NURSING LEADERSHIP AND MANAGEMENT

Mrs. Lili C. Del Rosario

PRAYERS IN PREPARATION EXAMINATION

FOR THE

BOARD

Remember , O most Loving Virgin Mary, that it is a thing unheard of that anyone who ever have recourse to Your protection, implored Your help or sought Your intercession was ever left forsaken. Filled therefore, with confidence, I fly unto You, O Mother, Virgin of virgins, to You I come, before You I stand, a sorrowful sinner. Despise not my petitions, O Mother of the world incarnate but graciously grant my prayers. Amen. (Mention here your requests)

MANAGEMENT

MANAGEMENT

the accomplishment of a task either by oneself or by directing others.

Management

has developed its own truths or laws based on the real experience in the real world. You might have seen or heard these without realizing that they are laws.

 Parkinson

time.

Law : Work expands to fill up

Paretos

Law : 80-20 rule 80 % of ____ is due to 20 % of ____ 80 % of the budget is spent on 20 % of the population.

Murphys

Law: Anything that can go wrong will go wrong. Rule

90-90

NURSE MANAGER
a

nurse whose job is to guide the organization attain its objective; the front line head nurse with legitimate source of power

(3) MAJOR AREAS OF RESPONSIBILITY IN NURSING MANAGEMENT:

Clinical Management = requires knowledge and skills identified with nursing care management Operational Management = businessrelated aspects such as management of available resources of people, facilities and money Human Resource Management = training and development of personnel at all levels

MANAGEMENT SKILLS OF A NURSE MANAGER:

Technical Skill = the ability to use tools, techniques and specialized knowledge to carry out a method, process or procedures = Almost all jobs involve technical skills. Not all technical skills require preparatory education but training is needed. Human Skills = abilities needed to function well in interpersonal relationships Conceptual Skills = abilities to see the organization as a whole and solve problems to benefit the total system

NURSE ENTREPRENEURSHIP

Entrepreneur - an individual who assumes the total responsibility and risk for discovering or creating equal opportunities to use personal talents, skills and energy, and who employs strategic planning process to transfer that opportunity into a marketable service or product. Nurse Entrepreneurship a proprietor of a business that offers nursing services of a direct care, educational, research, administrative or consultative nature. Nurse control of practice and patient care

SCOPE OF ENTREPRENEURIAL PRACTICE

Practice / Nursing Services Health care products and devices Development/ Teacher/ Trainors/ Consultants Assessment Sale Legal Services Health care/ policy consultation Health care/ policy publication Health care recruiters Nursing Informatics Patient advocate

MANAGEMENT THEORIES

A. Henri Fayol - Father of Management

Process School

All managers regardless of the type of organization or their level in the organization, have essentially the same tasks; planning, organizing, directing and controlling.

14 PRINCIPLES
Division

OF

MANAGEMENT

of labor Authority Discipline Unity of command Unity of direction Subordination of individuals interest for the common good Centralization/decentralization

14 PRINCIPLE OF MANAGEMENT

Hierarchy Order Equity Stability Initiative Remuneration Esprit de corps

B. MAX WEBER
Father of Organizational Theory He conceptualized a structure of authority that would facilitate the accomplishment of organizational objectives.

C. Frederick Taylor - Father of Scientific Management Principles of Scientific Management: choose best method choose the best people educate your best people develop a friendly relationship between labor & management

D. FRANK & LILLIAN GILBRETH Emphasizes the benefits of job simplification and the establishment of job standards as well as the effect of the incentive plans and fatigue on work performance.

E. HENRY GANTT Concerned with the problems of efficiency F. Chester Barnard He noted that the degree of cooperation depends on non financial inducements which informal organization can help provide.

G. MARY FOLLETT Perceives organization as a social system and management as a social process, she considers subordination as offensive. (Law of the situation) H. Curt Lewin Group dynamics

I. RENSIS LIKERT
Participative Management Identified 3 types of variable in an organization causal leadership behavior, org. structure, policies and control intervening perceptions, attitudes, motivation end-result measures of profit, costs & productivity

Four Types of Management Systems

Variables behavior System 1
Exploitative Authoritative

System 2

System 3

System 4 Participative

Benevolent Consultative Authoritative

trust/ Confidence
motivation

little/none

Condescending

substantial but not complete

complete

fear, threats, punishment, occasional rewards

rewards some fear some punishment

rewards, economic Rewards occasional punishment more participation

Variables information flow

System 1 downward

System 2 downward most; permits up

System 3 down & up

System 4 down, up and with peer

use of ideas and opinions of subordinates

involvement in decision

seldom

Solicit some

usually

always

limited to the top

some delegate with policy control

broad policy at the top and specific at down level

througho ut the organization

J. HENRY MINTZBERG
10 roles of a manager 3 interpersonal roles figure head, leader, liaison 3 info. roles - monitor, disseminator, spokesperson 4 decision roles entrepreneur, disturbance handler, resource allocator, negotiator

K. ROBERT BLAKE & JANE MOUTON

Two critical dimensions of leadership concern for people and concern for production

5 Basic Management Styles task manager (9,1) impoverished manager (1,1) team manager (9,9) organization manager (5,5) country club manager (1,9)

MANAGEMENT PRINCIPLES
Principles

of authority responsibility and accountability Authority a leaders right to decide and command Responsibility the obligation of an individual to do the task that has been assigned to her. Accountability the responsibility of an individual to answer all actions she has done.

MANAGEMENT PRINCIPLES
Principle

of delegation decision making and tasks should be delegated down to the chain of command. Span of control - no individual can manage if too many persons report to him. An ideal span of control is 8 reporting persons but not less than 4. Hierarchal level more than 5 levels of workers from the top man to the lowest level of management is too heavy with management.

MANAGEMENT PRINCIPLES
Principle

of definition it is the job of the manager to ascertain that each worker has a clear idea of what is expected. Job description or performance responsibilities precise job content activities. Responsibilities and results expected from the various roles. Orientation the formal process of appraising the new employee of the organization and her place in it.

MANAGEMENT STYLES
Authoritarian

Primary strength - stresses prompt, orderly

and predictable performance Primary weakness - approach ends to stifle individual initiative

Democratic Primary strength - enhance personal

commitment through participation Primary weakness - democratic process is time consuming

Laissez- Faire

Primary strength - permits self-

starters do things as they see fit without leaders interference Primary weakness - group may drift endlessly in the absence of direction from leader.

