ncm 105 cmo 30 notes

NCM 105 (CMO 30) - NURSING MANAGEMENT AND LEADERSHIP

Unit 1. The Concept of Management and Leadership Additional Notes for Students

Description of Management. Management is a process of coordinating actions & allocating resources to achieve organizational goals.

Role of Managers (Venzon and Nagtalon, page 4)1. interpersonal role2. informational role3. decisional role

Description of Leadership. Leadership is the process of influence in which the leader influences others toward a goal achievement.

Influence is an instrumental part of leadership and means that leaders affect others, often by inspiring, enlivening and engaging others to participate. It involves the leader and the follower in interaction.

Difference between a Leader and ManagerSubject Leader Manager

Essence Change StabilityFocus Leading people Managing workWanted to have Followers SubordinatesHorizon Long Term Short termSeeks Vision ObjectivesApproach Sets direction Plans detailsDecision Facilitates MakesPower Personal charisma Formal authorityAppeal to Heart HeadEnergy Passion ControlCulture Shapes EnactsDynamic Proactive ReactivePersuasion Sell TellStyle Transformational TransactionalExchange Excitement for work Money for workLikes Striving ActionWants Achievement ResultsRisk Takes MinimizesRules Breaks MakesConflict Uses AvoidsDirection New roads Existing roadsTruth Seeks EstablishesConcern What is right Being rightCredit Gives TakesBlame Takes Blames

Principles of Management described by Henri Fayol1. Division of Labor. He recommended that work of all kinds must be divided & subdivided and allotted to various persons according to their expertise in a particular area. Subdivision of work makes it simpler and results in efficiency. 2. Party of Authority & Responsibility. Authority refers to the right of superiors to get exactness from their sub-ordinates whereas responsibility means obligation for the performance of the job assigned. 3. Principle of One Boss. A subordinate should receive orders and be accountable to one and only one boss at a time.

A sub-ordinate should not receive instructions from more than one person because of the following reasons: it undermines authority weakens discipline, divides loyalty, creates confusion, delays and chaos, escaping responsibilities, duplication of work, overlapping of efforts

Unit 1. The Concept of Management and Leadership . . .continuation Additional Notes for Students

4. Unity of Direction. There should be one plan for a group of activities

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having similar objectives. Without unity of direction, unity of action cannot be achieved.

Basis Unity of command Unity of directionMeaning It implies that a sub-

ordinate should receive orders & instructions from only one boss.

It means one head, one plan for a group of activities having similar objectives.

Nature It is related to the functioning of personnel’s.

It is related to the functioning of departments, or organization as a whole.

Necessity It is necessary for fixing responsibility of each subordinates.

It is necessary for sound organization.

Advantage It avoids conflicts, confusion & chaos.

It avoids duplication of efforts and wastage of resources.

Result It leads to better superior sub-ordinate relationship

It leads to smooth running of the enterprise

5. Equity 6. Order . Arrangement of things is called material order and placement of people is called social order. Material order- There should be safe, appropriate and specific place for every article and every place to be effectively used for specific activity and commodity. Social order- Selection and appointment of most suitable person on the suitable job. There should be a specific place for every one and everyone should have a specific place so that they can easily be contacted whenever need arises. 7. Discipline. This principle applies that subordinate should respect their superiors and obey their order. 8. Initiative. 9. Fair Remuneration10.Stability of Tenure11.Scalar Chain. ’The chain of superiors ranging from the ultimate authority to the lowest”. 12.Sub-Ordination of Individual Interest to General Interest. individual must sacrifice for bigger interests. 13.Espirit De’ Corps (harmony in the work groups and mutual understanding among the members). To inculcate Espirit De’ Corps following steps should be undertaken: 13.1 There should be proper co-ordination of work at all levels 13.2 Subordinates should be encouraged to develop informal relations

among themselves. 13.3 Efforts should be made to create enthusiasm and keenness among

subordinates so that they can work to the maximum ability. 13.4 Efficient employees should be rewarded and those who are not up to the mark should be given a chance to improve their performance. 13.5 Subordinates should be made conscious of that whatever they are doing is of great importance to the business & society. 14.Centralization & De-Centralization. Centralization means concentration of authority at the top level. Decentralization means disposal of decision making authority to all the levels of the organization

Theories of management1. Management Theories. Based on the classical perspective of management that were introduced in the 1800’s during the industrial age 1.1 Bureaucratic Theory . The bureaucratic organization is when orders from the top are transmitted down thru the organization via clear chain of command.


1.2 Human Relations. The individual worker is the source of control, motivation, and productivity in organizations. The idea that people increase their work output in the presence of others was a result of the Hawthorne experiments.

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Hawthorne Effect, the effect of being watched and receiving special attention could alter a person’s behavior. It is a phenomenon of being observed or studied, resulting in changes of behavior.2. Administrative principles. POSDCORB: planning, organization, supervising, directing, controlling, and organizing, reviewing, and budgeting. Unity of command and direction means workers would get orders from only one supervisor and related work would be grouped under one manger.3. Human Motivation Theories 3.1 Maslow’s Hierarchy of satisfaction of physiology, safety, belonging, ego, and self actualization needs

3.2 Two Factor. Hygiene and Maintenance factors prevent job dissatisfaction; provide adequate salary and supervision, safe and tolerable work conditions.3.2 X Theory. Leaders must direct and control as motivation results from reward and punishment3.3 Y Theory. Leaders remove obstacles as workers self control, self

discipline; their reward is their involvement in work.3.4 Z Theory. Collective decision making, long term employment,

mentoring, holistic concern, and use of quality circles to manage service and quality, a humanistic style of motivation based on Japanese organization.4. Leadership Theories 4.1 Autocratic Leadership. Centralized decision making with the leader, making decisions, and using power to command and control others.

4.2 Democratic leadership. Participatory, with authority delegated to others4.2 Laissez-faire leadership. Passive and permissive and the leader defers decision making = low productivity and feeling of frustration

5. Situational Theories. Addresses follower characteristics in relations to effective leader behavior

High task behavior is called a telling leadership style o telling leadership style - high task behavior and low

relationship behavioro selling leadership style - high task, high relationshipo participating leadership style - low task and low

relationshipo delegating leadership style - low task and relationship

NOTE: The leader not only changes leadership style according to followers needs but also develops followers over time to increase their level of maturity.6. Transformational Theories

Transformational TransitionalLeaders and followers raise one another to higher levels of motivation and morality.

It empowers others to engage in pursuing a collective purpose by working together to achieve visions of a preferred future.

It’s influence by both the leader and the follower to a higher level of conduct and achievement the transforms them both

The manager that is concerned with the day to day operations

Motivate others by behaving in accordance with values , provide a vision that reflects mutual values, and empowers others to contribute.


Transformational leadership has been a popular approach in nursing

7. Generational Issues 7.1 Boomers

o 1946-1964

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o Demonstrate loyalty to an employero Work hard with strong emphasis on money and acquire

thingo More personalized training methods

7.2 Busters o 1965-1981o Regularly change organizations to advance their

developmento More individual approach to worko Value work-family balance lifestyle more highlyo More computer skilled and comfortable with high tech

toolso Note: Different styles reveal differences in how learning

occurs and the methods best suites us.

Management process and the roles that they fulfill in an organization

Management Process – are those performed by managers which involved planning, organizing, directing, motivating, controlling and decision-making.

These processes are also termed as organizational processes because they go beyond an individual manager and affect the entire organization.

Strategic planning process: Vision/mission/ philosophy objective/core values

Decisions are not always directed at problems. Decisions may be proactive and used for making plans for the future. Managers make decisions with both short and long term implications for what the work environment will be.

A strategic plan is a written document that tells what an institution is all about.

