Application in Nursing Book

Faculty of Nursing Helwan University
Master of nursing administration 2022/2023
Application in Nursing
Manegment
Under supervision
Prof/ Lamiaa Esmail

Professor of Nursing Administration
Faculty of nursing
Helwan university
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The content:
NO Title Prepared by Page No

1 Planning ‫ محمد محمود‬- 3 - 81
Problem solving ‫ شيماء مرعي‬-
Decision making
Time management
2 Staffing ‫عبدهللا كامل‬ 82-98
3 Motivation ‫محمد محمود‬ 99-118
4 Performance Appraisal ‫سمر محمد‬ 119-140
5 Risk Management in ‫ هبه محمد‬- 141-163
Education and Hospital ‫ فاطمة عبد التواب‬-
6 Patient Safety ‫عبدالرحمن يحي‬ 164-183
7 Total Quality Management ‫ فاطمة عبد التواب‬- 184-206
Education and Hospital ‫ صفاء محمد‬-
‫ عبدهللا كامل‬-
8 Documentation in Nursing ‫عبد الرحمن يحي‬ 207-239
‫هبه محمد‬
9 Leadership ‫داليا جاسر‬ 240-254
Collected by Abdelrahman yahia
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(1)
Planning
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Goal
To Provide the Participants with Knowledge Skills and

Positive Attitude toward Concept of planning and Hierarchy
planning.
Objectives:
At the end of this lecture the participant will be able to:
1) Identify planning and Hierarchy planning.
2) State purposes of planning.
3) List advantages and disadvantages of planning
4) Discuss Characteristics of planning
5) Discuss types of planning.
6) Enumerate steps of planning process.
7) Enumerate Barriers of effective planning.
8) Describe How to over-come barriers of planning
9)Application of nursing planning
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Outlines:
⮲ Introduction.
⮲ Definitions of planning and Hierarchy planning
⮲ Purpose of planning
⮲ Advantages and disadvantages of planning
⮲ Characteristics of planning.
⮲ Types of Planning
⮲ Planning Process
⮲ Barriers of planning
⮲ How to over-come barriers of planning
⮲ Application of nursing planning.
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Introduction
Planning is based on the theory of “thinking before acting”. Planning
is the most basic and primary function of management. It is the pre-
decided outline of the activities to be conducted in the organization.
Planning is the process of deciding when, what, when where and how
to do a certain activity before starting to work. All other function of
management is useless if there is not proper planning system in an
Organization.
Definitions
Plan
It is a method for doing or making some-thing and consisting of a goal
and course of action.
Planning
● Is the process of thinking about the activities required to achieve
a desired goal It is the first and foremost activity to achieve desired
results. It involves the creation and maintenance of a plan.
● Planning is continuing process that take place at all level of
management. It involves the selection of organization objectives,
developing policies, procedures, budgets and strategies.
Planning hierarchy:
A planning hierarchy: represents the organizational levels and units in
organization for which you want to plan.
Planning hierarchy: provide a framework for your planning activities
in consistent planning and level-by-level planning.
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Purposes of Planning:
▪ Achieving goals and objectives.
▪ It helps in coping with crisis situations.
▪ It is cost effectiveness
▪ It helps a manager exercise more control in a situation, establish
goals "proactively"
▪ It orients people to action instead of reaction.
▪ It increases employee involvement and improves
communication
▪ It acts as a bridge between where we are and where we want to
be.
▪ It helps in saving resources, money and time.
Planning hierarchy
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Hierarchy of planning in management:

1- Vision
2-Mission
3-Philosophy
4-Goals
5-objectives
6-policies
7-procedures
8-Rules
9-Programs
10-Budgets
1- Vision
✔ Statement of future-oriented.
✔ Designed to identify the desired future of an organization.
✔ Should be brief, consisting of one or two phrases or sentences.
✔ Creativity and passion help create Mission/Vision.
2- Mission
✔ A brief statement identifying the reason an organization exists,
and addresses its position regarding ethics, principles, and
standards of practice.
✔ It is the highest priority in the hierarchy of planning.
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3- Philosophy
✔ Flows from the mission statement and defines the set of values
and beliefs about the nature of the work require to accomplish
and guide all actions of the organization, it is the basic
foundation that directs all further planning toward the mission.
Healthcare organization Philosophy.
4- Goals
✔ A goal is a desired future state that an organization tries to
achieve.
✔ A goal may be defined as the desired result toward which the
organization is working. Although goal should be measurable,
ambitious but realistic.
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5- Objectives
✔ Objectives are more specific and measurable than goals because
they identify how and when the goal is to be accomplished.
✔ Objectives provide direction for all managerial decisions and
actions.
6- Policies
✔ A plan of action agreed to by a group of people with the power
to carry it out and enforce it.
✔ Are instructions that direct organizations in their decision
making.
✔ Policy is a statement of expectations that sets boundaries for
action taking and decision making.
7- Procedures
✔ A procedure is a series of steps, taken together, to achieve a
desired result. It is a particular way of accomplishing something
as in a repetitive approach, process or cycle to accomplish an end
result.
✔ Procedures are often associated with or supported by other
documents like policies.
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8- Rules
✔ Rules are very specific statements that define an action or non-
action. Also, rules allow for no flexibility at all, they are final.
Generally included as part of policy and procedure statements,
rules describe situations that allow only one choice of action.
✔ All employees of the organization must compulsorily follow and
implement the rules. Not following rules can have severe
consequences.
✔ Rules are instructions that tell you what you are allowed to do
and what you are not allowed to do.
9- Programs:
It is a statement of activities essentials to accomplish a
single-use plan. It is a comprehensive plan consisting of a
complex set of goals, procedure, rules, resource flow. It is
an aggregate of several related action plans that are
designed to accomplish a mission.
10- Budgets:
It is a short-term financial plan which is presented in terms of
money .it is designed to allocate the resources of an organization.
It is the basis of measuring actual performance achieved with that
of standard and identifying the variance.
Characteristics of planning
Primacy: -
Planning is an important element in the administration that
usually precedes other elements or functions. Various other activities
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of Management, like, organization, direction, coordination,

motivation, and control are carried out, only after this function.
Continuity:
Planning is a continuous process because the planning of
activities goes on continuously right from the Inception of the idea
for the starting of the business to its accomplishment.
Planning is a continuous and ending activity of an administrator or
manager to keep the enterprise as a going concern.
Flexibility:
Flexibility is to be in grained in planning for adapting the course
of action to demands of current situation.
Unity:
Planning is made by different administrators or managers at
different time so, unity is one of the most essential requirements.
"Unity has meant execution of only one plan at a time".
Precision:
Planning must be precise as its meaning, scope and nature. As
guides for action, planning is to be framed in intelligible and
meaningful terms by way of pinpointing the expected results.
Pervasiveness:
Planning is a pervasive activity. It is required for management
(organization, direction, coordination ,motivation, and control)
activities, at all levels of Management and in all departments
(production, finance, marketing, personnel).
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Types of planning
1- Strategic Planning
⮲ Strategic plan is the plan which is formulated by the top-level
management for a long period of time of five years or more.
⮲ They decide the major goals and policies to achieve the goals. It
takes in a note of all the external factors and risks involved and make
a long-term policy of the organization. It involves the determination
of strengths and weaknesses, external risks, mission, and control
system to implement plans.
2- Tactical planning
⮲ It aimed at achieving tactical goals, is developed to implement
specific parts of a strategic plan. It typically involves upper and
middle management
⮲ It has a somewhat shorter time horizon and a more specific and
concrete focus. Thus, are concerned more with actually getting
things done than with deciding what to do.
⮲ It involves how the resources of an organization should be used in
order to achieve the strategic goals. The tactical plan is also known
as coordinative or functional plan.
3-Operational Planning
⮲ Operational plans are the plans which are formulated by the lower
level management for short term period of up to one year.
⮲ It is concerned with the day to day operations of the organization.
It is detailed and specific. It is usually based on past experiences.
It usually covers functional aspects such as production, finance,
Human Resources
Etc.
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Planning process
1-Establishment of objectives
▪ It involves identification of goals and objectives of the
organization by carefully examining the internal and external
environment affecting the work.
2- Developing Premises
▪ Premises are assumption about the environment in which plan are
made and implemented. Thus, assumption about market demand,
cost of raw materials, technology to be used, government policy
etc.…are to be made while formulating a plan.
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3- Evaluating and selection of alternatives

▪ Change in external environment pose different alternative for
organization to carry out a particular task.
▪ Different alternatives are evaluated against cost, risk and benefit
involved in following specific course of action and the best
alternative is chosen.
4-Formulating Derivative Plan
▪ Derivative Plan are secondary plans formulated to support basic
plan e.g. “detailed plan formulated for various departments,
unites, activities etc. “. Derivative Plan indicated the time schedule
and sequences of performing various tasks.
5-Securing Cooperation and Participation
▪ Manager must involve people in various departments and take
their suggestion and criticism to rectify the defect in the plan if
any. Participation of employee in formulation of plan motivates
them to carry out the plan with best of their abilities.
6-Providing for Follow Up
▪ Plans are constantly reviewed to ensure their relevance and
effectiveness with the changing dynamics in the work
environment. It helps to develop sound plan for the future and
avoiding mistakes that surface after or while implementing plan.
Barriers of planning:
● False assumptions
● Not enough alternatives
● Inadequate time or other resources
● Low motivation levels
● Sound strategies not used
● Inadequate delegation of authority
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● Not recognizing organizational goals and needs

● Planning too narrow in scope—not recognizing community,
legal, and licensing requirements
● Unknowable Future
● Poor Communication
● Insufficient Resources.
● Lack of Creative Thinking
● Resistance to Change
● Failure of people in planning.
● Inability to plan or inadequate planning
How to overcome barriers of planning?

 Starting at the Top
 Recognizing the Limits to Planning
 Communication
 Participation
 Revision and Updating
 Contingency Planning
 Discussion
 Training
 Explanation of Planning Objectives
 Creation of a Planning Climate
 Use of Aids of Planning
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Application of nursing planning

The Nursing Administration Department is department that offers
courses for the required knowledge, attitude and skills needed to
the students to work in clinical areas and behaves professional
nurses with commitment to service to assist them in developing
their management and leadership abilities.
Vision
The vision of the Nursing Administration Department is to prepare
competent nurses who are able to meet the healthcare needs of the
society within the international standards and ability to have self-
assessment and motivation in continuing education.
Mission
The mission of the Nursing Administration Department is to
prepare professional nurses with leadership and managerial
abilities who are imbued with real commitment to excellence,
innovation, and community services.
Philosophy
The philosophy of the Faculty of Nursing is reflected in the values
and beliefs of the department of the Nursing Administration
regarding human being. Health, society, nursing, nursing
education and research, learner and curriculum.
We believe in the need to provide intellectually stimulating and
supportive environment that foster individual and collective
development of persons and prepare students who are competent
to fulfill their professional roles.
Goals
this course ill equip nursing student with the essential knowledge,
skills and attitudes needed to become effective managers and
leaders in their healthcare...
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-After completion of this course the students will be able to:

Apply the elements of planning process in various healthcare
setting. Emphasis on the development of leadership skills,
delegation, motivation, and performance appraisal of nursing
personnel to give high quality of nursing management.
The objectives of the Nursing Administration Department are to:
1. Apply modern learning teaching outcomes strategies of the

merged nursing with Administration recent technology students
that to competent level as well as lifelong learning.
2. Support the enhancement of clinical skills in students from basic

to advanced skills considering patient safety through guidelines,
hospital policy and quality.
3. Motivate students to become professional nurses who are self-

motivated with attributes of critical thinking. Clinical judgment
and leadership abilities.
4. Participate in preparing graduate nurses to be professional and

being knowledgeable, safe and competent in skills within
appropriate ethical boundaries.
5. Promote professional development through continuing nursing

education and research activities.
6. Contribute to the Faculty/University Ministry of Health plans for

continuing education related to clinical skill competency to
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improve the quality of nursing care through faculty development

and nursing competency for safe practice.
7. Extend services to the community to attain, maintain or regain

quality of health services for people through collaboration with
the ministry of health, ministry of education and governorate.
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Problem solving
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Goal:
To improve participant’s knowledge, skills and positive attitudes in
problem solving
Objectives:
At the end of the lecture participants will be able to:
 Identify key terms.
 List importance of problem solving
 Discuss types of problem
 Enumerate key problem-solving skills
 Apply problem solving process
 List barriers of problem solving
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Outlines:
 Identify key terms.
 Importance of problem solving.
 Types of problem.
 key problem-solving skills
 problem solving process.
 Problem solving methods
 Sources of problem solving.
 Barriers of problem solving.
 Application.
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Definitions:
Problem is an undesirable event or in other words, "Any Gap between
what is expected and what is obtained."
Problem Solving This process is used to address a problem to reach a
solution It is based on a cause-and-effect thinking pattern which
enables us to accurately identify, describe, analyze and resolve a
situation in which something has gone wrong without explanation.
Problem solving skills refers to our ability to solve problems in an
effective and timely manner without any impediments.
Importance of problem solving:
1. Increase brainstorming ability
2. problem solving provides ongoing assessment information that can
help to make decisions.
3. Make the impossible possible
4. Propose solutions and Implementation of best solutions.
5. Save resources and avoid the loss.
6. Increased confidence
7. having the ability to solve problems
Types of problems:
There are four types of problems
A-Caused /reactive
There problems are result of something not going as well as it show
and you need to fix it.it is include:
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Type 1-Trouble shooting