TYPES

OF

LEADERS

Formal Leaders appointed by organization and given office or legitimate authority to act. Hospital Wide
CEO, COO,COB

Levels of Management
Top Level

Nursing Service Division

DON, CNO, CN

Directors
Supervisors, Coordinators

Middle Level
First Level

Supt. Mgrs, Supervisors

Head Nurses

Informal Leaders
Not

appointed by an organization Senior nurses authorities in their own rights Dont have official power/ sanction to direct activities of others

MANAGEMENT FUNCTIONS AND PROCESSES

Planning

I. Planning Determining objectives and identifying methods that lead to the achievement of those objectives. Making future projections to achieve desired results. Thinking ahead

ACTIVITIES IN PLANNING
Forecast

estimate future Set objectives determining results desired Develop and schedule programs, define activities needed and set the time frame Prepare budget and allocate resources Establish policies, procedures, definite course of action and methods

KINDS OF PLANNING
Long range or strategic planning

extends 3-5 years determine the direction of the organization, allocates resources and determine time frame

Short range or operational planning

Short planning that deals with day to day maintenance activities Done in conjunction with budgeting usually a few months before the new fiscal year.

PLANNING TOOLS
1.

Vision outlines the organizations future roles and functions; it gives the agency something to strive for.

2. Purpose or mission statement what it will be and what it should be. An aim to be accomplished 3. Values is the worth, usefulness or importance of something.

4. Philosophy beliefs that influence nursing

practice.

5. Goals (end to be accomplished ) and Objectives (something aimed at or strived for; things done to achieve the goal) 6. Policies means for accomplishing goals and objectives 7. Procedures chronological sequence of steps within a process.

8. Rules plans that define specific action or non-action

STEPS

IN

PLANNING

1. Forecast 2. Set objectives 3. Develop and schedule the program 4. Prepare budget

TYPES OF BUDGET

STANDARD COST
May

be developed to predict what labor and supplies should cost.

the standard cost by the volume predicts the variable cost.

Multiplying

ZERO-BASED BUDGET
With Each

zero-based budgeting, no program is taken for granted. program must be justified

each time funds are requested.

Nursing budget based on

preconceived needs for proposed series of programs to deliver patient care during the fiscal year.

Hospital budget financial plan to

meet future service expectations; derived from community needs; includes manpower, equipment & supplies to be provided at the highest level of quality at a minimum cost.

COMPONENTS OF BUDGET

A.

PERSONNEL BUDGET
The

largest of the expenditure is the workforce or personnel budget because health care is labor intensive. The manager should monitor the personnel budget closely to prevent understaffing or over staffing.

B.

OPERATING BUDGET

Reflects

expenses that change in response to the volume of service. Included in this budget are such daily expenses as the cost of electricity, repairs and maintenance and supplies.

C.

CAPITAL / FINANCIAL BUDGET

It

is not used in daily operations and is more expensive than operating supplies. Capital budget are composed of long term planning or a major acquisition component and a short term budgeting components.

TIME MANAGEMENT

TIME MANAGEMENT
A

technique for allocating ones time through the setting of goals, assigning priorities, identifying and eliminating wasted time, and using managerial techniques to reach goals effectively. How time is used

20 Time Wasters
1. 2.

3.
4. 5.

6.
7. 8.

Management by crisis Telephone interruptions Inadequate planning Attempting to do so much Drop in visitors Inefficient delegation Lack of self-discipline Inability to say no

Time Wasters
procrastination 10. paper work 11. leaving task unfinished 12. socializing 13. inadequate staff 14. confused responsibility 15. poor coordination 16. inadequate control system (budget, appraisals)
9.

Time Wasters
17.

18.
19. 20.

meetings incomplete information personal disorganization travel

Organizing

ORGANIZING
establishing

formal authority; set up organizational structure, identify groupings, roles & relationships using resources human and material to achieve predetermined outcomes determining staff needed, develop & maintain staffing patterns, distribute in areas needed Develop job descriptions , define qualifications and functions of personnel

PRINCIPLES

OF

ORGANIZING

Unity of command Scalar principle Principle of exception Homogenous assignment/departmentation Span of control Decentralization/ centralization Principle of requisite authority Principle of continuing responsibility Principle of centrality

CONCEPTS
1.

OF

ORGANIZING

expected of a person by those with whom he/she interacts 2. Power ability to obtain, retain and motivate people to use material & informational resources to attain a goal.

Role set of behaviors & attitude

Bases of power

legitimate power because of position in society reward control and administer rewards for compliance coercive founded on fear, ability to punish expert special abilities or skill referent attractiveness, appeal or connection with powerful individual

self emanates from age, gender, maturity, experience informational occurs when one person provides information about why another should behave in a certain way personal derived from the degree of self-confidence

3. Authority- legitimate right to act or

decide for the organization 4. Status rank that a reference group confers to an individual 5. Communication process of exchanging information and meaning from sender to receiver with the hope that the message sent will be received and understood as the sender intended.

COMMUNICATION PROCESS
Sender Transmitting (Channel)
-Verbal -Non verbal -Sees, hears, feels -Interprets -Symbolizes message for meaning -Ignores

Receiver Decoding Action

Message
-Fact -Ideas -Concept -Feeling

Encoding
-Words -Gestures -Facial expression -Color -Characterization -Letter -Memo

-Face to face
-Groups -Written -Instructional media

-Stores
-Delay -Perform

-Understands correctly

Sender Feedback

Noise

Receiver Feedback

Set- Backs in Communication

Meta communication = body language (head/facial agreement or disagreement, eye contact, tone, volume, gestures, body posture/position, dress and appearance) and environmental factors Intrasender Conflict = difficulty in interpreting the intended meaning of a message due to incongruity between verbal and nonverbal communication Intersender Conflict = difficulty in interpreting the intended meaning of a message due to 2 conflicting messages received from differing sources Rumors are caused by: lack of communication; misunderstanding; prejudices and personal opinions of the listener.

4 Cs of Communication
1. 2. 3. 4.

Clear understood by the listener Concise enough but not too much additional communication Correct accurate & is aligned to rules regulations or job descriptions Complete leaves no room for doubt on the part of the supervisor or delegates

LINES

OF

COMMUNICATION
Upward
Superior

Horizontal
Serves/members of health team

Outward

Nurses

Patient, Significant Others, .community

Downward
Subordinate

ORGANIZATION
established social system designed to carry out specific objectives.

ORGANIZATIONAL STRUCTURE

formal mechanism through which the organization is managed (Stoner)

KINDS

OF ORGANIZATIONAL STRUCTURE

Formal describes the positions,

responsibilities of these occupying the positions and the working relationships among the various units or departments.

ADHOCRACY ORGANIZATIONAL MODELS

Also

called as Organic Models More free form, open, flexible, or fluid models Boundaries separating internal and external relationships are more easily penetrated Gives grater recognition to the informal structure Less likely to use organizational charts Rewards are based on individual and group results

INFORMAL ORGANIZATION

consists of personal and social relationships among the members of the organization. It is not reflected in the organizational chart.

Organizational chart a drawing that shows how

the parts of an organization are linked.

Kinds:
1. 2.

