CATEGORIES:

Interpersonal roles managers assume to coordinate and

interact with employees and provide direction to the organization Figurehead role : symbolizes the

organization and what it is trying to achieve

5//carengreyes

Leader role : train, counsel, mentor and encourage high employee performance

Liaison role : link and coordinate people inside and outside the organization to help achieve goals

Informational associated with the tasks needed to obtain and

transmit information for management of the organization Monitor role : analyzes information from

both the internal and external environment Disseminator role : manager transmits

information to influence attitude and behavior of employees

Spokesperson role : use of information to positively influence the way people in and out of the organization respond to it

Decisional associated with the methods managers use to

plan strategy and utilize resources to achieve goals Enterpreneur role : deciding upon new

projects ot programs to initiate and invest Distubance handler role : assume

responsibility for handling an unexpected event or crisis

Resource allocator role : assign resources between functions and divisions, set budgets of lower managers

Negotiator role: seeks to negotiate solutions between other manager, unions, customers or shareholders

KEY MANAGEMENT COMPETENCIES: Promote personal and associated development and

empowerment Encourage risk taking innovation and organizational

development Demonstrate socially responsive and ethical behavior Solve problems and make decisions Engage strategic thinking Building partnership with external customers Build and utilize internal network and teams Communicate with others

3 GENERAL CATEGORIES OF MANAGERIAL SKILLS AND ABILITIES: Conceptual skills : ability to analyze and diagnose a

solution and find the cause and effect Human skills : ability to understand, alter, lead and

control people's behavior Technical skills : job specific knowledge required to

perform a task. Common example include marketing, accounting and manufacturing all 3 skills are enhanced through formal training,

reading and practice

NURSING MANAGEMENT LEVELSFIRST LEVEL MANAGER

responsible for supervising non-managerial staff day-to-day activities of a specific unit primarily responsibility for motivating the staff to

achieve the organization

MIDDLE MANAGER supervises a number of 1st level manager's usually in

related specialties or in a given geographical area responsible for people and activities within the

department supervise acts as liaison between upper and 1st level managers

TOP LEVEL executive managers chief nurse executive (CNE) it is to them that middle manager reports primarily responsible for establishing organizational

goals and strategic plans responsible for buffering the effects of the external

environment on nurses within the organization

MANAGERIAL QUALITIESATTRIBUTES OF SUCCESSFUL MANAGERS:

command of basic facts relevant professional knowledge self-knowledge mental agility proactive creative analytical, problem-solving and decision/judging-

making skills continuing sensitivity of events social skills and abilities emotional resilience balance learning habits

FUNCTIONS OF MANAGEMENT • PLANNING: deciding on course of action to achieve desired

results

• ORGANIZING: setting up and staffing the most appropriate organization to achieve the aim

• LEADING: exercising leadership to motivate people to work together smoothly to the best of their ability as part of the team

• CONTROLLING: measuring and monitoring the progress of work in related to the plan of and taking corrective action when required

PLANNING is a mental predisposition to do things in orderly way to think

before acting and to act in the light of factors rather than guesses

deciding for the best alternative among others to perform different managerial functions in order to achieve predetermined goals

PURPOSE: gives direction

6//carengreyes

anticipate and offset change effective use of resources give meaning to work improve program and activities basis for control compels visualization of whole

CHARACTERISTICS: purposeful process not an act deliberate, rationale and objective futuristic flexible largely conceptual dimensional hierarchy in nature

PRINCIPLES: objectives - specific, clear and understood facilitates action coordination and communication maybe delegated constantly improved/re-planned tentative and interim

PLANNING HIERARCHYMission/Vision

Vision – mental image or the power of imagination to see something that is not actually visible

Mission – an aim to be accomplished Philosophy

articulate a vision and provide a statement of beliefs and values that direct one’s practice

Goals the end or outcome to be accomplished

Objectives something aimed at/or striven for; things done to

achieve the goalPolicies

a governing plan for accomplishing goals and objectives

Procedures chronological sequence of sets within a process

Roles set of responsibilities or expected results associated

with a job

KINDS OF ORGANIZATIONAL PLANS:STRATEGIC PLAN

a generalized plan outlining decisions of resource allocation, priorities and action steps to reach strategic goals

have long term focusTACTICAL PLAN

plan aimed at achieving tactical goals developed to implement parts of strategic plans concern more with activity getting things done that

deciding what to do have more specific and concrete focus

OPERATIONAL PLAN focuses on carrying out tactical to achieve

operational goals have short term focus and relatively narrow in scope

TIME FRAME FOR PLANNINGLONG-RANGE PLANS

covers many years any plan beyond 5 years

INTERMEDIATE PLANS less tentative and subject to change usually covers from 1 to 5 years specially important for meddle or first line managers parallel tactical plans

SHORT-RANGE PLANS covers 1 year or less generally affects managers day to day activities 2 KINDS OF SHORT-RANGE PLANS:

Action Plan Reaction Plan – develop to react to unforeseen

circumstances

BARRIERS TO GOAL SETTING AND PLANNING AND HOW TO OVERCOME:BARRIERS:

inappropriate goals improper reward system dynamic and complex environment reluctant to establish goals resistance to change constraints lack of resources government restrictions strong competition

OVERCOMING THE BARRIERS: understand purpose of goals and plans communication and participation consistency, revision and updating effective reward system contingency planning – determination of alternative

course of action to be taken if intended plan of action is unexpectedly disrupted/rendered inappropriate

PURPOSES OF GOALSprovide guidance and unified directionpromote good planning and facilitate future goal settingserve as source of motivation to employeesprovide an effective mechanism for evaluation and control

CORPORATE PLANNINGPHASE I – STRATEGICPHASE II – OPERATIONPHASE III – FEEDBACK AND CONTROL

PLANNING PROCESS

7//carengreyes

STAGE 1: ANALYSIS OF OPPORTUNITIES SWOT Analysis – this is formal analysis of your

strengths and weaknesses, and if the opportunities and threats that you face

Risk Analysis – understanding pressures for changeSTAGE 2: IDENTIFYING THE AIM OF YOUR PLAN

What do I want the future to be? What benefits do I want to give my customers? What returns do I seek? What standards am I aiming at? What values do I and my organization believe in?

STAGE 3: EXPLORING OPTIONSSTAGE 4: SELECTING THE BEST OPTIONSTAGE 5: DETAILED PLANNINGSTAGE 6: EVALUATION OF THE PLAN AND ITS IMPACTSTAGE 7: IMPLEMENTING CHANGESTAGE 8: CLOSING PLAN

PLANNING CYCLE

STEPS IN PLANNING FUNCTIONS: Establishment of objectives Establishment of planning premises Choice of alternative course of action Formulation of derivative plans Securing Co-operation Follow-up/Aprraisal of plans

BUDGETa planning document used by a department or organization

that forecasts both receipts and expendituresa systematic programming of organizational activities

based on their cost and on the amount of resources available

BUDGET PROCESS

refers to those activities and steps needed to be taken for the manager to formulate a budget

BUDGET WORKSHEET a tool used for/by a manager to prepare their budget

VARIANCES a general term to describe the difference between a

budgeted number and an actual resultSTEPS IN BUDGETING:

Review past performances Review the organization's goals and projection Review the variance Actual preparation of budget

TYPES OF BUDGET: Operating (revenue, expense) Personnel Capital Expenditure Cash Flexible

NUMBERIZING PLANS BY BUDGET: developed such budget as volume and price of sales operating expenses necessary for plans expenditure for capital equipment

GANTT CHARTimplemented work over a perioda time-scale is given on the chart's horizontal axis and each

activity is shown as a separate horizontal rectangle (bar) whose length is proportional to the time required (or taken) for the activity's completion

in project planning, these charts show start and finish dates, critical and non-critical activities, slack time, and predecessor-successor relationship

also called CHRONOOGRAM, invented in 1917 by Henry L. Gantt (1861-1919)

PRINCIPLES OF THE GANTT CHART: measure activities by the amount of time needed to

complete them represent amount of activity that should have been

done in time

ORGANIZING the establishment of a formal structure of authority, through

which work subdivisions are arranged, defined and coordinated for the achievement of defined objectives

provide the relationships between people activities in such way as to organizational goals

occurs through interactional phenomena because of hierarchal arrangement of interdependent people

can be defined as: act of deploying the resources needed to achieve an

identified goal including human resources organizing is critical to success for any enterprise considers whether the resources at their disposal are

effectively deployed PURPOSE: best use of the organizations’ resources to achieve

organizational goals Special phenomenon:

power authority status process of delegation

8//carengreyes

LEVELS OF ORGANIZING*Organizing take place in many levelsFIRST: ORGANIZE YOURSELF

get control of your desktop and work area at scheduled intervals

critically evaluate your daily routine at scheduled intervals

avoid time-wasting people and activities inventory your inbox contents organize your day so that your daily activities will

accomplish your plans do not over-schedule yourself

try to avoid scheduling more than half of any day if at all possible

leave time for the work that will have to be done as a result of the events that you have scheduled

examine your daily routine try to avoid scheduling more than half of any day if at

all possible practice the “first things, first” rule

always do first things never do second things

delegate, don’t abdicate inform other who need to know delegate only those things you should avoid procrastination

do the tasks you enjoy the least, firstORGANIZE YOUR DEPARTMENT TO MEET ITS GOALS AND

OBJECTIVES how many layers of management you are in? If there

is more than one why? is the span of control principle observed in your

department? do employees understand the department’s goals

and objectives? are you using the most effective means of

communication? do you have (or attend) too many meetings? do all meetings have a stated purpose and a written

agenda? Agenda item assigned a time limit?

