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Theories & Minimum Requirements of Nursing Care
Theories & Minimum Requirements of Nursing Care
Theories & Minimum Requirements of Nursing Care
NURSING CARE
Presented by- PRABU.G, M. Sc Nursing, CN, JIPMER.
INTRODUCTION:-
Nursing profession is considered a caring profession to begin with, it was an art and a
vocation. Now it is considered a scientific profession nursing care is defined as the care of the
patient with regard to nursing needs, with he ever increasing dimension of medical sciences
quantitatively and qualitatively6 nursing care is becoming more and more complex with its
management services.
ORGANIZATION-
Definition of organization
The term organization has been used since time immemorial. It is as old as the existence
of human beings. Different writers however hold different views of organizations.
Denyer (in Kumet and Mittal, 2001) consider organization as the arrangement of work,
with the division of activities and responsibilities.
Characteristics of organization
Organizations have the following characteristics:
a) Organizations consist of a group of individuals.
b) Organizations are dynamic.
c) Organizations have specific activities which are conducted under the direction of a
leader.
d) Organizational output is the result of collective effort
Types of Organizations
There are two types of organizations.
a. Formal organizations
Formal organizations are characterized by planned structure and represents the patterns of
relationship that exist among the components of an organization.
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Characteristics
b. Informal Organizations
❖ Develop Standards of behavior; Informal organizations generally develop its own laws,
taboos and beliefs about what is right and wrong behavior or conduct.
❖ Pressures to conform; Informal groups tend to exert pressures upon which its members
conform to.
❖ Informal leadership; Leaders in informal organizations merge from groups through
persuasion and influence.
Theory
• A Theory is a set of inter related concepts, definitions & propositions that present a systematic
view of phenomena
• It also specifies the relationship among variables with purpose of explaining and predicting
the phenomena.
Organization theory
• Refers- to the study of the phenomena or occurrences of organizational functioning and
performance and of the behavior of Groups and individuals working in them.”
• There are several theories which explain the organization and its structure.
NURSING SERVICES:-
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Definition of Nursing Services: -
WHO expert committee on nursing defines the nursing services as the part of the total
health organization which aims to satisfy major objective of the nursing services is to provide
prevention of disease and promotion of health.
• While others shared this belief, Fayol was the first to identify management as a
continuous process of evaluation.
Additionally Fayol recognizes fourteen principles that should guide the management of
organizations. Fayol’s 14 Principles:
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7. Remuneration of Personnel—payment should be fair and satisfactory for employees
and the organization
9. Scalar Chain (Line of Authority)—the chain of command from the ultimate authority
to the lowest
10. Order—people and supplies should be in the right place at the right time
11. Equity—managers should treat employees fairly and equally
14. Esprit de Corps—managers should foster and maintain teamwork, team spirit, and a
sense of unity among employees
• The organization has a well-defined line of authority. It has clear rules and regulations which
are strictly followed.
• Weber first describes the concept of bureaucracy – an ideal form of organizational structure
• He defines bureaucratic administration as the exercise of control on the basis of knowledge
• Power: any relationship within which one person could impose his will, regardless of any
resistance from the other.
• Authority: existed when there was a belief in the legitimacy of that power.
Weber classifies organizations according to the legitimacy of their power and uses three basic
classifications:
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❖ Charismatic Authority: based on the sacred or outstanding characteristic of the
individual.
❖ Traditional Authority: essentially a respect for customs.
❖ Rational Legal Authority: based on a code or set of rules.
Weber recognizes that rational legal authority is used in the most efficient form of organization
because:
• A legal code can be established which can claim obedience from members of the organization
• The law is a system of abstract rules which are applied to particular cases; and administration
looks after the interests of the organization within the limits of that law.
• The manager or the authority additionally follows the impersonal order
• Membership is key to law obedience
• Obedience is derived not from the person administering the law, but rather to the impersonal
order that installed the person’s authority
Weber outlined his ideal bureaucracy as defined by the following parameters:
• A continuous system of authorized jobs maintained by regulations
• The finances and interests of the two should be kept firmly apart: the resources of the
organization are quite distinct from those of the members as private individuals.