Steps in the Strategic Planning Process Vision – An organization’s vision reflects what an organization hopes to

become. It answers “where” the organization is going. Mission – A mission statement lays out the purpose of an organization. It tells “why” an organization exists. Core Values – The values an organization chooses to highlight reflect beliefs about priorities. Core values may be related to characteristics specific to the organization. For example, an organization that is faith- based may espouse Christian values. Goal Setting – Setting goals clarifies what the organization hopes to do. Goals are “what” the plan sets out to accomplish. Environmental Assessment – The resources of an organization must be carefully examined to see what the organization is able to support. An unfavorable organizational climate may negate the ability to implement certain strategies. Strategies – The last step is to develop strategies for reaching the goals. Strategies should be grounded in the environmental assessment. Strategies should be fairly specific, addressing the timing when actions should be initiated and who is responsible.


Standards of nursing practice: 1. Scope of Nursing Practice from Article VI Section 28 of RA 9173 1.1 Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral

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medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established; 1.2 establish linkages with community resources and coordination with the health team; 1.3 Provide health education to individuals, families and communities; 1.4 Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and 1.5 Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice2. Core Competency Standards for Nursing Practice in the Philippines

The Eleven Core CompetenciesA. Safe & quality nursing practice B. Management of resources & environmentC. Health educationD. Legal responsibilityE. Ethico – moral responsibilityF. Personal & professional developmentG. Quality improvementH. Research I. Record managementJ. Communication K. Collaboration & teamwork

Legal Basis: Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act

2002” Board shall monitor & enforce quality standards of nursing practice 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.

Significance of Core Competency Standards A. Unifying framework for nursing practice, education, regulation B. Guide in nursing curriculum development C. Framework in developing test syllabus for nursing profession

Entrants D. Tool for nurses’ performance evaluation E. Basis for advanced nursing practice, specialization F. Framework for developing nursing training curriculum G. Public protection from incompetent practitioners H. Yardstick for unethical, unprofessional nursing practice

The 7 M’s in Management 1. Man 2. Material 3. Machine 4. Money 5. Method (the art of doing or implementing things) 6. Morals 7. Measurement (the process of evaluation)Unit II. The Management Process and Functions Additional Notes for Students

Purpose of the Nursing Management Process (POSDCORB).1. To achieve scientifically-ba s e d , holistic, individualized care for the patient. 2. To achieve the opportunity to work collaboratively with patients and others 3. To achieve continuity of care

Planning. Pre-determined course of action in order to arrive at a desired result.

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Types of Planning1. Strategic or Long-Range Planning2. Operational or Short-Range Planning3. Continuous or Rolling Plans

Principles of Planning1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the institution.2. Planning is a continuous process.3. Planning should be pervasive within the entire organization covering the various departments, services and various levels of management to provide maximal cooperation and harmony.4. Planning utilizes all available resources.5. Planning must be précised, realistic, focused in its scope and nature.6. Planning should be time-bound.7. Projected plans must be documented.

Importance and Reasons for Planning1. It leads to success in the achievements of goals and objectives2. It provides meaning to work3. It provides for the effective use of available personnel and facilities4. It helps nurses cope with crises and problems calmly and efficiently5. It is cost effective6. It is based on past and future activities.7. It reduces the element of change8. It is necessary for effective control

Characteristics of a Good1. It should have clearly worded objectives, including results and methods for evaluation2. Be guided by policies and/or procedures affecting the planned action3. Indicate priorities4. Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities and time5. Develop a logical sequence of activities6. Select the most practical methods for achieving each objective

Approaches in Planning:1. Reactive Planning - is done in response to an existing problem 2. Proactive Planning - done before a problem occurs. It may done in anticipation of changing needs or to promote growth & excellence.

Reasons for failure to Plan Effectively1. Lack of knowledge in the philosophy, goals and objectives.2. Lack of understanding of the significance of the planning process.3. Unable to accept changes4. Time constraints for planning5. Lack of confidence to plan

Major Aspects of Planning1. Planning should contribute to objectives.2. Planning precedes all other processes of management3. Planning pervades all levels4. Planning should be efficientUnit II. The Management Process and Functions . . . continuation Additional Notes for Students

Elements of Planning1. Forecasting or estimate the future 1.1 Forecasting is looking into the future 1.2 Refers to estimation of time series, cross sectional or longitudinal data

1.3 In making forecast, the planner should consider 3 things: 1.3.1 Agency 1.3.2 Community affected 1.3.3 Goals of care

1.3.4 Forecast must be supported by facts, reasonable estimates and accurate reflection of policies and plans

2. Set objectives / goals and determine desired results 2.1 Goals

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2.1.1 Goals are broad statements of intent derived from the purposes of the organization2.1.2 Is a desired aim or condition toward which one is willing to work2.1.3 Individual goals-are personal goals; based on one’s desired in life2.1.4 Group goals-may refer also to organizational goals although on a smaller scale2.1.5 Organizational goals-management goals of an organization that are established to justify its existence2.1.6 They are the potential result that will move the organization closer to its vision & mission

2.2 Objectives2.2.1 specific aims, purposes or targets set for, or accomplishment 2.2.2 Should include plan of action to facilitate the accomplishment of needs or desired goals.

2.2.3 Should answer the questions of: who, What, Where, and Why. 2.2.4 Be flexible enough to allow for changes or elimination when they are no longer useful

The objectives of the Nursing Department is congruent to its vision as well as to the 11 key areas of responsibilities to nursing practice: To observe ethical principles and standards that

govern nursing practice. (ethico-moral-legal responsibilities) To establish well coordinated referral system for the continuity of patient’s care. (communication) To assure the application of acceptable performance of functions,

duties, and responsibilities of every position in the nursing department.

(safe & quality nursing care, management of resources) To encourage its nursing personnel to participate in

nursing research for improving nursing care. ( research) To utilize media for information campaign to intensify health

education program. (health education)

2.3 Mission or Purpose. The mission statement outlines the agency’s reason for existing (whether hospital or healthcare), who the target clients are (the poor, the needy, the middle or upper class), and what services will be provided (in-patient, out-patient, emergency)

Reason for the existence of the organization (Nursing service exist to promote and maintain health)

The BON shall unwaveringly pursue the advancement of nursing development in the country by:

1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders

Unit II. The Management Process and Functions . . . continuation Additional Notes for Students

2. ensuring adherence to professional, ethical and legal standards as

mandated by existing regulatory laws 3. unifying the nursing sector through good governance 4. fostering linkages with the domestic and international stakeholders 2.4 Vision. A thought, concept or objective formed by the imagination. 2.4.1 What do you want to create within a certain period of time? 2.4.2 What do you want to be? 2.4.3 Where do you what to be?

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The Board of Nursing under the guidance of the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.

2.5 Philosophy. It is the sense of purpose of the organization and the reason behind its structure and goals

2.5.1 Philosophy states the beliefs that influence nursing practice and beliefs about health care

2.6 Policies. Are guidelines to help in the safe and efficient achievement of organizational objectives.

2.7 Procedures. Are specific directions form implementing written policies.

3. Develop and schedule strategies as well as set time frame

Strategy. Techniques, methods, or procedure by which the overall plan the higher management achieve desired objectives

Programs. Activities put together to facilitate attainment of some desired goals.

Time Management. A technique for allocation of one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goals efficiently

Principles of Time Management A. Planning for contingencies-planning anticipates the problem that will arise from actions without thought

B. Listing of task-task to be accomplished should be done in sequence which are Prioritized according to importance C. Inventory D. Sequencing E. Setting and keeping deadlines-and adhering to deadline is an excellent exercise in self discipline F. Deciding on how time will be spent

Time Saving Techniques, Devices and Methods to Better Use of Time Methods to Better Use of Time

A. Conduct an inventory of activities B. Set goals and objectives and write them downC. With the use of calendars, executive planners, logs or journals,

write what you expect to accomplish yearly, monthly, weekly or daily.

