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Organizational Communication: Psychological Perspective
Organizational Communication: Psychological Perspective
Organizational Communication: Psychological Perspective
Definition
pivotal to the day-to-day operation of any organization, affecting patient safety and
quality care, employee satisfaction, and customer relations and satisfaction.
Communication theories
MECHANISM PERSPECTIVE
Sender encodes the message into units of spoken language that conveyed by sound
waves to the receiver.
Any feature not intended by the sender but inadvertently included in the message is
called noise.
PSYCHOLOGICAL PERSPECTIVE
Builds from mechanical perspective, acknowledging the sender and receiver, and the
message, but based in large part on learned behavior.
This process of give and take, in which (1) a message is sent, (2) it stimulates the
receiver to respond, (3) a response is sent, which then (4) stimulates the receiver to
respond, is a learned behavior.
INTERACTIONIST PERSPECTIVE
Types of Communication
Vertical Communication
If not met, the employees often feel that their input and questions are not welcomed and
complain that they do not receive satisfactory responses, which may have a negative
impact on employee satisfaction and productivity.
Horizontal Communication
Horizontal communication occurs when managers and others communicate with people
on the same level in the organizational structure. Staff nurses communicate with other
staff nurses, or nurse managers communicate with other managers.
Diagonal Communication
Informal communication can occur in chance encounters within the organization but
may be useful in accomplishing goals. The nurse executive may use informal
communication to clarify a formal communication, to provide or seek additional
information on an issue, or as a vehicle for negotiation and persuasion.
Grapevine
The grapevine is the informal and unsanctioned information network within every
organization. Word is spread from one person to another outside the formal
communication network. The grapevine is the spread of information without regard for
the traditional networks of communication.
Clinical information systems allow nurses to chart at the bedside, eliminating duplicate
documentation. Wireless technology allows nurses, for example, to access patient
records, answer call lights from remote locations, and access databases for clinical
practice
Note that immediate access to health information and data regarding patients’
diagnoses, allergies, medications, laboratory test results, etc., is useful in timely
decision making. Results management speaks to the ability of providers of care in
multiple settings to have quick access to new and past data, such as laboratory test
results, thereby increasing patient safety and quality of care.
Business Writing and reporting Skills
Memo Writing
Part 1: HEADER
TO: provide the names and titles of everyone who will receive your memo
FROM: provide your complete name and title
DATE: provide the complete and accurate date – don’t forget to include the year
SUBJECT: provide a brief, yet specific description of what the memo is about
Part 2: MESSAGE
Introduction – explain the purpose
Body – addresses the information required
Conclusion – (Summary and possible recommendations)
Minutes of the meeting
Definition
Meeting minutes are notes that are recorded during a meeting. They highlight the key
issues that are discussed, motions proposed or voted on, and activities to be
undertaken. The minutes of a meeting are usually taken by a designated member of the
group. Their task is to provide an accurate record of what transpired during the meeting.
Takes place when two or more people share information about the client care
either face-to-face or by telephone.
Records Management
Sentinel Events
Sentinel events are patient safety events (not primarily related to the natural course of
the patient’s illness or underlying condition) that reach a patient and result in any of the
following:
Death
Permanent harm
Severe temporary harm (critical, potentially life-threatening harm lasting for a
limited time with no permanent residual, but requires transfer to a higher level of
care/monitoring for a prolonged period of time, transfer to a higher level of care
for a life-threatening condition, or additional major surgery, procedure, or
treatment to resolve the condition.
Suicide of any patient receiving care, treatment, and services in a staffed around-
the-clock care setting or within 72 hours of discharge, including from the
hospital’s emergency department
Unanticipated death of a full-term infant
Discharge of an infant to the wrong family
Abduction of any patient receiving care, treatment, and services
Any elopement (that is, unauthorized departure) of a patient from a staffed
around-the-clock care setting.
Invasive procedure, including surgery, on the wrong patient, at the wrong site, or
that is the wrong (unintended) procedure
Unintended retention of a foreign object in a patient after an invasive procedure,
including surgery
Fire, flame, or unanticipated smoke, heat, or flashes occurring during an episode
of patient care.
Anecdotal Report
An anecdotal record is an observation that is written like a short story. They are
descriptions of incidents or events that are important to the person observing. Anecdotal
records are short, objective and as accurate as possible.
It has some significant item of conduct, a record of an episode in the life of students, a
word picture of the student in action, a word snapshot at the moment of the incident,
any narration of events in which may be significant about his personality
The incident doesn’t have to have caused harm to a patient, employee, or visitor,
but it’s classified as an “incident” because it threatens patient safety.