(a) A tendency to a leveling of social classes by allowing a wide range of recruits with technical
competence to be taken by any organization
(b) Elite status because of the time required to achieve the necessary technical training
(c) Greater degree of social equality due to the dominance of the spirit of impersonality or
objectivity
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Features of Bureaucratic Organization
• The characteristics or features of Bureaucratic Organization are as follows:
Although Bureaucratic organization is suitable for organizations where change is very slow
and it is also appropriate for static organizations. Bureaucratic organization is criticized
because of the following reasons:
i) Too much emphasis on rules and regulations. The rules and regulations are rigid
and inflexible.
ii) No importance is given to informal groups. Nowadays, informal groups play an important
role in all business organizations.
i) Bureaucracy involves a lot of paper work. This results in lot of wastage of time, effort
and money.
ii) Bureaucracy is very rigid and does not give importance to human relations
vi) There will be unnecessary delay in decision-making due to formalities and rules.
vii)Too much importance is given to the technical qualifications of the employees for
promotion and transfers. Dedication and commitment of the employee is not considered
Viii)There is difficulty in coordination and communication.
Every organized enterprise does not exist in a vacuum. It is rather known to depend on
its external environment – which is a part of a larger system, such as the industry to which it
belongs, the economic system and the society (Weihrich et al, 2008).
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According to them, the organization receives inputs, transforms them and exports the
outputs to the environment as shown in the basic input-output model below.
In their own opinion, the above model requires expansion and development into a
model of process, or operational management that indicates how the various inputs are formed
through the managerial functions of planning, organizing, staffing, leading and controlling.
However, the following sub topics are the basic components of a system.
i) Inputs -
The composition of inputs from the external environment may include people, capital,
managerial skills as well as technical knowledge of skills. It also includes the various claimants
– groups of people making demands on the organization; such as employees, consumers,
suppliers, stockholders, federal, state and local governments.
iv) Outputs –
Inputs are secured and utilized by transformation through the managerial functions – with due
consideration for external variables into outputs. Outputs of different kinds vary with the
organization. They usually include many of the following; products, services, profits,
satisfaction and integration of the goals of various claimants to the organization.
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Types of systems
1) Cybernetics and closed systems thinking:
The field of cybernetics exemplifies the modern version of closed systems thinking and it is
attributed to the work of Norbert Wiener.
The cybernetic closed systems model is the intellectual base for traditional cost and
quality management approaches. Another key idea in closed systems is the increase in entropy
or the tendency to maximum disorder. This is because the system is closed to the environment
and has no ability to import energy to counteract the growth in entropy. This view, exemplified
by the second law of thermodynamics, means that closed systems will
inevitably tend to breakdown from an increase in entropy.
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2) Biology and open systems thinking:
Open systems theory has its foundations in biology, particularly Darwin's work on the
evolution of the species. The popular version of open systems theory is attributed to Ludwig
Von Bertalanffy who used the term ‘general systems theory’ to describe the main ideas and to
distinguish them from closed systems thinking. Bertalannfy maintained that closed systems
thinking was not appropriate to study biological phenomena because biological systems
interact with their environment, grow and survive. However, the environment of living
organisms is less forgiving and often the luxury to learn from errors does not exist.
There are four main differences between closed and open systems theory. Each difference is
discussed below.
1. Relations with the external environment. Open systems theory focuses on the interchange
between a system and its environment. Biological organisms are open systems because they
constantly evolve and adapt to the needs of their environment. Their behaviour is a response to
the threats and resources available in the environment in which they exist.
2. Variables considered. A second area, which differentiates open and closed systems thinking,
is the number of variables included. A closed system has a few variables. An open system
typically deals with a more complex set of interrelationships. Cost and quality, viewed from a
closed systems perspective, are internal variables that need to be managed within the
boundaries of a firm. In an open system, cost and quality are viewed as externally driven
variables that must be managed by understanding the environmental influences on these
variables.
3. Form of regulation or control, closed systems use error-controlled regulation. This is control
after-the-fact. Open systems use anticipatory control. They are regulated by anticipating errors
before they occur and taking corrective measures before final output. Like a mouse, open
systems anticipate a cat’s next move. Waiting for feedback from errors is usually fatal. This
form of regulation is called ‘feed forward’ control. If cost is to be managed as an open system,
it should be controlled before a product is produced and not after.
