B. P. Koirala Institute of Health Sciences, Dharan Nepal

APPLICATION FORMAT FOR RESEARCH GRANT

Section–A

1. Title of the research project:

Effectiveness of Education Intervention Programme on Leadership Qualities Among Nursing Managers Working in Medical-Surgical Nursing

Department of BPKIHS

2. Name and designation of:

a. Principal investigator:

Name:

Designation: Associate Professor, Medical-Surgical Nursing Department

S.N. Name Designation Department

3. Expected duration of the proposal: 1 Year

4. Amount of grant in – aid asked RS. =

5. This is new project: Yes.

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Declaration

1. I/we have read the terms and the terms and conditions of BPKIHS research grants, and agree to abide by them.

2. I/we agree to submit, within three months from the date of termination of the project, a report on the work done.

3. I/we agree to maintain a stock book for purchases made for he project. I/we shall submit the complete statement of account within three months of the termination of the project, and at any other time as required by the accounts section.

4. I/we agree to acknowledge the grant in any publication resulting from the project if it is approved for financial assistance.

5. I/we declare that no research grant is already available for the research project from any other source.

6. I/we declare that the project will be conducted as per the highest ethical standards applicable to animal/human experiments.

Signatures (with seal and date):

Principal Investigator Signature Date

Co-investigator Signature Date

Remarks form the HoD of the Principal Investigator:

Date: Signature & Seal of the HoD

Remarks for the HoD of the Co-investigator:

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Section-C

Details of the research project

1. Title of the research project Effectiveness of Education Intervention Programme on Leadership Qualities Among Nursing Managers Working in Medical-Surgical Nursing Department of BPKIHS Nursing Managers includes: Nursing Officers and Senior Staff Nurses 2. Aims and Objectives:

Aims of the Study:

To offer practicing nursing managers educational activities that enhances the cognitive and practical skills necessary to strengthening leadership qualities among the nursing managers working in medical-surgical nursing department of BPKIHS.

Objectives of the study:

• To assess the existing quality of nursing managers.

• To offer planned educational activities related to Managerial skills required to strengthen their leadership qualities.

• To measure the effect of "education intervention" in relation to strengthening leadership qualities among the nursing managers.

3. Summary of the research project. In order to move towards higher quality care, a better information base on existing provision is commonly required. Local and national risk factors need to be understood. The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risk. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance or risks and benefits. Single group pre-test post-test research design will be used to conduct the study among the nursing managers (Nursing Officers an Senior Staff Nurses) regarding strengthening the leadership qualities, working in medical-surgical nursing department of B.P. Koirala Institute of Health Sciences. Total 42 subjects (18 Nursing Officer and 24 Senior Nursing Officer) were included in the study. After obtaining the pre-test the planned education intervention on leadership qualities will be implemented. Total 15 hours theoretical and 3 hour interaction session will be arranged. The list of topics related to managerial skills will be included in the session. After 6 weeks of teaching session the post-test will be conducted. The evaluation of the training programme will be done.

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4. Review of the literature pertaining to the project.

Knowledge, like muscles, must be nourished constantly and used frequently to retain function. Learning like motion, is more easily

maintained if it's momentum has not been interrupted.

In accordance with the subject for study, an extensive review of the relevant literature is carried out from the published, unpublished, national, as well as international textbooks, periodicals, journals on nursing and administration. Surfing of the Internet and Medline is also carried out to collect the latest information pertaining to the subject. The literature that has been reviewed related to the subjects has been dealt as below:

Health care workers all over the world are facing difficult challenges. The public's expectation of them continues to rise. Yet as a result of fiscal constraints, often created by worsening economic conditions, they are asked to provide higher quality health services with fewer resources. At the same time, the knowledge and skills-base needed to perform effectively in their chosen fields of endeavor continues to grow and change rapidly. Health care personnel will continue in the workforce for many years, while the information that they acquired during their education may rapidly become obsolete. Health care institutions and their managers are also confronted with these realities. The challenge is to continue to maintain or improve the quality of the care provided and maintain, or even expand, the comprehensiveness of health service converge, while introducing changes in care delivery or service mix necessitated by reduced budgets. Finally governments at local, regional and national levels are attempting to obtain greater value for the money they spend on health care. Faced with growing expectations of quality they are being asked to be more accountable for the results of their health care expenditures. Thus, they also have an important role to play in ensuring and improving the quality of health services provided in both the public and private sectors.1

People might get sick sometimes in their life. Each patient has right to receive best nursing care. To provide standard and qualitative nursing care, nurses must have through knowledge in being rational in their activities or interventions which will help them to satisfy in their performance. The people of our country are not much aware of " what nursing actually is?"