STEPS IN ORGANIZING PROCESSReview plansList tasksGroup tasks into jobsGroup jobsAssign workDelegate authority

TERMINOLOGIESJOB – collection of tasks and responsibilities that an

employee is responsible to conduct; jobs have titlesFUNCTIONS – large number of tasks a complex positions in

the organizationTASK – typically defined as a unit of workROLES – set of responsibilities or expected results

associated with a job

TIME MANAGEMENT

set of skills, tools, systemswork togetherhelp you get more value out of your timewith the aim of improving the quality of your lifeTIME MANAGEMENT STRATEGIES:

Action Idea Logic People time styles Time analysis Daily planning Crisis control Problem analysis Time control Time evaluation

BARRIERS TO EFFECTIVE TIME MANAGEMENT: Habit Work expansion Oversuspension Underdelegation Losing sight of objectives

PRINCIPLES OF TIME MANAGEMENT: Communication Planning Delegating Prioritizing goals

SKILLS ASSOCIATED WITH TIME MANAGEMENT: Planning Prioritizing Goal setting Scheduling Managing your workload

KINDS OF TIME: Managerial Response Discretionary

TIME MANAGEMENT PROCESS: analyzing the present situation

where am I now? developing relevant assumptions

what conditions will most likely exist within the time span of the plan

establish objectives what do I want to achieve?

developing alternatives what ways might I attain objectives?

making a decision implementing the decision establishing review and control

TIME MANAGEMENT TECHNIQUES: personal commitment to improving deciding what not to do learning to say no recording how time is used planning use of time fire fighting vs fire prevention prime time programming blocks of time organizing the workspace memoitis – essential but use only when necessary

COMMON TIME WASTERS: overcommitment visitors

9//carengreyes

telephone meetings indecision paperworks and readings lack of delegation lack of priorities

MANAGE MEETINGS: start on time end on time develop agenda only those needed must be present gather information prior to meeting

TECHNIQUES TO STOP PROCRASTINATION: break a large job down to smaller tasks do a start-up task take advantage of your moods consider the consequences of not doing the job consider hiring someone to do the job consider switching job with someone divide up the job to do what one likes to do make a commitment to someone/wager with

someone set goals set realistic time schedule gather necessary information avoid over-commitment give yourself a reward organize the department

functional product geographical process

BENEFITS OF TIME MANAGEMENT: efficient success healthy

OBSTACLES TO EFFECTIVE TIME MANAGEMENT: Obstacles

Unclear objectives Disorganization Inability to say “NO” Interruptions More interruptions Periods of inactivity Too many things at once Stress and fatigue All work and no play

What we can do? Recognize that obstacles exist Identify them Set goals (Specific, Measurable, Attainable,

Realistic, Time bound) Prioritize (Do, Delegate, Delay, Delete) Organize Learn to say “NO”

You can't do everything Don't undertake things you can't complete Remain consistent to your goals

Use your waiting time on public transportation at doctor's office waiting for your phone

on hold when you are early correspondence letter/memos book/tapes

Concentrate on the task at hand Focus on your goal

Consider personal time Morning? Evening? Late night?

Celebrate your success

DECISION-MAKINGis the skill to solve problems by selecting the one course of

action from several possible alternativesit is a key component of time management skills DECISION MAKING PROCESS:

identify the problem and analyze the situation explore the alternatives choose the most desirable alternative implement the decision evaluate the results

DECISION STRATEGIES: Optimizing : greatest possible gain Satisficing : good enough solution Mixed Scanning : satisfied to remove least promising

solutions than select best of remaining options Opportunistic : solution chosen by problem identifier Do Nothing : waiting for the storm to pass Eliminate Critical Limiting Factor : remove most

powerful obstacle to succeesPROBLEM SOLVING PRINCIPLES:

rely on policy for small problem: conserve time for large, unique problems

delegate recurring problems to subordinates trained to handle them

seek information for problem solving from internal and external experts

ensure adequate time and relaxed conditions for creative problem solving

after appropriate consideration, select and implement best solution without rumination

STAFFINGprovides the appropriate numbers and mix of nursing staff

and nursing care hoursto match the actual/projected patient care needsthat will lead to the delivery of effective and efficient

nursing careDETERMINING NURSING CARE HOURS

Nursing Hours Per Patient Day (NHPPD) calculated by dividing the total nursing care

hours by the total census (number of patient) there are no specific standards for nursing care

hours, it varies from the average of 5-7 hours in the medical/surgical units; 10-24 in CCU; 2428 for new, severely burned, selected clients

DETERMINING FULL-TIME EQUIVALENT (FTEs)

10//carengreyes

one FTE = 40 hours of work/week for 52 weeks or 2080 hours/year

this is used to staff a unit 24 hours a day, 7 days a week

techniques in determining FTEs hours of week for the staff for 2 weeks, average

daily census and hours of care formula:

ave nsg care hrs x days of staffing period x ave px census hours of week/FTE in 2 weeks

data:− number of hours worked/FTE in 2

weeks = 80− number of days of coverage in 2 weeks

= 14− average daily census = *depends− average nursing care hours (based from

patient classification system) = 6.15 DETERMINING DISTRIBUTION OF STAFF

patient census – or average patient days (annual census/number of beds)

activities workload (care demands) skills of staff training and staff development exposures occupancy rate (average patient days/number of

days in a year) patient-related groups (DRGs)

SCHEDULING cyclic list of nurses working in a given week, in a

particular unit shows balance to work flow between nursing needs

and staff available it allows efficient giving of assignments and improve

staff utilization

PATIENT CLASSIFICATION SYSTEM (PCS)a scheme that groups patients according to the amount

and complexity of their nursing care requirements; it serves as a tool to reassure patient needs, caregivers interventions and the skill levels, required to meet those needs

developing a fair, objective, and reliable way to predict the required number and skill level of staff

to meet patient needsproviding appropriate staffing assignmentmeasured by standards of caredetermined by the number of hours of care neededto provide quality of care to the patientPURPOSES OF PCS:

determine the unit measure for: nursing time nursing hours per patient day (NHPPD)

time needed to provide patient care according to hospital department standards of care and practice

determine: number

monitor changes in patient care needs provide data on each patient care unit to project

staffing needs

ensure quality nursing care provided in a safe environment

PATIENT CLASSIFICATION SYSTEM: Category I – ambulatory; needs no assistance from

health professional Category II – with minimal assistance; with IV

tubings; NSD minor surgery, few days post-operative Category III – with moderate assistance; immediate

post-operative Category IV – full assistance with dependence on

health professional; comatose neurological patientUSES OF PCS:

improve patient satisfaction by providing required time to the patient according to his/her needs

enhance staff satisfaction monitor the provision of quality nursing care

PRIORITY SETTINGINVOLVES:

list the things that frequently get in the way identify aspects of your work that lies in and out of

your control keep a time log (set time frames) evaluate and analyze likely upcoming demands

SUGGESTED PRIORITY SETTING PRACTICES: set up a written priority matrix to analyze activities

that really merit higher priorities attach deadlines “To Do item” always allot a margin of time for interruption in your

plans clarify the time needed for the interruption; decide

whether you can handle it now when you become overloaded, ask for a meeting

with appropriate people: explain the competing demands suggest alternatives ask for additional ideas press for a decision about re-ordering priorities

and responsibilities when you take on a task, clarify scope and

expectations for its completion determine where the importance of this task file in

the “big picture” whenever delegating a task, explain set a specific task

CONSIDERATIONS IN PRIORITY SETTING: ABC of the ABC Maslow’s Hierarchy of Needs Professional ethics/laws Institutional safety rules/regulations

safety firstDELEGATION

it is handling of a task over to another person, usually a subordinate

it is assignment of authority and responsibility to another person

allows a subordinate to make decisions ensure that the delegate understands:

why the work is to be done why they are expected to do

11//carengreyes

the date by which they are expected to do it the authority they have to make decision the problems they must refer back the progress or completion report they should

submit how you propose to guide and monitor them the resources and help they will have to complete

the workTIPS FOR DELEGATION:

competent employee reasons for selecting employees explain what and why guidance and support delegate, don’t abdicate inform other who need to know only those things you should

MODALITIES OF DELIVERING NURSING CAREFUNCTIONAL

Advantages The needs of a group of patient are broken down

into tasks Tasks are assigned to RNs/LPNs so the skill are

used to the best advantage Contribute to efficiency and effectiveness in doing

assigned tasks Disadvantages

Uneven continuity of care No holistic view of patient Time consuming Problem with follow-up

TEAM NURSING

a team of nurse provides total patient care to a group of patient A team of nurse to a group of patient Modular limit the team in a geographical area

Advantages Allows use of less prepared nurses Coordinated care

Disadvantages Requires much time for effective communication,

supervision and coordination Diminished continuity of care Fragmented care of client Role confusion

TOTAL PATIENT CARE

also called Case Method one RN is responsible for all aspects of care of one or

more patient Advantages

Continuous, holistic, expert Total accountability Continuity of communication

Disadvantages Too expensive Spends much time with tasks that can be

delegated Places the RN back to the patient bed side from

admission to discharge There is decentralized care RN designs, implements and evaluates patient

care

CASE MANAGEMENT

a model identifying, coordinating and monitoring the implementation of services needed to achieve desired patient care outcomes with a specified period of time

Advantages Reduced complications Reduced cost Increase collaborations Improved quality care

Disadvantages Case manager does not give direct nursing care Treatment focused High level of coordination, supervision and

communication Expensive

PROGRESSIVE DISCIPLINE APPROACH

No Discipline

Goal Warning

Written Warning

Supervision

12//carengreyes

Charge Nurse

Med Nurse

TreatmentNurse

Bath duty Nurse(ADL)

Charge Nurse

Patient

Team/Module leader

Team/Module leader

Patient Patient

Charge Nurse

RN RN RN

RN / LPNs RN / LPNs RN / LPNs

Team/Module leader

Patient Patient Patient

Patient Caseload

Caregiver

Case Manager

Caregiver Caregiver

Improper Behavior

Termination

Steps in Progressive Discipline: Counsel the employee regarding the performance

problem and expectations for improvement. Timeless for improvement are given

Reprimand the employee for the first time if the unacceptable behavior continues. This may be oral/written, depending on policies/contacts

Reprimand the employee for the second time if the unaccepted behavior continues. This must be written

Suspend the employee for a given period of time if the unacceptable behavior continues

Terminate employee if the unacceptable behavior continues after return from suspension

Principles of Disciplinary Actions: Have a positive attitude Investigate carefully Be prompt Protect privacy Focus on the act Enforce on the act Enforce rules consistently Be flexible Advice the employee Take connective, constructive action Follow-up

Principles of Disciplinary Actions: Describe the situations and review previous

agreements Ask for explanation Listen and response with empathy Indicate what action you must take and why Agree on specific action Express confidence

Modification of Employee Behavior: Reinforcement Shaping Punishment Extinction

Components of a Disciplinary Action: Codes of conduct Authorized penalties Records of offense and corrective measures Right to appeal

LEADING the 3rd function of management ability to inspire and to influence others in order to attain the

objectives FIRST ACTIVITY

give directions − Clear− Concise− Consistent− Conforms to requirements

should conform with the requirements of the situation tone of directions (different situation requires different

emphasis)

DIRECTING

function of management that gets work done through others

5 SPECIFIC CONCEPTS OF DIRECTING: Giving directions Supervising Leading Motivating Communicating

REASONS WHY PEOPLE ARE DIFFICULT TO DIRECT: Fundamental disagreement Rivalry Different values Real or imagined sight Arrogant behavior or as perceived Feeling worthless Frustrated ambition Not being able to get own way Concern about impact of change Too much pressure – real/ perceived

SUPERVISINGconcern with training and discipline of the work forcefollow-up to ensure prompt execution of ordersSUPERVISOR’S ROLE AS LINE/MIDDLE MANAGER:

People management Managing managerial costs Providing technical expertise Organizing, such as planning work allocation,

monitoring work process Checking quality Dealing with customers/clients Measuring operational performance

SUPERVISOR’S ROLE IN TRAINING: Formulating training objectives Planning the training program Performing training program Evaluating effectiveness

SUPERVISOR’S ROLE DURING ON-THE-TRAINING: preparing the trainer: setting an atmospheres of

receptivity demonstrating the parts of the job; tell and show performance by the trainee; do not permit trainee to

learn in error follow-up and review

QUALITIES OF A SUCCESSFUL SUPERVISOR: Gives clear work orders, communicates well Praises others when deserved Is willing to take the time to listen Has confidence and self-assistance Gains the group’s respect through personal honesty Fair to everyone Demands good work for everyone Gains group trust by representing their view to

higher management Has appropriate technical knowledge of the work

being supervised Understands the group problems Goes “to bat” for the group Is approachable, friendly yet retains some distance