Kardex
The Kardex is used as a reference throughout the shift and during change-of-
shift reports.
201 File
A file containing the employees personal records which are submitted to the
organization for profiling.
Rowland (2004) defined staffing as the "process of determining and providing the
acceptable number and mix of nursing personnel to produce a desired level of care to
meet the patient's demand for care."
Safety of the patient shall be the fundamental principle to guide staffing. It is also mostly
relevant in the compliance of minimum requirements for the hospital licensure to ensure
quality and safe delivery of care to patients.
Importance of Staffing
Recruits’ competent personnel for various clinical areas based on patient's needs.
Allocates job tasks properly among the nursing personnel according to their
qualifications, and specializations.
Provides the numbers and mix of nursing staff needed per nursing unit.
Ensures adequate and equitable manpower for efficient and effective delivery of
nursing care.
Optimizes the utilization of nursing human resource at the least manpower cost but
high on quality nursing care.
Retains, develops, and places the right nursing staff in the right job positions.
The principles of staffing are adapted from the American Nurses Association as cited by
Yoder-Wise (2011).
Appropriate staffing levels for a patient care unit must reflect analysis of individual
and aggregate patient needs.
There is a critical need to either retire or seriously question the usefulness of the
concept of nursing hours per patient day.
Unit functions necessary to support delivery of quality patient care must also be
considered in determining staffing levels.
2. Staff Related
3. Institution/Organization Related
Organizational policy should reflect an organizational climate that values
registered nurses and other employees are strategic assets and exhibit a true
commitment to filling budgeted positions in a timely manner.
All institutions should have documented competencies for nursing staff including
agency or supplemental traveling registered nurse for those activities that they
have been authorized to perform.
Organizational policies should recognize the myriad needs of both patient and
nursing staff.
There are factors affecting staffing that should be considered in determining the number
and mix of nursing personnel. These are as follows but not limited to:
1. Patient factors
census fluctuations
patient acuity
level of care /degree of dependence
patient age group
special treatment and procedure
communicability
rehabilitation needs
patient and family care demands/expectations
2. Staff factors
type of hospital
services offered/population served
work time policy
administrative policy on weekend and holiday duty
presence of support services
nursing unit architectural design
availability of resources like equipment. materials and supplies
technology anticipated
projected units of services
budget limitations
patient then can be assigned to an acuity or complexity category that will indicate how
many actual hours of nursing care the patient needs during a particular shift.
The Nursing Care Hours Per Patient Day (NCHPPD) is defined as a standard
measure that quantifies the nursing time available to each patient by available staff. It
simply means the amount of time nurses spend with each patient per day. It is
calculated by dividing the total number of productive hours worked by nurses with direct
patient care responsibilities with the total cencus or number of patients in a day or
month.
40 patients
= 96 worked hours
40 patients
= 2.4 NCHPPD
The various nursing units may develop their own ways of classifying patient care
according to the acuity of their patient’s illness. The figures below are example of
patient care classification with nursing care hours/patients/day and ratio of professionals
(clinical nurses) and-professionals (assistive nursing personnel).
Classification of patient care by units, nursing care hours/patients/pay and ratio to RN
and non-professional staff needed.
Level 1 self-care or
1.5 55:45
minimal care
Level 2 moderate or
3.0 60:40
Intermediate Care
the duration of his work-up. Example, the average amount of nursing care hours per
patient per day is 1.50 while the ratio of professional to non-profession.al nursing
Level II- Moderate Care or Intermediate Care. Under this category. the patient can feed,
bathe. toilet and dress himself without help, but requires some assistance from the
nursing staff for special treatments or certain aspects of personal care i.e. A partial care
patient might require wound debridement or dressing, catheterization, colostomy
irrigation, intravenous fluid therapy, intramuscular or subcutaneous
injection or chest physiotherapy. Example, the average nursing care hours per patient
per day is 3.0 and the ratio of professional to non - professional personnel is 60:40.
Level III - Total, Complete or Intensive Care. Under this category, a bedridden patient
who lacks the strength or mobility, needs nursing assistance or all of the patient's daily
activities, such as feeding bathing. dressing, moving, positioning, eliminating, comfort
seeking, and injury avoidance. Example, the average nursing care per hours per per
patient is 6.0 with a professional to non-professional ratio 65:35.
Level IV - Highly Specialized Critical Care. Under this category, an acute or critically ill
patient who is in constant danger of death or serious injury would require critical care.
Measurements. Frequently, there are also significant changes in doctor's orders that
need to carry out. Example, the average nursing care hours per patient per day 1s 7.0
or more, and the ratio of professional to non-professional ranges from 70:30 to 80:20.