3.

vertical or tall horizontal or flat circular or concentric

Vertical or Tall

Flat or Horizontal

Circular

Staffing

STAFFING
The process of determining and providing the acceptable number and mixed of nursing personnel to produce a desired level of care and meet the demands of care.

Chief nurse I-II-III-IV

Plans, organizes and supervises the nursing service
Coordinates all activities of the nursing service department with other services

Prepares nursing services budget

Interviews and screens all applicants for the nursing service and evaluates their qualifications and experiences

Observes and evaluates the performance of personnel, as well as analyzes and evaluates the nursing activities

Supervising nurse
Checks the Senior Nurses plans for patient care and sees to it that they are properly executed. Interprets standard operating and new procedures and policies, reviews work performance of personnel to determine if it conforms to recognized standards.

Plans the programs and work of all the nursing personnel of the unit.

Directs arrangement of schedule of work hours, off duties, vacation leaves, etc., of all nursing person not assigned in the unit.

Evaluates work accomplished by each nursing employee in the ward.

Senior Nurse
Makes patient rounds and sees to it that all patients in her ward get the necessary care

Sees to it all equipments are in order and properly kept and supplies are available

Makes weekly schedules and daily assignment of her staff.

Checks and countersigns recording done by staff nurses

Assist the clinical instructor, prepares students assignments for their clinical experiences and assist in the evaluation of their performances.

Staff Nurse
Gives direct nursing care

Identifies nursing needs of patients

Plans gives, evaluates nursing care

Admits patients

Performs such nursing activities such as bathing and oral hygiene

Nursing Attendant
Checks and receives articles from outgoing aide

Accounts for all linen during her shift and endorses them to the nursing aide of the next shift

Attends morning rounds with the ward nurses

Assists in giving baths to ambulatory patients

Serves drinking water and nourishments

PATIENTS CLASSIFICATION SYSTEM

1.

Category I Minimal care

patients who are convalescing and who no longer require intensive, moderate or maximum care
patients who are moderately ill or are recovering from the immediate effects of a serious illness and/ or an operation

2.

Category II Moderate Care

3.

Category III Maximum Care

patients who need close attention throughout the shift, that is complete care for patients who require nursing to initiate, supervise and perform the most of their activities or who require frequent and complex medications or treatments.

4.

Category IV Intensive Care

acutely ill patients who have a high level of nurse dependency, including those requiring intensive therapy and/or intensive nursing care and whose unstable condition requires frequent evaluation with adjustment therapy.

METHODS
1.
2. 3. 4. 5.

OF ORGANIZING CLIENT CARE

Case Method Primary Nursing Functional Nursing Team Nursing Modular Nursing

COMPUTING FOR THE NUMBER OF NURSING PERSONNEL NEEDED

When

computing for the number of nursing personnel in the various nursing units of the hospitals, one should ensure that there is sufficient staff to cover all shifts, off-duties, holidays , leaves, absences, and time for staff development programs

 Forty

5901) 100 bed-capacity and up 40 hours a week Less than 100 bed-capacity or agencies located in communities with less than 1 million population - 48 hours a week

Hour week Law (Republic Act

Civil Service Commission Memorandum Circular No. 6 series of 1996.

(Three day special privilege to government employees) Birthdays Weddings Anniversaries Funerals Relocation Enrollment or Graduation Hospitalization Accident leaves.

EXAMPLE:
Find

the number of nursing personnel needed for 250 patients in a tertiary hospital.

Step 1: Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care (whether minimal, intermediate, intensive or highly specialized).

250 X .30 = 75 pts. needing minimal care 250 x .45 = 112.5 pts. needing moderate care 250 x .15 = 37.5 pts. needing maximum care 250 x .10 = 25 pts. needing intensive care

Percentage of Patients at Various Levels of Care per type of Hospital Type of Hospital
Primary Hospital

Minimal Care 70 65

Moderate Care 25 30

Intensive Care 5 5

Highly Spl. Care -

Secondary Hospital

Tertiary Hospital

30
10

45
25

15
45

10
20

Special Tertiary Hospital

Step 2: Find the total number of nursing care hours needed by the patients at each category level. Find the number of patients at each level by the average number of nursing care hours needed per day. Get the sum of the nursing care hours needed at the various levels.
75 pts. X 1.5 (NCH level 1) 112.5 pts. X 3 (NCH level II) 37.5 pts. X 4.5 (NCH level III 25 pts. X 6 (NCH level IV) Total = 112.5 NCH/day = 337.5 NCH/day = 168.75 NCH/day = 150 NCH/day = 768.75 NCH/day

Categories or Levels of Care of Patients, Nursing Care hours needed per patient per day and ratio of professionals to nonprofessionals
Levels of Care Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care 4.5 65:35 3.0 1.50 55:45 60:40 NCH Needed Per Pt. Per Ratio of Prof. To NonDay Prof.

Level IV
Highly Specialized Or critical Care

6.0 -7.0 or Higher

70:30
80:20

Step 3: Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year. 768.75 x 365 (days/yr) = 280,593.75 NCH/yr

Step 4: Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year.

8 hrs/day x 213 (working hrs./yr) = 1,704 working hrs/yr

Total Number of Working and Non working days and hours of Nursing personnel per year
Rights and Privileges Given Each Personnel Per Year 1. Vacation Leave 2. Sick Leave 3. Legal Holidays 4. Special Holidays 5. Special Privileges 6. Off duties as per R.A. 5901 40 hours 48 Hours

15 15 10 2 3 104

15 15 10 2 3 52

7. Continuing Education Program Total Non Working Days Per Year Total working days per year Total Working Hours Per Year

3
152 213 1704

3
100 265 2120

Step 5: Find the total number of nursing personnel needed. Divide Total NCH/yr by working hrs/yr Total NCH/yr = 280,593.75 = 165 Working hrs/yr= 1,704 Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week). 165 x 0.15 = 25 Add the number of relievers to the number of nursing personnel needed. 165 + 25 = 190 (total nursing personnel needed)

Step 6: Categorize the nursing personnel into professionals and non-professionals. Multiply the number of nursing personnel according to the ratio of professionals to non-professionals. 190 x .65 = 124 professional nurses

190 x .35 = 66 nursing attendants

Categories or Levels of Care of Patients, Nursing Care hours needed per patient per day and ratio of professionals to nonprofessionals
Levels of Care Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care 4.5 65:35 3.0 1.50 55:45 60:40 NCH Needed Per Pt. Per Ratio of Prof. To NonDay Prof.