D. Break down large projects into smaller parts E. Devote a few minutes at the beginning of each day for planning F. Organize work space so it is functional G. Close door when need to concentrate H. Learn to delegate I. In a meeting, define the purpose clearly before starting J. Take or return phone calls during specified time K. Develop effective decision-making skills L. Take rest breaks and make good use of your spare time


Multitasking. Part of daily life & becomes a way of life Trying to get more things done in less time which does not really

make a person more efficient Nurse is asked to do a lot of things, any one of which may demand

her full attention. The net effect of multi tasking, when several task are done at once,

some of them end up being performed in a haphazard manner which can have disastrous consequences

Developing and Scheduling Programs. Programs are predetermined, developed and targeted within a time frame to reach the set goals and

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objectives

4. Prepare budget and allocation of resources

Preparing the Budget

Budget. The annual operating plan, a financial “roadmap” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs.

A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year.

A hospital budget is a financial plan to meet future service expectations.

Factors in Budget planning A. Type of patient, length of stay in the hospital and acuteness of illness B. Size of hospital and bed occupancy C. Physical lay out of the hospital, size and plan of the wards, units, nurse’s station, treatment rooms, etc D. Personnel policies D.1 Salaries paid to various type of nursing personnel including OT pay or shift differential D.2 Extent of VL, SL, holidays D.3 Provision for staff development programs E. Grouping of patients such as those in specialized areas F. Standards of nursing care: kind and amount of care to be given as it affects the number of hours of bedside care G. The method of performing nursing care whether simple or complex; the method of documentation H. Proportion of nursing care provided by the professional nurses and those given by nonprofessionals I. Amount and quality of supervision available and provided; the efficiency of job description and job classification J. Method of patient assignment whether functional, case, team or primary K. Amount and kind of labor-saving devices and equipments L. Amount of centralized service provided: sterile supply , central supply, linen supply M. Nursing service requirements of the ancillary departments: clinics, Admitting office, ER N. Reports required by administration whether simple or complex O. Affiliation of nursing students or medical students5. Establish policies, procedures and standards

Nursing Standard. Standard-a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which quality of practice or education can be judged


Nursing Care Standard. A descriptive statement desired quality against which to evaluate nursing care

Purpose of nursing standards Improved quality of care Decrease the cost of nursing care Determine nursing negligences

Sources of nursing standards: DOH, BON, Professional Organization, Nursing Programs

Nursing Service Policies Policies in general are guidelines to help in safe and efficient achievement of organizational objectives Standing plans of the nursing organization.

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They are the conceptual plans that are translated into physical entities usually called manuals Usually develop by a policy committee At nursing division level, committee is made of representatives from nursing specialist and top nursing management

There are 3 general areas in nursing which requires policy formulation Areas in which confusion about the locus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfare Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property Areas involving matters of personnel management and welfare

Nursing procedures Procedures are specific directions for implementing written policies Manual contains detailed plans for nursing skills ( procedures) that include steps is proper sequence Procedures outline a standard technique or method for performing duties and serve as a guide for action

Phases of PlanningPhase I: Developing the Plan Developing a plan is to establish its purpose Must be clear about the purpose of planning to avoid confusion However, purpose may be stated in broad However, purpose may be stated in broad terms until assessment of the situation is done or problem is done. When assessing the situation/ problem:

Phase II: Presenting the Plan Plans for projects are presented to admin/management for approval Planner needs to be persuasive in convincing others to accept the plan Must be presented in organized manner & clearly, concise and direct in professional manner

Phase III: Implementation & monitoring: Identifying & arranging activities according to sequence Setting target dates for completing each activity Assignment of responsibilities to particular individuals Allocation of resources resource

Unit III. The Management Process and Functions . . . continuation Additional Notes for Students

Organizing. It is the process of establishing formal authority.

Involves setting up the organizational structure through identification of groupings, roles and relationships Determines staff needed through developing and maintaining staffing

patterns and distributes them in the various areas as needed Develops job descriptions by defining the qualifications and functions of personnel Organizing is one way which nursing management coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion. Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies

Principles of an Organization1. Communication. Effective and open communication in all forms; thread that binds the organization together

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Directions of communication: A. Downward B. Upward C. Lateral /Horizontal D. Grapevine

2. Unity of Command3. Span of Control4. Delegation of authority 5. Similar Assignments6. Unity of Purpose

Organizational Design or Structure. It is a formal, guided process for integrating the people, information and technology of an organization.

Principles of Organizational Design1. Division of labor2. Unity of command3. Authority and responsibility 4. Span of Control5. Contingency Factors

Elements of Organizing1. Organizational Structure - refers to the process by which a group is formed its channel of authority, span of control and lines of communication.

Importance of Organizational Structure A. It enables members what their responsibilities are, so that they may carry them out. B. It frees the manager and the individual workers to concentrate on their respective roles and responsibilities C. It coordinates all

Patterns of Organizational Structure A. Tall or Centralized Structure


Advantages DisadvantagesResponsible for only a few subordinates, so there is a narrow span of control

It makes use of expertise, and allows close communication between the workers.

Supervisory individuals screen the communication.

Because of the vertical nature of the structure, there are many levels of communication

Transpires that the most skilled individuals end up doing nothing while actual tasks are done by those less capable.

Communication from bottom to top is often difficult, and messages do not get to the top

Workers tend to be very “boss-oriented “ because of the close contact with their supervisor

B. Flat or Decentralized Structure

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Advantages DisadvantagesLower likelihood of messages being distorted

Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction

The principle of “shared governance” produces maximum potential for professional growth

Supervisor spend less time with each worker

Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions

C. Matrix Structure


Advantages DisadvantagesIndividuals can be chosen according to the needs of the project. The use of a project team which is dynamic and able to view problems in a different way as specialists have been brought together in a new environment.

Project managers are directly responsible for completing the project within a specific deadline and budget.

A conflict of loyalty between line managers and project managers over the allocation of resources.

If teams have a lot of independence can be difficult to monitor.

Costs can be increased if more managers (ie project managers) are created through the use of project teams

Types of Organization Classified by Nature of AuthorityA. Line Organization- each position has general authority over the lower positions in the hierarchy. (also known as

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Bureaucratic/Pyramidal). B. Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization). Refers to an organizational structure with few or no levels of intervention

between management and staff.C. Staff Organization- purely advisory to the line structure with no authority to put recommendations into action.D. Functional Organization – each unit is responsible for a given part of the organization’s workload.

Organizational RelationshipA. Formal relationship - represents by uninterrupted lines between units, showing who reports to whomB. Informal relationship - represented by a broken or dotted line, where power relationships are coordinated.

Organizational Chart. A line drawing that shows how the parts of an organization are linked.

Characteristics of an Organizational ChartA. Division of Work B. Chain of CommandC. Type of Work to be performedD. Grouping of Work SegmentE. Levels of Management

2. Staffing - is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients’ demand.

Steps in StaffingA. Determine the Number and Types of Personnel NeededB. RecruitmentC. Interview

D. Induct or Orient the Personnel in Organization Job Offer Centralized vs Decentralized Staffing Staffing decisions for all units are made by a central office or computer.

Tends to be fairer to employees because policies are implemented more consistently and impartially.


Frees manager to complete other functions.

Most cost effective, because it maximizes use of human resources organization-wide

Decentralized Staffing is done at unit level, frequently by unit manager.

Allows person who knows the individual unit the best to make staffing decisions for that unit.

Allows staff to take requests directly to their own manager, which gives them increased autonomy and flexibility.