B. P. Koirala Institute of Health science is an International level health science university; where medical, Dental, Nursing and other health manpower of different levels are trained. The existing indoor bed capacity of the BPKIHS hospital is 646; where various specialty and super specialty services are provided. Nurses are involved in various indoor, outdoor, Emergency, Community and out rich clinics in the clinical services area. As it is obvious that nurses working in this institute have dual responsibility i.e. service as well as education which is unique and characteristics features in Nepal as well as globally. A study conducted by "Ogilvie L" in 1995; concluded: Low moral among nurses, insufficient knowledge and little awareness about new issues like AIDS, lack of in-service education and no interest in continuing education2. Since this research is mostly concerned with nurses working in Government Health Services; though these factors may affect nursing service in any Institute.

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In order to move towards higher quality care, a better information base on existing provision is commonly required. Local and national risk factors need to be understood. Information on numbers and types of providers is a basic and often incompletely fulfilled-requirement. An understanding of provider market structure and utilization patterns is also needed, so that policy makers know why this array of provision exists, as well as where it is growing. Information on the interventions offered and on major constraints on service implementation are also relevant to overall quality improvement.3

The need of in-service education programme has been felt strongly by most of large health science institute to improve knowledge, skill and attitude of human resources as a continuing process. Therefore, in-service education has become an indispensable tool for human resource development in a health care institution at present context. The past Twenty-years brought tremendous changes both in Medical knowledge and in Medical practice and professional nursing. The use of new technology and sophisticated instruments have provided us with insight into the mysteries of the cell structure, molecular biology, genetic studies, and a host of the other biological phenomena. we are beginning to know more about diseases, the control of infection, and the propitious use of synthetic drugs. Most dramatic are the variety of transplantation and biomedical engineering achievements that have taken place in medical sciences7. An important role of my health care system of all countries is to ensure the quality of its service and to improve the efficiency and effectiveness of the health service delivery at all levels. It is not a new concept, but rather a new approach, seeks to strengthen the existing health care services, quality care must be defined properly before setting the technical standards. Quality health care is care that is needed and delivered in a manner that is important, caring, cost effective, and timely and minimizes risk and achieves maximum benefits. Quality is not a luxury; it is essential to improve the health services. Quality of care can be improved with the same resource8. The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risk. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance or risks and benefits. Proper performance of interventions that are known to be safe, that are affordable to the society in question, and that have the activity to produce an impact on mortality, morbidity, disability and malnutrition. The dimensions of quality are: Technical competence (Clinical skill), effectiveness (correct manner), efficiency (maximum benefit to client with available resources), continuity service delivery without interruption, interpersonal relations (respect, confidentiality, courtesy, responsiveness and equality), safety (maximum risk of injury; infection and side effect), and Amenities (physical appearances of facilities, personnel and materials). Some of the important quality assurance mechanism, which is considered, for providing health care in our country is: Licensure, credentialing (granting authorization to provide specific patient care and treatment), Accreditation, standards, indicators, continuous education, procedure and infection control.

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This paper describes strategies for improving the performance of health care workers. Many factors interact to affect the quality of health care. The structure of the health care system, educational opportunities for health practitioners, the administrative system, the pace of change, economic conditions and the technology available may influence the ability of the existing workforce to acquire new skills and implement them in practice. Thus a comprehensive strategy is needed if the quality of the overall system is to improve, including the development of indicators to measure progress4. As there is great development in sciences and technology, medical field specialty and super specialty, advancement in investigative procedures, the nursing personnel must be competent with updated knowledge and skill for active participation and quality nursing care.