Moreover, the percentage of nursing hours to be given by professional nurses and by
non-professional nursing personnel may depend on the patient's condition in the
hospital setting in which the care is being given. The table below is an example of
patient classification according to type of hospital.
Level of Care
Primary 70 25 5 -
Secondary 65 30 5 -
Tertiary 30 45 15 10
Special 10 25 25 20
Tertiary
The table shows that for primary (Level 1) hospitals. it is assumed that about 70 percent
of their patients need minimal care 25 percent needs moderate care. Patients needing
intensive care are given emergency treatment and when their condition becomes stable
or when immediate treatment is necessary and the hospital has no facilities for this, the
patient is transferred to a secondary (Level 2) or tertiary (Level 3) hospital.
ln (level 2) hospitals, it is assumed that 65 percent or the patients need minimal care, 30
percent needs moderate care, and 5 percent needs intensive care.
In (Level 3) hospitals, 30 percent of the patients need minimal care, 45 percent needs
moderate care, 15 percent needs intensive care and 10 percent needs highly
specialized care. For special tertiary hospital it is assumed that 10 percent of the
patients need minimal care, 25 percent needs moderate care, intensive care and 45
percent needs highly specialized care, and 20 percent highly specialized care.
Staffing Methods
Basically, there are three metho ds of staffing to determine the number of personnel
needed. These are:
Ratio-Based Staffing reflects the number of nurses assigned to care for a certain
number of patients as a state-mandated regulatory requirement for a nurse-to-
patient assignment. The figures below are the Department of Health-mandated
nursing staffing ratios for government hospitals (Revised Organizational
Structure and Staffing Standards for Government Hospitals, CY 2013 Edition)
Total number of working days, non-working days and working hours of nursing
personnel per year.
1. Days of vacation 15 15
3. Legal holidays 10 10
4. Special holidays 2 2
Staffing formula
Hereunder are the formula and steps to illustrate on how to calculate the number of staff
needed in the in-patient areas of the hospital. Example used is a staffing requirement
for a 300-bed capacity tertiary hospital.
2. Find the total number of nursing care hours needed bu the patients at each
category level.
Find the number of patients at each level by the average number of nursing
hours needed per day.
Get the sum of the nursing care hours needed at the various level.
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.
4. Find the actual number of working hours rendered by each nursing personnel per
year. multiple the number of hours on duty per day by the actual working days
per year.
7. Distribute by shifts.
Professional
Non-professional
Morning 80 X .45 = 36
Afternoon 80 X .37 = 30
Night 80 X .18 = 14
Supplemental guidelines for staffing standards pattern per hospital category can be
found in the "Revised Organizational Structure and Staffing Standards for Government
Hospitals, CY 2013 Edition.
Shift Options
It is important for Nursing Administrators and staff nurses to be aware of the various
options 1n work schedules. as well as the advantages and disadvantages of each. The
staff nurse will then be able to select the scheduling pattern best suited to meet the
nurse's need. The Nurse Administrators will be able to select the scheduling patten
best suited to meet the staffing needs of their floor or unit (See Appendix H. DOH
memorandum Circular No. 2016-0032)
Eight-Hour Shifts. Planning staffing for employees on the eight-hour shift includes
arranging for staffing for three-shifts (3) days, evenings and nights. The day shift begins
at 7 am and ends at 3:30 pm, the evening shift begins at 3 pm and ends at 11:30 pm,
and the night shift begins at 11 pm and ends at 7:30 am. Full time employees on the 8-
hour shifts work five (5) days a week for a total of 40 hours per week. Staff may work
permanent days, evening, or nights, or they may rotate to different shifts.
The traditional work day is 8 hours. Therefore, the staff does not have to adjust to
an extended workday.
Staff may have the option of selecting from three (3) shifts.
Table. Personnel Staffing Schedule: Eight-Hour Shift
No.
NAME SMTWTFS SMTWTFS SMTWTFS SMTWTFS
A-1 X X X X X X X X
B-1 X X X X X X X X
NOTE: For hospitals following the regulation of the DOLE, they are advised to
consider DOLE D.O. # 182 Section 4 "Hours of Work" for item Letter A
Section 4. Hours of Work - The normal hours of work of health personnel shall
not exceed eight (8) hours a day. (Refer to MC No. 3, s. 2016, Office of the Pres. Phil.)