Reactive problem solving based upon quick respond on immediate
symptoms.
Type 2-Gap from standard
Structured problem solving that focusing on problem definition, goal
setting and root cause analysis that aim to prevent problem from
recurring by eliminating its underlying causes.
B-Created/proactive
There problem is result of you wanting to continuously improve and
drive the standards up.
Type3-Target condition
Continuous improvement that goes beyond existing performance of a
stable process or value streams, it seeks to eliminate wastes,
overburden. unevenness rather than responding to one specific
problem to deliver superior value or performance towards a target
condition
Type 4-Open ended
Innovation problem solving based upon creativity, synthesis, and
opportunity, it seeks to identify new problems, solutions and
opportunities not previous recognized.it achieve radical improvement.
key problem-solving skills include:
1.Active listening
you need to be able to show that you’re listening and engaged and
really hearing what the problem is or what a solution may be.
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2.analytical skills
The first step is to recognize that there is a problem and discover what
it is or what the root because of it is. You can’t begin to solve a problem
unless you’re aware of it.
3.Research
Defining and solving problems often requires you to do some research
this may be a simple Google search or a more rigorous research project.
4.Creativity
Problems are usually solved either intuitively or systematically.
Intuition is used when no new knowledge is needed - you know enough
to be able to make a quick decision and solve the problem, or you use
common sense or experience to solve the problem. More complex
problems or problems that you have not experienced before will likely
require a more systematic and logical approach to solve, and for these
you will need to use creative thinking.
5.Communication
6.Decision making
Problem solving and decision making are closely related skills, and
making a decision is an important part of the problem solving process
as you will often be faced with various options and alternatives.
7.Team-building
Many problems are best defined and solved with the input of other
people. Team working may sound like a 'work thing' but it is just as
important at home and school as well as in the workplace
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problem solving process
First Step: Define the problem

In the first step, you recognize what the problem is. Ask yourself: What
am I trying to solve? You need to make sure you have a good view of
the problem because you don’t want to be fixing something that is
already working. Understanding this might be hard, especially if it
involves a group of people, but it’s crucial for future success.
In addition to recognizing the problem, you should also establish a goal
for what you want to achieve. The flow here should be very clear:
* Something is wrong or something could be improved.
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Second Step: Determine the root cause(s) of the problem

Skipping to the solution of the problem without recognizing its
symptoms usually means the problem will come back in the future.
Like in medicine, we need to understand the difference between
treating the symptoms and curing the condition. Treating symptoms
helps you in the short run, but it doesn't eliminate the real reason for
the problem. Recognizing the deeper issue helps to adjust the treatment
and eliminate the root of the problem.
Third Step: Develop possible solutions
It’s time to get creative and come up with as many possible solutions
as you can. This is a brainstorming session, so don’t rule out some
ideas because they don't seem perfect.
Fourth Step: Select a solution
Now it’s time to go back to earth. Your job is to evaluate your list of
ideas. Start by excluding those that are unrealistic to do or not helpful
in any way. If you’re solving a problem for your team, think about it
from their perspective. Which solution would be the best for those who
will be implementing it? Here are some questions that will help you
choose the right solution:
Can this solution be implemented in the timeframe you need?
Is it practical, helpful, and cost-effective?
Can it adapt to conditions that evolve and change?
Is it risky?
Is it beneficial to you, the team, or the company?
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Fifth Step Implement the solution. It’s

time to put everything from the paper into action. However, keep in
mind that execution follows only after planning. If a problem applies
to other people as well, establish these key things:
Who is responsible for implementation?
Who else is involved in the process?
What is the time frame for implementation?
What are the objectives?
What exact actions need to be taken before and during
implementation?
While implementing the solution, it’s best to act in short iterations
with testing the outcome and getting feedback from others. Keep in
mind that there’s no need for it to be perfect the first time. That’s also
the reason you shouldn’t get attached to only one solution. If you see
that the solution you chose is failing to give you the outcome you
desire, try using some of the different solutions you established before.
Final Step Evaluate the outcome

In last step devote some time to review the results. What happened
after you implemented the changes? What worked, what didn’t, and
what did your solution improve? Analyze if your actions made the
required impact and if you addressed the root causes of the issue. It’s
also time to look for improvements in the solution and to plan ongoing
monitoring. You can also analyze what you’ve learned and what still
needs to be learned when it comes to problem-solving processes and
skills.
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Problem Solving Methods

1- PDCA – cycle
2- DMAIC Method.
3- 8D Method
4- A3 Method
1-PDCA
The PDCA cycle is a problem-solving methodology applied by many
organizations in different industries. Remember when you were in
school, and you learn in science about hypothesis and
experimentation? PDCA is a way to test different theories in a
controlled environment. It is based on the scientific method, a process
used by scientists to test whether any statement or theory is accurate.
PDCA stands for Plan, Do, Check, Act. There are a couple of
variations or names for it, like PDSA (Plan-Do-Study-Act), Deming
Wheel, and Shewhart Cycle. The cycle is a four steps model for
problem solving and processes or services continuous improvement.
Below is a basic description of each step.
The steps: Plan, Do, Check, Act

After you recognize an opportunity for improvement or a problem,
you start with
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 the first step, Plan. As the name indicates, during this step you
plan the activities and set the goals for your experiment. It is
important to understand the situation and analyze the problem, or
opportunity before developing theories about what the issues may
be. As soon as all this is clear, decide which one to test.
 During the second step, Do, you test the solution. You carry out
a small-scale study by completing the planned activities,
including measuring the results.
 In Check, the third step, you study or analyze the results, and
decide if the hypothesis is correct or not. What did you learn? Did
you accomplish the objectives or goals stated during the Plan
step?
 The last step is Act, where you take action based on the previous
step learnings. If the objectives were not accomplished, you need
to go through the cycle again. If the test was successful, use what
you learned to improve the process. While implementing the
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solution, do not forget to change the standard work and

communicate the changes to the team.
Advantages.
✔ Can be helpful in all situations
✔ Simple assembly requires little instruction.
✔ The cyclical idea invites constant improvement.
✔ The iterative approach allows control and analysis.
Disadvantages
✘ The unspecific definition can lead to incorrect use
✘ Changes must be planned over longer periods of time
✘ With the PDCA cycle, one reacts considering everything and rarely
acts proactively
2-DMAIC Method
The Six Sigma Strategies DMAIC Problem-Solving Method. The Six
Sigma system uses a number of quality methods and tools that are used
by Six Sigma trained professionals within the organization. The
DMAIC problem-solving method can be used to help with any issue
that arises, usually by professionals in the organization who have
reached the "green belt" level.
The DMAIC Method
The DMAIC problem-solving method is a roadmap that can be used
for any projects or quality improvements that need to be made. The
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term DMAIC stands for the five main steps in the process: Define,
Measure, Analyze, Improve, and Control.
»Define phase: where you understand the problem you want to

address.
»Measure phase: where you collect data to help you make an
informed decision about what’s causing the problem.
»Analyze phase: where you examine and interpret the collected data
to attempt to identify the root cause of the problem.
»Improve phase: where you fix the root cause of the problem.
»Control phase: where you put in place a mechanism to ensure the
improvements you’ve made are sustained.
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Advantages of the DMAIC method are:

 The structured approach is useful in any situation where you need
to improve a complex process.
 The DMAIC method aims to analyze a process before
 Implementation, and this reduces the chance of fixing the wrong
issue.
 It helps to improve team and organization communications. This
leads to improved performance overall, and ultimately this can
filter through to happier customers.
Disadvantages
 A one size fits all approach does not suit an organization that
relies on creativity.
 Without awareness, during the implementation of DMAIC, it is
easy to become too focused on using the tool, rather than finding
the right solution.
 It is cumbersome for simple and obvious problems.
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3- 8D Method
This methodology was developed by ford motors and widely used by

many manufacturing industries
D1 Establish the Team: Establish a small group of people with the

process and/or product knowledge
D2 Describe the Problem: Describe the internal or external problem
and detailing the problem in quantifiable terms.
D3 Develop Interim Containment Actions: Isolate the effects of the

problem until permanent corrective (preventive) actions are
implemented.
D4 Define Root Cause(s) analysis: by testing each root cause theory
against the problem description
D5 Choose Corrective Actions: Select the best permanent corrective
actions to remove the root cause
D6 Implement Permanent Corrective Actions: Plan and implement
selected permanent corrective actions,
D7 Prevent Recurrence by Modifying the necessary systems,
including policies, methods, and procedures, to prevent recurrence of
the problem and similar ones.
D8 Recognize Team and Individual Contribution
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Advantages of 8D Problem Solving
1- To start with, the system is focused on getting to the root

cause of problems, which is necessary to fix issues now, and
prevent them from coming back in the future.
2- It is also helpful because it looks at "Escape Points" to
improve the ability to detect failure should something go wrong
again in the future.
3- It helps to eliminate the conditions that allowed the failure
in the first place.
4- To put it simply, the biggest benefits of the 8D systems is
that it uses a multi-step approach to identify problems, come up
with and implement solutions, and remain focused on ensuring
the problem does not recur in the future. When implemented over
time, this will help to dramatically reduce problems in the
workplace, which will help to improve the overall bottom line.
Disadvantages of 8D Problem Solving
There are relatively few disadvantages of using the 8D problem

solving concepts.
The most significant one is that
1- It will require those who participate in the problem-solving
efforts to receive some training on how 8D works.
2- In addition to learning about the actual 8D problem solving
strategies, those learning this concept will also need to understand
other related things. This may include things like fishbone
diagrams, process maps, pareto charts, and more.
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4- A3 Method
It is widely used by Toyota Motors and its suppliers.

Eight Steps of A3 Methodology are mentioned below.
1- Clarify the issue

2- Break down the issue
3- Set the Target
4- Analyze the root cause
5- Develop countermeasure
6- See Countermeasure
7- Evaluate results & Processes
8- Standardize Success
Advantages of A 3
1- Creates a consistent approach to solving problems throughout
the entire organization.
2- Requires a balanced way of thinking both visually and
analytically (Right Brain/Left Brain)
3- Reduces complexity and keeps focus on the problem
Generates alignment and consensus.
4- Provides a visual representation of data that is easy for everyone
to understand
5- Short circuits the temptation to jump to conclusions and
implement improvements without due consideration
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Sources of problem solving.

 Primary sources.
 Media
 Articles
 Books
 Reference tools
 Web sites
Barriers of problem solving:

-Assumptions
When dealing with a problem, people often make assumptions
about the constraints and obstacles that prevent certain solutions.
-Functional fixedness
This term refers to the tendency to view problems only in their
customary manner. Functional fixedness prevents people from fully
seeing all of the different options that might be available to find a
solution.
-Irrelevant or misleading information
When you are trying to solve a problem, it is important to distinguish
between information that is relevant to the issue and irrelevant data
that can lead to faulty solutions. When a problem is very complex, the
easier it is to focus on misleading or irrelevant information.
-Mental set
A mental set is the tendency people have to only use solutions
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that have worked in the past rather than looking for alternative ideas.4
A mental set can often work as a heuristic, making it a useful problem-
solving tool. However, mental sets can also lead to inflexibility,
making it more difficult to find effective solutions.
Problem solving application

Scenario
The infection control committee at AAA hospital, they noticed an
increase in the incidence of covid 19 among the isolation nursing staff
conformed by ct -chest and sputum culture.
Problem solving steps using DMAIC method
1. Problem definition
increase in the incidence of covid 19 among the isolation nursing staff
at AAA hospital Due to incorrect removal of of personal protective
equipment.
2. Analyze the problem
In AAA Hospital there are 50 nurses in the isolation department. In the
first week of April, 3 of the nursing staff were infected with Covid 19,
and it was believed that they had been infected outside the hospital, but
in the second week the number increased to 10, which affected the
workflow. The infection control committee began to search the matter
and it was revealed the injury Resulting from incorrect wearing or
removing they’re of personal protective equipment in the right way.
3. Generating possible solutions:
1-Provid department with nursing staff to plug the deficit in nurses.
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2-Conducting training programs on how to deal with personal

protective equipment.
3-Provide personal protective equipment
4. Selecting the best solutions:
After listing potential solution try to identify benfits and costs to
implement each one
After comparing all the solutions I found out that the best solution is:
Conducting training programs on how to deal with personal protective
equipment.
5. Implementing the solutions:
Implementation by giving nursing educational programs on dealing
with personal protective equipment.
6. Evaluation and control
After providing training program to nursing staff and observe their
performance we found decrease incidence rate of covid19 infection
among nursing staff
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Decision Making
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Goal:
To empower participants with knowledge, skills and positive attitude
toward decision-making.
Objectives:
At the end of this lecture, the participant will be able to:
-Define key terms.
-List importance of decision-making
-List the types of decision-making.
-Enumerate Factors affecting decision-making
- Explain Barriers to good decision making.
-Apply Process of Decision-making.
-Have positive attitude toward attributes of an affective decision
maker.
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Outline:
 Definition of key terms
 Importance of decision making
 Types of decision making
 Factors affecting decision making
 Process of decision making
 Positive attributes of an affective decision maker:
 General guidelines for decision making:
 Barrier of decision making
 Application
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Introduction
A person's life passes through many variables, conditions and
situations that are exposed to the process of differentiation or selection,
and it is known administratively for decision-making.
- Decision making is an important step in the problem solving process,
is an important tasks that relies heavily on critical thinking and clinical
reasoning skills, decision are made at all level of organization
concerning an organization goals and strategies. In clinical practice the
nurse manager can make decision based on being able to diagnose the
problem appropriately, adapt solution to the situation at hand and reach
the resolution.
Definitions of key terms:
Decision: - is a choice or judgment made between two or more
available alternatives.
Decision making: - Is a scientific problem solving and systemic
sequential process of choosing among alternatives and putting the best
choice into action.
Decision making capacity:
Refers to a person’s ability to make day to day decisions about legal,
medical/health care, financial and personal matters, including:
 where to live
 What to buy.
 What support or services they need.
 When to go to the doctor.
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Importance of Decision making