A study conducted by Tamubla (1994) on the public's perception of quality nursing care in Botswana health care institutions, reported that, the Botswana public were dissatisfied with the care they received from nurses when they were patients in a health care institution. The findings showed that the socio-demographic variables had no impact on the subject's perception of quality nursing care. Caring with humanity and love was the main expectations from nurses. It was found that nurses needed to get closer to the "Customer" by formulating well-designed strategies that will incorporate the public's perception into the profession's perceptions of quality care9. Twentieths century saw nursing as a profession, and a distinct discipline. Many nursing theories were propounded. Research work was undertaken, standards were set by different nursing associations, Educational levels of nursing were streamlined, current issue and trends found their place in nursing and expanded roles of nursing practice paved the way towards new directions for nursing with increased autonomy10. In recent years, acquired a new philosophy of health, which may be stated as : Health is human fundamental rights, health is essence of productive life, and not the result of ever increasing expenditure of medical care, health is intersectorial, health is integral part of development, health is counter to the concept of quality of life, health involves individuals, states and international responsibility and health and it's maintenance is a major social investment and health is world-wide social goal. Sister Olivia2 (1995), viewed nursing as being both as an art and science. The high quality nursing is the, right of all patients and the responsibility of all nurses who give it has been universally accepted, together with the view that each individual nurse is accountable for sound professional practice. Therefore it is very important to examine the nurse's behavior towards their patient's in this teaching institution. The new millennium belongs to nursing profession to show it's vision, strength and strategy. They are to pass on to a strong, socially relevant, vocationally satisfied profession for future generation of nurses and citizens12. A study conducted by "Ogilvie L" in 1995 concluded: Low moral among nurses, insufficient knowledge and little awareness about new issues like AIDS, Lack of in-service education and no

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interest in continuing education2. Since this research is mostly concerned with nurses working in government health services; though these factors may effect nursing service in any institution. On a study conducted by Oermann, Dillon and Tecuplin on "Indicators of quality of care in clinics; Patients' perspective" showed that the most important indicators of nursing care quality were communicating with the nurse, being treated with respect, being cared for by nurses who were up-to-date, teaching by the nurse, and not being rushed through the visit19. Some issues that influence nursing in future are: rising public expectations, changing demographic characteristics of population, changing disease pattern, technology and information explosion (e.g. CT Scan, MRI, e-mail, Internet, Etc), Globalization of changing world or work12. (Factors: economic, demographic, social, political and technological).

Nurses are prime sufferer of public anger because of the facts like: Nurses stay with clients 24 hours, mistakes or faults make by other discipline, the nurses are in front to give the answer, very high work load, has less time for counseling and guidance, unable to explain their own role in clients care, and poor orientation to clients and relatives12. Carman JM (2000) in her study on patients perception of service quality, combining the dimensions", found that consumers evaluated the technical dimensions of nursing care, physician care and outcome as more important than accommodation functions of hospital care and there are significant interactions among the technical dimensions20. Nursing is defined as art and science in which verbal and non-verbal, tangible and intangible health related activities are systematically performed by specially educated licensure and companionate person21. According to WHO, "Health is a state of complete physical, mental, social and spiritual well being and not merely an absence of disease or infirmity22". The health effects can be classified in two main categories: psychological and behavioral changes including hostility, aggressiveness, anxiety, depression, tiredness, alcoholism, drug abuse, sickness-absenteeism; and psychosomatic ill health includes: fatigue, headache, pain in the shoulder, neck and back, propensity to peptic ulcer, hypertension, hear disease, and rapid ageeng16. Based on the trend of rapid scientific, technological and social changes, international council for nurses (ICN) is convinced of the importance of continuing education in order to ensure safe and effective nursing care. Continuing education should answer the needs of the service as well as the development of nurses: updated knowledge for on-going practice, preparation for career advancement15. Transitions in health care have sparked public and professional concern regarding the status of inpatient hospital nursing and it's effect on the quality of care in hospitals, prompting the Institutes inquiry into this issue. It has been well documented that the work environment affects nurse satisfaction and turnover; which in turn influences the organizational lost of replacing nurses. Theoretically, the environment in which care is delivered affects patient, nursing and

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institutional outcome. Nursing can be though of as an organization's surveillance system, in that nurses are present around the clock. In addition, nurses functioning in such an environment can apply resources as appropriate for best meeting patient needs and for communicating problems to the physician in a timely manner. Theoretically, these environmental factors are responsible for better patient, nurse and organizational outcomes. 2. Rational of the study. In a period of fiscal constraints and health care reforms, peoples around the world are demanding grater quality in the health care they receive and accountability in the health care system. Evidence for the need to improve quality is widespread. Large variations in patterns of practice are observed that cannot be explained by differences in the needs of the populations served. Studies report high rates of inappropriate care and error during care giving. We can expect workers in the health care system today to continue to work for twenty or thirty more years. Thus, attention must be paid to how to continue their professional development and addict them in improving the care that they provide. These workers must continuously change their practice behavior to keep abreast of new developments in the health care field4.