Level IV
Highly Specialized Or critical Care

6.0 -7.0 or Higher

70:30
80:20

Step 7: Distribute by shifts. Studies have shown that the morning or day shift needs the most number of nursing personnel at 45 to 51 percent; for the afternoon shift, 34 to 37 percent; and for the night shift, 15 to 18 percent. In the Philippines the distribution usually followed is 45% for the morning shift, 37% for the afternoon shift, and 18% for the night shift. 124 nurses x .45 = 56 nurses on AM shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x .18 = 22 nurses on night shift total = 124 nurses

66 nursing attendants x .45 = 30 NA for AM shift 66 nursing attendants x .37 = 24 NA for PM shift 66 nursing attendants x .18 = 12 NA for evening shift Total = 66 nursing assistants

STAFFING SCHEDULE

SCHEDULING

making a time-table showing planned worked days and shifts for nursing personnel assign working days and days off to the nursing personnel so that adequate patient care is assured. desirable distribution = fair treatment know their schedule in advance

TYPES OF SCHEDULING
1. Centralized Scheduling based on a master pattern that is carried out by one person who plans and coordinates the schedule of the nurses
2. Decentralized Scheduling allows the nurse manager to staff his or her own unit. nurse managers are given authority and assume responsibility

3. Self Scheduling nurses and other staff collectively develop and implement work schedules, taking into consideration policies and variables affecting staffing
4. Rotating work shifts common in most hospitals; There must be equal share of morning, afternoon and night shift, as prolonged night shift may affect the health of the personnel.

5. CYCLICAL SCHEDULE
Cyclical length- The cyclical schedule covers a designated number of weeks. It assigns the required number of nursing personnel to each nursing unit consistent with the units patient care requirements, the staffs preference, their education training and experience.

Personn el
7am 3pm

W T h
X

T h

T h

T h

Head/Sr. nurse Staff nurse Nursing att. 1 Nursing att. 2

3pm- 11pm

Staff nurse Nursing att.

11pm- 7am

Staff nurse Nursing att. Gen. Rel.

3pm-11pm, 11pm-7am 3 1 1

31 1

Staff nurse Nursing att.

1 1 7 X

31 1

1 1 7 X

1 1 7 7 3

7 3

31 1

31 1

1 1 7 X

7 3

31 1

3 1 1

1 1 7
31 1

1 1 7
31 1

3 1 1

1 1 7 7 3

1 1 7
31 1

73

31 1

3 1 1

1 1 7

7 3

3 1 1

1 1 7

311

1 1 7

1 1 7

3 1 1

7 3

1 1 7

1 1 7

1 1 7

3 1 1

1 1 7

Directing

DIRECTING
guiding and motivating others to meet the expected outcome; actuating efforts to accomplished goals Delegate nursing care assignments Utilize, revise, update policies & procedures Supervise and harmonize goals thru guidance Coordinate, unite personnel & services Communicate & ensure common understanding via various routes Develop people, provide staff development program Decide/make judgment

Change any alteration in a status quo Phases of Change: Unfreezing = awareness of an opportunity ,need or problem and perception that some action is necessary Experiencing = incorporation of what is new or different into work and interpersonal processes Refreezing = accepts and uses the new attitude/behavior like a new habit

Leadership the use of ones skill to influence others to perform to the best of their ability towards goal achievement. Influence ability to affect perception, attitude and behavior of others. Nursing Leadership process by which a nurse influence one or more person to achieve specific goals in the provision of nursing care in one or more patients.

DIFFERENT INFLUENCE TACTICS

assertiveness ingratiation rationality sanctions exchange upward appeal blocking coalition

THEORIES
1. 2. 3. 4. 5.

OF

LEADERSHIP

Great man Theory Charismatic Theory Trait Theory Situational Theory Contingency a. Leader- follower relationship b. Task structure c. Position power 6. Expectancy Theory 7. Path-Goal Theory

KINDS

OF

LEADERSHIP
Transformational

Transactional
Exchange posture that identifies needs of followers Competitive Task focus A contract of mutual benefit Provide rewards to meet needs Caretaker Focused on day-to-day operation

Attends to need/motive of followers Cooperative, focusnetworking Process focus Promote employee development. Inspire through optimism Role model Provide sense of direction

MOTIVATION
The

force within the individual that influences or directs behavior. Intrinsic motivation comes from within the person, driving him/her to be productive Extrinsic motivation is enhanced by the job environment or external rewards.

MOTIVATIONAL THEORIES
Maslows

hierarchy of needs Skinner behavior that is rewarded will be repeated, & behavior that is punished or goes unrewarded is extinguished Herzberg 3 motivators achievement, recognition, potential for growth Vroom people make conscious decisions in anticipation of rewards

MOTIVATIONAL THEORIES
McGregor Theory X & Theory Y Ouchi Theory Z McClelland 3 basic needs; achievement-oriented people focus on improving what it is; transform ideas into action affiliation-oriented people focus their energies on families & friends power- oriented people motivated by the power that can be gained as a result of a specific action

Assignment describes the distribution of

work that each staff is to accomplish on a given shift or work period.

Delegation transferring to a competent

individual the authority to perform a selected nursing task in a selected situation. The nurse in return assumes responsibility for its satisfactory performance and is held accountable for its results

FACTORS

AFFECTING IMPACT OF DELEGATION

Responsibility Authority Accountability

Delegation process involves: 1. identification of the needs 2. select most suitable person 3. clear communication of expectations 4. acceptance of task 5. monitoring of performance (periodic) 6. feedback

WHAT
1.

CANNOT BE DELEGATED

2.

3.

Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit Authority to sign ones name is never delegated Evaluating the staff and/or taking necessary corrective or disciplinary action

WHAT CANNOT BE DELEGATED

4. Responsibility for maintaining morale or

the opportunity to say a few words of encouragement to the staff especially the new ones 5. Jobs that are too technical and those that involve trust and confidence.

5 RS OF DELEGATION
Right

circumstances based on area of practice Right task to the right person Right direction what they need to do and how task must be done Right supervision and evaluation Right person trust, licensure, role, preparation

Supervision
the provision of guidance and direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel.

STEP-BY-STEP
SUPERVISION
1. 2. 3. 4. 5.

FEEDBACK PROCESS IN

Ask for the members input first Give credit for what has been accomplished Offer observations or concerns Ask for the delegates idea on how to resolve the issue Agree on a course of action and plan for the future

COORDINATION

Unites personnel and services towards a common object synchronization enhances, collaborate efforts resulting in efficient and smooth and harmonious flow of work.