Time consuming for head of the unit

Staffing Formula:Requirements - Standard Value of Nursing Care

Cases NCH per Patient per Day

Professional to NonProfessional Ratio

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General Medicine 3.5 60:40Medical 3.4 60:40Surgical 3.4 60:40Obstetrics 3.0 60:40Pediatrics 4.6 70:30Pathologic Nursery 2.8 55:45ER/ICU 6.0 70:30CCU 6.0 80:20

Distribution per ShiftShift PercentageAm 45%Pm 37%

Night 18%

Categories of PatientLevels of Care NCH Needed per patient

per dayProfessional and Non

ProfessionalLevel ISelf-Care or Minimal Care 1.50 55:45Level IIModerate or Intermediate Care 3.0 60:40Level III Total or Intensive Care 4.5 65:35Level IV Highly Specialized or Critical Care

6.0 7.0 or higher

70:3080:20

Percentage of Patients in Various Levels of CareType of Hospital Minimal

CareModerate

CareIntensive

CareHighly

Specialized Care

Primary Hospital 70 25 5 -Secondary Hospital 65 30 5 -Tertiary Hospital 30 45 15 10Special Tertiary 10 25 45 20

Total Number of Working and Non-working Days and Hours of Nursing Personnel per Year Right s and Privileges Given each Personnel/Yr Working Hours per Week

40 hours 48 hoursVacation Leave 15 15Sick Leave 15 15Legal Holidays 10 10Special Holidays 2 2Special Privileges 3 3Off Duties as per R.A. 59017 104 52Continuing Education Program 3 3

Total Non-Working Days/Year 3 3Total Working Days/Year 152 100Total Working Hours / Year 213 265RA 5901 = 40H WK LAW 1,704 2,120

Steps for Computing the Staff Needed in the in-patientUnit of the Hospital

Computation:Case: 250 Bed Capacity

Tertiary HospitalHow many staff nurses do we need?

1. Categorize patient according to Level of care

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250 X 30% = 75 minimal care 250 X 45% = 112.5 moderate care 250 X 15% = 3.5 intensive care 250 X 10% = 25 highly specialized nursing care

2. Find the Nursing Care Hours (NCH) Needed 75 X 1.5 (NCH @ Level I) = 112.5 NCH/day 112.5 X 3 (NCH @ Level II) = 337.5 NCH/day 37.5 X 4.5 (NCH @ Level III) = 168.75NCH/day 25 X 6 (NCH @ Level IV) = 150 NCH/day 768.75 NCH/DAY

3. Find NCH per year 768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR

4. Find the actual working hours needed by each nursing personnel / year 8 hrs/day X 213 (working day/year) =1,704 (working hrs/year)

5. Find the total number of nursing personnel needed5.1 Total NCH/Year = 280,593.75 = 165 Working Hrs/Year = 1,704

5.2 Relief X Total Nursing Personnel 165 X 15% = 25

(Constant: 15% for 40 Hrs/Wk & 10% FOR 48 HRS/WK)

5.3 Relievers + Total # of Nursing Personnel Needed 165 + 25 = 190 Total Personnel Needed

6. Determine Professional from Non-Professional

e.g. tertiary hospital

190 X 65% = 124 Professional190 X 35% = 68 Non-Professional

7. Distribute per shift PROFESSIONAL(124) NON PROFESSIONAL(66)

AM (45%) 56 30 PM (37%) 46 24 NIGHT (18%) 22 12


3. Scheduling. A schedule is a timetable showing planned work days and shifts for nursing personnel

Factors to Consider in Making a ScheduleA. Different levels of the nursing staff B. Adequate coverage for 24 hours, 7 days a week C. Staggered vacations and holidaysD. WeekendsE. Long stretches of consecutive working daysF. Evening and night shiftsG. Floating

Assessing a Scheduling SystemA. Ability to cover the needs of the shiftB. Quality to enhance the nursing personnel’s knowledge, training and experienceC. Fairness to the staffD. Stability E. Flexibility

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Types of SchedulingA. Centralized ScheduleB. Decentralized ScheduleC. Cyclical Schedule

Scheduling VariablesA. Length of scheduling period whether 2 or 4 weeksB. Shift rotationC. Week-ends off D. Holiday off E. Vacation leaveF. Special daysG. Scheduled events in the hospital , training programs, or meetingsH. Job categoriesI. Continuing professional education (CPE) programs

4. Developing job descriptions. Statement that sets the duties and responsibilities of a specific job.

Contents of a Job DescriptionA. Identifying DataB. Job Summary C. Qualification RequirementsD. Job RelationshipsE. Specific and Actual Functions and Activities

Uses of Job DescriptionA. For recruitment and selection of qualified personnelB. To orient new employees to their jobsC. For job placement, transfer or dismissalD. As an aid in evaluating the performance of an employeeE. For budgetary purposesF. For determining departmental functions and relationships to help define the organizational structure


G. For classifying levels of nursing functions according to skill levels requiredH. To identify training needsI. As basis for staffingJ. To serve as channel of communication

Patient Classification SystemLevel I – Self Care or Minimal Care. Requires minimal medical treatment. Requires minimal nursing intervention but close observation. Average amount of nursing care hours per patient per day is1.5. Ratio of professional to nonprofessional nursing personnel is 55:45.

Level II – Moderate Care or Intermediate Care. Requires minimal medical treatment. Requires moderate nursing observation and intervention. Average nursing care hours per patient per day is 3and the ratio of professional to non-professional is60:40.

Level III – Total, Complete or Intensive Care. Requires frequent, close nursing observation and intervention. Requires moderate medical intervention. The nursing care hours per patient per day is 6 with a professional to non professional ratio of 65:35.

Level IV – Highly Specialized Critical Care. Requires continuous treatment and observation. The nursing care hours per patient per day may range from 6-9 or more and the ratio of professionals to nonprofessionals also range from 70:30 to80:20.

Modalities of care. This refers to the manner in which nursing care is organized and provided. It depends on the philosophy of the organization, nurse staffing and client population.

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1. Total care or Case Nursing Method - One nurse is assigned to one patient for totality of care during his or her time on duty.

Advantages DisadvantageConsistency in carrying out the NCP

Patient needs are quickly met as high number of RN hours are spent on the patient

Relationship based on trust is developed between the RN and the patient’s family

It can be very costly

2. Primary Nursing. The hallmark of this modality is that one nurse cares for one group of patients with a 24-hour accountability for planning their care.

Advantages DisadvantageIncreased satisfaction for patients and nurses

More professional system: RN plans and communicates with all healthcare members. RNs are seen as more knowledgeable and responsible.

RNs more satisfied because they continue to learn as part of the in-depth care they are required to deliver to their patient

Only confines a nurse’s talents to a limited number of patients, so other patients cannot benefit if the RN is Competitive

Can be intimidating for RNs who are less skilled and knowledgeable


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3. Team Nursing. The goal of team nursing is for a team to work democratically. In the ideal team, an RN is assigned as a Team Leader for a group of patients.

Advantages DisadvantageEach member’s capabilities are maximized so job satisfaction should be high

Patients have one nurse (the Team Leader) with immediate access to other health providers

Requires a team spirit and commitment to succeed

RN may be the Team Leader one day and a team member the next, thus continuity of patient care may suffer

Care is still fragmented with only 8 or 12 hour accountability

4. Modular nursing (District Nursing). This is a modification of team and primary nursing. It is a geographical assignment of patient that encourages continuity of care by organizing a group of staff to work with a group of patients in the same locale.

Advantages DisadvantageUseful when there are a few RnsRNs plan their care

Paraprofessionals do technical aspects of nursing care

5. Functional nursing - particular nursing function is assigned to each nurse.

Advantages DisadvantageVery efficient way to delivery care.

Could accomplish a lot of tasks in a small amount of time

Staff members do only what they are capable of doing

Least costly as fewer RNs are required

Care of patients become fragmented and depersonalized

Patients do not have one identifiable nurse

Very narrow scope of practice for RNs

Leads to patient and nurse dissatisfaction


Directing/Leading. The issuance of orders, assignments and instructions that permits the worker what is expected of to achieve organizational goal.

Delegation of work to be performed Utilization of policies and procedures Supervision of personnel Coordination of services Communication Staff development Making decisions

Direction must be complete, understandable and given in logical order.

It is the connecting link between organizing for work and getting the job done through employees.