Health personnel in cities and municipalities with a population of at least one million
(1,000,000.00) or in hospitals and clinics with a bed capacity of at least one hundred
(100) shall hold regular work hours for eight (8) hours a day, for five (5) days a week,
exclusive of time for meals, except where the exigencies of the service require that such
personnel work for six (6) days or forty-eight (48) hours in which case, they shall be
entitled to an additional compensation of at least thirty percent (30 %) of their regular
wage for work on the sixth day.
Scheduling
Scheduling Systems
Centralized Staffing is a system wherein the power and authority for staffing decisions
occur centrally for the entire hospital, commonly the staffing and scheduling office of the
nursing service department. Usually under this system a person in the nursing
administration office plans the coverage for all nursing unit. A master staffing pattern is
developed for all the nursing units and staffing is based on pre-established standard.
Decentralized Staffing is a system wherein the power and authority for staffing
decisions are methodically dispersed to first-line nurse managers of each nursing unit.
Scheduling Approaches
Block Scheduling is an approach in which the work schedule for nursing units is
planned in block of weeks, regularly 1 to 4 weeks at a time. It has flexibility because the
next block of time need not necessarily follow the pattern of the preceding/following
week.
Cyclical Scheduling is an improvement of the block schedule in which it has a cyclical
repetitive work pattern of 4 weeks. It is known as "team rotation" because the nursing
team is scheduled as a unit. This method is used in the team nursing modality of care.
The Nursing Service Department must have developed staffing and scheduling policies
reviewed and updated periodically. These written policies aim to provide a fair and
consistent work schedule among nursing personnel. Once a person is work satisfied, it
has a positive impact on patient clinical outcomes and staff satisfaction and retention.
Staffing and scheduling policies should include the identified list of items that Marquis
and Huston (2009) identified. These are as follows but not limited to:
Name of person responsible for the staffing schedule and the authority of that
individual if it is other than the employee's immediate supervisor
Type and length of staffing cycle used
Rotation policies, if shirt rotation applies
Day of week schedule begins
Weekend off policy
Policy for change days off
Procedures for days off request
Procedure for vacation time request
Procedure for holiday time request
Emergency request policy
Procedure for resolving conflicts on request for days off, holiday or requested time
off
Time and location of scheduling posting
Tardiness policy
Absenteeism policy
Low census procedures
Rotating to other units policy
Policies and procedure on requesting transfer to other units
Mandatory overtime policy
Master rotation plan is an overall plan which shows rotation of all nursing personnel to
various clinical and specialty areas in a given year. however, in hospitals where there
are specialty areas, nurses with special trainings or certification can be assigned only in
areas related to their trainings for safety of the patients.
Master Staffing Pattern is the number, and types or categories of staff assigned to the
particular units and departments of a hospital or other health care facility. Staffing
patterns vary with the unit, department, and shift and with the patient acuity levels.
This helps the Chief Nurse to visualize the equitable distribution of nursing personnel
among the various units. It serves as a guide in planning vacation coverage, as a time
table for replacement of personnel, as a support for budgeting request, as an aid in
forecasting future needs. Daily and weekly time sheets and monthly summary reports of
nursing coverage are accompanying tools.
Assignment
The routines of the ward, such as the time when dressing are changed, the time doctors
do their rounds and examine patients: and many other factors, such as modalities of
care must also be considered.
Assignment Techniques
The Senior Nurse must make an assessment of the abilities and capabilities of each
member and delegate the work consistent with the needs of the patients based on the
patient care classification system and the workers. A standard form of patient
assignment should be accomplished by the senior nurse/charge nurse and posted in the
bulletin board provided.
Job Description
Job Description is a statement setting forth the duties and responsibilities of a specific
job and the characteristics of the individual needed to perform it successfully. Job
description is usually developed by conducting a job analysis that includes examining
the necessary knowledge and skills to perform delegated, work efficiently distributed,
talents fully used, and morale maintained .
A job description contains the basic job-related data, which are as follows but not
limited to:
Job title
Position classification
Salary gade
Job summary
Job duties and responsibilities
Reporting relationship
Nature of supervision
Equipment, machines and tools to be used
Working environment
Hazards and risks
Qualifications such as:
o Educational requirement
o Professional license, if applicable
o Training and technical skills necessary
o Work experience
o Philippine Qualification Framework (Republic Act No.10968, An Act
Institutionalizing the Philippines Qualifications Framework (POF).
Serves as a basis for recruitment, selection, and job placement of qualified individuals.
Determines and classifies departmental functions and relationships to facilitate in the
structuring of the nursing service organogram.
Prevents overlapping of duties and responsibilities that might led to work conflict and
unproductivity.
Used as a reference in the performance appraisal of nursing personnel.
Determines the staff training needs for their personal and professional growth and
development.
Utilized in making up the budget for salary requirement justification.