KEY POINTS TO SUPERVISOR’S ROLE IN TRAINING:

13//carengreyes

efficiently trained employees will produce less waste and have fewer accidents

poorly trained employees have higher roles of absenteeism, tardiness and turnover

wait for competently trained employees; don’t rush the process

key part of training is the preparation of the trainee remember the 3 basic objective of training point out what the employees know, and do not

know and what they should know and do define what is considered acceptable performance real education should be directed to improve

competence beyond the job now held supervisor plays a critical role in the updating of

training programs and employees skills

CONFERENCEwidely used method of training in healthcareoffers participants the unusual opportunity to contribute

ideas, exchange experiences and solve problem by areas of pooled judgments

drawing together employees with varying skills, experiences and responsibilities in order for the group to learn from each other

success of the conference is dependent on its composition and the skill of the leader

SUPERVISOR AS CONFERENCE LEADER knows the topic planned for the conference fully aware of its goals

EFFECTIVE CONFERENCE MANAGEMENT CHECKLIST Make certain the subject is worth a meeting Plan carefully Work out a plan of action Inspect the meeting room Know the participants Review your responsibilities Don’t forget follow-up

THEORIES OF LEADERSHIPSituationalContingencyTransformation

LEADERSHIP STYLESAutocraticDemocraticLaissez-faire

MOTIVATINGset of skills manager uses to help employee to indentify

own needsfind ways within the organization to help satisfy themcaused behavior, a psychological process that gives

behavior purpose and directionTHEORIES OF MOTIVATION:

Need theorists (Maslow) Personality type

Dissatisfies – relate to pay, job security Satisfiers – content with work

Expectancy theory (Vroom) chance of high satisfaction rewards through

effort HOW TO MOTIVATE PEOPLE?

Take care Be optimistic Respect your employee Create an environment that has meaning for the

employee/his work Encourage new ideas and innovations Develop your employees professionally and

personality at all times Provide awards and rewards Total commitment Make efforts to retain talented and committed

employees

COMMUNICATINGinteractive process whereby the leader influence a groupthe medium by which leadership is conveyed to the groupinvolves the what, how, why the direction is necessarytransfer of information and understandingCOMPONENTS OF COMMUNICATION:

Message – the idea to be conveyed

Communication process – consists of 6 steps Ideation Encoding Transmission Receiving Decoding Response

Communication Climate Positive – enhances the message Negative – detracts from understanding the

message10 BASICS FOR GOOD COMMUNICATION:

Clarify your ideas before communicating to others Consider the physical setting Consider the psychological environment Consult with others when necessary to be sure your

communication is accurate Be mindful of the tome as well as the words of the

message Take the opportunity to convey something to help,

value or praise to the receiver Follow-up your communication Non-verbal communication should support

communication Be an active listener Be assertive when expressing your view

ACTIVE LISTENING Stop talking Put other person at ease Don’t interrupt Empathize Paraphrase Ask open minded questions Use silence

14//carengreyes

Allow reflectionBLOCKS TO COMMUNICATION:

Poor listening habits Time and work demands Semantics Frame of reference

CONTROLLING a process comparing actual performance and taking corrective

action if needed to achieve desired objectives PRINCIPLES OF CONTROLLING:

Reflect the nature and needs of the activity Report deviations promptly Forward-looking Objective Flexible Point up exceptions at critical points Economical Understandable Lead to corrective action Reflect the organization pattern

PURPOSES OF CONTROLLING: Establish standards of performance Determine tools to measure performance

− 7 Ms to control: Manpower Mins (time) Money Machine Method (Policies) Materials

Evaluate and provide feedback of performance Improve productivity Provide quality management Institute necessary change

TYPES OF CONTROL: Feedforward – anticipating for the outcome or the

future Concurrent – continuous supervision Feedback

PRINCIPLES OF SUPERVISING CONTROL: Preventive control Management by exception Strategic control point

CONTROL PROCESSStep 1: Establish performance standardsStep 2: Measure actual performanceStep 3: Compare measured performanceStep 4: take corrective action

CHARACTERISTICS OF EFFECTIVE CONTROLProperly designedPrevent problems it was designed to detectSet appropriate standardsSpecify solutionsAccurate and timely

PERFORMANCE APPRAISAL

as a structured formal interaction between a subordinate and supervisor that usually takes the form of a periodic interview (annual or semi-annual) in which work performance of the subordinate is examined and discussed with a view to identifying weaknesses and strengths as well as opportunities for improvement and skill development

APPRAISAL METHODS: Rating Scales

offers a high degree of structure for appraisals traits relevant to appraises job are rated on a bipolar scale/points ranging from “poor” to

“excellent” Advantages :

Structured and standardized Same criteria, rating process for all Easy to use and understandable

Disadvantages : Trait relevance Systematic disadvantages Perceptual errors Perceived meanings Rating errors

Essay Method the appraiser prepares a written statement about

the employee being appraised statement usually:

concentrates on describing specific strengths and weaknesses in job performance

suggests causes of action to remedy the identified problem areas

statement maybe written and edited by the appraiser alone, or it be composed in collaboration with the appraise

Advantages: Less structured and confining Permits the appraiser to examine relevant

issue or attribute of performance Process is open-ended and very flexible

Disadvantages: Time-consuming Difficult to administer Demanding Writing skills of appraisers can

upset/distort the whole process Process is subjective

Rating Scales measure employee performance by examining

the extent to which predetermined work objectives have been met

objectives are established jointly by the supervisor and subordinate

once an objective is agreed, the employee is usually expected to self-audit

to identify the skills needed to achieve the objective they are expected to monitor their own progress and development

Advantages: Concentrates on actual outcomes Employees are judged according to real

outcomes Direct results can be observed

15//carengreyes

Advocate that employees performance cannot be taken into constituent parts

Disadvantages: May lead to unrealistic expectations about

what can and cannot be reasonably accomplished

Need for a strong “reality checking” skills for supervisors

Tend to impose a certain rigidity Variable objectives may cause employee

confusionTECHNIQUES OF PERFORMANCE APPRAISAL:

Encourage discussions Constructive intervention Set performance goal Credibility of the appraiser Steps:

Do background work for the performance review Clarify job description and responsibilities Clarify employee development interests and

needs List specific development areas for concentration Review performance objectives and performance

standards Review progress toward objectives through

ongoing feedback and pre-discussions Decide on purpose (s) include giving employees

answers to: What am I expected to do? How well am I going? What are my strengths and weaknesses? How can I do a better job, how can I

contribute more?BENEFITS OF APPRAISAL:

Motivation and satisfaction Training and development Recruitment and in direction Employee evaluation

COMMON MISTAKES IN APPRAISAL: Fear factor Judgment aversion Feedback-seeking Appraiser preparation Employee participation Employee education

BIAS EFFECT OF APPRAISAL: “Matthew Effect”

suggests that no matter hard an employee strives, their past appraisal records will prejudice their future attempts to improve

CHARACTERISTICS OF EFFECTIVE APPRAISAL: Specific Descriptive Certain that feedback is not self-serving Directed towards behavior that can be changed Sensitive to time Feedback is clearly understood

MAINTAINING IMPROVED PERFORMANCE: Describe the improvement Explain the benefit of said improvement to you and

the group Listen with empathy to employee’s comments

Ask the employee if there is anything you can do to further improvement

If appropriate, indicate your intention to take such action

Thank the employee for the improvement

ALLOCATION OF RESOURCESAllocation – decision an organization makes regarding how

many of its resources will be devoted to a particular effortResource Allocation – distribution of organizational assets

to meet identified organizational goalsCONCERNS OF ALLOCATION:

Making staffing mix decisions Meeting regulations requirements Providing care to individual who are medically

indigent and have long-term care needs Providing needed patient care programs Compare values Learning to use finite resources efficiently Wise distribution of available resources Ensure cooperation of everyone

PROCESS OF ALLOCATION: Identify organizational goals Identify available organizational assets/resources Define constraints on decision maker Finding appropriate resources

COST CONTROLThe monitoring of costs, recording, and analysis of the data

to take correctiveCost control implies good cost management which must

include: Cost Estimating Cost Accounting Project Cash flow Earned value reporting

CONCEPT OF COST CONTROL: Cost control is designed

To put pressure on the project manager To perform exceptionally good project So that changes will be minimized

PHASES OF COST CONTROL:

*operating cycle from phase II – phase VPURPOSE OF COST CONTROL:

Derivation of output specifications (project – objectives)

Delineation of required activities (work) Coordination and communication between

organizational units

16//carengreyes

Determination of type, amount and timing of necessary resources

Recognition of high-risk elements and assessment of uncertainties

Suggestion of alternative courses of action Realization of effect of resource level changes on

schedule and output performance Measurement and reporting of genuine progress Identification of potential problems Basis for problem solving, decision making and

corrective action Assurance of coupling between planning and control

QUALITY CONTROLRefers to quality related activities associated with the

creation of project deliverablesUsed to verify that deliverables are of acceptable quality

and that they are complete and correctExamples: Peer review; testing processInvolves performance management and maintenanceIncludes systematic method of ensuring conformance to a

desired standard or normQUALITY ASSURANCE (QA)

Refers to the process used to create the deliverables, and can be performed by a manager, client or even a third party reviewer

Examples: process checklist; project audits Process of establishing a target degree of excellence For nursing intervention and taking action to ensure

that each client receives that agreed on level of care Objectives of QA:

Set standard for nursing care delivery Establish as basis to evaluate this standard

Components of QA program: Clear and concise written statement of purpose,

philosophy, values and objectives Standards or indication for measuring quality of

care Policies and procedures for using such standards

in data gathering Analysis and reporting of the data gathered with

isolation of problems and variances Use of the results to prioritize and correct

problems and variances Monitoring of clinical and managerial

performance and ongoing feedback Evaluation of the Q.A. system

QUALITY IMPROVEMENT (QI) Concerned with performance development On going Involved with fixing NOW Preventing future costly mistakes Fostering breakthrough Continuous Quality Improvement (CQI):

Ongoing process of monitoring structure, process and outcome indicator in order to identify signal events, significant trends and opportunities for change

It integrates QA, QC, and QIDIFFERENCE BETWEEN QA AND CQI:

Q.A. – goals only air at maintaining care quality at a present level

C.Q.I. – ongoing process through which care standards and practice behaviors are progressively enhanced Current research findings Practice Patient and public welfare

NURSING CARE STANDARDSStandardThe desired quantity, quality or level of performance that is

established as a criterion against which worker performance will be measured

PURPOSES: Guide the provision of nursing care Provide the means by which nursing personnel are

evaluated in the provision care Provide the means by which to measure the end

results of nursing care through patient outcomesSTANDARDS OF CARE REFERS TO:

Nurses conducting themselves professionally according to generally accepted reasonable practice of nursing care

Conduct themselves with the degree of care, skill and knowledge that reasonably competent nurses would exhibit in any situation

Practice that avoid being found negligent Exercise good judgment, education and training to

the best of their ability under any circumstancesSOURCES OF STANDARD OF CARE:

Nursing Law Professional organizations Code of Ethics for Nurses Joint Communication Accreditation of Healthcare

Organization (JCAH) Case Law and Published opinions by judges State Statutes and Administrative Codes Hospital Policies Authoritative Nursing Journals

LEADERSHIP • NURSING LEADERSHIP:

- What is a leader?- Who is a good leader?- What are the characteristics of a good leader?