In-service education programme is an essential and distinctive component of a staff development programme involving formal teaching learning activities within the institutional setting, aiming at consistent and conscious improvement and maintenance of quality of service through developing the potential of the health workers.

As there is great development in science and technology, medical field specialty, and super specialty, advancement in investigative procedure, the nursing personnel must be competent with update knowledge and skill for active participation and quality nursing care. In BPKIHS medical-surgical nursing department consists about 60% hospital beds. In each ward nursing officer act as a in-charge of the ward and senior staff nurses act as the assistant of the ward in-charges most of the times and in absence of ward in-charge they will act as nursing managers. They are the key managers of the ward and playas main role in the patient care, store management, supervision and evaluation of staffs, and involved in all the managerial activities, hence to update their knowledge and skill periodically is mandatory, so the project is designed.

This quasi-Experimental study will:

• Initiate continuing education programme for nursing managers to update knowledge, skill and attitude in concerned practice area.

• Equip nurses with advanced and modern concepts emerging in nursing profession. • Aiding nursing personnel in personal growth. • Helping nurses in professional development. • Update nurses to meet the demands of other medical specialties. • Increase great efficiency of operations among nurses • Establish more effective scheduling of ward activities • Reduce absenteeism of nurses, by increasing their motivation • Improve nurse physician relations • It will generate resources for nurses working in BPKIHS.

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BPKIHS is a tertiary care center, which provides specialty and super-specialty medical services along with preventive, promotive, curative as well as rehabilitative services. Most of the admitted patients are referred and critically ill. Since no such type of research study has been conducted in Nepal, therefore, the study being undertaken will generate literature for the future references and also aid in quality patient care at BPKIHS. Hence, the above factors motivated the investigator to conduct a research study on, "Strengthening Leadership Qualities among the Nursing Managers Working in Medical-Surgical Nursing Department of B.P. Koirala Institute of Health Sciences". Theoretical framework:

An essential component of the nursing management philosophy is it's premise of valuing human resources. Thus, it was essential that the first focus of the strategic plan would be staff satisfaction and the implementation of action plans to recognize progressive achievement, promote communication and shared decision making, enhance team spirit and retain skill of staff to develop the specialist concept6.

Nursing practice framework: While implementing strategies to recognize progressive achievement and develop the specialist concept, it became apparent that although everyone know what nurses did, there is no clear framework that defined nursing practice or provided the basis for staff development. Determining and documentation the work role not only increased staff satisfaction, but provided a measurable correlation between nursing functions, client needs and health outcomes.

The nursing roles identified in each patient care area were categorized using the concepts developed by Patrica Benner5. According to Benner, nursing competencies (specific knowledge, skills and altitudes) can be clustered according to similarities in intent, function and meaning. Benner calls these clusters "Nursing domains" details in figure I . The clinical model (Figure-II) includes the overlapping components of practice, research, and education or consultation. Administration overlaps all these components through participatory decision-making structures (both personnel and committees). The key message emanating from the clinical model is that care outcomes are determined by the degree to which the three components (practice, education or consultation, and research) permit the life of the organization. The implementation of the strategic planning process resulted in increased effectiveness and efficiencies in case outcome5.

Figure – 1: NURSING DOMAINS:

i) Helping Function :

Nurses maximize the client's participation and control in treatment and recovery progress by establishing a helping environment, controlling distressing symptoms, providing comfort measuring, and providing guidance through emotional and developmental changes.

ii) Teaching and coaching function:

Nurses teach the client about the disease and it's treatment protocol. Information and emotional support is provided.

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iii) Diagnostic and monitoring function:

Nurses monitor tests and therapeutic interventions, detect and document significant changes in the patient's condition, and anticipate future problems.

iv) Effective Management of rapidly changing situations:

Nurses respond to emergency situations and rapidly match demands and resources. They identify the signs and symptoms of common emergencies and initiate the appropriate care.

v) Administering and monitoring therapeutic interventions:

Nurses administer therapies including intra-vascular therapy, medications, and other invasive and non-invasive therapeutic procedures.

vi) Monitoring and ensuring the quality of health care practices:

Nurses make plans to ensure the safe delivery of care. They are always present and coordinate the multiple interactions of the patient with the health care team. Nurses are in a position to detect and prevent possible errors. Their actions include providing safe care, getting appropriate and timely responses from physicians, and acting as patient advocates.

vii) Organizational and work role competencies:

Nurse's co-ordinate client needs, engage in team building, which facilitates optimum therapy, and participate in contingency planning to overcome issues such as shortages of resources.