4. Purpose of Regulation. Unlike closed systems, open systems are not interested in returning
a system back to some predetermined stable state. They recognize that the purpose of regulation
is to adjust and move the system on a dynamic path. Open systems seek continuous
improvement and not just stability. They are said to achieve a dynamic equilibrium. Like living
systems, most organizations operate in constant interchange with their environment. They have
many complex interactions and interrelationships within their boundaries.
Systems theory and effectiveness
In everyday conversation, the term system is used. A variety of meanings and interpretations
are given to describe accounting systems, inventory control system, a car’s ignition system, an
ecological system and the Nigerian tax system. Each system consists of elements or characters
that interacts (Gibson et al (1997).
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According to them, system theorists propose that systems can be categorized in three
ways:
Systems theory can also describe the behaviour of individuals and groups within an
organization. An input (cause) can be processed by an individual mental and psychological
process to produce a particular output (outcome).
a) Components: A system consists of more than one part called component elements of a
system. A component refers to anything that is part of a system or sub-system. The term
element implies the smaller components that one would wish to identify separately.
Organization of a system is the specification of relations between its elements.
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b) Connection: These components of a system are connected together.
c) Structure: The form of this connection is fixed in an organized way called structure. The
concepts of structure and organization become more interesting in large systems, where more
than just one or two possible structures or organizations may be considered.
d) Interaction: The components affect each other by their presence in or removal from the
system which results from mutual interaction with the systems environment.
e) Process: the changes resulting from these interactions are called processes.
f) Holism and emergent properties: A system is a whole which exhibits properties which only
have meaning in terms of the interactive processes of its components.
g) Identity: The properties of a system that enable it to be identified and separated from other
things which are not part of the system.
h) Environment: There are things which are not part of the system, which significantly affect
it, but which the system can only marginally influence, called the environment of the system.
i) Conceptualization: a system is a concept whose particular form reflects the aims and values
of the individual or group whose concept it is (Harry, 1990).
Like living systems, most organizations if not all, operate in constant interchange with their
environment. They have many complex interactions and interrelationships within their
boundaries. To survive, organizations must grow and achieve a dynamic equilibrium rather
than simply return to a steady state. It is for these reasons that general systems theory has come
to be applied to the study of organizational phenomena such as design of management planning
and control systems.
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4)CONTINGENCY APPROACH THEORY
Definition
Also sometimes called the situational approach.
The contingency approach to management is based on the idea that there is no single best
way to manage. Contingency refers to the immediate contingent circumstances. Effective
organizations must tailor their planning, organizing, leading, and controlling to their particular
circumstances. In other words, managers should identify the conditions of a task, the
requirements of the management job, and people involved as parts of a complete management
situation. The leaders must then work to integrate all these facets into a solution that is most
appropriate for a specific circumstance.
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5) INTEGRATED DELIVERY SYSTEM (IDS)
Definitions
An organized, coordinated and collaborative network that: (1) links various health care
providers, via common ownership or contract, across three domains of integration – economic,
noneconomic, and clinical – to provide a coordinated, vertical continuum of services to a
particular patient population or community and is accountable both clinically and fiscally for
the clinical outcomes and health status of the population or community served, and has systems
in place to manage and improve them.
Types of integration
Horizontal and Vertical Integration There are two main types of integration used in
integrated delivery systems (IDS) – horizontal and vertical.
Horizontal integration
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● manage global capitation form large patient and provider pools to diversify risk o
reduce cost of payer contracting
• Access goals offer a seamless continuum of care and respond to state legislation
• Quality goals
• Kaiser Permanente operates in nine states, including Washington, DC, and has almost
9 million members, 14,000 doctors and 160,000 employees.
• The system owns and operates more than 420 freestanding ambulatory care facilities
and 30 medical centers (hospitals and ambulatory).
• The medical centers offer one-stop shopping for most services including hospital,
outpatient offices, pharmacy, radiology, laboratory, surgery and other procedures, and health
education centers. This set-up encourages patient compliance and enhances opportunities for
physicians at the primary care level to communicate and consult with specialists, hospital
personnel, pharmacists, etc
• Model 1 is an IDS or multispecialty group practice (MSGP) with a health plan, which is both
provider and payer. This model involves physicians in strategic planning. Its advantages
include enhanced collection and integration of data, utilization review and cost-control
capacity. Duplication of services is greatly minimized.
o Kaiser Permanente follows this model by serving only members in its health plan. o
Geisinger Health System also follows this model, but serves patients outside of its health plan.