• LEADERSHIP:- the process of influencing people while operating to

meet organizational requirements and improving the organization through change

- use of personal traits to constructively and ethically influence organizational outcome are achieved through collective efforts

• LEADER: a person who demonstrates and exercises influence and power (charismatic) over others

• MANAGEMENT: activities need to plan, organize, motivate

• MANAGER: person who directs team of workers• DIFFERENCE BETWEEN MANAGERS AND LEADERS:

MANAGER LEADER- have an assigned position - often do not have delegated

17//carengreyes

within the formal organization- have legitimate source of

power d/t delegated authority that accompanies their position- expected to carry out

specific functions, duties and responsibilities- emphasize control, decision

making, analysis, and result

- directs people

-manipulates people, the environment, money, time and other resources to achieve organizational goals- have greater formal

responsibility, accountability and control than leaders- directs willing and unwilling

subordinates

authority

- obtains power through other means such as influence

- has a wide variety of roles than managers do

- focuses on group process, informing, gathering, feedback and empowering others- emphasizes interpersonal

relationships- have goals that may/may not

reflect those of the organization

-may or may not be part of the organization

- directs willing followers

LEADERSHIP CONCEPTS People ask the difference between a leader and a boss… The

leader works in the open, and the boss in convert. The leader leads, and the boss drives. – Theodore Roosevelt

3 ESSENTIAL ROLES OF LEADERS: Define task Achieve the task Maintain effective relationships

PRINCIPLES OF LEADERSHIP: Leaders are made not born It can be learned It requires certain traits No one best style or leadership

PROCESS OF LEADERSHIP: Vision Mission Critical Success factors Goal Actions Steps Results!

FUNCTIONS OF A LEADER: Motivator Mentors Confessors Cheerleaders Coaches Role models Sounding boards

LEADER AND MANAGERLEADER

Facilitator Coordinator Peers or followers Inspiring and integrating Coaching and challenging

Macro Management Problem solving and quality management

MANAGER Director Controller Micro management Blaming Problem identifying Telling and selling Subordinates

THEORIES OF LEADERSHIPDEVELOPMENT OF LEADERSHIP THEORY (1900-PRESENT):

Management and leadership theory is dynamic What is known and believed about leadership Contributes to change overtime

LEADERSHIP THEORY: Describe the nature of leaders

Who are they? What are their unique accomplishments? What are the situations where leadership

intervention required?THEORIES OF LEADERSHIP:

Theories of Leadership (1900-1940) Great Man (1841)

Thomas Carlyle Born with the necessary characteristic to

be great

Trait (1940) C. Bird Inherited could be obtain through learning

and experience Behavioral Theory (1940-1980)

Leadership Style (Kurt Lewin) Authoritarian Leader – dependence

− Strong control is maintained− Motivated by coercion− Communication downward− “I”

Democratic Leader – Independence− Less control− Directed through suggestion and

guidance− Communication flows up and down

− Decision making involves others − “We”

Laissez-faire Leader – Chaos − No control− No direction

Humanistic (1960) Ability to manage “people” more than

organization resources Social environment

Theory X and Theory Y McGregor X – controlled, coerced with threaten Y – self-directed, self-control

Theory Z (1965) W.G. Ouchi Lifetime employment

18//carengreyes

Slow promotion Self-Actualization (1965)

Abraham Maslow Contingency Approach (1960)

F.E. Fieldler Task structured Leader-maker Position power

Path Goal (1971) R.J. House Minimize obstruction

Situational (1950-1977) Hershey and Bianchard The follower become leader in some situation

Servant – Leadership (1977, 1991) Natural feeling that one wants to serve

Charismatic (1994) Max Weber Inspires by obtaining emotional commitment Strong beliefs, high, self confidence

Transformational (1994) Heinrich von Pierer Valuing Empowering Promoting quality

Visionary (1994) P. Senge To follow vision through self confidence Empathy

Ethical (1994) R. Heifets

QUALITIES OF A LEADER (MAXWELL)CharacterCharismaCommitmentCommunicationCompetencyCourageDiscernmentFocusPositive AttitudeProblem SolvingRelationship

ResponsibleGenerosityInitiativeListeningPassionSecurityServant hoodSelf DisciplineTeach abilityVision

ABC OF LEADERSHIPPositive Attitude – Self knowledgeEffective Behavior – Communication skillsPersonal Confidence – Transformative practice

PHASES OF LEADERSHIP GROWTHPhase 1 – I don’t know what I don’t knowPhase 2 – I know what I don’t knowPhase 3 – I grow and know and its starts to showPhase 4 – I simply go because of what I know

Ineffective – 1 and 2 Effective – 3 and 4

FORMAL AND INFORMAL LEADERS

Formal – those who are officially assigned leadership responsibilities within the organizationBasis for

ComparisonInformal Formal

General Unofficial OfficialMajor concepts

Power and politics

Authority and responsibility

Primary Focus Person PositionSource of power

Given by group

Delegated by management

Guidelines for behavior

Norms Rules

Sources of control

Sanctions Rewards and penalties

FACTORS OF LEADERSHIPSituationFollower – LeaderCommunication

HOW TO BECOME A GOOD LEADERKnow yourself and seek self improvementBe technically proficientKnow your people and look for their well-beingKeep your workers informedSeek responsibility and take responsibility for your actionsEnsure that the tasks are understood, supervised and

accomplishedDevelop a sense of responsibility in your workersTrain a teamUse the full capabilities of your organization

MORAL ASPECT OF LEADERSHIPRelease of human potentialMutual interdependence of individual and groupMaintain and review valuesFoster individual initiative and responsibilityVALUES:

Deeply held values and principles provide the road map for the way we lead and the way other people respond to us

Managers are people who do things right while leaders are people who do the right thing – Warren Bennis PhD

KNOW the four factors of leadership (follower, leader, communication, situation)

KNOW yourself KNOW human nature DO provide direction DO implement DO motivate BE a professional BE a professional who possesses good characteristics

PROFESSIONAL AND PERSONAL DEVELOPMENT

19//carengreyes

ETHICO-MORAL ASPECTS OF NURSING PRACTICE ETHOS: meaning MORAL DUTY, the practical science of the

morality of human conduct MORALS: specific behaviors to accomplish ethical practices HEALTH ETHICS: division of ethics that relate to human health;

also termed as the ethics for the health profession PROFESSIONAL ETHICS: obligations of professional to the

general public BIOETHICS: moral issues in the field of health

NURSING ETHICS(Venzon, et. Al) – the interrelatedness of all principles of

right conduct as they apply to nursing profession(Johnson) – examination of all ethical and bioethical issues

from the prospective of nursingPURPOSES OF NURSING ETHICS:

it directs and teaches the professional nurse how they should act and how it should be

it pertains to the manner of acting and the means to do a certain act in the right way

IMPORTANCE OF BIOETHICS: Every health care provider is a moral agent The health care provider must make his decisions

responsibility through correct moral reasoning and well grounded judgment

PROFESSIONAL CODEBody of information that nurses confer or consult in

making decisions

2 TYPES: Code of Ethics – consists of declarations of faith and

ideas, which the profession upholds and the members conform and follow

Code of Conduct – consists of a paradigm of moral action or a framework of behavior, it is of guideline professional behavior

LAWA system of principles and practices by which people who

live in a society deal with their disputes and problems, seeking to solve or settle without resort to force

Serve as a guide to conductThe sum total of rules and regulations by which society is

governed; rule of conduct pronounced by controlling authorities

Rules of conduct, established and enforced by authority, which prohibit extremes in behavior so that one can live without fear for one self or one’s property

CLASSIFICATION OF LAW (in general): Divine Law – authority – GOD Human Law – authored by man

Public Law – applies generally to people of state enacting it Criminal Law – treats of the nature, extent

and degree of every crime

International Law – regulates the intercourse of nations

Political Law - defines the organization and operation of the government organs of the state and regulates relation between state and individual that compose it

Private Law – relates to private matters that do not concern public at large and administered between citizen and citizen Civil Law – has double purpose of

organizing the family and regulating property

Commercial Law – relates to the rights of property and the relations of persons engaged in commerce

Remedial Law- prescribes method of enforcing rights obtaining redress of their invasion

LEGAL RIGHT That which a man entitled to have or to do, or to

receive from others within the limits prescribed by law

That right to which the states gives sanction A claim which can be enforced by legal means

against persons or the community whose duty is respect it

PURPOSES OF STUDYING ETHICO-LEGAL AND LEGISLATIVE ISSUES: Serves as guide in the performance of nursing

functions and responsibilities addressed by the law Reflect certain concepts of the law in the day to day

functions and tasks Prevent/resolve conflict that may affect basic

societal and individual rights Appreciate nursing’s overall mission, its limits and

constraints Analyze impact of law/legislative issue on nursing

ESSENTIAL SOURCES OF LAW: Constitution Statutes/legislation Regulations issued by executive branch of

government Case decisions/judicial opinions Presidential decrees Letters if instructions

TYPES OF LAW: Tort – legal wrong committed against a person or

property, e.g. assault, battery Unintentional – negligent acts Intentional – presence of interest to harm

another person Liability – obligation incurred or might incurred due

to actions or failure to act Personal – individual person is liable for his/her

actions Vicarious – negligence is assumed due to

association with negligent person Corporate – the organization is responsible for

wrongful conduct of its subordinate

LEGAL ISSUES OF NURSING PATIENT CARE ISSUES:

20//carengreyes

Patient’s rights Invasion of privacy Confidentiality Informed consent Sexual Harassment Occupational safety

MANAGEMENT ISSUES: Delegation and supervision Staffing Job reassignment (floating) Policies and procedures Incompetent practice Sexual Harassment Occupational safety

SCOPE OF NURSING: Provide nursing care utilizing nursing process Establish linkages with community resources and

coordination with health team Promote Health education Teach, guide and supervise students in nursing education

programs Undertake nursing and health human resource

development, training and research

CONTRACTAn agreement which creates an obligationAgreement upon sufficient consideration to do or not to do

a particular thingMeeting of minds of mind between 2 persons/parties

whereby one birds himself with respect to the other, to give something or to render some services (Civil Code)

TYPES: Express

Agreement is formal and stated either verbally or in writing

Terms of agreement are declared by the parties in writing or verbally at the time it is entered into

Implied Agreement is presumed or inferred from the acts

of the parties May also arise from mere consent

VALIDITY OF CONTRACT: Must be binding on both contracting parties Contracting parties may established such

stipulations, clauses terms and conditions deemed convenient provided not contrary to law, morals, good customs, public order or public policy