1-Facing problem and challenge: -
Quick and correct decisions help face and tackle new problems and
challenges.
2-Achieving Objectives:
Rational decisions help the organization to achieve all its objectives
quickly. This is because rational decisions are made after analyzing
and evaluating all the alternatives.
3- Increase efficiency:
Decisions help to increase efficiency; efficiency is the relation
between returns and cost. If the returns are high and the cost is low,
then there is efficiency and vice versa. Rational decisions result in
higher returns at low cost.
4-Facilitate Innovation:
- Rational decisions facilitate innovation. This is because it helps to
develop new ideas, new products, new process, etc. This results in
innovation. Innovation gives a competitive advantage to the
organization.
5-Prevents Conflict:
- When a manager is not assertive and leaves too many decisions up to
the staff that can create conflict in the workplace.
6- Fosters Respect:
- Employees want a strong leader whom they can follow.
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Types of decisions:
1-Programmed decisions and Non - programmed decisions.
2-Routine and Strategic decisions
3-Tactical (Policy) and Operational decisions.
4-Organizational and personal decisions.
5-individule and group decisions.
1-Programmed decisions:
Programmed decisions are routine repetitive works and the
organization typically develops specific ways to handle problem. A
programmed decision might involve determining how products will
have arranged on the shelves of a supermarket. For this kind of routine,
repetitive problem, standard arrangement decisions are typically made
according to established management guidelines.
*Non - programmed decisions:
Non programmed decisions are typically one shot decisions that are
usually less structured than programmed decision.
2-Routine and Strategic decisions:
Routine decisions are related to the general functioning of the
organization. Strategic decisions are important policy matters. These
are non-repetitive in nature and are taken after careful analysis and
evaluation of many alternatives.
These decisions are taken at the higher level of management.
3- Tactical (Policy):
● Middle level
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● Short term
● Involves decisions related to production, finance, marketing,
personnel, and getting task done.
● this type of decision affects directly on lower level; it must take
based on organizational policy.
● It can make employee satisfied or not related to fairness in making
decision
*Operational Decisions:
1. Lower level
2. Concerned with day to day works.
3. Taken on important plans& policies made by top level.
4. involves timing schedules, amount of remuneration, set up of
machines and tools.
5. It affect directly on staff.
6. It play a major role in staff satisfaction and performance.
7. This decision must base on adequate information about requirements
of staff and departments.
4-Organizational Decisions:
When a particular decision has been taken by a person as an executive
of an organization. Such decision can be considered as an
organizational decision. The impact of such decision can be felt on the
working of the entire organization. The power of taking an
organizational decision can also be delegated by a superior to
subordinates.
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* Personal Decisions.
An executive can also take a decision that is related with him. Such
decisions are known as personal decisions. Generally the effect of
these decisions is on the personal life of the decision-maker. At the
same time, the authority of taking such decision cannot be delegated
to others.
5-Individual Decisions:
When the decision is taken by a single individual, it is known as
individual decision. Usually routine type decisions are taken by
individuals within the broad policy framework of the organization.
* Group Decisions:
Group decisions are taken by group of individual constituted in the
form of a standing committee. Generally, very important and pertinent
matters for the organization are referred to this committee. The main
aim in taking group decisions is the involvement of maximum number
of individuals in the process of decision making
Factors affecting decision making
1-Time pressure:
As time pressure increases, the ability to examine and compare choice
alternative is challenged, and the decision making process is modified.
These changes include ignoring some choice alternatives together,
making information more efficient, information selectivity, change of
threshold for responding.
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2-Iinternal context
● Psychological: like priority, values, perceptions, acceptability, goals
and judgement.
● Emotional: never make decision when you are angry or euphoric.
● Physical: don’t take decision if you are very exhausted or very ill
2-External context:
Decisions are not made in isolation. They don't only depend on
objective data. A variety of external influences play a major role in
how information is perceived, processed, evaluated, and represented,
which all have critical roles in the decision making process and its
outcome, like life style, risks, economical status and resources.
3-Expertise the decisions
made are further Mediated by experience
4-Age
Cognitive resources decrease with ageing but experience and
"wisdom" increase
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Steps of Decision making process
Decision making
Is the process of making choices by identifying a decision, gathering
information, and assessing alternative resolutions? Using a step-by-
step decision-making process can help to make more deliberate,
thoughtful decisions by organizing relevant information and defining
alternatives. This approach increases the chances that you will choose
the most satisfying alternative
Possible.
Step 1: Identify the decision Realize needing to make a decision.
Try to clearly define the nature of the decision that must make. This
first step is very important.
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Step 2: Gather relevant information Collect information before

make the decision:
What information is needed, the best sources of information, and how
to get it. This step involves both internal and external “work.” Some
information is internal: seeking it through a process of self-assessment.
Other information is external: finding it online, in books, from other
people, and from other sources.
Step 3: Identify the alternatives
Collect information, will probably identify several possible paths of
action, or alternatives. Also use imagination and additional
information to construct new alternatives. In this step, list all possible
and desirable alternatives.
Step 4: Weigh the evidence
Information and emotions to imagine what it would be like if carried
out each of the alternatives to the end. Evaluate whether the need
identified in Step 1 would be met or resolved through the use of each
alternative. Go through this difficult internal process, begin to favor
certain alternatives: those that seem to have a higher potential for
reaching goal. Finally, place the alternatives in a priority order, based
upon own value system.
Step 5: Choose among alternatives
Once have weighed all the evidence, and getting ready to select the
alternative. Choose a combination of alternatives. Choice in Step 5
may very likely be the same or similar to the alternative placed at the
top of list at the end of Step 4.
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Step 6: Take action Ready to take some positive action by

beginning to implement the chosen alternative in Step 5.
Step 7: Review decision & its consequences
In this final step, consider the results of decision and evaluate whether
or not it has resolved the need to identify in Step 1. If the decision has
not met the identified need, may want to repeat certain steps of the
process to make a new decision. For example, might want to gather
more detailed or somewhat different information or explore additional
alternatives.
Positive attributes of an affective decision maker:
Moral integrity:
It is generally a personal choice to hold oneself to consistent moral and
ethical standards. In ethics, integrity is regarded by many as the
honesty and truthfulness or accuracy of one's actions.
Sensitivity and caring:
Making choices based on objectives.
Responsibility:
It is essential that roles and responsibilities for carrying out the
necessary procedures and making decisions are clearly defined.
Empowerment:
A management practice of sharing information, rewards, and power
with employees so that can take initiative and make decisions to solve
problems and improve service and performance.
Patience:
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Patience is an exercise of self-control that shows ability to handle life

when times get tough, and can withstand judgment when needed. In
short, exhibiting patience shows having a high moral standard in life.
General guidelines for decision making:
Always be clear about the situation.
• Gather as much information as possible and continue to add to it if
the situation will allow.
• Use the full period of time to make good decisions.
• Always consider the time element that will be involved in reaching
the decision.
• Once have made the decision, implement it quickly and decisively.
Communicate frequently and effectively with others.
• Stay current with regard to knowledge of nursing, patient care and
the environment.
Barriers of effective decision making.

1. Lack of information
Another major impediment I decision making is that leaders often
work with limited information.
2. Lack of context
The lack of context or structure can also refer to the absence of
values; important decisions are also often those which require us
to examine our values more closely.
3. Too much information
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Overwhelming volume of information can drown out any ability

to assess situation reliably and in timely fashion.
4. Lack of feedback and practice:
We often don't get feedback from subordinates. Peers and
supervisors. The lack of feedback can be strong constraint to
progress innovation.
5. Cultural barriers
The difference in values, Languages, etiquette can lead to
misunderstandings. Which adversely affect decision making
Applying decision making in nursing situations:

1- Situation in NNICU:
In OR, receiving newborn baby with zero Abgar score, physician
insert ETT to maintain breathing. No mechanical ventilator at OR, So
make decision.
A) Identify the decision:
This decision is a lifesaving decision.
B) Gather relevant information:
*Baby condition is
Unstable *Not all supplies are available at OR.
*baby on Ambo bag.
*No Mechanical ventilator at OR.
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C) Identify the alternatives:

* Take baby immediately to NNICU.
*Continue resuscitation at OR.
*Bring Mechanical ventilator to OR.
D) Weigh the evidence:
*put baby on mechanical ventilator as soon as possible.
*complete newborn care.
*monitor baby condition.
*keep all necessary equipment.
*Insert IV line.
E) Choose among alternatives:
* Taking baby to NNICU is the most important action in this situation.
F) Take action:
Baby become on mechanical ventilator at NNICU.
G) Review decision and it is consequences: Baby become stable, all
vital signs within normal.
2- Situation in medical ward:
*Sudden arrest of patient with hypertension, Ischemic heart diseases
&Type 2 diabetes.
1-Identify the decision:
Must take decision to save patient life.
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2-Gather relevant information:

*Patient with Hypertension, IHD and diabetes.
*DC shock machine available at ward.
*Adequate nursing staff available.
*physician available. * Inform ICU charge nurse to be ready.
3-Identify the alternatives:
*Start CPR.
*Ask for help.
Inform ICU charge to be ready to receive patient.
4- Weigh the evidence:
*Start CPR.
*Ask for help by code blue alarm.
*Inform ICU to receive patient.
5- Choose among alternatives:
• The best decision is start CPR with physician and nursing staff of
ward to save patient life
6- Take action:
*CPR started at ward.
7- Review decision and it is consequences:
*Patient return to life.
*Standard CPR given to patient by Physician and nursing staff.
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* Patient transferred to ICU to be under close observation.

* Nursing role in patient decision making
• Increase patient knowledge about health care
• Involve patient in treatment
• Nurses must be aware of patients’ rights in making decisions about
their treatment & must support them
• Nurses may need to collaborate with others to determine what
information to be shared with patient and family.
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Time management
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Goal
To provide the participants with knowledge, skills, and
positive attitude toward time management.
Objectives:
At the end of this lecture every student will be able to:
-
 Define key terms.
 Enumerate importance of time management.
 Describe symptoms of inappropriate time management.
 Classify time Wasters.
 Enumerate the three basic steps in time management
Explain the strategies to dealing with time waster.
 Differentiate between personal time management styles.
 Discuss time management tools.
 Explain the nurse manager role in managing time.
 Have positive attitude toward time management.
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Outlines:
 Introduction.
 Definitions of (time- management- time management)
Importance of time management.
 Symptoms of inappropriate time management.
 Times wasters.
 Types of times wasters.
 Three basic steps in time management.
Strategies for time management.
Personal time management styles
Time management tools.
 Nurse manager's role in managing time.
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Introduction:
 Everyone has the same number of hours available in a given
day, no more and no less. So while we cannot save it, we
can spend it more effectively. Because nurses work long
hours, they should work smarter no harder to get more done
in less time.
 Time is the most important and often misused recourses
available to humans. Time management is the optimal use
of available time, It is vital to accomplish work.
Definitions:
What is a time?
Time is the duration of one's life hours and days which a person
has at his disposal.
Management:
 Is a process of getting things done through the effort of
others to achieve the organizational objectives.
Time management:
 It is a deliberative process of identifying and focusing on
the activities needed to accomplish tasks and goals.
 It is making optimal use of available time.
 Time management is the use of personal and professional
management tools and strategies to assure that investment
in activities leads toward achieving a desired, high priority
goal.
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Importance of time management:

1. To reduce stress and anxiety.
2. To save and gain time.
3. To be self-disciplined.
4. To increase work output.
5. To have more control in our life.
6. To motivate & initiate.
7. To increase productivity and self-esteem.
8. To achieve goals quickly and easily.
9. To achieve greater success, dreams and visions.
Symptoms of improper time management:
1. Tardiness:
Being that person that is always last into the meeting, flustered and
apologizing for being late. Arriving at your appointment late. Apart
from being disrespectful of other people’s time, being late is a major
sign of poor time management.
2. Always rushing, managing by crisis:
This frequently results in tardiness. If you’re always rushing about, it’s
a sign that you haven’t prepared sufficient time to complete whatever
it is you need to do in time.
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3. Missing deadlines:
If the sound of deadlines whooshing past your head is an all too
familiar sound, you might want to ask yourself why it keeps
happening. Sometimes
4. Impatience, frustration:
Impatience and frustration is usually the result of struggling to meet
deadlines, feeling overwhelmed and running late all the time.
5. Putting stuff off:
Procrastination is a huge time management issue. If you have a huge
backlog of stuff you’ve been intending to do for ages and never get
around to completing, the chances are, your time management could
benefit from a bit of attention.
6. Always multi-tasking:
Although a lot of people take pride in the fact, they can multi-task, in
reality doing more than one task at once is a productivity killer.
Attacking tasks individually is a much better way to manage them.
7. No clear goals or responsibilities:
If you’re going about your daily tasks without any clear goals, you’ll
find it difficult to prioritize anything, which means that you’re almost
certainly spending unnecessary time and effort on tasks that are neither
urgent nor important.
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8. Difficulties in concentrating:
An inability to focus on a task and getting distracted easily means that
you’re not managing your time well in terms of preparation.
9. Poor performance:
This can apply to errors in your work or bad grades at school. If you
don’t manage your time well, it can be difficult to perform to your
ability. Common reasons include lack of sleep, poor preparation and a
lack of prioritization.
10. Frequently feeling stressed or anxious:
This is a common symptom of poor time management. Having your
day under control will help alleviate this feeling.
11.Tired/no energy:
Struggling to get to sleep each night or not getting to bed early enough
can sometimes be traced to poor time management. Of course, it is
usually more complex than that, but if you can manage your time
better, it usually results in less stress and more restful sleep.
12.Often working overtime:
If you are always working late, you need to ask yourself why. Is it
because you are not productive enough during the day or is your task
load genuinely too big? Either way, you need to address it. You work
to live, not live to work.
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13.Indecisiveness:
The inability to make decisions can lead to procrastination and can be
a distraction when you should be focusing on other tasks, which is a
poor use of time.
14. Can’t say ‘no’
If you accept every task and responsibility thrown your way, it’s hard
to be proactive and manage your important and urgent tasks well. If
you’re on top of your time management, you will know what you can
and cannot handle, so don’t be afraid to say ‘no’. Don’t overextend
yourself.
15. Can’t/won’t delegate:
If you have a bit of the “control freak” in you (I know I do), this one
will resonate. But not delegating low value and unimportant tasks can
impact on how efficiently you can complete the high-value ones.
Time wasters:
It is something that prevents a person from accomplishing or
achieving the job.
⚫ Time wasters include:
1-External time wasters: is that outside of our control.
2-Internal time wasters :(personal).
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Common time wasters include:

1- External time wasters:
A. Unnecessary meetings
Meetings that have no agenda, no timeframe, and no clear takeaway
is a recipe for disaster. Not only are you wasting your time, but you're
also preventing others from getting things done as well.
B. Distractions
Even if you're ready to dive into deep work, not everyone or everything
will be considerate enough to let you do so. Whether it's a notification
from your phone, a knock on your office door, or a call from a relative,
the distractions are endless.
That's why it's best to set limitations for your workspace and work
session. Turn off notifications, quit browsing tabs, close apps, and
hang a "do not disturb" sign if you have to. Remember, it's always up
to you to guard your time and your work because no one else will.
C. Implementing new systems
It's important to note that trying new things or implementing new
systems will take some time to get used to. There will always be a
learning curve when it comes to creating a new website, trying out a
new software, hiring new team members, testing new strategies, etc.
However, this doesn't have to be an excuse to waste time. Instead, plan
and prepare for the transition by clarifying the goal of the new system,
having a buffer or contingency plan, and setting reasonable deadlines
or boundaries.
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D. Lack of motivation
You may have all the right tools and all the latest strategies but
sometimes, you just can't help but procrastinate or put things off. Don't
worry because no matter how much of a high achiever you are, you'll
reach a point that your motivation will stagnate or decline. This
happens to everyone, from athletes to CEOs, and authors to artists, so
don't be discouraged if it takes a while for you to be inspired to start
taking action again. This is the perfect time to rely on your habits and
systems (provided you've already established them) as you ride it out.
E. Repeating the same tasks
If you find yourself doing the same tasks over and over, you're
throwing time out the window. Instead, you need to standardize your
processes — Create templates, master copies, or workflow outlines to
eliminate unnecessary repeated work. Try using tools such as Asana,
Trello, Basecamp, or other project management software.
2)Internal time wasters:

Poor planning: -
Failure to establish goals and objectives.
Lack clear goal, objectives, and priorities.
Lack daily and weekly plan.
Leaving task unfinished.
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Day dreaming.
No time deadline.
Ineffective delegation: -
In ability to assigned proper task to proper person.
Procrastination: -
It is the tendency to put off to another time something that is important.
Open door policy.
Inability to say no
Making tasks to another person although these tasks not related to my
duties or plans.
Lack of self-discipline.
Leaving tasks unfinished.
Over involvement in routine details.
Three basic steps in time management:

The first step requires that time be set aside for planning and
establishing priorities.
The second step entails completing the highest-priority task (as
determined in step 1) whenever possible and finishing one task before
beginning another.
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The final step, the person must reprioritize the tasks to be

accomplished based on new information received.
Time management strategies:

1)Goal setting.
2)Time management plan.
3)Organizing.
4)Implementing for control.
1) Goal setting:
A Critical component of time management is defining short- and long-
term goals and time frames.
Goals provide direction and vision for actions and time line in which
activities will be accomplished
Goal Must be specific, measurable achievable, Realistic and time-
based goals.
2) Planning and scheduling:
Priority Setting
⚫ Establish A. B, C, and D priorities:
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A: Something which is important & urgent.

EX: Replacing two call- offs and ensuring sufficient staffing for the
upcoming shift.
B: Something which is important but not urgent.
EX: Drafting an educational program for nurses on the change in
medical science and technology.
C: Something which is urgent but it is not important.
EX: completing and submitting the beds available list for a disaster
drill
D: Something which is neither important nor urgent. EX: compiling
new charts for future patient admission. Categories of prioritizing:
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⚫ The “do now’’ requests most commonly reflect a unit’s day-to-day

operational needs
⚫ Some “do later’’ items reflect trivial problems or those that do not
have immediate deadlines; thus, they may be procrastinated.
⚫ The “don’t do’’ items probably reflect problems that will take care
of themselves, are already outdated, or are better accomplished by
someone else.
3) Organizing:
A) Tasks
1- maintain normal routine every day.
2- concentrate on one activity.
3-use a daily time planner.
B) Things
1- Organize paper work.
2- Keep a neat desk.
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4) Implementation:
Strategies to dealing with external time waster.
A) Managing the telephone interruptions effectively:
1. Have someone else take your calls and Handle them if possible.
2. Handle all return calls at set times of the day.
3. If you answer the phone with “Hello who can I do for you? rather
than hello, how are you, the caller encourage to business
B) Manage socialization:
1. Don’t make yourself overly accessible.
2. Be brief.
3. If you would like to chat and have the time to do so, use coffee
breaks and lunch hours for socializing.
C) Makes your meeting effective:
Prepare and announce an agenda before the meeting.
Begin meeting on time.
Stick to the topics on the agenda.
Make decision or come to conclusions
D) Handling paperwork overload and a poor filling system:
Keeping Correspondence organized in easily retrievable
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Increased use of computerization and electronic mail to reduce the

paper use and to increase response time in time-sensitive
communication.
Strategies to dealing with internal time waster:
A) Procrastination
Means to put off something until a future time, to postpone, or to
delay needlessly.
Causes:
You are not really committed to doing the job.
You are afraid of the job.
You do not place enough priority on the activity.
You do not know enough to do the task.
You simply do not want to do the job.
Strategies can help overcome the Procrastination:
1.Examine motivation and personal benefit
2.Identify and confront the fear, and act despite the fear.
3.Break a large job into smaller task
4. Gather the information you need, and plunge into the task.
5. Avoid over commitment.
6. Determine if the task should be done by someone.
7. Be comfortable saying “NO
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B) Learn to say “NO”:

⚫ IF you simply do not have the time, say No as politely as
possible.
⚫ Handel people who drop in:
1. Close your door for periods of time.
2. Stand up remain until the visitor leaves.
3. Train your boss and work group to respect your time.
C-Learn to delegate:
⚫ Transferring tasks to another individual That involves:
a- delegate jobs that will help employee to develop.
b- delegate jobs that employees perform better than you
D-Personal time management:
It is refers to “the knowing of self.’’ Managing time is difficult if a
person is unsure of his or her priorities, including personal short- term,
intermediate, and long-term goals.
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Personal Time Management Styles
Monochronic styles Polychronic styles
prefer to do one thing at a Typically do two or more

time things simultaneously.
people tend to begin and People tend to change
finish projects on time, have plans, and emphasize on
clean and organized desks as relationships rather than
a result of handling each tasks, and build longer-
piece of paperwork only term relationships.
once, and are highly
structured.
Time management tools:

 To-do-list
 Time log
 Time Inventory
 Gantt chart
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To-do-list
-It's a list of responsibility to be accomplished by specific time frame.
-Is a very simple remembering system to tell you what you want to do.
-It is free and you can get your own to do list up and running in no time
by carrying paper and pen.
-It's performed before starting the shift or at the end of the shift to next
day.
-It started from the beginning of the shift to the end of it.
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Time log;
-It is journal of activities that are useful in analyzing actual time spend
on specific activities
-Time log analysis it is important to identify how time being used and
determine whether the time use is appropriate to management role.
Time log format
Time Activities Comment
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Time inventory:
-It is one way to gain insight into how and when a person is most
productive. It also assists in identifying internal time-wasters.
-Divided the day hourly in schedule to identify your activities for 24
hours and write your activities on regular basis, start the period of time
when you most productive.
-Don't include sleep time
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Gantt chart:
-Also Called: milestones chart, project bar chart, activity chart.
-A Gantt chart is a bar chart that shows the tasks of a project, when
each must take place and how long each will take.
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Nurse Manager’s role in managing time:

⚫ Appropriately prioritizes day-to-day planning to meet short-term
and long-term unit goals.
⚫ Builds time for planning into the work schedule.
⚫ Analyzes how time is managed on the unit level using job analysis
and time-and motion studies.
⚫ Eliminates environmental barriers to effective time management for
unit staff.
⚫ Handles paperwork promptly and efficiently and maintains a neat
work area.
⚫ Breaks down large tasks into smaller ones that can more easily be
accomplished by unit members.
⚫ Utilizes appropriate technology to facilitate timely communication
and documentation.
⚫ Functions as a role model, supporter, and resource person to
subordinates in setting priorities.
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Application:
At Fayoum university hospital in the surgical department where there
are 30 beds, on Sunday 30/12/202, Ms./ Rania Ahmed as a head nurse
in the surgical department wants to manage her time in morning shift
as she has a lot of extra tasks to accomplish today. She Starts to
prioritize her tasks by using to do list to manage her time as the
following: -
Urgent- important. High
Urgent- not important. High
Important-not urgent. Moderate
Not important- not urgent. Low
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No. Activities
1 Handover patients and unit from responsible nurse.
2 Assign duties on her staff. Check inventory list.
3 Make assignment sheet and delegate duty for
4 assistant nurse. Delegate lab and rays’ sheet for
5 assistant nurse.
6 Prepare equipment that needed for unit.
7 Prepare equipment which will be needed in
8 emergency. Check nursing care plan for the nurse
9 (professional) Participate nursing round and medical
10 round.
11 Check nursing activities.
12 Check infection control in her unit. Conduct the
13 meeting.
14 Check the staffing pattern regarding goal grooming.
15 Fill the Kardex.
16 Write shift report and write daily conditional report
Deliver shift report to next shift.
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(2)
Staffing
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Goal
Provide participants with knowledge skills and positive attitude toward
staffing process.
Objective
At the end of this presentation, participants will be able to:
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Outline
1- Introduction
2- Staffing definition
3- Mission of staffing
4- Objective of staffing
5- Philosophy of staffing
6- Importance of staffing
7- Element of staffing
8- Factor affecting staffing
9- Staffing process
10- Method of calculating staffing
11- Manpower planning
12- Steps of manpower
13- Definition of recruitment
14- Purpose of Recruitment.
15- Factors influencing recruitment
16- Recruitment Process
17- Recruitment method
18- Strategy for Targeting Best Candidates for Recruitment
19- Manpower forecasting
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Introduction
Introduction The third fundamental management function is actuating.
Actuating is getting all the members of the group to strive to achieve
the objectives of the enterprise. Planning and organizing lay the
foundation for the actuating function which requires that an enterprise
be staffed with the most competent people available. Staffing is an
adjunct or prerequisite activity to actuating.
Staffing ◼
Staffing is the process of ascertaining that adequate numbers and an
appropriate mix of personnel are available to meet daily unit needs and
organizational goals
◼ It is the process of determining and assigning the right personnel
with the right qualifications to the job in a right time to accomplish the
purposes of the organization.
Mission of staffing
1. To ensure maximum utilization of human resources.
2. To discover and obtain competent personnel for various jobs.
3. To ensure the continuity and growth of the enterprise through
adequate staffing.
4. To improve job satisfaction and morale of the employees through
objective assessment.
5. To be able to meet crisis/emergency situations.
6. To deliver good quality of care and attain job satisfaction and patient
satisfaction.
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Objectives of staffing
1. To recruit adequate number of human power resources to attain the
goals of management.
2. To carry out the managerial functions such as planning, directing
and controlling the organization by recruiting adequate human
resources.
3. To recruit competent staff. Effective functioning of an organization
reflects the ability of the staff recruited. Therefore, the success of the
organization depends on the competency of the staff recruited.
4. To retain right number of staff and utilize their ability to the
maximum so that they give quality output.
5. To provide training programs to strengthen the personnel skills and
abilities of the staff. 6. To ensure adequate staffing to have proper
usage of resources in an organization
Philosophy of staffing
1. The knowledge and skill of the staff can adequately fulfill the needs
of the patient and thereby ensure both job satisfaction and quality care.
2. Only professionally trained nurses can provide a high quality of
patient care and handle critically ill patients by providing both
technical and intrapersonal skills.
3. A professional nurse can not only treat chronically ill patients, but
also provide health education and rehabilitative care, which is more
complex.
4. By determining patient needs and doing assignments, job
quantification and analysis can be done.
All sorts of nursing-related plans, e.g. master rotation plan, duty roster,
etc., should be done only by nursing heads. 6. A staffing plan should
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be delegated to each unit-level head nurse so that the activities of each

ward and details of each shift are planned well.
Important of staffing
1-filling the role by obtaining competent personal.
2-placing the right person at the right job .
3-growth of enterprise.
4-optimum utilization of resources.
5-helps in competing.
6- improves job satisfaction and morale of the employee.
7-key to effectiveness of other functions.
*Elements of Staffing
1. Human resources planning.
2. Recruiting.
3. Selecting.
4. Orientation.
5. Performance appraisal
6. Training & development
7. Compensation
8. Employment decision
Factors affecting staffing