• Model 2 is an IDS or MSGP single-entity delivery system that does not own a health plan.
o The Mayo Clinic is the world’s oldest and largest integrated MSGP.
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o HealthCare Partners Medical Group is a nonprofit organized delivery system in greater
Boston and eastern Massachusetts.
• Model 3 involves private networks of independent providers that share and coordinate
services. Similar to the first two models, these networks include infrastructure services (e.g.,
performance improvement and care management).
Other integration structures under Model 3 include the following:
● physician-hospital organizations
● management service organizations
● group practices without walls
● individual practice associations
● California "delegated model" health maintenance organizations
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Domain 3: Financial Integration:
• The system is well-prepared for assuming risk-based payment and has conducted considerable
analysis of the implications.
• The system has a very good ability to manage contractual relationships with payers with
sufficient staff/resources and compatible information systems.
• Transitions and handoffs between settings are effectively managed and need little
improvement.
• Strong collaboration exists between the hospital system and social services.
• The system has almost fully integrated behavioral health programs into primary care.
• The EHR system can track all patient encounters and combine all data to system wide level
for evaluation and benchmarking.
• EHRs can track health outcomes of patients with specific conditions within all physicians’
panels.
• The system provides almost full or full, 24/7 access to care via phone, email or in-person
visits.
• The system has trained all or nearly all staff in cultural competency skills.
He wrote and published the result of his studies in 1911 on the PRINCIPLES OF
SCIENTIFIC MANAGEMENT.
Creates systems to gain maximum efficiency from workers and machines in the factory.
Focuses on time and motion studies to learn how to complete a task in the least amount of time.
The time studies performed by Taylor, which were later classified as time and motion
studies, were characterized by timing a worker’s series of motions and determining the optimal
way in which to perform their particular job. The goals of the study are as relevant today as
they were back then - to increase the efficiency of a business process.
Time and motion studies have been successful in various implementations enabling
companies to move forward in providing logical frameworks for improving and leaning their
operations.
“One best Way” Taylor's scientific management consisted of four principles:
1. Replace rule-of-thumb work methods with methods based on a scientific study of the tasks.
2. Scientifically select, train, and develop each employee rather than passively leaving them
to train themselves.
3. Provide "Detailed instruction and supervision of each worker in the performance of that
worker's discrete task" (Montgomery 1997: 250).
4. Divide work nearly equally between managers and workers, so that the managers apply
scientific management principles to planning the work and the workers actually perform the
tasks.
⮚ Structure
⮚ Process
Structure
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staff in organization find that the organization structure what does the organization look
like and the process how things are done become important
for example if staff nurse does not understand to whom he or she reports this can be a
problem( structure ) or if nurse does not understand the communication process for reporting
another process this can lead to problems.Structure an organizational chart is the best placed to
find out about an organization structure.
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oriented process eliminates functional departments and spreads functional specialist
throughout the key process teams.
For example, in line staff nurse would report to the nurse manager the nurse manager
to the director of the service the director of the service to the nurse executive the executive to
the chief executive officer
Staff authority-staff who functions in an advisory capacity and cannot force other stuff to do
something but must use influence to make an impact. This can be a difficult question but it has
become more common. Staff authority is less clear because this relationship is advisory
Key skills for success in this type of position are effective communication, negotiation
and building collaborative relationship
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service or product department such as women's health.
Dual authority is a part of this type of structure as staff report to to managerial system.it
facilitates efficient use of resources and allows for more flexibility during times of change with
more timely response and interchange of information vertically and horizontally and it
encourages greater interdisciplinary interaction and innovation and improve motivation and
commitment as staff have no responsibility for decision making and eat freeze managers for
greater opportunity to enhance planning.
PROCESS
Organizational process the second critical descriptor of an organization. focuses on how
the organization operates?
Organization’s vision, mission statement and goals and objectives should be included
in a review of an organization’s process
A vision is important in describing the organizations belief and values in organizational
philosophy answer the question of ‘’why’’ for an organization.
Goals and Objectives identify how the organization plans to meet its Vision and mission
Delegation - Decisions should be made close to the task or activity as possible which has made
delegation even more important in today's healthcare organization.it is important to remember
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that delegation does not relinquish the person who is delegating from the responsibility over
the task.