Obligations arising from contracts have the force of law between the contracting parties and should complied in good faith

STATUTORY REQUISITES OF A CONTRACT (ESSENTIAL REQUISITES WITHOUT THERE CAN BE NO CONTRACT): Consent of the contracting parties Object certain which is the subject matter of the

contract Cause of established obligation

OBJECT/SUBJECT MATTER OF A CONTRACT: All things which are not outside the commerce of

men, including future things All rights which are not in transmissible

Future inheritance in case expressly authorized by law

All services which are not contrary to law, morals, good customs, public order and public policy

CAUSE OF CONTRACT: Consideration of the contract that is the inducement

to it or the motive price, or impelling influence which induces a contracting party to enter into the contract

Contract to be valid must have sufficient cause or consideration

WILLAn act whereby a person is permitted the formalities

prescribed by law to control to a certain degree the disposition of his estate to take effect after his death

Making of a will is a strictly personal actNo one can lawfully substitute his intention and willMere mechanical work writing the testator’s work may be

done by a third personTESTATORY CAPACITIES:

Ability to comprehend the nature of the transaction in which the testator is engaged at the time

To recollect the property to be disposed of and the persons who would naturally be supported to have claims upon the testator

To comprehend the manner in which the instrument will distribute his property among the objects of his bounty

Testator must be of sound mind at time of executionHOLOGRAPHIC WILL:

With entirely written, dated, and singed by hand of the testator himself

Subject to no form and need not be witnessed The disposition of the testator written below his

signature must be dated and signed by him for validity

DISALLOWANCE OF WILL: If will was not executed and attested in accordance

with formalities required by law If testator at time of execution of will was in sense or

otherwise mentally incapable of making a will If testator executed will through force or under

duress or influence of fear/threats If will was procured through undue and improper

pressure and influence by the beneficiary or some other persons for the benefit of beneficiary

Of the signature of the testator was procured by fraud or trick

If testator acted by mistake or did not intend at the time he affixed his signature to the will that instrument he signed should be his will

NURSES AND CRIMINAL LIABILITYNurse may incur criminal liabilityPerforming an act offensive against persons or property Committing a felony

Acts or omissions punishable by law committed by: Deceit (dolo) – performed with deliberate intent

freedom intelligence elements essential in a criminal

21//carengreyes

− Fault (Culpa) - wrongful act results from

imprudence, negligence, lack of foresight/ lack of still

CONSPIRACY: Exists when two or more persons come to an

agreement concerning the commission of a felony and decide to commit it

CLASSIFICATION OF PERSONS CRIMINALLY LIABLE: Principal

Those who take a direct part in execution of the act of

Those who take directly force/induce others to commit it

Those who cooperate in the commission of the offense of another act which the crime

Accomplices Persons not being principles by direct

participation inducement or cooperation through another act essential to the consummation of the crime cooperate in the execution of the offense by previous or simultaneous acts

Known also as accessory before the act Accessories

Those who having knowledge of the commission of the crime and without having participated therein either as principal or accomplice, take part subsequent to its commission in any of the following manners: By profiting themselves or assisting the

offenders to profit by the effects of the crime

By concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery

By harboring, concealing or assisting in the escape of the principal of the crime

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY: Justifying Circumstances

circumstances surrounding the commission of a crime may be justified by: Act in defense of oneself of his rights Act in fulfillment of a duty under order of a

superior Exempting Circumstances

imbecile, under 9 y/o, under 15 y/o, merely an accident without intention, under compulsion of an irresistible force, uncontrollable fear, prevented by lawful or insuperable cause

Mitigating Circumstances does not constitute justification but in fairness

and mercy may be considered extending or reducing the degree of moral capability

Aggravating Circumstances increase the criminal liability of the offender or

make his guilt more severe these includes taking advantage, committed with insult to public authority and abuse, committed in consideration of a reward, causing intentional damage

Alternative Circumstances

those which must be taken into consideration as aggravating or mitigating according to the nature and effect of the crime and other conditions attending its commission; these are usually relationship of intoxication to the degree of instruction

LEGAL DOCTRINESFORCE MAJEURE

an irresistible or superior force it is a fact or accident which human prudence can

neither foresee nor prevent extraordinary circumstances cause the act which is

independent of the actorHOLD-OVER DOCTRINE

the principle under which a public officer is permitted to continue in possession of an office and to continue to exercise the functions of the office after the end of his lawful term

JUS SOLIS the principle that the nationality of a person is

determined by the law of the place of his birthRES IPSA LOQUITOR

“the thing speaks for itself” under this doctrine the defendant is presumed to be

negligent where the instrumentality causing another’s injury was in the defendant’s control and where the accident was one which ordinarily does not happen in the absence of someone’s

RESPONDENT SUPERIOR “Let the superior answer, let the principal answer for

the acts of his agent” Under the legal maxim, the principal or master is

answerable for the acts of his agent or servantDOCTRINE OF NEGLIGENT CONDUCT

“the nurse is liable for negligent conduct”

DOCTRINE FOR DAMNUM ABSQUE INJURIA “although there was damage, there was no legal

injury”

INFORMED CONSENTRelated to the principle of autonomy and respect for

person Any procedure to be done on a person may only be

administered with his free and informed consent Gives valid permission for others to act in certain specific

ways ELEMENTS OF INFORMED CONSENT:

Knowledge Information disclosure by the health care

provider, truth of the proposed action, its nature, probable benefits, possible risks, and alternative options

comprehensive subject Consent

Subject competence (decisions based on the reasons)

Subject freedom (able to choose and act without undue pressure of time, emotional upset,

22//carengreyes

confusion, persuasion, threat, deception, manipulation, fear)

LEGAL DOCTRINES OF NURSING PRACTICE: Malfeasance, Misfeasance, and Nonfeasance

Performance of action not to be done, improper performance of an action, omission of an action ought to be done

Doctrine of Informed consent The right to information and decide voluntarily

Doctor’s order rule It is legally safe to follow doctor’s order

Good Samaritan Law A nurse or any persons with proper knowledge

and skill may render first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the consequences of the act

Negligence Refers to the commission or omission of an act,

pursuant to a duty, that a reasonable prudent person in the similar circumstance would or would not do and the acting or the non-acting of which is the proximate cause of injury to another person or his property

Elements of Professional Negligence: Existence of a duty on the part of the

person charged to use due care under circumstances

Failure to meet the standard of due care The foreseeability of harm resulting from

failure to meet the standard The fact that the breach of this standard

resulted in Malpractice

Improper or unskillful care of patient by a nurse, also may be considered as stepping beyond one’s authority with serious consequences

negligence or carelessness of professional personnel

negligent act committed in the course of professional performance

REPUBLIC ACT NO. 9173Philippine Nursing Act of 2002 (Changes in the new law):

Section 4 members of the board of examiners

Section 23 suspension of license not to exceed 4 years

Section 26 requirements for inactive nurse returnees

Section 28 scope of nursing practice, emphasizes code of

ethics, safe practice, APO-NPA Section 32

salary scale Section 34

funding for comprehensive nursing specialty program by PCSO

Section 35 incentive and benefits non-cash in nature standard nurse-patient ratio

PRC BOARD OF NURSING PD 223 – created the professional regulations commission

and prescribed its power and functionsJune 23, 1973Composition – Chairman and members representing 3

areas of nursing (NE, NS, CHN)QUALIFICATIONS:

Natural born citizen, permanent resident of the Philippines

Masters in Nursing, education or allied medical profession

At least 10 years of continuous practice of profession, last 5 years in the Philippines

Member of good standing of the accredited professional organization of nurses

Good moral characterPOWERS AND DUTIES OF THE BOARD OF NURSING:

Conduct licensure exam Issue, suspend or revoke Monitor and enforce quality standards of nursing

practice Ensure quality nursing education Conduct hearings/ investigations Promulgate Code of Ethics in coordination with

accredited professional organization Recognize nursing specialty organization Prescribe, adopt, issue and promulgate guidelines

and decisions for improvement of nursing practice and advancement of profession

QUALITIES OF NURSING EXAMINES: Filipino citizens BSN graduate from an accredited college/university good moral character

REGISTRATION OF RECIPROCITY: professional license issued without examination to

nurses registered under foreign laws Requirements:

Licensure in said country substantially the same as prescribed by Philippine Nursing Act

Laws of said state/country grant same privileges to registered nurses of the Philippines in sane basis as their citizens

From Foreign countries (Licensed nurses granted special/temporary permit): Internationally well-known specialists or

outstanding experts in any filed of nursing who renders service for free or not free

Those on a medical mission whose services shall be free in a particular hospital, center/clinic

Those employed as exchange professors in specially of nursing by school/colleges of nursing

Note: Permit maybe issued by the BON subject to approval of the commission and upon payment of prescribed fee. Permit effective only for duration of the project, medical,

Revocation or Suspension of Professional License and Certificate of Registration: Criminal offense involving moral turpitude

(unprofessional and unethical conduct) Gross impotence/ serious ignorance

23//carengreyes

Malpractice/negligence Guilty of fraud, deceit or false statements to

obtain certification of registration Violation of Nursing Act, Code of Ethics for

Nurses, technical standards of nursing practice Practicing professional

TERMINOLOGIESREVOCATION

recall of a power or authority that was conferred of Elimination of the professional statue of a professional nurse

CANCELLATION to annul or to render void/invalid

SUSPENSION forced temporary withdrawal from the practice of

nursing. Stop temporarily privilegeCRIMINAL OFFENSE

violation of law with malicious intent or with intent to injure others

MORAL TURPTITUDE an act contrary to the accepted and customary rule

of right and duty between man and his fellow men or society in general

IMMORAL CONDUCT personal behavior contrary to good morals or

inconsistent with the rules and principles of morality behavior harmful to public welfare according to

standards of the communityDISHONORABLE CONDUCT

personal behavior that is disreputable, discreditable, disgraceful, shameful or scandalous

personal conduct which stains person’s character or lessens his reputation

UNPROFESSIONAL CONDUCT behavior that is unbecoming a member of a

profession in good standing behavior violates rules or ethical code of the

profession

PHILIPPINE NURSING ACT OF 2002ARTICLE I – TITLE

Section 1. Title. This Act shall be known as the "Philippine

Nursing Act of 2002."ARTICLE II – DECLARATION OF POLICY

Section 2. Declaration of Policy. It is hereby declared the policy of the State to

assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses.

The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country.

ARTICLE III – ORGANIZATION OF THE BOARD OF NURSING

Section 3. There shall be created a Professional Regulatory

Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the president of the Republic of the Philippines from among two (2) recommendees, Per vacancy, of the Professional Regulation Commission, hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act.