DECISION MAKING

choosing among options directed towards resolution of problem and achievement of goals

Attributes of a Decision Maker

Freedom to decide Capacity to make wise decisions Will/motivation & commitment to choose Will to take responsibility for the choice made

STEPS IN MAKING DECISIONS

1. Identify the problem

2. Gather data 3. Explore alternatives 4. Evaluate alternatives 5. Select the appropriate solution 6. Implement the solution 7. Evaluate the results

DECISION MAKING TOOLS

1. PROBABILITY THEORY
applied

when uncertainty is present in a decision the likelihood of an events occurrence the smaller the probable error, the greater the amount of confidence that can be put in the findings criteria that assume that previous experience is necessary to work with probability

2. SIMULATION, MODELS, AND GAMES

SIMULATION
way of using models and games to simplify problems by identifying the basic components using trial and error to determine a solution

Models

developed to describe, explain, and predict phenomena

conceptualization critical element of model building objective of modeling provide a simplified, abstract version of reality

 simulation player

GAME THEORY

of systems operations

maximize gains and minimize losses regardless of what the competitor does

War

games commonly used to train personnel and to test plans and equipment under field conditions games used primarily to train personnel rather than to solve competitive problems

Management

3. GANTT CHART

Henry L. Gantt Highly developed schedules that allow one to visualize multiple tasks that have to be done

Task Collect
information

Responsible Mon Tues Wed

Thurs

Fri

Type report

Revise report

Submit report

4.PROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)

3 PROJECTED TIMES ARE DETERMINED: A. THE OPTIMISTIC TIME (TO) ESTIMATES
THE COMPLETION TIME WITHOUT

B.

THE MOST LIKELY TIME (TM) PROBLEMS

COMPLICATIONS

ESTIMATES

THE COMPLETION TIME WITH NORMAL

C. THE PESSIMISTIC

TIME (TP)

- ESTIMATES

THE COMPLETION TIME GIVEN NUMEROUS PROBLEMS

MANAGEMENT DECISION-MAKING TECHNOLOGY

DECISION GRID
A

decision Grid allows one to visually examine the alternatives and compare against the same criteria. Although any criteria may be selected, the same criteria used to analyze each alternative.

Alternative

Financial Effect

Political Effect

Departmental Effect

Time

Decision

DECISION TREE ANALYSIS

Decision

Trees are useful tools for helping you to choose between several courses of action. a highly effective structure within which you can explore options, and investigate the possible outcomes of choosing those options.

Provide

CRITICAL PATHWAYS

are

predetermined courses or progress that patient should be making after admission for a specific diagnosis or after a specific surgery. done day by day, with daily expected outcomes for the patient

PAY OFF TABLES

PAY OFF TABLES REQUIRES THE
MANAGER TO ESTABLISH THE COST-VERSUS-BENEFIT RELATIONSHIP AND THE PROBABILITIES OF CERTAIN OUTCOMES USING CURRENT INFORMATION AND HISTORICAL DATA.

QUEUING THEORY
IT BALANCES THE COST OF
WAITING VERSUS THE PREVENTIVE OF WAITING BY INCREASING SERVICE; IT ACKNOWLEDGES THAT ALTHOUGH DELAYS ARE COSTLY, ELIMINATING THEM BY EVEN MORE COSTLY.

human system responds to input that has disturbed the steady state of the body

Stress - a condition of being wherein the

Crisis - state of disequilibrium resulting

from the interactions of an event with the individual or familys coping mechanisms which are inadequate to meet the demands of the situation combined with the individuals or familys perception of the situation.

Conflict - clash between two opposing and

sometimes hostile parties.

TYPES

OF CONFLICT

Intrapersonal

within the individual Interpersonal involves 2 or more persons who do not share the same perspective, views and attitude Intra-group or organizational conflict exist between 2 or more persons within a group or organization. Sources: policies, norms, role, communication, authority

STRATEGIES

IN CONFLICT MANAGEMENT

Avoidance parties ignore either consciously or unconsciously so as not to interfere with their relationship; neutrality is maintained at all cost (L-L) Accommodation self- sacrifice (L-W) Competition win at all cost; (W-L) Compromise split the difference; (L-L) Collaboration (W-W)

 Smoothing

disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence (L-L) Withdrawing one party is removed thereby making it impossible to resolve the issue Forcing yields an immediate end to the conflict but leaves the cause of the conflict unresolved; an order may be issued but commitment to the demanded action is not guaranteed.

Controlling

CONTROLLING
A. Performance appraisal using performance standards as criteria for measuring success and taking corrective actions; assessing or regulating performance. monitor and evaluate nursing care services a method of acquiring and processing information needed to improve the individual workers performance and accomplishments Focuses on the worker

STEPS

IN PERFORMANCE APPRAISAL

1.

Data collection accurate data about employee performance Preparation interviewer must be knowledgeable re: job description, relevant data whether (+) or (-) In conducting the appraisal privacy and time are critical Follow-up

Standards level of performance that management can expect from a person

Types:
structure

the management used to organize and deliver care process the actual nursing procedure outcome measuring the results of nursing care

QUALITY ASSURANCE
Measurement

of the actual level of service provided plus the efforts to modify when necessary the provision of these services in the light of the results of such measurement is the degree of excellence & assurance means formal guarantee of a degree of excellence

Quality

QUALITY

IMPROVEMENT

Involves

the pursuit of excellence in the delivery of care Continuous QI is necessary to identify actual and potential problem as well as designing possible solutions Quality Monitoring Activities: 1. Accreditation process outcome-based evaluation (JCAHO Joint Commission on Accreditation of Health Care Organization) 2. Case management 3. Total quality management organization philosophy that is directed toward customer/ client satisfaction

4. Continuous quality improvement involves multidisciplinary team members to analyze the system based on data collected, measured objective & outcomes and proposes informed changes 5. Benchmarking 6. Utilization review assessing medical necessity, appropriateness of health care services 7. Staff education 8. Risk management

Appraisal via: SWOT S ---- Strengths [Competent Nurses, committed nurses] W ---- Weaknesses [Scarcity of faculty /staff ; lack of training, poor quality care] O ---- Opportunities [New programs, new positions] T ---- Threats [Low patient satisfaction] From SWOT data as assessed from external and internal environment, objectives are established Develop strategies Implementation and evaluation of strategy

 Nursing

Audit assuring documentation of the quality of nursing care in keeping with standards established by the agency, nursing department ,and the national governmental and accrediting groups

RESOURCES

something to which one resorts for comfort or help to gain one end. Major resources 1. money 2. manpower 3. materials 4. machines 5. methods 6. milieu 7. minute

INVENTORY stock of various supply items kept on hand to provide service to users, feed a production line to provide goods for sale or demand while waiting for deliveries Methods: periods or physical inventory Perpetual COST CONTAINMENT the goal is to keep cost within acceptable limits for volume, inflation and on acceptable parameters.

MANAGEMENT BY FILIPINO VALUES

FOUR GENERAL
STYLES OF

MANAGEMENT

FILIPINO

REALIST MANAGER- MANAGEMENT-BY-KAYOD

The manager of this type works day in and day out, fired by an inner zeal that does not make any difference between working days, Sundays, and holidays. His work is his pleasure, his life. He wants quick actionHe is an autocrat- relies on the authority of power. He woos the person with power and not the person with titles.