Evaluation - Evaluation of the organization’s performance and that of the individual staff
performance assist organization intimating its needs in the planning process so that goals and
objectives can be met. All processes are evaluated in some form whether it be a formal
revelation of staff concluding that some action was successful on an informal basis an informal
basis
It also means graded organization of several successive steps in which each of lower level
is immediately subordinate to the next higher one and show right up to the top hence authority
command and control design from top to bottom.
The person has to go from up to down or down to up without skipping the intermediate
level through proper channel
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It was also illustrated as Fayaz gave the concept of gang plank, it shows that if F wants to
communicate with K Usually the message will flow from F to A via E ,D, C ,B and from A it
will come down to K through G H I J, but if it is essential to communicate immediately a
gangplank ( dotted line ) may be created between F and K without weakening the chain
There are many types of organizational structures. There’s the more traditional
functional structure, the divisional structure, the matrix structure and the flatarchy structure.
Each organizational structure comes with different advantages and disadvantages and may only
work for companies or organizations in certain situations or at certain points in their life cycles.
An advantage of this structure is employees are grouped by skill set and function,
allowing them to focus their collective energies on executing their roles as a department.
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individual departments. For example, one department working with another on a project may
have different expectations or details for its specific job, which could lead to issues down the
road.
In addition, with groups paired by job function, there’s the possibility employees can
develop “tunnel vision” — seeing the company solely through the lens of the employee’s job
function.
for example, a cardiology service line at an acute care Hospital might include all
professional technical and support personnel providing services to the cardiac patient
population
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the limitations of this model can include increase expense associated with the location
of service , loss of professional or technical affiliation and lack of standardization.
Matrix structures
Matrix structures are complex and design to reflect both function and service in an
integrated organizational structure. in matrix organization the manager of a unit responsible for
service reports to both the functional manager and service or product line manager
for example, a director of pediatric nursing could report to both our vice president off
periodic services service line manager and vice President of nursing the functional manager.
Geometric structure combines both about bureaucratic section under flag structure teams are
used to carry out specific program for projects
Matrix structure superimposes horizontal program management over the traditional vertical
hierarchy, this creates an interdisciplinary team.
Service line manager and product manager must function collaboratively in a matrix
organization. for example, in asking that may be a chief nursing executive and ask manager
and staff nurses in the line of authority to accomplish nursing care
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Flat structure
the primary organizational characteristics of a flat sector is the delegation of decision
making to the professionals doing the work. The term flat signifies the removal of hierarchical
layers thereby granting authority to act and placing authorities act at the action level.
Shared governance
In its simplest form, shared governance is shared decision-making based on the
principles of partnership, equity, accountability, and ownership at the point of service. This
management process model empowers all members of the healthcare workforce to have a voice
in decision-making, thus encouraging diverse and creative input that will help advance the
business and healthcare missions of the organization.
This feeling leads to
• longevity of employment
• increased employee satisfaction
• better safety and healthcare
• greater patient satisfaction
• shorter lengths of stay
Characteristics of shared governance-
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Four principles of shared governance
• Partnership——links healthcare providers and patients along all points in the system; a
collaborative relationship among all stakeholders and nursing required for professional
empowerment. Partnership is essential to building relationships, involves all staff members
in decisions and processes, implies that each member has a key role in fulfilling the mission
and purpose of the organization, and is critical to the healthcare system’s effectiveness
(Porter-O’Grady and Hinshaw 2005; Batson 2004).
• Equity——the best method for integrating staff roles and relationships into structures
and processes to achieve positive patient outcomes. Equity maintains a focus on services,
patients, and staff; is the foundation and measure of value; and says that no one role is more
important than any other. Although equity does not equal equality in terms of scope of
practice, knowledge, authority, or responsibility, it does mean that each team member is
essential to providing safe and effective care (Porter-O’Grady and Hinshaw 2005; Batson
2004; Porter-O’Grady, Hawkins, and Parker 1997).
The nursing administrator receive orders from Medical personnel in charge of their
Hospital.
The supervisor receives from nursing administrator and also their receive
instructions related to patient care from Medical personnel of their respective
departments.
The operation level nurses report and receive orders from nursing administrator as
well as from nursing supervisor and medical personnel regarding patient care.