Section 4. Qualifications of the Chairperson and Members of the Board. The Chairperson and Members of the Board shall,

at the time of their appointment, possess the following qualifications:; Be a natural born citizen and resident of

the Philippines Be a member of good standing of the

accredited professional organization of nurses

Be a registered nurse and holder of a master's degree in nursing, education or other allied medical profession conferred by a college or university duly recognized by the Government: Provided, That the majority of the members of the Board shall be holders of a master's degree in nursing: Provided, further, That the Chairperson shall be a holder of a master's degree in nursing;

Have at least ten (10) years of continuous practice of the profession prior to appointment: Provided, however, That the last five (5) years of which shallbe in the Philippines; and

Not have been convicted of any offense involving moral turpitude; Provided, That the membership to the Board shall represent the three (3) areas of nursing, namely: nursing education, nursing service and community health nursing.

Section 5. Requirements Upon Qualification as Member of the Board of Nursing. Any person appointed as Chairperson or Member

of the Board shall immediately resign from any teaching position in any school, college, university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any subdivision, agency or instrumentality thereof, including government-owned or controlled corporations or their subsidiaries as well as these employed in the private sector. He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes.

24//carengreyes

Section 6. Term of Office. The Chairperson and Members of the Board shall

hold office for a term of three (3) years and until their successors shall have been appointed and qualified: Provided, That the Chairperson and members of the Board may be reappointed for another term. Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under Republic Act No. 7164 until their replacements have been appointed by the President and shall have been duly qualified.

Section 7. Compensation of the Board Members. The Chairperson and Members of the Board shall

receive compensation and allowances comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards.

Section 8. Administrative Supervision of the Board, Custodian of its Records Secretariat and Support Services. The Board shall be under the administrative

supervision of the Commission. All records of the Board, including applications for examinations, administrative and other investigative cases conducted by the Board shall be under the custody of the Commission. The Commission shall designate the Secretary of the Board and shall provide the secretariat and other support services to implement the provisions of this Act.

Section 9. Powers and Duties of the Board. The Board shall supervise and regulate the

practice of the nursing profession and shall have the following powers, duties and functions: Conduct the licensure examination for

nurses Issue, suspend or revoke certificates of

registration for the practice of nursing Monitor and enforce quality standards of

nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation

Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the Commission on Higher Education

upon the written recommendation of the Board

Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum (writ of summons to testify orally) but it includes clauses to bring in hand books, papers, etc. for the court). And subpoena duces tecum( "bring with you under penalty of punishment") is a court summons to appear and produce tangible evidence for use at a hearing or trial) to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such proceedings, upon application with the court

Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act

Recognize nursing specialty organizations in coordination with the accredited professional organization

REPUBLIC ACTSREPUBLIC ACTS TITLE

RA 6675 Generic Drugs Act of 1988RA 9165 Comprehensive Dangerous Drug Act of

2002RA 953 Narcotic Drug Act

RA 9262 Antiviolence against Women and their Children Act

RA 7610 Anti-child abuseRA 7658 Act prohibiting employment of children

below 15 y/oRA 6809 Emancipation LawRA 8172 Salt IodizationRA 3573 Providing Prevention and Supression of

dangerous communicable diseasesRA 7305 Magna Carta for Public Health WorkersRA 8749 Phil. Clean Air Act of 1999RA 6713 Code of Conduct and Ethical Standards for

Public Officials and employeesRA 8344 Act penalizing refusal of hospital/medical

clinic to administer emergency treatmentRA 7160 Local Gov’t CodeRA 2644 Phil Midwifery ActRA 2382 Practice of Medicine by NursesRA 9710 Magna Carta for WomenRA 7600 Rooming in and breast feeding Act of 1992RA 7432 Senior Citizen’s Act of 1992RA 9257 Senior citizens Act of 2004RA 9994 Expanded Senior citizens Act of 2010RA 8423 Establishment of traditional and alternative

25//carengreyes

health careRA 877 Philippine Nursing Law 1953

RA 4704 Philippine Nursing Law 1966RA 7305 The Magna Carta of Public Health WorkersRA 8981 The PRC Modernization Act of 2000RA 9262 Anti Violence Against Women & Children

Act 2004RA 9439 Hospital Detention Bill 2007

BON Resolution #220

The Code of Ethics for the Registered Nurse

BON Resolution # 112

Competency Standards for Nursing Practice 2003 (11 Competencies)

CHED Memo Order # 30

Updated Policies and Standards for Nursing Education

EO 496 Procedures/criteria for Selection of Nominees for Vacant Positions in the PRC

HB 4110 Reproductive Health BillHB 5043 The Philippine Reproductive Health Bill and

Population Development Act of 2008HB 13 Providing for the Safety and Protection of

the Unborn Child and for other Purposes (R. Goilez)

HB 3667 The New Anti-Abortion Act of 2010 (A.S. Bagatsing)

SB 2497 Protection of the Unborn Child Act of 2010 (JP Enrile)

SB 1695 Mental Health Patient’s Bill of RightsPD 603 Child and Youth Welfare CodePD 651 Immediate registration of birth w/in 30

daysPD 996 Compulsory Basic ImmunizationPD 856 Sanitation Code of the Philippines

Administrative Order related to EINCPhil constitution

– Art. 3 Sec 1Bill of Rights

AO 2007-0026 Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternal and Newborn Care Services

AO 2008 – 0029 Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality

AO 2009 – 0025 Adopting New Policies and Protocol on Essential Newborn Care

AO 2010-0036 The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos

WHO GUIDELINES: Baby Friendly Health Initiatives: Revised, Updated

and Expanded for Integrated Care : Section 4 - Hospital Self-appraisal and Monitoring (January 2006)

Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice (Integrated Management of Pregnancy and Childbirth, 2006)

WHO Recommendations for the Prevention of Postpartum Hemorrhage, 2006

Newborn Care until the First Week of Life Clinical Practice Pocket Guide, 2009

Philhealth Circular No. 011-2011 New Philhealth Care rates for Selected Medical Cases

and Surgical Procedures and the No Balance Billing Policy

PERSONAL/PROFESSIONAL STAFF DEVELOPMENT

The provision of creative and consistent high-quality education to adult learners who practice nursing in an environment of rapid advances in technology, budget constraints, and sophisticated performance improvement techniques

It is based on a philosophy of ADULT EDUCATION that utilizes teaching-learning principles and concepts that apply to people who have a combination of responsibilities (such as in the including family, financial obligations, employment commitment, and identified areas of interest or specialization)

Nurses who are adult learners combines many of these traditional adult responsibilities with the demands of increasingly complex societal and health care provider roles

AIM OF STAFF DEVELOPMENT PROGRAMS: to educate the whole person towards building

competencies for performing various roles in life (Malcolm Knowles, 1978)

ROLE OF MOTIVATION IN STAFF DEVELOPMENT: Motivation is the energy that causes adults to strive

toward competence that are importantSTAFF DEVELOPMENT PROCESS:

Focuses on developing nursing skills and knowledge within a comprehensive program that includes: Orientation

Introduces employees to new situations and includes content related to philosophies, goals, policies, procedures, personnel, benefits, role expectations, and physical facilities

Orientation is essential every time there is change in the roles responsibilities of a nurse

In-service Education Provides learning experiences in the work

setting for the purpose of:− Refining basic skills− Developing new skills and knowledge-

related to job performance− These learning experiences are aimed

at only one competency or knowledge area and are usually narrow in scope and conducted in a short period of time

Continuing Education Program are planned and organized around learning

experiences in a variety of settings that are intended to build on the educational and experiential bases of the nurse

it offers nurses new approaches to health care delivery and enhance practice, education, administration, research, and theory development

Example includes workshops, conferences, self-learning modules and seminars

Job-related Counseling

26//carengreyes

Involves promoting the professional growth of employees by assisting them to deliver their best job performance

It may include counseling related to promotion possibilities and assistance in obtaining formal training in a specialized field

PHILOSOPHY OF STAFF DEVELOPMENT: it must reflect the vision-mission and philosophy of

the organization of which it is a part It needs to address the following:

How learning takes place Teaching methods Employees responsibility for their own learning Organizational responsibility for providing staff

development Client’s right to health care

MODELS OF STAFF DEVELOPMENT PROGRAM: Centralized Model

An agency with a wide staff development department

Composed of nursing and non-nursing multi departmental educators

All departments collaborate in determining and planning the job needs of their staff

Decentralized Model An in-service program managed by the nursing

department It addresses the specific needs of the department

that are solely nursing concerns Concerns may include the use and scheduling of

classrooms, potential duplication of efforts and the cost of providing multiply small programs

RESOURCES NEEDED FOR STAFF DEVELOPMENT: Personnel

Nursing service administrators are responsible for staff development to promote quality client care

The following are among their responsibilities: Providing financial and human resources Establishing policies for staff development Providing release time, finances, or both

for staff to attend continuing education offerings

Motivating employees to assume responsibility for their own professional development

Providing mechanisms to identified staff growth needs

Evaluating the effects of staff participation in continuing education offering on quality of client care

Advisory Committees An advisory committee identify needs and

resources and for planning programs. Member of the committee represent all fields of practice in the health care agencies

CONSIDERATION IN DESIGNING A STAFF DEVELOPMENT PROGRAM: Needs Assessment

Target population Development time Cost

Financial and human resources Analysis time Anonymity Objectivity

Teaching Methods To maximize learning, staff should be aware of

three important aspects involved in teaching adult learners: Collaboration between teacher and

student is essential for active learning to occur

Critical thinking may be seen as a basic principle of adult education

Self-directed learning has an important place in the educational activities of adults

Evaluation Evaluation is essential to provide staff with

information to improve programs or determine whether training programs should be done continued

Adult learners should have a sense of progress toward their goals and should be involved in evaluating their learning

When measuring learning, a before and after approach should be used so that learning can be related to the training programs

TECHNIQUES TO EVALUATE LEARNING: Observation of skills or behavior. Observation guides

need to be developed and observers need to be told specifically what they should be scrutinizing

Paper-and-pencil methods, such as true-false, multiple-choice, or fill-in-the blank tests

Unobtrusive measures, e.g. chart reviews, audits, wear of textbook pages, or numbers of staff using self-directed learning modules

PROGRAM EVALUATION: The content, process, and method of a program

should be evaluated: What the participants liked or disliked about the

program Whether the faculty and speakers were prepared Whether objectives were met How well the program was organized Whether the facilities were adequate Suggestion for improvement Suggestion for future programs

TRANSITIONING TO ROLE OF SKILLED CLINICIAN: Embedded within the transition from school to work

is the process of becoming a SKILLED CLINICIAN Dr. Patricia Benner studied the process of new nurse

skill acquisition and critical thinking and concluded that NEW GRADUATES’s perceptions of complex clinical situations were significantly different from those of nurses with more experience and skill

STAGES OF SKILL ACQUISITION: Novice

Applies theory learned in school Translates lessons into real-life patient care

environment Learns the rule and rule-based reasoning Begins the use of intuition related to patient care

27//carengreyes

After successfully adjusting to numerous experiences with real patient care settings, the novice progresses to the advanced beginner stage

Advanced Beginner Begins to discern among situational elements of

clinical decision making Knows the rules that govern care in a situation

but begins to understand how and when the rules can be applied based upon the patient’s condition, desire, and needs

Feels overwhelmed “by the effort required to notice all relevant elements and to remember and increasing number of more complicated rules.”