IDEALIST MANAGER- MANAGEMENT- BYLIBRO

a highly- trained professional who prefers American management styles with all their technical jargon and sophisticated tools of management. Thinker- reflects on the problems first before acting on them. He looks into basic concepts and approaches before defining and solving problems. Technocrat- he relies on the authority of facts. He is very statistics- oriented.

OPPORTUNIST MANAGER MANAGEMENT BY- LUSOT

often wants least hardship and sweat, paying off problems and taking shortcuts. He prefers to take shortcuts, to practice unethical moves if necessary to clinch a deal.
Basically Inclined Seeks

a maker of deals. to easy settlements

to reduce pressures and to pass on the buck. He does not cooperate unless it also benefits him.

RECONCILER- MANAGER- UGNAYAN MANAGEMENT

Seeks synergy, optimizing the use of different components- money, people, materials, machine, information, energy, etc.- so that something more powerful, innovative, useful can emerge.
He

has balance. accepts and works to integrate the idealist and realist managers.
management style- there is no one single answer; it all depends. is solid.- he knows his game; he knows which staff member to use to solve his problems.

Contingency He

FILIPINO VALUES

THERE

ARE SOME NEGATIVELY ORIENTED VALUES THAT HINDER THE ATTAINMENT OF QUALITY:

 Amor

propio Filipino oversensitive to correction and criticisms. Filipinos are proud winners but have the inability to take defeat gracefully. Gaya-gaya or keeping up with the Santoses copy-cats pasikatan competition bahala na or Procrastination is the thief of quality. Maana Habit

 Puede

na rin (not bad); value leads to lack of quality. Superstition and fatalism values : iginuhit ng tadhana , swerte , malas Ningas-Kugon sudden burst of fanatical frenzy in attempting to start something but dismally ends in accomplishing nothing kappa-kapa system lack of methodology wala kang paki-alam value mind your own business.

POSITIVE

DIMENSIONS

 Gaya-gaya

can serve as inspiration to workers to strive to produce the best products. Ang galing-galing can be morale booster. Pakikisama Hiya Bayanihan

AIM HIGH !!! MAKE IT. WORTHWHILE!!! GOOD LUCK!!!

Mrs. Lili C. Del Rosario, BSE, BSN, RN, LLB, MAEd, MAN

NURSING RESEARCH

Mrs. Lili C. Del Rosario

Research
derived from the old French word cerchier, meaning to seek or search, the prefix re means again and signifies replication of the search.

Nursing Research
A

systematic, controlled, empirical and critical investigation of hypothetical propositions about the presumed relationship among natural phenomena.

A testing of knowledge that can be used to guide nursing practice; concerned with examining questions and verifying interventions based on human experiences. (NCNR)

HISTORY OF NURSING RESEARCH

1st issue of Nursing Research was published Notes on matters affecting the health efficiency and hospital administration of the British Army Florence Nightingale 1890 Notes in Nursing, What it is and What it is not Florence Nightingale clearly illustrated her environmental approach in the care of the sick focusing on the physical environment. Nursing Studies Index (Virginia Henderson ) was the first annotated index in nursing research 1900 Nursing Education 1940 Availability and demand of nurses in times of war 1970s Clinical Outcome
1858

HISTORY OF PROFESSIONAL NURSING (SIMMONS AND HENDERSON)

First Phase late 1800 The trained nurses were products of hospitals Second Phase 1900 1930 Marked the beginning of nursing education in institutions of higher learning while hospital programs were being expanded Third Phase 1930 to the present There has been a tendency to look inward for the purpose of improved quality nursing care and nursing education.

In the later part of the 19th century, nurses applied medical research to determine procedures and nursing treatments. Then they turned into educational research to apply some of its methods and aims while research on industrial management helped in the scientific utilization of personnel. EVIDENCED - BASED PRACTICE a researched based decision making process utilized to guide the delivery of holistic care by nurses.

COMPONENTS OF SCIENTIFIC RESEARCH:

1. Order and System 2. Control imposition of conditions in the research situation, to minimize bias and maximize the precision and validity of data gathered 2. 3. Empiricism gathering of evidence and relying on ones own senses 4. Generalization research findings may be applied to a situation or population larger than the one studied.

PURPOSES:
Description

Exploration
Explanation Prediction

and control

TYPES OF

RESEARCH:

1. Basic or Pure Research - undertaken to extend the base of knowledge in a discipline; to formulate or refine a theory Example: Isaac Newtons Law of Action states that a body at rest will remain at rest and a body in motion will continue to move with the same velocity in a straight line unless acted upon by an external force 2. Applied research - focuses on finding solution to an existing problem Example: To study the various application of various methods of contraception, determine the effectiveness of each method and their respective problems.

3. Action Research - focused on immediate application not on the development of theory or for general application. Example: The application of quality assurance to improve nursing care services to clients in a particular unit.

STEPS IN THE RESEARCH PROCESS

I. Conceptualizing the Research Problem: A. Sources: 1. Nurses experience 2. Nursing literature 3. Social issues 4. Theory 5. Ideas from external sources

II. EVALUATING RESEARCH PROBLEM

Criterion/considerations: 1. Significance of the problem 2. Researchability 3. Feasibility > Time and timing > Availability of participants > Cooperation of others > Facilities and equipment > Administrative support > Interest of the researcher > Knowledge of the researcher

 Ethical

Issues:

NUREMBERG

CODE - one of the first internationally recognized efforts to establish ethical standards development after the NAZI atrocities or human rights violations. REPORT - articulated three primary ethical principles on which standards of ethical standards of ethical conduct in research are based: beneficence, respect for human dignity, and justice.

BELMONT

1. Beneficence to do good; freedom from harm; freedom from exploitation. 2. Principle of Respect for Human Dignity > Principle of self-determination > Freedom from coercion of any type > The right of full disclosure > Covert data or concealment - videotaping > Deception deliberately withholding information 3. Principle of Justice > Right to fair treatment > Right to privacy > Anonimity

INFORMED CONSENT
Full information re: research, comprehend information, have power of free choice to agree or decline voluntarily participants status study goals type of data procedures nature of commitment
comprehension

of informed consent documentation of informed consent

III. COMMUNICATING RESEARCH PROBLEM:

Problem statement an expression of the dilemma to be resolved or disturbing situation that needs investigation for the purpose of providing understanding and direction.

Ex. A Co-Relational Study on the Predictors of

Performance in the Nursing Licensure Examination of Bachelor of Science in Nursing Graduates in a Tertiary Institution

2. Statement of purpose establish the general

direction of the inquiry and provide a synopsis of its overall goal.

Ex. This study aims to determine the relationship between academic performance and performance in the Nursing Licensure Examination of nursing graduates of XYZ College for the school year 2005, 2006, 2007.