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How does the organization handle decision making? this can be highly variable from
one organization to another and even within an organization. Each organizational leader has
greater skill in this area than other leaders. All organization’s need improvement in decision
making.
Do staff feel that decision are handled well is there staff input?
Is shared governance used and how effective is it?
What is the response of accountability? How empowered are the staffs?
5) Span of control
The span of management and of control of span of supervision or used to denote the
same concert that the number of subordinates and officer or superior can effectively supervise.
It is span of attention applied to the work of supervision
It can be direct single relationship( contacts of Suprior with subordinates) , direct group
relationship(between supervisor and subordinates in all possible combinations) , gross
relationship ( mutual interaction of subordinates working under common supervisor)
Factors affecting span of control
capacity of supervisor
characteristics of subordinates
natural work
number of assistants
degree of decentralization
The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing
Council, 1985)
The norms are based on Hospital Beds.
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individual or breaking down the total work into simpler and repetitive tasks.the groups and
individual should be allowed to specialise in their specific field so that one can become more
efficient and confident in their work.
For managerial functions in nursing management
7) Authority
Authority defined as the power to make decisions which guide the action of another.it
is a relationship between two individual one superior and another subordinate. The superior
frame and transmits the decision with the expectation that this will be accepted by the
subordinates.
The subordinate executes the function and his or her contact is determined by them.
Features of authority
Types of authority- Formal authority - this type of authority is held by the administrator due to
his or her question in the organization and that is achieved by delegation from higher position
Informal authority type of authority is either due to accidents by the subordinates maybe for
his or her personal quality are due to technical competence or leadership qualities of a person
8) Delegation of authority
It is one of the most important factors in the process of organizing as well as in formal
organization. It refers to the authorization of a person to make certain decision
Delegation refers to a manager's ability to share his board and with others. it consists
in granting authority for right to decision making in certain defined areas and charging
subordinates with responsibility of carrying through in the assigned task.
Grand of authority
Creation of accountability
9) Responsibility
Responsibility is the duty to which a person is bound by reason office status for task.
It is an obligation of an individual to carry out assigned activities to the best of his ability.
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It refers to execution of duties associated with a particular role.
Delegation of responsibility in nursing services
responsibilities in hospital nursing services are categorised into two broad headings
administrative and supervisory
1. She/he will be responsible for efficient running of Nursing Services of the Main
hospital and various centres of AIIMS.
2. She will assist the Director in formulating broad policies concerning Nursing
Services.
3. She will disseminate the AIM, objectives and policies regarding patient care to
all cadres of nursing services.
5. She/he will plan future requirements of nurses and carry out recruitment of
nurses from time to time.
6. She/he will plan and disseminate programmes for continuing education re-
orientation programmes for nurses.
10. She/he will keep herself abreast of latest happenings in nursing care by
attending National / International conferences.
11. She will strive to implement standard nursing practices and maintain highest
quality of care.
12. She will critically analyse the budgets for nursing services from Main hospital
and various centers before being forwarded to Director.
13. Evaluate confidential reports of higher level nursing officers and recommend
for promotion.
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14. She will be assisted in her duties by nursing Supdt.’s, of Main Hospital and from
the centres.
15. She will keep the Director informed about the happening concerning the
hospital.
5. She will officiate as CNO in the absence of CNO (The senior most amongst the
NS will do so).
6. She will recommend personnel and material requirement for nursing various
nursing service departments of the hospital.
7. She will assist MS/Addl. MS or Chief of Centres in recruiting nursing staff.
8. She will carry out regular rounds of the hospital.
9. She will accompany MS/Addl. MS while making hospital rounds.
10. She will ensure safe and efficient care rendered to patients in various wards etc.
11. She will prepare budgets for nursing services.
12. She will be a member of various condemnation boards for linen and other
hospital stores.
13. She will be responsible for counselling and guidance of sub-ordinate staff.
14. She will attend hospital/intra hospital meetings and conferences.
15. She will investigate all complaints regarding nursing care and personnel, and
take suitable corrective action.
16. She will initiate and encourage research in nursing services.
17. She will evaluate confidential reports of her sub-ordinate staff and recommend
for promotion, higher studies etc.