Competent Begins to understand and adopt a hierarchical

perspective, i.e., to categorize the rules according to relevance and set priorities;

Determines which elements in a situation are deemed to be important in creating nursing care plans

Recognizes that decisions made has specific outcomes, and becomes emotionally involved in the outcome

Proficient Performs interventions with concern and full

involvement Has initiative and able to prioritize task at hand Performs required procedures with proficiency

speed, and confidence Actions become easier and less stressful

Expert Able to handle complex and unique situation Develops the ability to discriminate and choose

one priority over another that requires maturity and practice

Learns and gains experience in the new specialty Joins organizations where he/she can meet

his/her professional goal FIELDS OF SPECIALIZATION:

Institutional nursing (Staff Nursing) In-service Education

Public Health Nursing Occupational Health/Industrial Nursing School Health Clinical Nurse

Private Duty Nursing Military Nursing Advanced Practice Nursing Independent Nurse Practitioner Legal Nursing Consultant Nurse Informatician Nursing Education Flight Cruise Nursing

MIGRATION The movement of persons from one country or locality to

anotherA group of people migrating together (especially in some

given time period)WAVES OF MIGRATION:

First Wave Early 1900’s Filipinos served as plantation

workers of farmlands in Hawaii, Guam, and other US territories

Second Wave 1950’s Filipino nurses, doctors, engineers,

teachers and other professionals by thousands hurdled to the US Mainland and European continent

Third Wave 1980’s when petrodollar countries in the Middle

East required construction workers Fourth Wave

1990’s the verge of the feminization of migration high for women to serve as house helps, entertainers, teachers, nannies, caregivers, etc

CAUSES OF MIGRATION: Economic

Employment to a better job (Financial/ Professional growth)

Employees of: Transnational corporations International NGOs Diplomatic Corps “expatriates”

Non-economic Missionary work Education Retirement migration (migration from rich

countries to lower-cost countries with better climate)

Persecution Asylum

Personal Based on relationships Marriage Reunion with family

ACCULTURATION The process whereby the attitudes and or behaviors

of people from one culture are modified as a result of contract with a different culture

It implies a mutual influence in which elements of two cultures mingle and merge

Deals broadly with changes in cultural attitudes between two distinct cultures

Focus on the group rather than the individual and on how minority or immigrant groups relate to the dominant or host society

Ethnic identity as an aspect of acculturation is concern with individuals and how they relate to their own group as a subgroup of the larger society

Two Distinct Models of Acculturation: Linear Model

a strong ethnic identity is not possible among those who become involved in the mainstream society and that acculturation is inevitably accompanied by a weakening of ethnic identity

Two-dimensional Model Suggests that both the relationship with

the traditional or ethnic culture and the relationship with the new or dominant culture play important roles in the process

28//carengreyes

Acculturation Process (JW Berry): Assimilation

Movement toward the dominant culture Integration

Synthesis of the two cultures Rejection

Reaffirmation of the traditional culture, or marginalization (alienation from both cultures)

Measures of Acculturation: All of the scales used to measure acculturation

include: SECOND-LANGUAGE PROFICIENCY

− because being able to communicate in the language of the host culture is a prerequisite to learning about it

PATTERNS − of language use, friendship choices,

food, music or movie preference, cultural awareness, ethnic pride, place of bitch, and contact with one’s homeland

PERCENTAGE− of one’s lifetime spent in the host

country

− One’s age at the time of immigration (have been shown to correlate with more extensive and detailed measures of acculturation and are therefore good indicators of an individual’s level of acculturation when more detailed information is unavailable)

AGING POPULATION: Demography

International UN (2000) 590 million, and by 2025 to over

1.1 billion, that is an increase of 224 percent since 1975

Constitute 13.7 percent of the world’s population

National The total population of the Philippines

stand at 73,130,885 The elderly population is equal to

4,280,364 or 5.8 percent of our population Issues on the Aging Population

Security in old age Occurrence of abuse committed Health status Policies and legislative for welfare Economic impact of aging

Complementary Therapy They go along with the medical care they receive

from their health care provider They are used alongside the more standard

medical care you receive (e.g. herbal teas with acupuncture)

They don’t fit into the mainstream of Western medicine and health care

Common Complimentary Therapies: Physical (body) therapies

− Yoga

− Massage− Acupuncture

Relaxation techniques such as meditation and visualization

Herbal medicine (organic plants)MEDICAL TOURISM

Medical Tourism Philippines Welcomes tourists from all over the world to visit

the Philippines for medical and leisure needs The most common procedure are cosmetic and

plastic surgery dermatology, weight loss surgery, ophthalmology and dentistry

PERSONAL DEVELOPMENTis our conscious self-improvement and self-transienceit is the aspiration to realize our higher self

NURSING AS A CALLING “is nursing just a good career where job prospects

are good?” or “Is nursing more than a job; it s a‟ calling.”

Calling Deep desire to devote oneself to serving people

according to the high values of the task or profession

Direct invitation or commissioning from God for a specific task or assignment that God wants us to do

NURSING AS A VOCATION Nursing is…

Doing good deeds People-oriented Character building

NURSING PROFESSION nursing is a profession focused on assisting

individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning

Profession is a calling wherein each member profess to have

acquired the knowledge, skills, and attitude necessary to guide others in that special field

PERSONAL DEVELOPMENT TIPS: identify own strengths, weaknesses, limitations determine personal and professional goals pursue continuing education support activities related to nursing and health issues adopt a positive attitude towards change and

criticismCAREER PLANNING

career choices are life choices, take them seriously, do it right

Jobs – paid occupation; something you do regularly for pay

Career – is a long-term of life time job, a profession you choose to spent the rest, or most, of your time in

Career Planning – to plan what job you would like to do for most, or rest of your life; is a lifelong process and it includes: choosing an occupation

29//carengreyes

getting a job growing in your job possibly changing careers and eventually retiring

Career Planning Process: Knowing Yourself

Do self-assessment: Interests Values Roles Skills/aptitudes Preferred environment Developmental needs Your realities

Exploring your Options Know which occupations interest you Research the labor market Research on the institutions you wish to

work for When you have narrowed down your

options, you get specific information by: − Networking − Part time work − Internships − Volunteer opportunities − Written materials − Informational interviews

Making Decision/Match Try to identify possible occupations Evaluate these occupations Explore alternatives Choose both a short term and a long term

option Moving on/Action

Work towards goal by:

− Investigating sources of additional training and education, if needed

− Develop a job search strategy − Write a good resume − Gather information about the company − Learn to compose effective cover

letters − Prepare for job interviews − Learn to adopt to change

NURSING CAREER Getting started

Wrong idea: just to “get the first job” Correct idea: find the job that fits you and that is

a good first step on the path to a lifelong career in nursing

FOCUS: long-term career goals and the avenue by which they can be reached

SWOT: An in-depth look at what will make you truly happy in your work, use it for initial assessment of the job market Strengths

Relevant work experience Advanced education Additional product knowledge Good communication and people skills Computer skills Self-managed learning skills

Flexibility Weaknesses

Poor communication and people skills Inflexibility Lack of interest in further training Difficulty adapting to change Inability to see health care as a business

Opportunities Expanding markets in health care New applications of technology New products and diversification Increasing at risk populations

Threats Increased competition among health care

facilities Changes in government regulation

Beginning the Search Be psychologically self-employed

Your career belongs to you, not your employer

Security and advancement on the job are up to you

Security may be elusive, but opportunities for nurses are growing every day

Learn for employability Take personal responsibility for your career

success Learn for your current position but also for

your next position Technical, people skills, work in teams and

make presentations Plan for your financial future

Ask yourself, “How can I spend less, earn more, and manage better?”

Decisions based on financial matters makes one feel trapped and note secured

Develop multiple options Moving up is only one option Be aware of emerging trends in nursing,

adjacent fields, lateral moves, projects Build a safety net

Networking is extremely important Join professional organizations Take time to build long term nursing

relationships Interview Questions:

What is your philosophy of nursing? Relate it to the position you are seeking

What is your greatest weakness? Strengths? Start with weakness (make it sound like a

desirable characteristic); state the obvious (e.g. lack of experience)

End with a positive note (Strengths) Where do you see yourself in 5 years?

Do not employers think that you will use position as a brief stop on the path to another job

Answers should reflect the career plan in tune with the organization s needs (get‟ history of position.. investigate how long staff stays)

What are your educational goals? Be honest and specific

30//carengreyes

RN, MAN, other trainings Foreign language, computers Indicate school

Describe your leadership style. How effectively you work with others Give examples of how you have

implemented your leadership in the past What can you contribute to this position?

Review SWOT and job description Be specific in relating your contributions to

the position What are your salary requirements?

You may be asked minimum salary range Investigate employer s salary range for this‟

position beforehand Be honest with your expectations, but

make it clear you are willing to negotiate “What if” questions

Competency-based reviews Be concise Focus on hospital’s philosophy and goals If you don’t know the answer, tell them

how you will go about getting the answer (You are a new graduate, you are not expected that you know everything)

Personal Questions: How would you describe yourself?

Repeat what is in resume/cover letter How would your peers interview

Say only strengths What would make you happy with this position

Discuss needs related to your work environment

Do you enjoy self-direction, flexible hours, and strong leadership support? cite specifics related to your ideal work

environment Describe your ideal work environment; Describe

hobbies, community activities, and recreation Brevity is important This is just used to gauge communication

and interpersonal skills You May Ask:

What is this position s key responsibility ‟ What kind of person are you looking for What are the challenges of the position Why is this position open To whom would I report directly Why did the previous person leave this position What is the salary for this position What are the opportunities for advancement What kind of opportunities are there for

continuing education CAREER MAPPING

Career maps contain detailed information to facilitate choices based on individual s talent and‟ organizational needs. Thus, they enable HR organizations and employees separately or together to choose development paths that build intersections between career aspirations and the needs of the business

“jobs come and go but people who are the „best at what they do and who have achieve the highest‟ recognition for their skills and knowledge in their profession are treasured forever.”