3. Research question specific queries researchers want to answer in addressing the problem; guides the type of data to be collected in a study.
Ex

What are the performance of the Nursing Graduates of XYZ College of the school year 2005, 2006, 2007 in terms of: General weighted average in 1. general education subjects 2. professional education subjects categorized as: a. Preventive b. Promotive c. Curative & Rehabilitative

What is the rating in the Nursing Licensure Examination of the Nursing Graduates of XYZ College of the school year 2005, 2006, 2007 under the following category: Preventive Nursing Promotive Nursing Curative A Nursing Curative B Nursing Rehabilitative Nursing What is the relationship between the variables mentioned in problem number 1 and the variables mentioned in problem number 2? Which among the variables is the best predictor of performance in the Nursing Licensure Examination

Variables an attribute of a person or object that varies, that is, takes on different values (body temp. , age, heart rate etc). Kinds: endogenous a variable whose variation is determined by other variables within the model.
exogenous

model

determinants lie outside the

independent presumed CAUSE; can be MANIPULATED dependent presumed EFFECT; can be MEASURED

continuous can take a wide

range of values fr. 0 100; not restricted to whole numbers discrete can take only a finite number of values; can take only whole number equivalents; compatible with life

FORMULATION OF HYPOTHESIS
Hypothesis statement of predicted relationship between variables; Proposed solution or answers to queries Serves as framework for drawing conclusions.

Ex. Does history of sexual abuse in children affect the development of irritable bowel syndrome in women? The researcher may predict:

Women who are sexually abused have a higher incidence of irritable bowel syndrome than women who are not.

Types: Null no significant difference exists; no relationship or interaction Alternate the operational statement of research problem.

Inductive generalization based on observed relationship; researcher observe certain patterns, trends, associations among phenomenon and then use the observation as basis for predictions.

Deductive have a starting point; theories that are applied to particular situations. Simple - relationship between one dependent and one independent variable. Ex. Patient receiving a warmed solution for body cavity irrigation during surgical procedure (X) will maintain an increased core body temperature (Y) than patients receiving a room temperature solution.

Complex 2 or more dependent variables and independent variable Ex. Among breast CA survivors emotional wellbeing (Y), is influenced by womens self esteem (X1),their resourcefulness, (X2) and their degree of support (X3)
Directional - predicts a path or direction the relationship will take. Ex. Aromatherapy decreases stress. Non- directional predicts a relationship but not the path or direction the relationship will take. Ex. Aromatherapy affects level of stress.

SIGNIFICANCE OF THE STUDY:

The researcher attempts to present the long range effect of the results of the study . The results of the present study may have a significant effects in any existing theory, methodology and practice.
Ex. The identification of the predictors for the performance in the Nursing Licensure Examination will aid the Nursing Department in strengthening and reinforcing its admission and retention policies so that qualified students who will enroll in the nursing course will have the highest opportunity of completing the program.

SCOPE AND LIMITATION OF THE STUDY:

The researcher presents the firm boundaries and the studys limitations and weakness. The limitations could be:

The ability of the researcher The correct tools of measurement

Number of subjects involved

Number of trials made Length of time the study was conducted

Availability of adequate amount of knowledge

THEORETICAL/CONCEPTUAL FRAMEWORK

Conceptual framework less formal attempt at organizing phenomena than theories; made up of concepts that are placed within a logical sequential design. It is represented by a diagram.

Concept - an abstraction based on observation of certain behaviors or characteristics (ex. pain, stress). Assumption - basic principles that are accepted as being true on the basis of logic or reason, without proof or verification (ex. Nurses can sense the fears and anxieties manifested by pre-surgical patients.)

Theoretical framework consists of theories that seems to be interrelated that provide rationale for the hypothesis.

Theory - an abstract generalization that presents a systematic explanation about a relationships among phenomena. Ex. Orems Self-Care Theory focuses on each individuals ability to perform self-care

GOAL of nursing is to help people meet their own therapeutic self-care STUDY influence of socio-cultural and economic circumstances on the self-care practices of young adolescents (using Orems theory)

DEFINITION OF TERMS:
1. Operational

definition

Ex. Weight is defined as the amount that an object weighs in pounds, to the nearest full pounds; weight will be determined in pounds not kilograms.

2.Conceptual definition
Ex. Weight is defined as the heaviness/ lightness of an object

IV. RELATED LITERATURE

Purpose: It lays the foundation of the study. Sources: 1. primary 2.secondary

CINAHL cumulative indices of nursing and allied health literature index of compilation of literature MEDLINE related to nursing, medicine and dentistry

V. PLANNING
Determine research design and over-all plan for the collection of data Types of Research Design: A. Quantitative

Centers on why, where, who, what, when. how Examines cause and effect Etic perspective analyzes data w/o considering their role as a unit in a system

Bigger sample size rule of 30 deductive process

QUANTITATIVE RESEARCH DESIGN

Experimental design:
1.True experimental design researcher has great deal of control to the research situation

Control the group that does not receive the experimental treatment (vs. comparison group) Manipulation the independent or experimental variable is controlled by the researcher Randomization each subject has an equal chance of being placed in any of the group in the study.

Quasi- Experimental
There

is manipulation but no control nor random 1. non-equivalent control group compares 2 groups that are not randomized. Ex. pre-test-intervention-posttest 2. time-series design a. longtitudinal studies b. cross-sectional studies 3. field experiment

Non- Experimental Descriptive Studies examines characteristics of just one sample design. 1. 2. 3. 4. Methodological study Comparative study Co-relational studies Survey

QUALITATIVE RESEARCH DESIGN

inductive and interactive > sample size is generally smaller because it focuses on the quality of data collected > examines quality rather than quantity > emic perspective participants provides the source of meaning rather than that of the researcher. > utilizes holistic approach to the participants
>

QUALITATIVE RESEARCH DESIGN

1. case study 2. ethnography culture of a group 3. grounded theory social structures (data are collected & analyzed & then a theory is developed that is grounded in the data.) 4. phenomenology examine human experiences through the description provided by the people involved; develops an understanding of human perspective (naturalistic inquiry) 5. Historical study documents & artifacts

Selecting a Sample:
Population - entire set of elements that meet specific criteria

Target population every element in the world that meet sampling criteria
Accessible population portion of the target population that investigator can reasonably reach.

SAMPLING REPRESENTATIVE OF A POPULATION

A. Probability random chance of being included 1. Simple random lotto; draw lots; 2. Stratified group according to levels

ex. smoking among college students

3. cluster geographic location, nationwide, or by region.