Responsibilities in Directing1. Promotive - to improve system2. Preventive - anticipate problems and difficulties


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3. Corrective - institute measures to correct problem4. Regulatory - to preserve existing assignments

Elements of Directing1. Delegation. The process of assigning specific task to workers with commensurate authority to perform the job

Principles of Delegation A. Select the right person to whom the job is to be delegated. B. Delegate both interesting and uninteresting tasks. C. Provide subordinates with enough time to learn. D. Delegate gradually. E. Delegate in advance. F. Consult before delegating. G. Avoid gaps and overlaps

Matters that Cannot be Delegated A. Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit. B. Authority to sign one’s name is never delegated C. Evaluating the staff and or taking necessary corrective or disciplinary action. D. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones E. Jobs that are too technical and those that involve trust and confidence.

Four Rights of Delegation A. Task. The right task should be within the scope of the person’s practice and consistent with the job description. B. Person. The right person should have the appropriate license or certificate, job description. C. Communication. The right communication should be clear, concise, complete and correct. D. Feedback The right feedback should ask for input, get the person’s recommended solution to the problem and recognize the persons effort

Aspects of Delegation A. Responsibility – denotes obligation B. Authority – the power to make final decisions and give commands. C. Accountability – refers to liability

2. Supervision. Providing guidelines for the accomplishment of task

Qualities of Good Supervision A. Good technical, managerial and human relation skills B. Ability to communicate well in both spoken and written language, ability to listen

C. Firmness with flexibility to adjust to the needs of the situationD. Fairness in dealing with employeesE. Familiarity with policiesF. Good decision makingG. Willingness to grow and developH. Ability to accept changesI. Dignified and pleasing personalityJ. Ability to motivate employees and provide opportunities for

continuing professional growth and developmentK. Advocacy for nurses and nursing

Principles of Good SupervisionA. Requires adequate planning and organization

facilitate cooperation, coordination and synchronization


B. Gives autonomy to workers fosters the ability of each worker to think and act for himselfC. Stimulate workers ambition to grow into effectiveness

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provides for opportunities and incentives for staff education and continuous professional grants and development

D. Creates an atmosphere of cordiality and trust creates suitable environment for productive workE. Considers the strength and weaknesses of employeeF. Strives to make the unit an effective learning situation

Leadership Theories1. "Great Man" Theory. Great man theories assume that the capacity for

leadership is inherent – that great leaders are born, not made. 2. Trait Theory. Assume that people inherit certain qualities and traits

that make them better suited to leadership. 3. Contingency Theory. Focus on particular variables related to the

environment that might determine which particular style of leadership is best suited for the situation.

4. Situational Theory. Propose that leaders choose the best course of action based upon situational variables.

5. Behavioral Theory. Based upon the belief that great leaders are made, not born which was rooted in behaviorism, this leadership theory focuses on the actions of leaders not on mental qualities or internal states.

6. Participative Leadership Theory. Suggest that the ideal leadership style is one that takes the input of others into account. 7. Management Theories: Management theories, also known as

transactional theories, focus on the role of supervision, organization and group performance.

8. Relationship Theory. Also known as transformational theories, focus upon the connections formed between leaders and followers. Transformational leaders motivate and inspire people by helping group members see the importance and higher good of the task.

Leadership Styles: Authocratic leadership, Democratic leadershipLaissez-faire leadership

Leadership Skills: Communication and Relationship Management; Professionalism; Knowledge of healthcare environment and Business skill and Knowledge.

Bases for Power. Refer to the methods that managers and leaders utilize to influence their employees.

Sources of Power for a Nurse The power of purpose

The power to invoke fear


The ability to grant favorsKnowledge and skillConfidence, poise and maturityThe ability to speak the truthThe ability o set a standard that influences others

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The ability to choose how to react in a situationThe ability to choose o follow or not followRelationships and associations with othersThe ability to withdraw supportThe power to control time and resources

Building Power Base

Develop self-management and self-care practices that allow you to maintain clear thinking, articulate expression and poised demeanor.

Actively participate in activities that contribute to the organization beyond basic expectations.

Identify who are powerful in your organization, both in the formal and informal power structures, and strive to understand their resources, needs and priorities.

Create and strengthen relationshipsLearn the culture of the organization and its prioritiesKeep your professional skills and knowledge current, as well as

your communication skills, particularly those of negotiation and persuasion. Strengthen and demonstrate confidence in your expertise and the

skill you bring to the situation.Maintain a broad vision and a sense of humor.Empower others.

Five bases of power were identified by French and Raven in 1960, which laid the groundwork for most discussions of power and authority in the latter half of the twentieth century. These five types of power are 1. Coercive Power. The ability of a manager to force an employee to

comply with an order through the threat of punishment. 2. Legitimate Power. Rests in the belief among employees that their

manager has the right to give orders based on his or her position. 3. Reward Power. Rests on the ability of a manager to give some sort of

reward to employees. These rewards can range from monetary compensation to improved work schedules. Reward power often does not need monetary or other tangible compensation to work when managers can convey various intangible benefits as rewards.

4. Referent Power. Derives from employees' respect for a manager and their desire to identify with or emulate him or her.

5. Expert Power. Rests on the belief of employees that an individual has a particularly high level of knowledge or highly specialized skill set. Managers may be accorded authority based on the perception of their greater knowledge of the tasks at hand than their employees.

6. Multidimensional Power

Communication. Is the transmission of information, opinions, and intentions between among individuals.

Purpose of communication1. facilitates work 2. increases motivation3. effects change4. optimizes patient care5. increases workers’ satisfaction6. facilitates coordination

Types of Communication1. Verbal Communication2. Written Communication3. Non-verbal Communication


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3.1 Personal appearance3.2 Intonation of the voice3.3 Facial expression3.4 Posture and gait 3.5 Touch

Lines of Communication Upward

(To Superior)

Horizontal: Outward (to patient, family, and(to peers and members of community to worker’sthe health family and friends)team)

Downward

(To subordinates)

Motivation Theories1. Abraham Maslow's Theory of Motivation

Maslow (1970) believed that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and that people seek a higher need only when the lower needs have been predominantly met.

2. Burrhus Fredric Skinner’s Operant Conditioning and Behavior Modification

Skinner (1953) demonstrates that people can be conditioned to behave in a certain way based on a consistent reward or punishment system.

3. Herzberg’s Motivators and Hygiene Factors Dissatisfiers Motivators* working conditions* policies and administrative practices* salary and benefits* supervision* status* job security* co-workers* personal life

* recognition* achievement* advancement* growth* responsibility* job challenge

4. Victor Vroom’s Expectancy Model Vroom (1964) says that people’s expectations about their

environment or a certain event will influence their behavior.5. David McClelland Human Motivation Theory

McClelland (1971) state that all people are motivated by three basic needs: achievement, affiliation and power.

Dominant Motivator

Characteristics of This Person

Achievement Has a strong need to set and accomplish challenging goals.

Takes calculated risks to accomplish their goals.

Likes to receive regular feedback on their progress and achievements. Often likes to work alone.


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Nurses

Affiliation Wants to belong to the group.Wants to be liked, and will often go along with whatever the rest of the group wants to do.Favors collaboration over competition.Doesn't like high risk or uncertainty.

Power Wants to control and influence others.Likes to win arguments.Enjoys competition and winning.Enjoys status and recognition.

6. Saul Gellerman Theory of Motivation Gellerman (1968): Gellerman states that most managers in

organizations over manage, making the responsibilities too narrow and failing to give employees any decision – making power.

7. Douglas McGregor Theory of X and Y McGregor(1960): it shows the importance of a manager’s

assumptions about workers on the intrinsic motivation of the worker. McGregor believed that there are two characteristics of an employees, that is Theory X and Y.

Theory X Theory YAvoid work if possibleDislike workMust be directedHave little ambitionAvoid responsibilityNeed threats to be motivatedNeed close supervisionAre motivated by rewards and punishment

Like and enjoy workAre self –directedSeek responsibilityAre imaginative and creativeHave underutilized intellectual capacityNeed only general supervisionAre encouraged to participate in problem solving

8. Clayton Alderfer’s ERG (Existence, Relatedness, Growth) Theory* Clayton Alderfer's ERG (Existence, Relatedness, Growth) theory,

collapses Maslow's five levels of needs into three categories such as Existence needs, Relatedness need and Growth needs.