Career Maps: Like a GPS in your care Display alternative routes to build mastery in the

core professions Mastery is being the “best you can be” Those who achieve mastery of their profession or

trades are leaders, mentors, and innovators The knowledge, skills, and ability that mastery

requires is enduring and guides both simple day-to-day decisions as well as complex challenges

Other Desirable Skills: Oral and written communication Ability to assume responsibility Interpersonal skill Proficiency/technical competence Teamwork ability Willingness to work hard Leadership abilities Motivation, flexibility, initiative Critical thinking and analytical skills Computer knowledge Problem solving/decision making

Where to look for jobs: Public employment agencies Private employment agencies HR departments Information from friends/relatives Newspapers, professional journals College and university career centers Career and job fairs Internet websites Other professionals (networking)

CORE-COMPETENCY STANDARDS SIGNIFICANCE OF THE CORE COMPETENCY STANDARDS:

The core competency standards will serve as a unifying framework for nursing education, regulation and practice

Guide in developing curriculum in nursing framework in developing test syllabus for entrants into the nursing profession

Tool for performance, evaluation among nurses Basis for advance practice and specialization Framework for developing a training curriculum for

nurses Protect the public from incompetent practitioners Yardstick for unethical ad unprofessional practice for

nursing CORE COMPETENCIES FOR THE ENTRY-LEVEL:

11 core competencies areas for nursing practice that were identified which include the following:

− Safe and quality nursing care− Management of resources and environment− Health education− Legal responsibility− Ethico-moral responsibility− Personal and professional development

31//carengreyes

− Quality improvement− Research− Record management− Communication− Collaboration and team work

APPLICATION OF CORE COMPETENCY IN NURSING PRACTICE:: Assessment of the individual patient needs for nursing:

− Establishes rapport and trust with the patient, family and significant others Welcomes the patient, family and

significant others on admission Greets patient by name, introduces self

and co-staff Communicates in a friendly, polite and

tactful manner Encourages verbalization of needs and

feelings through attentive listening Convey availability and willingness to help

by attending to needs at the soonest time possible

− Obtains a nursing history and does an initial and physical examination Applies the general principles of and

follows a logical sequence in history taking and physical examination

− Recognizes normal and abnormal findings from common laboratory and diagnostic examination results Compares results from a standard listing

of normal values/results of common laboratory and diagnostic examinations

− Defines health needs and problems from data gathered Identifies the significant findings from the

nursing history , physical examination and laboratory/diagnostic test results

Document all relevant information pertinent to patient care:

− Document all relevant information pertinent to patient care: Records where appropriate (kardex, flow

sheets and/or nurses notes) assessments results, treatments and medications, nursing and other health care interventions, and other pertinent information

Writes simply comprehensively and legibly

− Reports/endorses as appropriate Files reports relevant to patient care,

where appropriate (report book/ communication book/others)

Submits summary of endorsements of assigned patients to chare nurse or Nurse IV for inclusion in the endorsement report

− Records the disposition of dangerous drugs/narcotics Records in the disposition sheet the

name, of the patient, ward and bed number. Amount given, date and time administered, name and dangerous drug license number (S2) of the prescribing

physician name and signature of administering nurse

SAFE AND QUALITY NURSING CAREDemonstrate knowledge base on the health/ illness status

of individual/groups Indentifies the health needs of the patients/groups Explains the health status of the patient/groups

Provides sound decision making in the care of individuals/groups Identifies the problem Gathers data related to the problem Analyzes the data gathered Selects appropriate action Monitors the progress of the action taken

Promotes safety and comfort of patients Performs age specific safety measures in all aspects

of patient care Performs safe specific comfort measures in all

aspects of patient careSets priorities in nursing care based on patients’ needs

Identifies the priority needs of the patients Analyzes the needs of patients Determines appropriate nursing care to be provided

Ensures continuity of care Refers identified problem to appropriate individuals/

agencies Establishes means of providing continuous patient

careAdministers medications and other health therapeutics

Conforms to the ten(10) golden rules of medication, administration in health therapeutics

Utilizes nursing process framework for nursing. Performs comprehensive and systematic nursing assessment Obtains consent Complete appropriate assessment forms Performs effective assessment techniques Obtains comprehensive client information Maintains privacy and confidentiality Indentifies health needs

Formulates a plan of care in collaboration with patients and other members of the health team Includes patient and his family in care planning States expected outcomes of nursing interventions Develops comprehensive patient care plan Accomplishes patient centered discharge plan

Implements planned nursing care to achieve identified outcomes Explains intervention to patients and his family

before carrying them out Implements nursing intervention that is safe and

comfortable Acts according to client’s health condition and needs Performs nursing activities effectively and in a timely

mannerEvaluates progress toward expected outcomes

Monitors effectiveness of nursing interventions Revises care plan when necessary

Respond to the urgency of the patient’s condition Identifies sudden changes in the patient’s health

conditions Implements immediate and appropriate intervention

32//carengreyes

MANAGEMENT OF RESOURCES AND ENVIRONMENTOrganizes workload to facilitate patient care

Identifies tasks or activities that need to be accomplished

Plans the performance of tasks or activities based on priorities

Finishes work assignment on timeUtilizes resources to support patient care

Determines the resources needed to deliver patient care

Controls the use of supplies and equipmentEnsures functioning of resources

Checks proper functioning of equipment Refers malfunctioning equipment to appropriate unit

Delegate functions to other members of the health team Determines tasks and procedures that can be safely

assigned to other member of the team Verifies the competencies of the staff prior to

delegating tasksMaintains a safe environment

Observes proper disposal of waste Adheres to policies, procedures and protocols on

prevention and control of infection Defines to follow in case of fire, earthquake and

other emergency situation

HEALTH EDUCATIONAssess the learning needs of the patient and family

Obtains learning information through interview, observation and validation

Defines relevant information Completes assessment records appropriately Identifies priority needs

Develops health education plan based on assessed and anticipated needs Considers nature of learner in relation to: social,

cultural, political, economic, educational and religious factors

Develops materials for health education Involves the patient, family, significant others and

other resources Formulates a comprehensive health education plan

with the following components: objectives, content, time allotment, teaching-learning resources and evaluation parameters

Provides for feedback to finalize the planImplements the health educational plan

Provides for a conductive learning situation in terms of time and place

Considers client and family’s preparedness Utilizes appropriate strategies Provides reassuring presents through active listening,

touch, facial expression and gestures Monitors client and family’s responses to health

educationEvaluates the outcome of health education

Utilizes evaluation parameters Documents outcome Revises health education plan when necessary

LEGAL RESPONSIBILITYCore Competency 1: Adheres to practices in accordance

with the nursing and other relevant legislation including contracts, informed consent Fulfills legal requirements in nursing practice Holds current professional license Acts in accordance with the terms of contract of

employment and other rules and recommendation Complies with required continuing professional

education Confirms information given by the doctor for

informed cont Secures waiver of responsibility for refusal to

undergo treatment of procedure Checks the completeness of informed consent and

other legal forms

Core Competency 2: Adheres to organizational policies and procedures, local and national Articulates the vision, mission of the institution

where one belongs Behaves in accordance with establish norms of

conduct of the institution/organization Shows membership of the accredited professional

organization and a professional organization releveant

Core Competency 3: Documents care rendered to patients: Utilizes appropriate patient care records and reports Accomplishes accurate documentation in all matters

concerning patient care in accordance to the standards of nursing practice

ETHICO-MORAL RESPONSIBILITYRespects the rights of individual/groups

Renders nursing care consistent with the patient’s bill of rights

Accepts responsibility and accountability for own decision and actions Meets nursing accountability requirements as

embodied in the job description Justifies basis for nursing actions and judgment Projects an positive image of the profession

Adhered to the national and international code of ethics for nurses Recites the code of ethics for nurses and abides by its

provision Reports unethical and immoral incidents to proper

authorities

PERSONAL AND PROFESSIONAL DEVELOPMENTIdentifies own learning needs

Verbalizes strengths, weaknesses limitations Determines personal and professional goals and

aspirationPursues continuing education

Attends formal and non-formal education Earns required continuing education units

Get involve in professional organization and civic activities

33//carengreyes

Participates actively in professional, social, civic and religious activities

Maintains membership to professional organizations Support activities related to nursing and health

issuesProjects a professional image of the nurse

Demonstrate good manners and right conduct at all times

Dresses appropriately Demonstrates congruence of words and actions Behaves appropriately at all times

Possesses positive attitude towards change and criticism Listens to suggestions and recommendations Tries new strategies or approaches Adopts to changes willingly

Performs functions according to professional standards Assess own performance against standards of

practice Sets attainable objectives to enhance nursing

knowledge and skills Explains current nursing practices when situations

call for it

QUALITY IMPROVEMENTGathers data for quality improvement

Demonstrate knowledge of method appropriate for the clinical problems identified

Detects variation in the vital signs of the patient day to day

Reports necessary elements at the bedside to improve patient’s stay in the hospital solicits feedback from patient and significant others regarding care rendered

Participates in nursing adults and rounds Contributes relevant information about patient’s

condition as well as unit’s condition and patient current reactions

Shared with the team current information regarding particular patient’s condition

Speaks for the patient what is relevant to his condition

Documents and records all nursing care and actions Performs daily check up of patient’s

records/condition Completes patient’s records Actively contributes relevant information of patient

during rounds thru readings and sharing with othersIdentifies and reports variances

Documents observed variance regarding patient care and submits to appropriate group within 24 hours

Identifies actual and potential variance to patent care

Submits reports to appropriate groups within 24hours

Recommends solutions to identified problems Gives appropriate suggestions on corrective and

preventive measures Communicates and discusses with appropriate

groups Gives an objective and accurate report on what was

observed rather that an interpretation of the event

QUALITY IMPROVEMENTGather data using different methodologies

Able to identify researchable problems regarding patient care and community health

Identify appropriate methods of research for a particular patient/community problem

Combines quantitative and qualitative nursing design thru simple explanation on the phenomena observed

Analyzes data gatheredRecommends actions for implementation

Based on the analysis of the data gathered, recommends practical solutions appropriate for the problem

Disseminates results of research findings Able to talk about the results of findings to

colleagues/ patients/family and to others Endeavors to publish research Submits research findings to own agencies and

others as appropriate

RECORDS MANAGEMENTMaintains accurate and updated documentation of patent

care Completes updated documentation of patient care

Records outcome of patient care Utilizes a record system ex. Kardex of Hospital

Information SystemObserves legal imperatives in record keeping

Observes confidentiality and privacy of the patient’s records

Maintains an organize system of filing and keeping patient’s records in a designated area

Refrains from releasing records and other information without proper authority

COMMUNICATIONEstablishes rapport with patient

Creates all TRUST and CONFIDENCE Greets client in an open and respectful manner Asks client about themselves Tells client about choices depending on client’s

needs Helps client make an informed choice Explains fully how to choose options Returns visits for future consultation

Listen actively to clients queries and requests Spends time with the client to facilitate conversation

that allows client to express concernsIdentifies verbal and non-verbal cues

Interprets and validates client’s body language and facial expression (IEC materials)

Utilizes formal and informal channels Interprets and validates client’s body language and

facial expression (IEC materials)Responds to needs of individuals, family group and

community Provides reassurance through therapeutic, touch,

warmth and comforting words of encouragement Readily smiles

34//carengreyes

Uses appropriate information technology to facilitate communication Utilizes telephone, cell phone email and internet for

disease information Identifies a significant other so that follow up care

can be obtained Provides “holding” or emergency numbers for

services

COLLABORATION AND TEAMWORKEstablishes collaborative relationship with colleagues and

other members of the health team Contributes to decision making regarding client’s

needs and concerns Participates actively in patient care management

including audit Recommends appropriate intervention to improve

patient care Respect the role of other members of the health

team Maintains good interpersonal relationship with

clients, colleagues, and other members of the health team

Collaborates plan of care with other members of the health team Refers clients to allied health team partners Acts as liaison/advocate of the client Prepares accurate documentation for efficient

communication of services

35//carengreyes