Figure – 2: Clinical Model

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Research

Practice

Cornerstones

Nursing Information

System

Nursing Research

Programme

Nursing Delivery System

Quality Improvement Programme

Professional Advancement

Shaired Decision making structure

Education/

Consultation

Administration

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3. Research design and methodology. Single group pre-test post-test research design will be used to conduct the study among the nursing managers (Nursing Officers an Senior Staff Nurses) regarding strengthening the leadership qualities, working in medical-surgical nursing department of B.P. Koirala Institute of Health Sciences. Total 42 subjects (18 Nursing Officer and 24 Senior Nursing Officer) were included in the study. After obtaining the pre-test the planned education intervention on leadership qualities will be implemented. Total 15 hours theoretical and 3 hour interaction session will be arranged. The list of topics related to managerial skills will be included in the session. After 6 weeks of teaching session the post-test will be conducted. The evaluation of the training programme will be done. The research study will be conducted in Medical-Surgical Nursing Departments i.e. in medical, surgical, orthopedics, Eye, ENT, Paying, emergency, operation theaters, dialysis, ICU/CCI wards of BPKIHS. Sample will comprise all the nursing managers working in selected wards of BPKIHS, who fulfill the set selection criteria. The Nursing Managers interested to participate will be only included in the study.

Following topics were included in the education intervention:

1. Nursing Management Process 2. Recent concepts of Management 3. Principles and Functions of Management 4. Recording, reporting and Audit 5. Patient Assignment System. 6. Therapeutic Communication. 7. Clinical Supervision and student supervision. 8. Ethical, Legal and Medicolegal aspect. 9. CPCR 10. Universal precaution and Nosocomial infection. 11. HIV/AIDS 12. Nursing Standard & Nursing Audit 13. Quality nursing Service 14. BT, IVI & Anaphylaxis 15. Psychological aspects in Patient care

Statistical Analysis: The Data collected will be analyzed in the following ways:

Descriptive date Analysis: Percentage, Mean and Standard Deviation will be used for describing the socio-demographic, health profile and other variables of the respondents.

Interferential Data Analysis: Chi-squire, ANOVA, Normal distribution will be used to test the hypothesizes.

Ethical considerations: Written permission will be obtained from the concerned authority after approval of the project. Informed verbal consent will be obtained from the respondents. Anonymity of the subject will be maintained. Subjects will be assured of the confidentiality of their information. Professional norms will be maintained with the control group.

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6. ORGANIZATION OF THE STUDY: (TIME SCHEDULE)

SN Activities Duration/Time 1. Literature review and finalization of the project 2 Months 2. Pre-testing and finalization of tool 1 Months 3. Education intervention and follow up 6 Months 4. Analysis of Data 1 Months 5. Report writing and Submission 2 Months ………………………. 1 Year

Section-D

Details of the Budget:

SN Item/Particular Details

Amount (In NP Rs.)

1 Tool: Preparation, Printing & Testing. 50 sets 1,900 2 Preparation of training package 50 sets x 75 Rs 3750

3 Training Programme

50 person X 5 days x 40 8750

4 Statationary 1500 5 Data Processing: coding and entry 800

6 Report preparation and Typing 3000

7 Data Analysis 2000

8 Photocopy, Printing and Binding 1800

9 Miscellaneous 1500

Grand Total 25,000 /-

Rs. Twenty Five Thousand Only

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References: - 1. Aiken LH, Patrician PA. Measuring organizational traits of Hospitals: The Revised Nursing work Index: Nursing

Research: 2000; 49(3): 146-153.

2. Ogilivine L. Nursing in Nepal: The Canadian Nurse: 1995: 91(8): 29-34.

3. The world, Health Report 200, Who, Geneva, Switzerland.

4. Woodard CA. Issues in health service delivery .WHO, Geneva, 2000

5. Agrwal AK. Quality management in Hospital services. IGNOU, New Delhi. 1998.

6. Benner P. From novice to expert. Excellence and Power in Clinical nursing practice. Menlo Park, CA, Addison-Webley Publishing Company: 199

7. Bhattacharya A. Manpower strategies to increase access to PHC in Nepal: 1982; 4(2): 168-80.

8. Singh S. Nursing Situation in Nepal at psresent: A proceeding of International Nurses day: NAN; 1998: 25.

9. Neo TM. The public perception of quality Nursing care in Botswana Health care Institutions: University of Botswana, Department of Nursing education: 1994:339-56.