Maslow's Needs Alderfer's ERG TheorySelf-Actualization GrowthSelf-Esteem

RelatednessSocial NeedsSafety Needs

ExistencePhysiological Needs

Reasons for utilizing motivation theory in management1. Because motivation influences productivity, manager need to understand

and motivate employee. Motivation is driving force within individuals, thus the manager (motivator) should influence factors that motivate employees to gain higher levels of productivity.

2. Motivation theories are important to managers in attempting to be effective leaders.

Time Management. A set of principles, practices, skills, tools, and systems working together to help the managers get more value out of the time with the aim of improving the quality of life.


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Time Management Strategies Goal Setting Setting Priorities Organization Time Tools Managing Information

Relationship of Conflict to Management of Nursing Care1. Stressors in the Healthcare environment: *Increased demands *Limited and aging workforce *Decrease in resources *Increased acuity *Increased underinsured client population2. Management of nursing care: * Stressors affect staff members and contribute to conflict in the workplace * Nurse managers must learn to deal with conflict and try to resolve it effectively

Reason on the Importance of Time Management in Nursing1. To manage well the typically large patient caseloads. 2. Time management in nursing also is important so nurses feel less

stressed. When nurses know what they need to do and have a plan for doing it — along with the necessary room in their schedule to deal with unexpected crises — they will feel more positive about their extremely important jobs.

Conflict Management

Conflicts – clash, fight, battle or struggle; it may be constructive or destructive

Basis of the Conflict1. Intrapersonal2. Interpersonal3. Group4. Intergroup5. Organizational

Sources of the Conflict1. Cultural differences2. Different facts3. Separate pieces of information4. Different perception of the event5. Defining the problem differently 6. Divergent views of power and authority 7. Role conflicts8. Number of organizational levels9. Degree of association10. Parties dependent on others11. Competition for scarce resources12. Ambiguous jurisdictions13. Need for consensus14. Communication barriers15. Separation in time and space16. Accumulation of unresolved conflict

Types of Conflict1. Intrasender- conflict originates in the sender who gives conflicting instructions.2. Intersender- conflict arises when an individual receives conflicting messages from two or more sources.


3. Interrole- conflict can occur when an individual belongs to more than one group.

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4. Person-role- conflict is the result of disparity between internal and external roles.5. Interperson- conflict is common among people whose positions require interaction with other persons who fill various roles in the same organization or other organizations.6. Intragroup- conflict occurs when the group faces a new problem.7. Intergroup- conflict is common where 2 groups have different goals and can achieve their goals only at the others’ expense.8. Role Ambiguity - a condition in which individuals do not know what is expected onthem.9. Role Overload- the person is simply unable to accomplish so much within a limited time period

Conflict Resolution1. Avoidance- used by groups who do not want to do something that may

interfere with their relationship2. Accommodation- self-sacrifice3. Collaboration- inspires mutual attention to the problem and utilizes the

talents of all parties4. Compromise- in this method, accommodation and adjustment lead

to workable situations rather than to the best solution.5. Competition- it is an assertive position that fosters conflict resolution on

the part of the subordinate.6. Smoothing- disagreements are ignored so that surface harmony is

maintained in a state of peaceful co-existence.7. Withdrawing- one party is resolved thereby making it possible to resolve

the issue.8. Forcing- yields an immediate end to the conflict but leaves the cause of

the conflict unresolved.

Rules on Mediating a Conflict Between Two or More Parties:1. Establish clear guidelines and make them known to all.2. Do not postpone indefinitely.3. Create an environment that makes people comfortable to make suggestions.4. Keep two-way communication.5. Stress a peaceful resolution rather than confrontation.6. Emphasize shared interests.7. Follow-up on the progress of the plan.


Controlling. Controlling or evaluating is an on-going function of management which occurs during planning, organizing, and directing activities

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Reasons For Conducting Evaluation1. Evaluation ensures that quality nursing care is provided.2. It allows for the setting of sensible objectives and ensures compliance with them.3. It provides standards for establishing comparisons.4. It promotes visibility and a means for employees to monitor their own performance.5. It highlights problems related to quality care and determines the

areas that require priority attention.6. It provides an indication of the costs of poor quality.7. It justifies the use resources.8. It provides feedback for improvement

BudgetingThe allocation of resources on the basis of forecasted needs for the proposed activities over a specific period of time. A written financial plan aimed at controlling the allocation of resources.

Expenses – the costs or prices undertaken in the organization’s operations

Revenues – income or amounts owed for purchased services or goods.

Purpose of budgeting: To ensure the most effective use of resources.

Pre Requisites for budgeting• Sound organizational structure with clear lines of authority and

responsibility is needed• Nonmonetary statistical data- such as number admission,

average length of stay, percentage of occupancy and number of patient days- are used for planning and control of the budgetary process

• Chart of accounts are designed to be consistent with the organization plan• Management support is essential for a budgetary program• Formal budgeting policies and procedures should be available

in the budget manual

Preparing or Planning the budget• Nursing budget- a plan for allocation of resources based

preconceived needs for a proposed series of programs to deliver patient care during one fiscal year

• Hospital budget- is a financial plan to meet future service expectation

Items to be budgeted1. Salaries2. Stipend for students3. Equipments and repairs4. Linens and other household supplies5. Maintenance of vehicles6. Purchasing books, furniture and others for the library7. Office supplies8. Contingency fund9. Others: incidental teaching equipments, external lecturers


Types of budgeting1. Personnel Budget. The largest of the budget expenditures is

the workforce because health care is labor intensive. 2. Capital Budget. For the purpose of buildings or major

equipments.3. Operating Budget

Performance evaluation/appraisal. Performance appraisal is a control

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process in which employee’s performance is evaluated against standards.

Purposes of Performance Appraisal1. Determine salary standards and merit increases.2. Select qualified individuals for promotion or transfer.3. Identify unsatisfactory employees for demotion or termination4. Make inventories of talents within the institution.5. Determine training and development needs of employee6. Improve the performance of work groups by examining,

improving, correcting interrelationship between members7. Improve communication between supervisors and employees

and reach an understanding on the objectives of the job8. Establish standards of supervisory performance.9. Discover the aspirations of employees and reconcile these with

the goals of the institution10. Provide employee recognition11. Inform employees where they stand

Methods of Measuring Performance1. Essay 2. Checklist3. Ranking4. Rating Scales5. Forced-choice Comparison6. Anecdotal Recording

Staff development. Refers to the processes, programs and activities through which every organization develops, enhances and improves the skills, competencies and overall performance of its employees and workers. Training, the most common form of staff development, during which employees are improving their knowledge, attitudes, and skills during different seminars and conferences and training sessions.

The discipline in nursing is an art and science committed to professional excellence by providing highest care possible. Quality care is determined by the observable characteristics that depict the desired value of excellence.

Quality improvement /quality management. A system of review of selected hospital medical and/or nursing records by medical and/or nursing staff members, performed for the purposes of evaluating the quality and effectiveness of medical and/or nursing care in relation to accepted standards.

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Nursing Audits. It is an assessment of the quality of nursing care. Uses a record as an aid in evaluating the quality of patient care.

Types of Audits1. Internal Audit2. External Audit3. Financial Audit4. Operational Audit5. Department Review6. Integrated Audit

Variance (Incident) reports. It is an event that occurs during an organizational operations that may result

to problems and issues.

Purpose of an Incident Report1. To document the exact detail of an accident or

unusual incident that occurred in a health care institution.2. To be used in the future when dealing with liability

issues stemming from the incident.3. To protect the nursing staff against unjust accusation.4. To protect and safeguard the client in case of

negligence on the part of the nurse.5. Helps in the evaluation of nursing care to ensure safe

care to all patients.