18. She will maintain cordial relations with patients and Medical Social workers.
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19. She will periodically interact with clinical heads to discuss problems in patient
care.
20. She will educate nursing staff of all categories by conducting awareness
programme on universal Precautions.
1. Supervise the nursing care given to the patients in various departments by taking
regular round of her area.
2. Act as a liasion officer between Nursing Supdt. and the nursing staff of the
hospital.
3. Interpret the policies and procedures of the Nursing service department to sub-
oradinate staff and others.
4. Attend the emergency calls concerning nursing services or hostel problems.
13. Assist the nursing supdt. on planning and organising nursing services in the
hospital.
14. Officiate in the absence of nursing supdt.
15. Attend the official meetings.
16. Keep the senior nursing Officials (CNO & NS) informed of the happenings in
the wards.
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ASSISTANT NURSING SUPERINTENDENT
Asstt. Nursing Supdt, is responsible to Deputy Nursing Supdt. for the total nursing care
of patients, management and development of the unit assigned to her: -
A. NURSING CARE:-
1. Assist the total needs of patients in the unit and prepare planned nursing care.
2. Demonstrate and Supervise the nursing care of patients in the unit.
3. Attend regular round in the unit with the medical and nursing personnel.
4. Reviewing reports from Sr. Gr. I regarding the nursing care of patients in each
shifts.
5. Give counseling and health education to the patients and their attendants.
B. WARD MANAGEMENT:-
1. Plan and arrange duty for nursing personnel posted under her.
2. To ensure availability of adequate nursing staff in all shifts.
3. Maintain cleanliness of unit its annexes and environment.
4. Interact with the engineering service department for proper up keep of the unit.
5. Keeping Deputy Nursing Supdt., Nursing Supdt. informed of the needs of the
patient care areas and bring it to their notice any special problems.
6. Guide the Sister Grade-I to ensure supplies and equipment of different stores,
and re-checking their use and care.
7. Daily check of emergency and dangerous drugs, life saving equipment i.e.
monitors, ventilators, defibrillators, suction machines and O2 points etc., to ensure their proper
functioning.
8. Periodical check of all stocks and supplies.
10. Maintain good public relation with patients relatives and the public, and project
positive image of the hospital.
11. Maintain disciple of nursing and domestic staff.
12. Interpretation of Hospital policies, rules and regulations.
13. Daily check of attendance and reporting the lapses.
14. Investigate complaints if any.
15. Work evaluation and confidential reports.
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16. Guidance and counselling of nursing staff in the unit.
17. Project the annual requirements of drugs supplies and equipment’s for the units.
18. Take care of legal aspects and report about the medico legal cases in the ward.
C. TEACHING AND SUPERVISION:
1. Plan and implement a proper orientation programme for new nursing staff,
student nurse and domestic staff.
3. Give incidental and planned teaching to nursing personnel in the unit, as well
as domestic staff.
3. Demonstrate and carry out efficient nursing care, taking care of personal
comfort and toilet of patients, administration of drugs and treatment, observation and recording
of vital parameters.
4. Supervise patients diet.
5. Attending rounds with Medical/Nursing personnel.
6. Assist Medical staff in examination of patients and treatment.
7. Participate and help with clinical investigations/procedures.
8. Demonstrate and carry out preoperative and post-operative care of patients.
9. Maintenance of patient’s records.
10. Care of patient’s personal effects in accordance with hospital rules.
11. Giving and receiving reports.
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12. Follow prescribed rules in case of accident or death of a patient.
13. Give information and health education to patients and their attendants.
3. Co-ordinate and facilitate work of other staff, e.g. physical therapist, social
worker, dietitian, voluntary worker etc.
4. Maintaining good inter personal relationship among all categories of staff and
with patients and their relatives.
5. Maintain cleanliness of ward, its annexes and environments. Proper upkeep and
repairs of linen and ward equipment.
6. Make indents for drugs, surgical supplies, stores and issue.
7. Keep custody of dangerous drugs and record of their administration.
8. Daily check of emergency drugs and life savings equipment’s.
9. Maintenance of stock registers, inventories.
10. Investigate complaints if any.
4. To assist the patient in elimination, offering and removing the bed pans and
Urinals.
5. Bed making.
6. Assist in feeding the weak and debilitated patients.
7. Writing of diet sheet, Supervision and distribution of diets.
8. Assist in physiotherapy, ambulation and rehabilitation.
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9. Carry-out patient’s teaching and demonstration according to the need.