10. VISION, SOUVENIR, B.P. Koirala Institute of Health Science, Dharan, Nepal; 1999: 1-3.

11. Parajuli P. Adequacy of Care provided by the nursing personnel in meeting selected physical needs of adult immobilized orthopaedic patients in the orthopaedic ward: Christian Medical College and Hospital, Vellore: April; 1999.

12. Mehta R.S. Nursing. A Challanging Profession, Vision, B.P. Koirala Institute of Health Sciences; Dharan, Nepal; 2000: 30-31.

13. Health Hazards of human environment. The work environment, WHO, Geneva, 1972: 1251.

14. Thakur L. Factors affecting the role and functions of staff nurse in Nepal: TU, IOM, 1993.

15. Bottorff JL et al. Comforting: Exploring the work of cancer nurses: Journal of Advanced Nursing, 1995; 22: 1077-84.

16. Nurse Practioner. American Journal of Primary health care: 1989: 14(2): 44-54.

17. Erikson J. Rondey P, Starzomski R: When it is right to go: The Canadian Nurse: 1995; 8: 29-34.

18. Taylor C, Lillis C, Lemone P.: Fundamentals of Nursing: 3rd Edi. Lippincott; 1997.

19. Oermann MH, Dillon BL, Templin T. Indicators of quality of care in clinics: Patients perspective: College of Nursing, Wayne State University, Detroit, MI, USA, 2002; 229(6): 9-11.

20. Carmen JM. Patient's perception of service quality, combining the dimension; Han School of Business Administration and public health, University of California, Berkely; USA; 2000; 14(5): 339-56.

21. Mehta R.S, Singh S. Satisfaction of clients and their relatives receiving nursing care at BPKIHS; 1999.

22. Park JE, Park K. Text book of preventive and social medicine: 14th ed. Jabalpur; India; 1994.

23. WHO. Health research methodology: A guide for training in research methods, oxford university press, Delhi, 1993.

24. Planning healthy communites: A guidee to doing community need assessment. Southern community health, research unit, Australia,1991.

25. WHO. Health system research document.Technical discussion, WHO,1990.

26. Roherts J, Browne G, Milne C etal,. Problem solving counseling for care givers of the cognitively impaired: effective for whom? Nursing research. 1999; 48 (3): 162-171.

27. Kunaviktikul W, Nuntasupawat R, Srisuphan W etal. Relationship among conflict, conflict management, job satisfaction, intent to stay, and turnover of professional nurses in Thailand. Nursing and Health Sciences. 2000,2, 9-19.

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Appendices

Appendix: A Steps of planned continuing Education (Strengthening continuing education)

The best practices for strengthening Inservice education involves a process to incorporate mastery learning and competency based training into wards that addresses all of the elements of Inservice education system. There are four phases of the process for strengthening Inservice Education. They are:

• Phase 1 – Plan and orient • Phase 2- Prepare for and conduct Teaching • Phase 3 – Review and Revise Teaching • Phase 4 – Evaluate Teaching

The steps involved in each phase are as follows:

• Phase 1 – Plan and Orient - Create working group - Conduct a needs assessment - Orient opinion leaders and decision makers - Create a curriculum strengthening group • Phase 2 – Prepare for and conduct Teaching - Train the curriculum strengthening group by conducting a technical update and clinical

training skills course - Strengthen the curriculum using principles of instructional design - Develop and produce teaching learning and assessment materials - Equip the teaching unit - Plan for implementation in each unit - Orient decision makers faulty and clinical staff at each unit - Train additional faculty and relevant clinical staff - Prepare clinical practices sites - Coordinate teaching - Conduct and monitor teaching - Conduct follow up visits

• Phase 3- Review and Revise Teaching - Review the institutional plan of action - Assess the methods and materials used - Measure the outcome of teaching - Revise the institutional plan of action - Conduct review and revision visit - Review and revise the Institutional plan of action • Phase 4 – Evaluate teaching

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Appendix: B

Questionnaire Strictly–confidential ----cTo]Gt uf]Ko_ cTo]Gt uf]Ko_ cTo]Gt uf]Ko_ cTo]Gt uf]Ko_ Code No:

(Please do not write your name.) Section–I (SOCIO–DEMOGRAPHIC, HEALTH PROFILE AND JOB SATISFAC TION) Please (√√√√) tick the most appropriate answer: 1. Age (in years): (a) < 25 (b) 26-30 (c) 31-35 (d) >35

2. Post: (a) NO (b) SSN

3. Marital status: (a) Married (b) Unmarried (c) Divorced (d) Separated

4.Residence: - a. Permanent Address: district: - ……………….