The patient should be identified with the following details:1. Full name2. Hospital bed number3. Hospital ID4. Patients diagnosis5. Patient’s condition before and after the incident6. Other details included are:

6.1 Details of ward or clinical area 6.2 Date, time and place of incident 6.3 Details of equipments used including the serial number or asset tag identification

Solutions to identified problemsAs a nurse, you may face problems that impact nursing practice. The focus of this resource is to present a process for addressing problems that cannot be resolved at the individual level and must be forwarded to the employer.


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Professional practice problem1. puts clients at risk2. interferes with meeting Standards of Practice,

employer guidelines and policies, or other clinical standards.

Responsibilities: Nurses and employers have responsibilities in the workplace. Nurses: meet Standards of Practice; take action when problems impact client care; and communicate and collaborate with employers to

resolve problems.

Employers examine situations and work with nurses to resolve

problems, once they have been informed about them; and

provide resources and support so that nurses can meet the Standards of Practice.

Consider the problem: The first step to resolve a problem is to clarify the nature of the problem and how best to approach it.

Ask yourself: How does the problem put clients at risk? How does the problem conflict with Standards of

Practice and/or employer guidelines and policies?

Communicate the problem: Clarified the problem and start with verbal communication.

Verbal communication Ask manager for a meeting to discuss the

problem Explain how the problem puts clients at risk

and conflicts with Standards of Practice or employer guidelines and policies

Be specific, factual, include all relevant information, and respect client confidentiality

Listen with an open mind to your manager’s perspective and pay attention to any new information the manager provides

Be prepared to work together to resolve the problem, recognizing that some negotiation and compromise may be necessary

Work together to confirm the next steps

After the meeting, follow up in writing with the manager. Send the manager a summary of what was discussed, the response received, and the next steps the team agreed upon.

Written communication. Clearly and concisely document your communication. Keep a record of all correspondence. Treat all documentation as confidential


Use a workplace form, letter or, memo, workplace form and send in a secure manner

Include your manager’s name and title in this

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formal communication Start with a general opening statement such

as: “This is a follow up to our discussion of ...”

Describe the problem: date, time, place, who was involved (use initials for names), what happened, how it affected clients, what specific

Standards were reviewed and referenced Include possible solutions Ask for confirmation that the correspondence

has been received and request a response by a specific date, allowing a reasonable amount of time for progress to occur

Resolution is not always immediate. Continue to work within the system to improve client care. If you do not hear back by the specified date, follow

up with the manager (“What is happening with the problem?”)

If the problem has not been addressed, send a second memo or letter to the same person, re-state the problem, include any new information, attach the first correspondence, and request assurance that the problem will be addressed.

The manager may not be able to resolve the problem. Be prepared to take the concerns to the next level of management.

You may work with your manager to take the problem to the next level or you may take the issue forward yourself, advising the manager of your plan.

It is important to again ask for a meeting at the next level to communicate your concerns, and then to follow up with written documentation.

Unit III. The Leadership in Community Development Additional Notes for Students

Community Assessment

Basic concepts: 1. CHNs work at 6 levels: individual, family, group, subpopulations,

populations and communities.2. Working with communities is primary because the community directly

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influences the other levels, and because provision of health services mostly occurs at the community level.

The Community as a Client. Refers to the concept of a community-wide group of people as the focus of nursing service

Barriers to the concept of community 1. Individualism: Most researchers, personnel and health care institutions

focus on the care of individual illness rather then promotion of community health

2. Myths: focusing on locations rather than transferable skills, clinical skills only rather than a comprehensive body of knowledge ( for e.g. biostatistics, epidemiology in analysis and measurement and anthropology in understanding phenomena, and focusing on individuals and families as clients more than on communities.

Community. A group of individuals or families that share certain values, services, institutions, interests, or geographical proximity

Shared physical space or interest Social interaction Sense of identity

A functional special unit that meets people’s sustenance needs, helps form collective identities, and patterned social interaction (Fellin)

Functions of Community1. Socialization1. Production, distribution, consumption of goods2. Social control3. Mutual support4. Social participation

Changes in Communities 1. Urbanization, suburbanization, immigration

Diversification of population Minority populations younger Movement from rural to rapidly growing Urban areas

2. Transfer individual/family functions to govt/business, sewing, cooking, child care, elderly care, etc 3. Stronger ties to the larger community, (national, international, global village) 4. Changing values (Divorce, blended families, violence) 5. New structures (virtual communities)

Conclusion Community is client and tool/resource Societal changes result in communities causing problems (client)

rather than preventing or solving them (tools/resources) Social workers determine when to use 1+ of many community

approaches to solve a social problem Use generic social work process with communities Terms: change agent, target system, client system (stakeholders),

action system. Think of organizations in community practice as similar to

individuals in family practice

Community diagnosis. Assessing and defining the needs, opportunities and resources involved in initiating community health action programs.


It is also referred as a comprehensive assessment of health status of the community in relation to its social, physical and biological environment.

As a PROFILE, it is a description of the community’s state of health as determined physical, economic, political and social factors. It defines the community and states the community problems.

Purpose: To be able to obtain a quick “picture” of a community’s

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which is as accurate as possible and define existing problems, determine available resources and set priorities for planning, implementing and evaluating health action, by and for the community.

A community profile should: Summarize information; Present results and figures clearly; Be useful for planning and monitoring;

As a PROCESS, it is a continuous learning experience for the nurse/program coordinator and the staff, as well as the community people, for the following reasons: It enables the nurse /program coordinator/ staff to adjust or alter the program for optimum effectiveness. It allows the community to gradually become aware of the solution. It is an organized attempt to involve people in recognizing

and resolving problems that concern them most. It enables the community to understand at its own pace the potential advantages o change, which may eventually lead to alterations in attitudes, values, and behavior.

Types of community diagnosis1. Comprehensive Community Diagnosis. The Comprehensive

Community Diagnosis is more focused on obtaining general information about the community. Meaning, it takes the community as a whole and gives emphasis on all of its aspects, its strengths and weaknesses — everything. The prioritizing of the health problems will just come later on in the process.

2. Problem-oriented Community Diagnosis. It deals with problems that are readily seen and should be acted upon immediately.

Components of community diagnosis1. concept and purpose or aim 2. the process/steps undertaken 3. formulation of data collection tool 4. report writing and dissemination of findings 5. planning of interventions

Phases of community diagnosis 1. Initiation. In order to initiate a community diagnosis project, a dedicated committee or working group should be set up to manage and coordinate the project. The committee should involve relevant parties such as government departments, health professionals and non-governmental organizations. 2. Data collection and analysis. The project should collect both quantitative and qualitative data. Moreover, Population Census and statistical data e.g. population size, sex and age structure, medical services, public health, social services, education, housing, public security and transportation, etc. can provide background of the district.


3. Diagnosis. Diagnosis of the community is reached from conclusions drawn from the data analysis. It should preferably comprise three areas: - health status of the community - determinants of health in the community - potential for healthy city development 4. Dissemination. The production of the community diagnosis report is not an end in itself, efforts should be put into communication to ensure that targeted actions are taken.

Health problems / Nursing problems. There are 3 types of Community

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Nursing Problems:1. Health Status Problems — problems that are directly related to the community’s health (e.g. too many breeding grounds for vectors, epidemics, malnourishment)2. Health Resources Problems — problems that concern a community’s health resources (e.g. understaffing in the barangay health center, lack of hospitals, lack of health transportation)3. Health-related problems — problems that indirectly influence health (e.g. lack of funding from the government, indifference of the people)

Basic considerations and criteria in problem statement1. Nature of the condition or problem presented2. Magnitude of the Problem3. Modifiability of the Problem4. Preventive Potential5. Social Concern

Strategies in people participationCommunity participation' in development program is

defined differently by different people according to their cultural context. On the one extreme, 'participation' is perceived as the passive consumer response of receiving services from a development program. On the other extreme, it is viewed as the complete ownership of the program by the 'community'.