Patient factors
. ◼Patient type ( age , sex, diagnosis)
. ◼Fluctuation in admission
. ◼Length of stay
. ◼Complexity of care
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Staff factors
. ◼Personnel policies (vacation , overtime, part time, work(
. ◼Educational and experimental levels of staff
. ◼Job description
. ◼Market competition
Environmental factors
. ◼Number of patients' beds
. ◼Availability of supplies and equipment
. ◼Organizational structure
Staffing process
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Methods of calculating staffing

1. Patient classification system
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◼ It is system developed to objectively determine workload

requirements and staffing needs
2. Diagnostic related groups
◼ Based on the medical diagnosis of the patients
3. Acuity and complexity of care
◼ Estimate how many hours of nursing care will be needed during a
particular shift.
4. Staffing formulas
◼ Must consider hours which coverage is required, vacations,
holidays, absenteeism, and staff development time.
Manpower planning
Manpower planning may be defined as a strategy for the acquisition,
utilization, improvement and preservation of the human resources of
an organization.
This involves ensuring that organization has enough of the right kind
of people at the right time and also adjusting the requirements to the
available supply.
The main objectives of manpower planning
1. Ensuring maximum utilization of the personnel
2. Assessing future requirements of the organization
3. Determining the recruitment sources.
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4. Anticipating from past records, i.e. resignations, simple discharge,

dismissal and retirements.
5. Determining training requirements for management’s development
and organizational development.
Major activities of manpower planning
1. Forecasting future manpower requirements
2. Inventorying, present manpower resources and analyzing the degree
to which these resources are employed optimally.
3. Anticipating manpower problem by projecting present resources
into the future and comparing them with forecast of requirement of
requirement to determine their adequacy, both quantitatively, and
qualitatively
4. Planning the necessary program, recruitment, selection, training,
development, motivation and compensation, so that future manpower
requirements will be met.
Steps of manpower planning:
1. Scrutiny of present personnel strength
2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions
Recruitment
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Definitions of recruitment.
Recruitment means searching finding and recruiting the best talent
for an open job vacancy within the organization in specific time and
cost.”
Purpose of Recruitment.
 The process is important to encourage and attract candidates
and get ample amount of application for the job vacancies.
 It is very important step of planning and analysis about the
present and future manpower requirement of the organization.
 It helps to improve the selection process by proper sorting of
suitable candidate for the job.
 It reduces the turnover of employees due to correct matching
of candidate expectations and the rewards offered by the
organization.
Factors influencing recruitment
 Size of the organization
 Salary structure
 Work culture and working condition within the organization
 The growth rate of the organization
What is Recruitment Process in HRM?
 The recruitment process is the most important function of
HRM department. The Human Resource
 Manager use different tactics to reach the potential candidate.
The recruitment method used to
 contact the candidates differs based on the source of
recruitment.
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 The Recruitment In-charge often does the job analysis to find

out the skills and ability to perform
 the job. Once the skills and abilities required are clear they start
searching for people with such
 specialties. The HRM department explains the potential
candidate about their job profile and the
 benefits (rewards) they can gain from the organization. The
candidates interested in the job are
 further screened, interviewed by HR and finally best fit
candidates are selected for the job. In short,
A good hiring process involves the following:

1. Identify the Recruitment Needs through Job analysis
2. Recruitment or Manpower Planning
3. Writing or Creating a Right Job Description
4. Advertisement for Open Job Vacancies
5. Screening of Job Applications
6. Initial Short- Listing of the Candidates
7. Conducting Interviews
8. Assessment of the Applicant
9. Reference / Background Check
10. Issuance of Job Offer Letter
11. Joining & On-boarding
Recruitment methods
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There are three significant methods of recruitment which are regularly

used in the corporate world namely:
1. Direct Recruitment Methods
2. Indirect Recruitment Methods
3. Third Party Recruitment Methods
The major difference between direct and indirect method of
recruitment is that the organization send a representative to contact
the potential candidate (which means direct contact) in the case of
direct recruitment method while in the case of indirect recruitment
methods the candidates are informed about job vacancy through
different channel of advertisement.
1. Direct Recruitment Methods:
-The campus recruitment is a major part of recruitment carried out
using direct method. The organization sends a representative from
HRM department in educational institutes to interact with potential
candidates.
- The candidates who are seeking for jobs are explained about the job
vacancy in the organization and the skills which are required to
perform the job. The representative interacts with the candidates with
the help of placement cells of the institutions. A briefing session is
conducted before the actual screening and interview process.
- The Organization (Employer) gets information about the academic
records of the candidates through the placement cell.
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- Once the organization is ensured about the presence of excellent

working skills in the candidate the Human Resourse
- Representative is sent to the institution to conduct recruitment
process.
- The organization use various recruitment methods like conducting
seminars, participating in conventions, job fair to recruit the
candidates using direct method. Through this method the candidates
from the academic background of engineering, management and
medical science are mostly recruited by the organization.
- career days in several institutions and nursing schools during annual
career days’ programs.
1. Printed brochures distributed for senior students about
employment opportunities by an agency nurse.
2. Or each recruiter describes the organization, its purpose,
opportunities and answer all questions e.g. salary, job responsibility,
authority, in-service-education, and promotion.
- Conducting education programs While new nurses attending a
program can be given opportunities before the program, between
group discussions, during lunch. It is done to attract outside nurses
during attending the course.
2. Indirect Recruitment Methods:
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- In the indirect method of recruitment the organization use the

advertisement channel such as newspapers, radio, job sites, radio,
television, magazines and professional journals to reach the potential
candidates.
- The advertisement provides information about the job requirement,
the range of salary offered, the type of job (full time or part time) and
job location. The candidates who are interested in the job apply for it
and share their resume with the organization.
- Recruitment Literature It is a small printed brochure distributed
among different position and applicants with salary and benefits in
order to be familiar with the institution. The Human Resource
Management (HRM) Department of an organization uses indirect
method of recruitment in three situations:
- When organization doesn’t have a suitable employee who can be
promoted to perform the higher position jobs. o When the
organization is new to the work territory and want to reach out new
talent in the market o This method is often used to fill up the vacancy
in scientific, technical and professional department. To fill up the
higher position in the organization the widely dispersed advertisement
is very useful as it helps the company to reach various suitable
candidates.
3. Third Party Recruitment Methods:
- The third party method of recruitment includes the helping hands
which are outside the organization.
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- The Recruitment Consultant or Employment Agencies, Search &

Select Companies, Employee Referral, Voluntary Organization, Data
Banks, Trade Unions and Labor Contractors are different channels
which help the organization to establish contact with the potential
candidates.
- Employee Recommendation This method can be very effective, but
it can lead to hiring of friends and relatives of current work-force.
This practice may decrease equal opportunity employment
- Open house
◼ Health institution send invitations to nurses to mention:
◼ activities of the institution
◼ general characteristics
◼ ask for group tours to department
Strategy for Targeting Best Candidates for Recruitment

The recruitment procedure can be powerful if the organization totally
understands what sort of organization required which will be helpful
for the organization. This covers the following parameters as well:
o Performance Level Needed: Different strategies required for
focusing on hiring high performing candidates and average
performing candidates.
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o Experience Level Needed: The Planning should be clear as to what

is the experience level required by the organization. The Applicant's
experience can range from being a fresher to experienced
professionals.
o Category of the Applicant: Applicant can be from the same
industry, or Either from other industry, unemployed, top performers
of the industry etc.
Manpower forecasting: -
The process is as follows:
1. Receive employee indent from line staff which contains vacant
positions, tenure of employment, salary offered, etc.
2. Check the indent against the allotted posts of each department.
3. Check financial implications for proposed recruitment.
4. Find out whether the recruitment is within the budgetary sanctions of
the concerned departments.
5. Authorize the proposed recruitment with job specifications and salary
details.
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(3)
Motivation
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Goal:
To empower participants with knowledge, skills and positive attitude
toward Motivation in human relation.
Objectives:
At the end of this lecture, candidates should be able to;-
Identify motivation and its types.
Recognize importance of motivation.
List motivation factors.
Understand the strategies for creating motivational climate.
Discuss types of motivation theories.
Apply motivation theories indifferent situation.
Have positive attitude toward motivation
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Outlines:
 Introduction.
 Definition of Motivation.
 Importance of motivation.
 Nature and characteristics of motivation.
 Types of Motivation.
 Motivation factors.
 Strategies to create a motivating climate
 Application of motivation
 Types of motivation theories
Content Theories:
> Hierarchy of needs theory
> ERG theory
> Two-factor theory
> Acquired needs theory
Process theories
> Equity theory.
> Expectancy theory.
> Goal-setting theory.
> Reinforcement theory.
 Application of Maslow’s Hierarchy of Needs theory at A.H
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Introduction
Motivation Energize people to act and move you from a resting state
to an active state. Motivation refers to the initiation, direction, intensity
and persistence of human behavior. Motivation: It is the process by
which a person’s efforts are energized, directed and sustained
towards attaining a goal. Motivation may be intrinsic which animated
by personal enjoyment and interest or extrinsic which is governed by
reinforcement.
Definition of Motivation:
Motivation is a process of stimulating people to action to
accomplish desired goals.
Motivation is the process by which a person’s efforts are
energized, directed and sustained towards attaining a goal.
Nature and characteristics of motivation
1-Continuous process: It is unending process
2-component of direction: Responsibility of manager to motivate their
subordinates
3-Psychological aspect: It is internal feeling. It generates with an
individual. EX a word of appreciation
4-Goal directed. It generates goal directed behavior
Importance of motivation:
1-Enhance cognitive processing.
2-Improve performance and productivity.
3-Increased effort and energy.
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4-Improves efficiency with which the job is done.

5-Reduces absenteeism.
6-Improves good communication between employees.
7-Increases interpersonal relationship between manager and
employees.
8-Improves job satisfaction, self-esteem and creativity
Types of Motivation:
1.Intrinsic motivation:
Is a type of motivation in which an individual is being motivated
by internal desires. Ex independence
Social status
Acceptance
Social contact
2.Extrinsic motivation:
Is a type of motivation in which an individual is being motivated
by external desires and it is external in nature.
Ex; Employee of the month award
Motivation by external rewards or punishment: Pay, Promotion,
Feedback, Work condition. Things that come from a person’s
environment, controlled by others.
Motivation factors:
1)Level of education
2)Adequate training
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3)Inadequate resources
4)Physical state
5)Job security
6)Supervisor support
7)Manageable workload
8)Salary
9)Career growth
10) Compensation
11)Culture factors and attitude.
Strategies to create a motivating climate:
1.Have clear expectations for workers and communicate these
expectations effectively.
2.Be fair and consistent when dealing with all employees.
3.Be a firm decision maker using an appropriate decision-making
style.
4.Develop the concept of teamwork, develop group goals and projects
that will build a team spirit
5-Create a trustful and helping relationship with employees.
6- When appropriate, request participation and input from all
subordinates in decision-making.
7 -Create tasks that are beneficial to the company.
9- Hire top performers.
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10-Show appreciation and Set goals.

11- Display confidence. Motivation comes from caring, not scaring
Application of motivation in health care organization:
Strategies to Motivate Staff Nurses
1.Listen –
This is an easy one: Just listen. To employees’ ideas for job
improvement… or their problems, conflicts, kids’ issues, parents’
issues, – you name it, I’ve heard it.
2.Using Strengths:
- Taking advantages of your staff’s strengths can help your nurses feel
more confident and accomplished and can increase the efficiency of
your entire unit.
3. Communicating Often:
-It can be difficult to keep everyone informed about clinical updates,
policy changes, and other job-related news, particularly if nurses work
on different shifts.
-While the most important information is conveyed during shift change
meetings, you may find that there is not enough time to cover topics
unrelated to patient care during these meetings.
Using email and texts can help inform staff members of pressing issues
4. Set up Mutual Understanding
- Understanding the other person's point of view, experience and work
processes, eases frustration and develops cooperation teamwork and
problem-solving
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▪ Strategies to Motivate head nurse:

1.Encourage head nurse to have a sense of ownership in their work and
their work environment.
2.Use performance as the basis for recognizing, rewarding, and
motivating head nurse.
3.Sharing the celebrate successes of the hospital, the department, and
the individuals in it.
4.Involve head nurse in decisions, especially those decisions that
directly affect them.
5.Manager should thank head nurse for his/ her good performance.
6.Encourage independence
7.respect the personal live
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Types of motivation theories:
A. Content theories:
- Human needs and how people with different work situations.
Types of content theories (Needs theories):

1- Hierarchy of needs theory
2- ERG theory
3- Two-factor theory
4- Acquired needs theory
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1- Hierarchy of needs theory:

Developed by Abraham Maslow in 1943-1950
Abraham Maslow postulated that a person will be motivated when his

needs are fulfilled. The need starts from the lowest level basic needs
and keeps moving up as a lower level need is fulfilled.
Below is the hierarchy of needs:
Physiological: Physical survival necessities such as food, water, and

shelter.
• Safety: Protection from threats, deprivation, and other dangers.
• Social (belongingness and love): The need for association,
affiliation, friendship, and so on.
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• Self-esteem: The need for respect and recognition.