5. Total experience in nursing field (years): -……………………………………………

6. Total duration of service in current post: -……………………………………………

8. Are you interested for further education? (a) Yes (b) No

9. What made you decide to join this hospital Motivating factor? (MR) a. Attractive salary.

b. Quarter facilities

c. Big organization

d. Chance of further education

e. As I have no Job Else where

f. Non-transferable job

g. Safe place

h. Other specify: -

10. What is your Ultimate aim for your career (future plan)?

a. Stick to nursing service b. Switch to other profession / Job c. Plan to go aboard / foreign d. Not yet decided

11. According to your people what is the status of a Nurse?

a. Very high b. High c All right / average d. Low e.Very low 12. What was the reason for which you chose nursing profession (MR)

1. For easy access to job 2. Because my parents wanted me to join nursing 3. I was very interested to become a nurse 4. There is glamour in this profession 5. Due to financial problems 6. Thinking I would join other profession later 7. Due to peer pressure 8. As it is unable to labour hard 9. Others:

13. Ho do you rate (grade) your workload? (a) To much (b) All right (c) Not enough

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14. Please rate (mention) your satisfaction levels with the following. Please tick (√√√√) the most appropriate answer.

A= Fully satisfied B= Moderately satisfied C=Just satisfied D=Not satisfied at all

S. No Name of factor Responses 1. Job security A B C D 2. Pay scale A B C D 3. Allowances and other monetary benefits A B C D 4. Prestige of organization A B C D 5. Recognition of good work A B C D 6. Opportunity for promotion / development A B C D 7. Interpersonal relations A B C D 8. Achievements A B C D 9. Work it self A B C D 10. Responsibility (defined/given) A B C D 11. Organizational policies A B C D 12. General administration A B C D 13. Nursing administration A B C D 14. Supervision (to you) A B C D 15. Working conditions A B C D 16. Attitude of employee A B C D 17. Communication channel A B C D 18. Appreciation of individual performance A B C D 19. Health insurance / service policy A B C D 20. Duty hour A B C D 21. Cooperation with doctor A B C D 22. Quarter allotted A B C D 23. Evaluation system A B C D 24. Job description A B C D 25. Relation with immediate supervisor A B C D 26. The effect of your job on your personal life A B C D

15. How many years would you like to serve (job / service) in BPKIHS?

(a) >5 yrs (b) 5-10 yrs (c) 10-15 yrs (d) >15 yrs. 16. Are you satisfied with the nursing care services you provide to your patients?

(a) Fully satisfied (b) Partially satisfied (c) Not satisfied at all

17. Your overall satisfaction with your nursing service to patients in BPKIHS.

(a) Fully satisfied (b) Satisfied (c) Just satisfied (d) Not satisfied at all

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Section: II Professional Competencies (Knowledge, Skill & attitude) regarding quality

nursing care

1. Please rate (grade) your professional competencies regarding following nursing care components:

S. No.

CNE Components Responses

1 Nursing Management process.

Adequate Inadequate Not at all

2 Quality nursing service Adequate Inadequate Not at all

3 Patient assignment system Adequate Inadequate Not at all

4 Therapeutic communication Adequate Inadequate Not at all

5 Recording and reporting & nursing audit.

Adequate Inadequate Not at all

6 Nursing standard & quality nursing service

Adequate Inadequate Not at all

7 Supervision and clinical supervision

Adequate Inadequate Not at all

8 Ethical & Legal aspects Adequate Inadequate Not at all

9 Principles of Management Adequate Inadequate Not at all

10 Functions of Management Adequate Inadequate Not at all

11 Nosocomial Infection and Universal precaution

Adequate Inadequate Not at all

12 CPCR Adequate Inadequate Not at all

13 HIV/AIDS Adequate Inadequate Not at all

14 Evaluation Adequate Inadequate Not at all

15 BT, IVI & Anaphylaxis Adequate Inadequate Not at all