Different levels of community participation in development projects. Level I Level II Level III Level IV Level V

Community receives benefits from the service, but contributes nothing

Some personnel, financial or material contributions from the community, but not involved in decision making

Community participates in lower level management decision making

Participation goes beyond lower level decision making to monitoring and policy making

Programme is entirely run by the community, except for some external financial and technical assistance

Existing health programs including programs for basic health services ( maternal and child health, family planning, medical care, environmental sanitation, communicable disease control)1. Adolescent and Youth Health Program

Scenario: Non-communicable diseases account for more than 40% of the deaths in young people (10-24 years old) and injuries are the causes of death in almost one third of people in this age group. Assault and transport accidents are the leading causes of mortality among young people with a mortality rate of 9.7 and 5.8 deaths per 100,000 populations, respectively (Philippine Health Statistics, 2003).

Leading Threats to Adolescents HealthA. AssaultB. Transport AccidentsC. PneumoniaD. Tuberculosis of the Respiratory SystemE. Chronic Rheumatic Heart DiseaseF. Accidental drowning and submersionG. Nephritis, nephrotic syndrome and nephrosis

Factors Causing Threats to Adolescents HealthA. Continuing Rapid Population GrowthB. Attitudes, Lifestyles, Sense of Values, Norms and Behaviors of AdolescentsC. Rapid Advancement of Communication

ApproachesA. The program to address sexual and reproductive health issues likewise adopts gender-

sensitive approaches.B. The program is solidly anchored on International and laws, passages and polices meant

to address adolescent’s health concerns

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2. Botika Ng Barangay. Offer for sale and/or make available low-priced generic home remedies, over-the-counter (OTC) Drugs and two (2) selected, publicly-known prescription antibiotics drugs (i.e. Amoxicillin and Cotrimoxazole).

3. Breastfeeding. Encourages mothers to exclusively breastfeed their babies from birth up to 6 months. Exclusive breastfeeding means that for the first six months from birth, nothing except breast milk will be given to babies.

4. Blood Donation Program. Promotes voluntary blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act aims to inculcate public awareness that blood donation is a humanitarian act.

5. Dental Health Program. The program aims to reduce the prevalence rate of dental caries to 85% and periodontal disease by to 60% by the end of 2016.

5. Emerging and Re-emerging Infectious Disease Program. Prevention and control of emerging and re-emerging infectious disease from becoming public health problems.

6. Environmental Health. Concerned with preventing illness through managing the environment and by changing people's behavior to reduce exposure to biological and non-biological agents of disease and injury. It is concerned primarily with effects of the environment to the health of the people.

8. Expanded Program on Immunization

9. Essential Newborn Care. Emphasized the need to strengthen health services of children throughout the stages.

10. Family planning

11. Food and Waterborne Diseases Prevention and Control Program

12. Food Fortification Program

13. Garantisadong Pambata. Comprehensive and integrated package of services and communication on health, nutrition and environment for children available everyday at various settings such as home, school, health facilities and communities by government and non-government organizations, private sectors and civic groups.

14. Health Development Program for Older Persons - (Bureau or Office: National Center for Disease Prevention and Control ). The program intends to promote and improve the quality of life of older persons through the establishment and provision of basic health services for older persons, formulation of policies and guidelines pertaining to older persons, provision of information and health education to the public, provision of basic and essential training of manpower dedicated to older persons and, the conduct of basic and applied researches.

15. IMCI16. Leprosy Control Program17. Malaria Control Program18. Filariasis Elimination Program19. HIV / STI Prevention Program20. Mental Health Program21. Dengue Prevention and Control Program22. Prevention of Blindness Program23. Occupational Health Program24. Pinoy MD Program. A Medical Scholarship Grant for Indigenous People, Local Health Workers,

Barangay Health Workers, Department of Health Employees or their children. This is a jJoint program of the Department of Health (DOH), Philippine Charity Sweepstakes Office (PCSO), and several State Universities and Medical Schools. For interested applicants see the Pinoy MD flyer for the qualification and scholarship package details.

25. Philippine Medical Tourism Program. Increase the number of institutions offering advanced medical services suitable for Global HealthCare, the generation of jobs in the Medical Services industry and other related industries, thereby increasing the productivity of the workforce and enabling it to expand and upgrade.

25. Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat). Provision of safe water supply is one of the basic social services that improve health and well-being by preventing transmission of waterborne diseases.

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26. Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP). Provide competent midwives to areas that have not performed well in terms of facility-based deliveries, fully immunized child and contraceptive prevalence rates, hence, improve facility-based health services. By augmenting health staff to selected government units, the DOH may improve maternal and child health and attain the Millennium Development Goals (MDGs).

27. Schistosomiasis Control Program. To reduce the disease prevalence by 50% with a vision of eliminating the disease eventually in all endemic areas.

28. Soil Transmitted Helminth Control Program. Reduce the prevalence of STH infection to below 50.0% among the 1-12 years old children by 2010 and lower STH infection among adolescent females, pregnant women and other special population group.

29. Smoking Cessation Program30. Urban Health System Development (UHSD) Program. The DOH must help influence social

determinants of health in urban settings, with focused application on urban poor populations particularly those living in slums.

31. Unang Yakap (Essential Newborn Care: Protocol for New Life). ENC is a simple cost-effective newborn care intervention that can improve neonatal as well as maternal care. IT is an evidence-based intervintion that emphasizes a core sequence of actions, performed methodically (step -by-step); is organized so that essential time bound interventions are not interrupted; and fills a gap for a package of bundled interventions in a guideline format.

32. Violence and Injury Prevention Program33. Women's Health and Safe Motherhood Project. Improve maternal health34. Women Children Protection Program

Community organization. It is a process where people who live in proximity to each other come together into an organization that acts in their shared self-interest. It also refers to organizing which takes place in a geographically defined living area, such as an urban poor community or a rural village.

However, its principles have been widely used for organizing sectoral groups not necessarily living in a distinct location, like factory workers or students.

CO is a means for empowering people; its primary aim is to transform a situation of societal injustice, inequality and poverty.

CO is both a process and an orientation, an orientation for genuine and genuine and liberating social transformation.

Community Organizing (CO) is a social development approach that aims to transform the apathetic, individualistic and voiceless poor into a dynamic, participatory and politically responsive community. At times, CO is likened to "a form of experiential learning, a radicalized non-formal educational process."

During the 1994 National Rural CO Conference, CO was defined as a collective, participatory, transformative, liberative, sustained and systematic process of building people's organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing and oppressive exploitative conditions.

CO Principles1. The social condition of the poor itself gives opportunities to conscienticize the people.2. Tactics should be within the experience of the people and outside the experience of the target.3. People generally act on the basis of their self-interest.4. Man learns more effectively and more deeply from his own actual experiences. Hence the

importance of reflections on his actions, his experiences. Action – reflection form an integral part of the CO methodology.

5. The process of organizing moves from simple, concrete, short term and personal issues to more complex, abstract, long-term and systemic issues.

6. Man needs to deepen and widen his horizon, therefore, he must move from the particular to the universal, from the concrete to the abstract, to apply one's experience and its lesson to another situation. Hence, there is a need for theories, a need to read, and to meet other experiences learned in order to bring about the widening and deepening of each man's individual horizon.

7. Throughout the organizing process, the people must make their own decisions

Assignment: Please read about the topics listed below and write about the said topic. The discussion should be at least 3 – 5 paragraphs per concept (20 points each). Include answers in your NCM 105 Compilation of Notes and pass paper bound notes on or before March 21, 2013.1. Leadership training principles and process

2. Concepts and principles of networking and Linkage building

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3. Evaluation of programs and services

4. Recording and reporting (vital statistics, noticefiable disease and services

rendered to family and community

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ncm 105 cmo 30 notes

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