4. systematic sampling every kth - obtain a list of total population(N)

- determine sample size (n) - determine sampling interval k by N/n - k = N/n

B. Non-probability not all has the chance to be included

1. convenience or accidental
2. purposive or judgmental 3.snowballing- referral/networking 4. quota cluster not random

VI. DATA GATHERING:

Analysis process of organizing and synthesizing data so as to answer research question and test hypothesis. Interpretation - process of making sense of results of the study and examining their implications. Assignment of Observer to collect data
1. non-participant observer using quantitative scale 2. non- participant observer using qualitative scale 3. participant-as -observer 4. observer-as-participant

Major methods of data collection: 1. tests ascertain specific

knowledge
2. questionnaires 3. interviews 4. focused group 5. observation 6. secondary data 7. biophysiologic data in vivo (instruments); in vitto (lab results)

CRITERIA FOR INSTRUMENT SELECTION

Reliability-

consistency & dependability of a research instrument to which the same results are obtained on repeated administration of the instrument Validity the ability to measure the variable that it is intended to measure Sensitivity ability of the instrument to detect the differences among the subjects studied

Quantitative or Descriptive Statistical Data Analysis requires the use of numeric data to describe and interpret results. 1. Measures of central tendencies a. mean b. mode c. median

2. Frequency distribution occurrences; how many are males? Females? Married?; array of numerical values from the highest to the lowest together with the count of the number of times each value was obtained 3. Percentage represents the proportion of a subgroup to a total group.

4. Range - defines the distance in the scoring units of the units of the variables from the highest points achieved to the lowest.

5. Standard Deviation - measures the degree of variability in a set of score 6.Inferential making inferences/ hypothesis testing

a. T test - use to analyze differences between two means (Null hypothesis) b. Chi- Square test use to assess whether a relationship exists between two nominal level variables (Alternative hypothesis)

7. Analysis of Variance (ANOVA) tests mean differences among three or more groups by comparing the variability within the groups. 8. Analysis of Covariance (ANCOVA) - tests mean differences among groups on a dependent variable, 9. Levels of measurement a. nominal sex, marital status b. ordinal ranking mild, moderate, or severe c. ratio highest level of measurement; zero means absence d. interval zero may indicate a value

VII. COMMUNICATING RESEARCH

A. Select communication outlet

Journals
Internet Books

Conferences

B. Know the audience can be understood by the consumers

C. Development of plans manuscript

D. Write effectively

Research Problems:
The

role of pre-natal care in weight of the new

born
Decreasing

cigarette consumption thru contract setting among male smokers

study on the personal control (ability of patients to control their environment) and emotional comfort (state of relaxation that affected the physical status of the patient) of hospitalized patients.

The relational experiences of elderly women women living alone in rural community Effects of Pre-Op Instructions about early ambulation on patients post-op performance of performance of selected ambulation tasks A study measuring nutrition and weight loss/gain in clients with cancer

 Helping

mother cope with a birth of a defective infant: a study of 2 cases

A study

examining the bereavement process in spouses of clients with terminal cancer

A study

exploring factors influencing weight control behavior Peer support increases adherence to weight loss diets in diabetic women

A study measuring the effects of sleep deprivation on wound healing A study examining clients feelings before, during and after a bone marrow aspiration A study examining clients reactions to stress after an open heart surgery

A study measuring differences in blood pressure before, during and after a procedure A study examining oxygen levels after endotracheal suctioning Lived experiences of mothers of suicidal adolescents

AIM HIGH !!!

MAKE IT. WORTHWHILE!!!

GOOD LUCK!!!
Mrs. Lili C. Del Rosario, BSE, BSN, RN,LLB, MAEd, MAN

Thank you for listening!!!!!

NURSING INFORMATICS
Informatics science of computer information system Nursing Informatics the science of using computer information system in the practice of nursing. 1977 1st Nursing Information Systems conference was held in the U.S. October 1995 the 1st American Nurses Association certification examination in nursing informatics was given.

Computer hardware consists of the central processing processing unit, memory, keyboard and other input devices devices (mouse, scanners), and the monitor and other output output devices (printers, plotters as a hard copy). Computer software instructs hardware to perform certain certain task; this includes programs, applications or software word processors databasespreadsheets communication devices

COMPUTER SYSTEMS

Management Information System (MIS) - designed to facilitate the organization & application of used to manage an organization or department - provides analysis used for planning, decision making & evaluation of management activities.

data

Hospital Information System (HIS) - focuses on the types of data needed to manage client activities and health care organization - the goal is to provide people the data they need to determine appropriate actions and control over them - have subsystems in the areas of admission, medical records, clinical laboratories, pharmacy & finance.

care

COMPUTERS IN NURSING EDUCATION

A.Teaching and Learning: 1. Literature Access & Retrieval 2. Computer Assisted Instructions 3. Classroom Technology 4. Distance Learning B. Testing C. Student & Course Record Management

Computers in Nursing Practice

A. Documentation of client status and medical record keeping 1. Bedside Data Entry or bedside terminals allows recording of client assessment, medication, administration, progress notes, NCP updating, patient acuity, & accrued charges. 2. Computer-based data record (CPRs) or Electronic Medical Records (EMRs) permit data retrieval by caregivers administrators, accreditors, & other persons who require the data 3. Data standardization & classification 4. Tracking client status

CPR Institute established in 1992, identified 4 ways CPR can improve health care: * constant availability of client information across the life span * ability to monitor quality * access to warehoused (stored) data * ability of client to share in knowledge & activities influencing their own health

Concerns with CPRs *1. maintaining privacy and security of data - use of password - a nurse informaticist
* 2. use of diverse system setups offered by manufacturers - use one set of terms & a standardized organization of data base records - nurses will need to be involved in the design, implementation & evaluation of CPRs to maximize their use & effectiveness

B. Electronic Access to Client Data - data accumulated from various electronic devices can be part of the CPR & also stored for research purposes 1. client monitoring & computerized diagnostics (digital/tympanic thermometers, pulse oximetry, ECG monitoring etc.) 2.telemedicine/telehealth/teleconference uses technology to transmit electronic data about clients to persons at distant location

III. Practice Management A. modify budget B. provide different staffing C. move supplies to different location D. make changes for more efficient & higher quality care E. use for scheduling F. for accurate billing IV. Specific Applications of Computers in Nursing Practice A. Community & home health B. Case Management 1. patient data 2. requirements for health care benefits eligibility 3. document quality

V. Computers in Nursing Administration

A. Human resources 1. employees data base 2. examines staffing patterns 3. create budget projections B. Medical record management C. Facilities management D. Budget & finance E. Quality assurance & utilization reviews F. Accreditation JCAHO mandated that hospitals should have online mechanisms to monitor quality indicators so as to reduce the difficulty & time involved in the accreditation process; also required a move to computer systems that assess outcomes rather than processess.

VII. Computers in Nursing Research A. Problem identification B. Literature review C. Research design D. Data collection & analysis E. Research dissemination F. Research grants

AIM HIGH !!! MAKE IT. WORTHWHILE!!! GOOD LUCK!!!

Mrs. Lili C. Del Rosario, BSE, BSN, RN, LLB, MAEd, MAN

Thank you for listening!!!!!