10. Counselling the patients, and relatives.
11. Care of the dying and dead.
12. Administration of Medicines and Injections to the patients.
13. Assist in administration of intravenous injections, infusion and Transfusion.
14. Observing, recording and reporting of vital signs e.g. T.P.R. and Blood
pressure.
15. Carry out technical procedures, such as Naso-gastric intubation, Gastric Gavage
and Lavage, Oxygen Therapy, Dressing and Irrigation, Enema, Catheterization hot and cold
applications, suction etc.
16. Collecting, labelling and dispatch of specimens.
17. Preparation for and assistance in clinical tests and medical/surgical procedures.
18. Urine testing for sugar, and albumin.
19. Observation, recording and reporting of all procedures and tests.
20. Escorting serious patients to and from the department/wards for investigations.
B. WARD MANAGEMENT:
1. Handing over and taking over charge of patients, and ward inventory in each
shift.
2. Maintenance of therapeutic environment in the ward.
3. Keeping the ward clean and tidy.
4. Routine care and cleaning of dressing trolleys, cupboards apparatus, mackintosh
etc.
5. Care of clean and soiled linen.
6. Disinfection of linen, beds, floor and bed pans, and fumigation of rooms etc.
7. Preparation of room, trolleys, and sets for procedures.
8. Preparation of surgical supplies.
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13. Participation in professional activities.
14. Demonstration and supervision of domestic staff.
15. Report about the medico-legal cases if any admitted in the ward. To keep the
senior nursing officials informed of the happenings / in the ward like fire, absconding patients,
theft etc.
16. Any other duty that may be assigned by sister grade-I from time to time.
10) accountability
Accountability is a liability of of reckoning of responsibilities received by delegation
of authority
Features of accountability
For material accountability of the use of Lenin drugs and loss or breakage of
equipments in hospital is wasted on supervisors and operational level nurses and about
39-100 % of nursing supervisors affirmed of this accountability
for nursing care in most of the hospitals on nursing sisters and operational level nurses
aur accountable for rendering patient care
Accountability Responsibility
11) Centralization
In management centralization refers to concentration of authority for consolidating
decision making in one coordinating head . This term is used to do various connotations. It is
to be a process where the concentration of decision making is in few hands.
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Advantages
Limitation of centralization
It is a systematic effort to delegate to the lowest level of authority except that which
can be control and exercise at Central points.it is concerned with the placement of authority
with reference to responsibility
Implications of decentralization
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5) Planning process—
Skills for planning are needed, and planning should address a time frame, responsibility
for conducting the activities, the availability and use of human resources, management of
workflow, and financial resources.
6) Implementation—
8) Communication pattern
Communication runs an organisation.
If goals of a subsystem or not in alignment with overall organizational goals , there will be
conflict and it will be difficult to determine organizations outcome. All the subsystem must
convince the overall organization that this change is appropriate.
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In analyzing an organization ,in quality improvement of what need to be assessed.When
and organizations quality and safety assessed , we can be learn about the organizations vision,
mission, goals and objectives, structure and process communication, decision making
,utilization of resources and what is really important to the organization.
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16) Effective leadership
Effective leadership is critical to the success of any organization. Master of organization
or analyst it's leader should be identified and assessed. What is the leadership style? Does the
leadership provide what is needed to help the organization succeed?
CONCLUSION
The Nursing Services Delivery through above organization gives a relational structure
for reconciling disparate streams of research related to nursing work, staffing, and work
environments. The organization theory can guide future research and the management of
nursing services in large-scale healthcare organizations.
Bibliography-
❖ Davar. R.S. Personal management and industrial relations, Vikas publishing home,
New Delhi 2007.
❖ Fisher,M.(1996).redesigning the nursing organization.Albany,NY:Delmar
Publishers
❖ Grohar- Murray, M.,&dICroce,H.(2003).Leadership and mangement in nursing(3rd
edtion).Upper saddle River:Prentice Hall
❖ Patricia. S Yoder Wise, Leading and managing in nursing, Fifth edition, Elsevier
LLC WA publications ,2010
❖ TNAI, Nursing Administration and Management, TNAI, New Delhi, 2000 .
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