• Self-actualization: The opportunity for personal development,
learning, and fun/creative/challenging work. Self-actualization is the
highest level need to which a human being can aspire. Individual
differences.
2- ERG theory:
Developed by Clayton Alderfer 1969.
Three need levels:
1. Existence needs: desires for physiological and material well-
being.
2. Relatedness needs: desires for satisfying interpersonal
relationships.
3. Growth needs: desires for continued psychological growth and
development.
3- Herzberg’s two-factor theory:

Developed by Frederick Herzberg (1959).
It proposes that there are two different categories of needs that are
independent and affect behavior hygiene and motivators.
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Herzberg’s model can be used to identify broad issues that need to be

addressed or mitigated in general.
• For example, in an environment where employees are unsure of their
job security, managers can try to mitigate the demotivating effect by
reassuring employees about the situation.
4- Acquired Needs Theory:

Developed by David McClelland 1961.
People acquire needs through their life experiences.
Needs that are acquired:
1. Need for Achievement: Desire to do something better or more
efficiently to solve problems or complex tasks.
2. Need for Power: Desire to control other persons, to influence their
behavior or other people.
3-Need for Affiliation:
Desire to establish and maintain friendly and warm relations with other
persons
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B- Process theories:
Choices are based on:
1. Individual preferences.
2. Available rewards.
3. Possible workout comes
Types of process theories:
1. Equity theory.
2. Expectancy theory.
3. Goal-setting theory.
4- Reinforcement theory
1- Equity theory:
Equity Theory is based on the idea that individuals are motivated by

fairness.
Equity theory states that if an individual identifies an inequity between
themselves and a peer, they will adjust the work they do to make the
situation fair in their eyes. As an example of equity theory, if an
employee learns that a peer doing exactly the same job as them is
earning more money, then they may choose to do less work.
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2. Expectancy theory:
It is developed by Victor Vroom (1964).
Key expectancy theory variables:
•Expectancy: belief that working hard will result in desired level of
performance.
•Instrumentality: belief that successful performance will be followed
by rewards.
•Valence: value a person assigns to rewards and other work related
outcomes. creating fairness in their eyes.
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To maximize expectancy, managers should:

• Select workers with ability.
• Train workers to usability.
• Support work efforts.
• Clarify performance goals.
To maximize instrumentality, managers should:
• Clarify psychological contracts.
• Communicate performance-out come possibilities.
• Identify rewards that are contingent on performance.
To maximize valence in a positive direction, managers should:
• Identify individual needs.
• Adjust rewards to match individual need.
3- Goal-setting theory:
It is developed in 1960 by Edwin Locke. Motivational effects of task
goals:
• Provide direction to people in their work.
• Clarify performance expectations.
• Establish a frame of reference for feedback.
• Provide a foundation for behavioral self-management.
Key principles in the goal-setting process:
• Set specific goals.
• Set challenging goals.
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• Build goal acceptance and commitment.

• Clarify goal priorities.
• Provide feedback on goal accomplishment.
• Reward goal accomplishment.
4. Reinforcement theory:
It is developedin1957 by B.F. Skinner.
The reinforcement may be positive or negative.
Positive reinforcement: Issued for express purpose of increasing a
desired behavior
Negative reinforcement: Is used for inhibit an undesirable behavior.
Punishment is a common technique to eliminate the negative
enforcement.
Guidelines for using positive reinforcement:
• Clearly identify desired work behaviors.
• Inform every one about what must be done to get rewards.
• Recognize individual differences when allocating rewards.
• Follow the laws of immediate and contingent reinforcement
• Guidelines for using punishment:
• Tell the person what is being done wrong.
• Tell the person what is being done right.
• Match the punishment to the behavior.
• Administer punishment in private.
• Ethical issues in reinforcement:
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• Ignores individuality.
• Restricts freedom of choice.
Application of Maslow’s Hierarchy of Needs theory at A.H:

Vision:
We strive to become the pioneers of health care providers in the Middle
East a before 2020, affordable prices and a global service.
Mission:
Commitment to provide care elements for the tertiary level:
- Special skilled doctors.
- Nursing instructor committed to care systems.
- Technicians who are able to deal with and benefit from modern
technology.
- Support services and management of modern systems.
- Information Systems (Medical-Clinical-Financial-Administrative-

Operational).
- Total Quality Systems.
- Organization structure
-
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1. Physiological Needs:
•Eat: staff nurse will provide meal who spend more than 8 hours in
hospital.
•Drink: There is cafeteria for drinking hot and cold fluids for staff
nurse during shift.
•Sleep: hospital provides spaces and rooms for staff nurse spending
24hours in hospital.
•Housing and living: Provide a good monthly salary sufficient for
good life.
2. Security needs:
I. Economic:
• Wages and salaries: hospital provide good salary scale for nursing
staff.
• Fringe benefits: that every hour spending in work after shift, end
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will calculate as overtime in salary. Provide bonuses money for

working in vocation days and additional day
• Medical benefits: hospital provide medical treatment free for
nursing staff
• Childcare: provide 4 months Paid Payroll for labor and Child Care.
II. Psychological
• Before changing a transferor in hospital system, meeting will occur
with staff nurse.
• Solve staff nurse’s problems: employee problems will resolve
actually by his\her supervisor, director, human resources and
managing director.
III. Physical:
• Working conditions: hospital provides good working condition free
from hazards.
• Heating and ventilation: there are central air-conditioning and good
system for ventilation and elimination of heating.
3. Belonging Needs:
Encourage social interaction through:
• Scheduled weekly project team meeting. .
•Create team spirit by meeting with supervisor of unite.
• Facilitate outside social activities by arranging travels and trips for
half of price for nursing staff
• Allow participation indeed potent plan and provide her suggestions.
IV. Self-Esteem Needs:
Design challenging jobs through:
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• Use praise and awards as monthly ideal staff and for good things.
• Give training and accredited course through education team for ideal
staff
V. Self-Actualization Needs:
• Providing opportunity for Continuing education for development
post graduate to get another courses
•Encourage creativity as encourage him to participate in problem
solving of unite
• Give opportunity to grow and self-development.
• Reward with educational opportunity
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(4)
Performance Appraisal
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Goal
To Provide the Participants with Knowledge Skills and

Positive Attitude toward performance appraisal
Objective
At the end of this lecture the participant will be able to
1- Define the performance appraisal
2- Benefits of giving positive and constructive feedback
performance appraisal
3-Purpose of performance appraisal
4- Smart criteria of performance appraisal
5- Types of performance appraisals
6- The principals of effective performance appraisal
7- The steps process of performance appraisal
8- Performance appraisal methods
9- Standards for performance appraisal
10- Application
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Out line
1-Define the performance appraisal

2- Benefits of Performance Appraisal
2- Purpose of performance appraisal
4- Criteria of performance appraisal
5- Types of performance appraisals
6- The principals of effective performance appraisal
7- Standards for Performance Appraisal
8- The Steps Process of Performance Appraisal
9- Performance Appraisal Methods
10- Application
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Introduction
Performance appraisals often have formal designs by human resource
departments and company leadership to guide employee performance.
This often includes a schedule and specific requirements for
employees, their managers, peers or others for assessing performance
to determine goals and development
Definition
A performance appraisal, or annual review, is an evaluation of an
employee's work performance and contribution to department over a
designated period. This systematic process assesses an individual
based on determined set of criteria. It looks at factors such as an
employee's attitude, work ethic, attendance and mastery of their role.
Typically, a Supervisor or manager conducts the performance
appraisal once a year.
Benefits of giving positive and constructive
feedback performance appraisal
 Clarify expectations; assure the individual is on the right track
 Assess and discuss the relevance of goals and their measures
 Improve communication between individuals, particularly
supervisor and employee
 Opportunity to learn about ourselves and how we interact with
others
 Opportunity to develop ourselves and be the best we can be
 Assist in making “early corrections”
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Purpose of performance appraisal.

Performance appraisal can be done with following objectives in
mind:
1. To maintain records in order to determine compensation packages,
wage structure, salaries raise, etc.
2. To identify the strengths and weaknesses of employees to place right
men on right job.
3. To maintain and assess the potential present in a person for further
growth and development.
4. To provide feedback to employees regarding their performance and
related status.
5. It serves as a basis for influencing working habits of the employees.
6. To review and retain the promotional and other training
programmer.
7. To improve communication between supervisors and employee, and
to reach an understanding on the objectives of the job.
8. To earmark candidates for supervisory a management development
9. To help the organization determine if it is meeting, is goals.
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Good performance appraisal goals meet the following smart criteria

That the supervisor and the employee may develop for the next
evaluation period to Identify as many as you need, but make sure the
workload is realistic.
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S = Specific
State clearly what is to be accomplished in concrete terms that can be
easily observed and mutually understood.
M = Measurable
Objectives should be quantifiable, stating exactly what the criteria for
success is, how that success will be tracked and measured, and whether
the measurement tools are available.
A = Attainable
Can the result be realistically achieved? (Is the process used workable
and within the employee’s control
Are the needed resources available? Is the time frame reasonable?
R = Realistic
Based upon the employee’s knowledge of the job, the objective should
be linked vertically to the organization’s goals, as well as being
difficult, yet feasible.
T = Time Bound
Each objective should have a clearly defined time frame.
Studies have shown that good planning gets good results. Following
are several alternative methods to develop performance goals:
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Types of performance appraisals

1. Negotiated appraisal
Negotiated appraisals involve the use of a mediator during
the employee evaluation. Here, the reviewer shares what the employee
is doing well before sharing any criticisms. This type of evaluation is
helpful for situations where the employee and manager might
experience tension or disagreement.
2. Self-appraisal
A self-appraisal is an employee reflects on their personal performance.
so, identify their strengths and weaknesses. This type of appraisal
usually involves filling out a form, and manager may choose to follow
up on this written self-assessment with a one-on-one meeting.
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3. Peer reviews
This type of performance appraisal can help assess whether an
individual works well with teams and contributes to their share of
work.
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4. Client reviews
Client reviews occur when those who use a company's product or
service provide an evaluation. This provides the company with
feedback on how others perceive the employee and their organization.
Using this type of appraisal can help you improve both employee
performances and customer interactions.
The principal of effective performance appraisal are: -

• Performance appraisal must be based upon job description for the
position.
• Adequate & representative sampling of nurse's behaviors should
be observed in the process of evaluating her performance.
• The employee should be evaluated by his/her superior in line
organization structure.
• The performance appraisal must be focus on areas of strength &
weakness in the individual to improve performance.
• Nurses who are involved in the appraisal process consistently
perform better and are more satisfied.
• Performance appraisal should focus on the employee behavior
and results rather than personal traits.
• Appraisal should be written& carried out at least once a year.
Standards for performance appraisal
1. Job analysis: It is the procedure for determining the duties and
skill requirements of a job and the kind of person who should be
hired for it
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2. Job description: It is a written report outlining duties,

responsibilities and conditions of the work assignment. It is a
description of job and not of the person who happens to hold the
job
3. Job evaluation: It is the process of analyzing and assessing the
various jobs systematically to ascertain their relative worth in an
organization.
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Process of performance appraisal

There are six steps involved in the process of performance appraisal:
 1-Establishing Performance Standards:
 Is the setting up of the standards which will be used to compare
the actual performance of the employees against the standards set.
The standards set should be clear, easily understandable and
measurable.
 2-Communicating the Standards:
 Once performance standards are set, it is the responsibility of the
management to communicate the standards to all the employees

of the Organization. The employees should be informed and the
standards should be clearly explained to the employees. This will
help them to understand their roles and to know what exactly is
expected from them
3- Measuring the Actual Performance:

 It is a continuous process which involves monitoring the
performance throughout the year
 4-Comparing the Actual with the Desired Performance:
 The actual performance is compared with the desired or the
standard performance. The comparison tells the deviations in the
performance of the employees from the standards set. The result
can show the actual performance being more than the desired
performance
 5-Discussing Results:
 The result of the appraisal is communicated and discussed with
the employees on one-to-one basis. The results, the problems and
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the possible solutions are discussed with the aim of problem

solving and reaching consensus. The feedback should be given
with a positive attitude as this can have an effect on the
employees’ future performance. The purpose of the meeting
should be to solve the problems faced and motivate the employees
to perform better
 6-Decision Making:
 The last step of the process is to take decisions which can be
taken either to improve the performance of the employees, take
the required corrective actions, or the related HR decisions like
rewards, promotions, demotions, transfers etc.
Performance appraisal methods

There are different methods for evaluating an employee’s performance
and theses methods are broadly classified as traditional and modern
methods of performance appraisal
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Traditional method
1- Ranking Method:
In this, the superior ranks his or her subordinates in the order of their
merit, starting from the best to the worst. It is the simplest and old
method of merit rating.
2- Paired Comparison Method:
The paired comparison method is almost similar to ranking method.
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When variations are made in the ranking method so that it can easily
be used in large groups, it becomes paired comparison method. In
paired comparison method, every person is compared trait wise with
the other persons one at a time. The number of times one person is
compared with others is tallied on a piece of paper. With the help of
these numbers, ranks are allotted to the employees.
3- Grading System:
In this method, certain characteristics or abilities of performance are
identified in advance and the employees are put into the category
according to their behavior and traits. Such categories are defined as
outstanding, good, average, below average, and poor in terms of
letters like A, B,C,D,E where A indicates the best, and E the poorest.
4- Forced Distribution Method:
Raters sometimes suffer from a constant error i.e., either they rate
the employees as good, average, or poor. They do not evaluate the
employees properly. This system minimizes the rater’s bias so that
all employees are not similarly rated. In this method, the appraiser
is forced to appraise the appraises according to the pattern of the
normal curve. This system is based on the assumption that
outstanding, above average, average, below average, and poor
5- Checklist Method:
Under this method, a checklist of statements on the traits of the
employees and his or her job is prepared in two columns – viz. a
‘Yes’ column and a ‘No’ column. It is a list of statements that
indicate the performance of the employees on the job. All that the
rater has to do is to tick ‘Yes’ column if the answer to the statement
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is positive and column ‘No’ if the answer is negative. The

performance of the employee is rated on the basis of the number of
positive checks.
6- Essay Method:
This method requires the appraiser to compose a statement that best
describes the employee being appraised. The appraiser is usually
instructed to describe the employee’s strengths and weaknesses and
to make recommendations for his or her development. Essay method
is often used in combination with some other rating method. Here,
the supervisor continuously watches the subordinates and writes his
assessment in the report
Modern methods
1. Management by Objective (MBO)
MBO does not comprise of feedbacks and thus it is less time-
consuming. Rather management by objective focuses on self-
introspection by the employee as the employee is well aware of
the standards which are taken into consideration while evaluating
performance.
2. 360-Degree Feedback Method
This method of performance appraisal is very useful for startups
as it involves collecting feedback from each and every individual
who interacts with the employee during the course of work. These
individuals could be customer or friends or supervisors of the
employee.
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3. Assessment Centered Method

This method of evaluation is basically used by the organization for
evaluating managers who are subsequently going to deal with their
juniors. The assessment-based method judges the employee as per
the different situations and analyses their overall behavior like
acceptability, openness, tolerance towards fellow employees and
certain situations, etc. and performance. It includes various kinds
of business games like big basket games etc. to assess the
performance of the employee. Thus this method is best to evaluate
the performance of the employees at a senior level.
4. Behaviorally Anchored Rating Scale Method
This method has been recognized as the most effective
performance appraisal methods and gives the most precise result.
It is the combination of essay evaluation method and rating scale
method which makes it a bit expensive performance appraisal
method, however, it assures the best results. In this method of
performance appraisal, the employee is anchored as a good,
average or poor employee based on the overall performance and
behavior evaluation.
5. Critical Incident Method
This is a pretty lengthy and time-consuming method of
performance appraisal although it is very effective. As per this
approach of performance appraisals the manager documents all the
incidents of statements and behavior of the employee and
maintains a log of such incidents which are critical or displays the
ineffective behavior of the employee and the performance rating of
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the employee is done on the basis of such recorded incidents after

a discussion with the employee.
Application job Performance appraisal
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(5)
Risk Management in
Education and Hospital
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Goal:
To provide participants knowledge, skills, positive attitude toward
Risk management.
Objectives:
At the end of this lecture the participant will be able
to:
1) Define the risk, hazards and risk management
2) Explain Benefits of Risk Management.
3) Recognize scope of Risk management
4) Recognize steps of risk management process
5) list Roles for Risk Manager
6) Apply Risk Management Tools & Techniques
7) List Challenges to implement risk management
8)Application
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Out lines:
1) Definition of risk & hazards
2) Definition of risk management.
3) Benefits of Risk Management.
4) scope of Risk management
5) Steps of risk management process
6) Roles for Risk Manager
7) The Risk Management Tools & Techniques
8) Challenges of Risk Management
9) Application
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 Definition of risk
Risk is the chance or probability that a person will be harmed or
experience an adverse health effect if exposed to a hazard.
 Definition of hazard:
A hazard is any object, situation, or behavior that has the potential to
cause injury, ill health, or damage to property or the environment
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 Definition of risk management:

is the process of identifying, assessing and controlling threats to an
organization's capital and earnings?
Risk management in its best form may be to use it in a pro-active
manner in identifying and managing the risks. However, in case an
incident has happened; after the event handling, it should still be
tackled in line with the risk management principles as outlined here.
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 Benefits of Risk Management:

 Establish procedures to avoid potential threats and minimize their
impact should they occur and cope with the results.
 Confident in business decisions because organizations understand
the associated risks and how to prevent them.
 Corporate governance principles that focus specifically on risk
management can help a company reach their goals.
 Creates a safe and secure work environment for both staff as well
as customers.
 Decreases legal liability while increasing stability of business
operations.
 Protection from detrimental events.
 Helps establish a solid insurance plan and identify insurance needs
for protection but also to save on insurance premiums.
 Scope of the Risk Management:

 Clinical and patient safety
 Strategic
 Financial
 Human capital
 Legal and regulation
 Technological
 Environmental and infrastructure based hazards
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 Five Basic Steps of Risk Management
Step1: Identify risks

Identify Risks: Risk identification is the process whereby the
healthcare professional and the healthcare employees become aware of
the risks in the health care services and environment. The risks
identified are entered in the Risk Management Tool (RMT, also
sometimes known as the Risk Register.
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Sources of risk identification

A. Discussions with department chiefs, managers and staff
B. Patient Tracer Activity (Tracing the journey of a patient from
admission till discharge)
C. Retrospective screening of patient records
D. Reports of accreditation bodies
E. Incident reporting system & sentinel events
F. Healthcare associated infections (HAI) reports
G. Executive committee reports
H. Facility management & safety committee report
I-Patient complaints and satisfaction survey results
j. Specialized committee reports (such as Morbidity and mortality
committee, medication management and use, Infection control, blood
utilization, facility management and safety committee).
Step 2: Analyze risks
Risk analysis is about developing an understanding of the risks
identified.
It includes the following:
a. Level of the risk or Risk score
b. Underlying causes
c. Existing control measures
Existing controls: When examining the existing control measures,
consideration should be given to their adequacy, method of
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implementation and level of effectiveness in minimizing risk to the

lowest reasonably practicable level. These include all measures put in
place to eliminate or reduce the risk and may include: Policies,
procedures, protocols, guidelines & Alarms and beeps & Engineering
controls& Trainings &Emergency arrangements k. Preventative
maintenance controls Root Cause Analysis (RCA) represents a
systematic approach to identifying the underlying causes of adverse
occurrences
Step 3: Evaluate risks
The purpose of risk evaluation is to prioritize the risks based on risk
analysis score and to decide which risks require treatment and the
mode of treatment. Risk evaluation can be classified as
Accepting the Risk: Accepting a risk does not imply that the risk is
insignificant. Risks in a service may be accepted for a number of
reasons: The level of the risk is so low that specific treatment is not
appropriate within available resources. The risk is such that no
treatment option is available.
Step 4: Treat/Manage Risks (Also known as Risk reduction, Risk
mitigation):
The decisions in risk treatment should be consistent with the defined
internal, external and risk management contexts and taking account of
the service objectives and goals.
Risk treatment plan should have:
• Proposed actions
• Resource requirements
• Person/s responsible for action
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• Timeframes (Dates for actions to be completed and date for review.)

Step 5: Monitor and Review the Risk
Unfortunately, there are some risks that cannot be completely
eliminated and risk management isn't something that has a start and
finish, or end result.
It is an ongoing process within an organization that is constantly
changing.
The organization, its environment, and its risks are constantly
changing, so the process should be consistently revisited.
If an organization gradually formalizes its risk management process
and develops a risk culture, it will become more resilient and adaptable
in the face of change
 Roles for Risk Manager

1. Identify financial, safety or security risks that the client company
or organization may face
2. Prepare action plans to decrease risk factors
3. Gather confidential financial information from client such as
income, assets and debts
4. Manage company insurance policies
5. Perform risk evaluation, which assesses the way the company
previously handled risks
6. Make risk-avoiding adjustments to current methods of operation
in order to minimize their future risks
7. Prepare a risk-management budget-
8. Provide training and certification for organization staff so that
they can be aware of risks and try to avoid them.
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Risk Management Techniques and Tools

1. Brainstorming
2. Perform Root Cause Analysis
3. FMEA tool
4. Fishbone Diagrams
5-Risk Register
6. Probability and Impact Matrix
7- Risk Assessment Template
1. Brainstorming
The purpose of brainstorming is simply to come up with as many ideas
as possible, including “crazy ideas,” about possible causes for the
event being analyzed.
The steps are:
1. Acquire a whiteboard or flip chart to record ideas.
2. Open the floor to participants for launching ideas,
encouraging everyone to participate.
3. Write down every idea launched, using the same
wording as the original proposition.
4. Do not discuss, criticize, or evaluate ideas during the session.
5. Allow the flow of ideas to stagnate once because it will
usually pick up again; close the process when few
new ideas emerge.
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6. Evaluate ideas by sorting them into groups of decreasing

relevance
2. Perform Root Cause Analysis
The root cause analysis (RCA) process takes a retrospective look at
adverse outcomes and determines what happened, why it happened,
and what an organization can do to prevent the situation from
recurring.
 A tool called a fishbone diagram (or Ishikawa) may help display
the process of identifying contributing factor categories.
 Some organizations use the RCA only to determine causes of
sentinel events and adverse drug events and not with incidents of
near misses
 5 WHYS
Begin with a specific problem.
What is it that you are having an issue with? This can also help
the team focus on the same problem.
Ask why the problem happened and write the answer down below
the specific problem you listed in step one.
Keep asking “why” to each of the successive answers you write
down until you reach the root cause of the problem.
Again, this may take more or less than five “why’s. Make sure
your team sees eye-to-eye with each of the questions being
answered as well as the final root cause.
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3-Failure Mode and Effect Analysis (FMEA tool)

FMEA tool is a proactive, preventive approach to identify potential
failures and opportunities for error.
The Healthcare Failure Mode Effect Analysis (HFMEA) to use in the
healthcare industry.
There are six main steps to conducting the HFMEA:
1. Determine a process or topic to study.
2. Convene a multidisciplinary team with process or content experts.
3. Develop a flow diagram that clearly identifies each step of the
process and steps of any sub processes.
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4. Brainstorm possible reasons the process may fail and rate each
step using a Likert scale with a severity number and probability
of failure .
5. team determines appropriate actions to take to eliminate the
failure and redesign the process.
6. the team identifies outcome measures to test the redesigned
process
4-Fishbone Diagrams
The fishbone diagram is a tool used to understand relation-ships
between a problem or event and its causes .It is a technique that aids
brainstorming.
The approach follows these steps:
1. Using a whiteboard or similar surface, place the event at the right
end of a large arrow.
2. Identify main categories of causes and write them on
lines branching off from the large arrow.
3. Proceed through the chart, one main category at a
time, and brainstorm all possible causes, placing them
on the relevant branches.
4. Use brief and succinct descriptions of causes. Write causes that
belong to more than one category on all relevant branches.
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5-Risk Register
A risk register or a risk log is a document that is used to identify risks
that may affect businesses. It documents, tracks, and monitors any
potential risks and takes the right measures and actions to prevent and
correct them.
Creating a risk register is an important part of risk management as it
allows you to prioritize your risks, assign an owner or team member to
resolve them, and add notes and updates as and when it is needed. It’s
a great way to control the risks in a project.
With a risk register in hand, you can gather data on risks and find
ways to proactively respond to them if they show up in the project. It
also ensures that you don’t fall behind on your schedule or go over
your budget.
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6. Probability and Impact Matrix

Project managers can also use the probability and impact matrix to help
in prioritizing risks based on the impact they will have. It helps with
resource allocation for risk management. This technique is a
combination of the probability scores and impact scores of individual
risks. After all the calculations are over, the risks are ranked based on
how serious they are. This technique helps put the risk in context with
the project and helps in creating plans for mitigating it
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7- Risk Assessment Template

A risk assessment template is a risk management tool that provide a
numbered listing of all the risks in one place so that risk tracking and
project execution become easier.
You can create your risk assessment template in a spreadsheet so that
its built-in calculator can provide you with figures and probabilities of
risks and the impact they can have on your project or organization.
This helps you stay informed about the potential harm a risk can cause
and the likelihood of it occurring again.
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 Challenges of Risk Management:

1. How much information is needed?
2. Under reporting: It’s hard when you make a mistake, and even
harder when you’re forced to admit them.
3. Lack of right decision making skills
4. Lack of meaningful risk assessment
5. Lack of risk aware culture through the organization
6. Insufficient management commitment and support
7. The data required is not readily available.
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Application
Life threatening CASES, reach ER at 1:30 am, central line was inserted
through femoral vein Patient transfer to ICU after 30 min. In the third
day, he become febrile and BP were low.
Supervisor ICU Called infection control department to ask about this
case, infection control office asked laboratory made blood culture to
identify pathogen
Lab answer its staphylococcus aureus pathogen and not its infection
pathogen
Infection control office sent email for risk assessment manager told
them about infection, risk management
Officer sent email to emergency multidisplinary meeting, invited for
meeting
ER Manager and ER Nursing supervisor, ICU manger, nursing
supervisor, hospital matron, and infection control officer.
In meeting
First risk management officer welcomed for present person and
introduce short not about cause of meeting then infection control
officer talked about pathogen and method of translation after that
cooperative to make root cause analysis to identify cause of
infection according scientifically method and evidence based
CBC& IPC reference
There agreed used root cause analysis method to use to
determined what happened
1- ER department officer told pt came with ambulance with sever
bleeding doctor inserted center line through femoral vein
Patient after 30min transfer for icu infection control officer in
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these time asked icu nursing supervisor do you change center

line place she was answered no infection control officer told
here that was caused of problem according to evidence based
emergency center line or peripheral vein should be change
within 24 h.
2- Risk management officer called instructor office to
cooperative with infection control office to trained staff about
CLABSI.
3- Risk management and infection control created chick list for
CLABSI to prevent its rebated in the future
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(6)
Patient Safety
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Goal
To provide the participant with knowledge skills and positive attitude

towards patient safety.
Objective
At the end of the lecture the student will be able to:

 Identify safety and patient safety
 Important of patient safety
 Recognize international patient safety goals
 Illustrate principles of patient safety
 Discuss types of patient safety
 Know issues and barriers of patient safety
 Discuss tips for improving patient safety in organization
 Know role of nursing for patient safety
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Outlines:
 Definition of safety and patient safety.

 Importance of patient safety.
 International Patient Safety goals.
 Patient safety and security standards.
 Principals of patient safety.
 Types of patient safety.
 Issues and barriers of patient safety.
 Tips for improving patient safety in organization.
 Role of nursing for patient safety.
 Pt safety template.
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Introduction:
Patient Safety is a health care discipline that emerged with the
evolving complexity in health care systems and the resulting rise of
patient harm in health care facilities. It aims to prevent and reduce
risks, errors and harm that occur to patients during provision of health
care. A cornerstone of the discipline is continuous improvement
based on learning from errors and adverse events.
Patient safety is fundamental to delivering quality essential health
services. Indeed, there is a clear consensus that quality health services
across the world should be effective, safe and people-centred. In
addition, to realize the benefits of quality health care, health services
must be timely, equitable, integrated and efficient
To ensure successful implementation of patient safety strategies;
clear policies, leadership capacity, data to drive safety
improvements, skilled health care professionals and effective
involvement of patients in their care, are all needed.
What is safety?
(S) Sense the error.
(A) Act to prevent it.
(F) Follow safety guidelines.
(E) Enquire into accident/deaths.
(T) Take appropriate remedial measure.
(Y) Your Responsibility.
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Definition of Patient Safety:

Patient safety is the prevention of errors and adverse effects to patient
associated with health care.
Patient safety initiatives involve minimizing physical, mental, or
emotional harm, as well as safeguarding private patient information.
These initiatives may include protocols designed to prevent
accidents, neglect, or misdiagnoses that might inadvertently harm the
patient, as well as reporting issues that arise.
the Importance of Patient Safety
According to the latest scorecard report from the Agency for
Healthcare Research and Quality, improved patient safety procedures
contributed to a 13% decrease in hospital-acquired conditions, such
as injuries and infections, from 2014 to 2017. These procedures saved
20,700 lives and $7.7 billion in medical costs. These statistics
highlight the fundamental importance of patient safety.
1-Providing High-Quality Care
One of the primary benefits of patient safety efforts is that they yield
higher standards of clinical care. For example, safeguards against
misdiagnosis ensure that patients are treated for the correct
underlying condition; they help providers ensure they’re treating the
root illness, not just a peripheral symptom or side effect.
2-Preventing Risk
Patient safety programs help minimize preventable infections or
injuries.
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3-Patient Infections
Medical teams that have strict facility sterilization and sanitization
policies may see lower rates of patient infections, including pneumonia
or surgical site infections. Hand hygiene and patient
screening processes can also help reduce infection rates.
4-Patient Injuries
Nurses and physical therapists can rely on patient safety protocols to
keep patients from injuring themselves during rehabilitation, whether
by overexertion or by placing too much strain on an area still tender
from surgery. Even during brief walks around a hospital floor, patients
who are still weak may be prone to slipping and falling without proper
assistance.
5-Medication Errors
Medical facilities that enact medication management protocols can
help reduce drug errors, which can occur at prescribing and dispensing
stages and may result in additional patient interventions or serious
patient harm.
6-Protecting Sensitive Patient Information
Patient safety also involves informational safety. A primary goal of a
patient safety initiative is ensuring that all sensitive patient information
related to their medical history or finances is kept secure. This helps
save the patient from embarrassment, frustration, or financial loss, and
helps the organization guard against potential regulatory issues.
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7-Minimizing Costs
Patient safety errors cost medical organizations money. Providers may
have to expend additional resources and manpower to resolve injuries
or infections that could have been avoided. Meanwhile, significant
lapses in patient safety, including information breaches, may result in
costly patient lawsuits. Errors can also harm a facility’s quality ratings,
which could result in lower patient volumes or reduced reimbursement
rates. Patient safety protocols can reduce unnecessary expenses,
minimize legal risk, and improve a hospital’s reputation.
International patient Safety goals:
Goal 1: Identify patient correctly:

I D wrist band
Use at least 2 identifiers when providing care, treatment or services.
EX:
-use the patient name and medical number.
-Check identify patient before any process.
Do not identify patient by room number.
In situations where the identity of the patient is not known
(Unconscious patient
in A/E Department or Major Accident) special identity numbers are
used e.g.
-Unknown patient 123
Goal 2: Improve effective communication among care givers:

Report critical results of tests and diagnostic procedures on a timely
basis within 15 minutes.
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The reporting staff should inform the receiving practitioner clear

information and should document in the report (date, time, and
person).
Accurate , timely &complete nursing and physician endorsement per
shift.
Verbal order allowed only in critical situation: and should be write

down, read back and confirm.
Goal 3: Improve the safety of high-alert medications:

Label all medications, medication containers which include syringes,
medications cups and basins and other solutions as on and off the
sterile field.
Maintain and communicate accurate patient medication information.
Separation of high alert medication.
Proper labeling during storage, dispensing& preparation.
Red label color: high alert medication EX: insulin, heparin or
chemotherapy.
Blue: concentrated electrolytes.
Yellow: Look alike sound alike EX: (Zantac and Xanax) or
(Hydralazine and Hydroxyzine).
Green: sensitive medication.
Rights for medication administration:

Right patient name and MRN.
Right medication name.
Right dose.
Right rote.
Right time.
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Right patient education.

Right documentation.
Right to refuse
Right assessment.
Right evaluation.
Goal 4: Ensure safe surgery:

Ensure correct site, correct procedure, and correct patient surgery.
Wrong site, wrong procedure, wrong patient surgery is a common
occurrence in hospitals.
Causes of these errors:
Ineffective or inadequate communication between members of the
surgical team.
Lack of patient involvement in site marking, and lack of procedures
for verifying the operative site.
Inadequate patient assessment.
Inadequate medical record review.
Problems related to illegible handwriting the use of abbreviations.
How to apply:
1: Marking the surgical site includes:
 Draw non-washable arrow mark
 Do not use (x) mark.
 Surgical procedure site marking is done by the person performing
the procedure for the patient.
 A time-out that is held immediately before the Start of a
procedure.
 The hospital uses checklist or other process to document, before
procedure that the informed consent is appropriate to the
procedure ; that the correct site, correct procedure , and correct
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patient and medical technology needed are on hand , correct, and

functional .
 The full surgical team conducts and documents a time out
procedure in the area in which the surgery will be performed, just
before starting a surgical / invasive procedure. trend New
 The component of the time out includes correct patient
identification, correct side and correct procedure, and
confirmation that the verification process has been completed.
 Sign out after procedure / surgeries.
Goal5: Reduce the risk of health care-associated infections:

Health care associated infection (HALS) are Infections associated with
healthcare delivery in hospital, which are not present or incubating at
the time of admission to the hospital.
-The objective of the infection control program is the prevention or
reduction nosocomial infection among patient and prevention of the
hazards of the hazard of infection among hospital personal and visitor.
How to apply:
 Hand hygiene
Proper hand hygiene is the most important, simplest, and least
expensive means of reducing the prevalence of HAIs and the spread of
antimicrobial resistance (AMR). Cleaning hands healthcare workers
can prevent the spread of microorganisms.
The 5 Moments for (WHO) hand hygiene approach defines the key
moments when health-care workers should perform hand hygiene.
 before touching a patient,
 before clean/aseptic procedures,
 after body fluid exposure/risk,
 after touching a patient, and
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 after touching patient surroundings.

Environmental hygiene
Environmental hygiene is a fundamental principle of infection
prevention in healthcare settings. Contaminated hospital surfaces play
an important role in the transmission of micro-organisms,
including Clostridium difficile, and multidrug-resistant organisms
such as methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant enterococci (VRE). Therefore, appropriate
hygiene of surfaces and equipment which patients and healthcare
personnel touch is necessary to reduce exposure.
 Screening and cohorting patients
Early detection of multidrug-resistant organisms is an important
component of any infection control program. There is good evidence
that active screening of preoperative patients for MRSA, with
decolonization of carriers, results in reductions in postoperative
infections caused by MRSA. It has been described in patients
decolonized with nasal mupirocin.
 Surveillance
It is widely acknowledged that surveillance systems allow the
evaluation of the local burden of HAIs and AMR and contribute to the
early detection of HAIs including the identification of clusters and
outbreaks.
 Antibiotic stewardship
Optimal infection control programs have been identified as important
components of any comprehensive strategy for the control of AMR,
primarily through limiting transmission of resistant organisms among
patients.
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
Following guidelines
Keeping abreast of the latest findings regarding the spread of infections
and strategies for prevention is essential for a successful infection
prevention program.
Patient safety
Goal7: Reduce the risk of patient harm resulting from falls:

Who are at risk fall?
 pediatrics less than 5 years.
 Geriatrics more than 60 years.
 Patient have disturbed in conscious level.
 Patient has neurological disorder.
 Patients in ICU.
 Patient who coming for surgery and has history of fall.
How to apply:
 Risk assessment and apply (f) sign on the patient room and ID
wrist band.
 Periodic reassessment of individual patients.
 Keep side rails elevated.
 Educate the patient to use nurse call before moving alone.
 Appropriate lightening of the room even at night.
 Dry floor should be maintained. Use wheel chair.
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Patient safety and security standards. National
GOAL 1
Correct identification of the patient .
file number - four-fold name
GOAL 2
Improving effective means of communication, verbal orders,
delivery and receipt
-Report critical findings
GOAL 3
Separating and distinguishing dangerous and highly concentrated
drugs that are similar in shape and pronunciation in a correct manner
GOAL 4
Ensure the correct patient, correct procedure, surgical site,
instruments, gauze, gauze, and the suitability of equipment before use
GOAL 5
Apply standard infection control precautions
GOAL 6
Protect the patient from the risk of falling
GOAL 7
Safe delivery of catheters and tubes
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GOAL 8
dealing with Critical alerts
GOAL 9
Avoid getting bedsores
GOAL 10
Examination and protection protocol for patients exposed to venous
thromboembolism
GOAL 11
RRT policy for rapid responses to critical cases
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Principals of patient safety:

- Proper identification of patient and matching to their care elements.
-Prevention pf patient hand over error and safety during tradition
-Assessing medical accuracy while giving care to a patient.
-Performance of correct procedure at correct body site.
-Take appropriate precautions measures to avoid infection.
Types of Patient Safety:
 Environmental Safety
Adequate light.
Adequate ventilation.
Stairs with handrails.
Slip preventing floors.
Heavy and fixed bed.
Safe wheelchair and trolley.
Call bell system for patients.
Prevent noise pollution.
Fire extinguishers and alarms
 Medication Safety:
Patient name.
Medication name.
Dosage, frequency, and rout of administration.
Signature of physician.
Date and hour were written.
Before dispensing the drug, the pharmacist must receive the
physician's original
order or direct copy of the order (except in emergency situation).
Discourage telephone orders, do not accept verbal orders.
Examine safety code.
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
Surgical Safety:
Consent of the patient or relative in written.
Proper identification of patient, name wrist band.
Proper identification mark of parts to be operated.
Pre anesthetic checkup.
 Anesthetic safety.
Ensure no foreign body left inside.
Prevention of surgical wound infection
 Electrical Safety:
Safety fuses with each equipment.
No loose wires or connection.
Properly plugged and fixed.
If short circuit call electrician
 Blood Safety:
Proper grouping & cross matching.
Screening against HIV, Hepatitis, and Malaria.
Proper leveling of group, name of the patient.
Control of mismatch reaction.
Standard operating procedure and Use of sterile procedures.
Proper segregation & transportation of biomedical wastes.
Sanitation& hygiene of different parts of hospital to avoid infection.
 Laboratory safety:
Avoid needle prick & spilling of blood.
Safety measures in radiology & radio therapy.
Care in handling acids, regents, and inflammable substances
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Issues and barriers of patient’s safety:
 lack of basic nursing care, Lack of resources, inadequate

staffing, and work overload.
 misdiagnosis.
 Patient safety not considered a top priority.
 Availability and cost of patient safety technology.
 delayed investigations and treatment.
 non-treatment decisions and DNAR orders.
 Resistance to change, the assumption that providers are already
providing safe care.
 Lack of senior leadership understanding of and involvement with
patient safety issue.
 Culture of health care workforce Perceptions, Attitudes, and
behaviors of error.
 Difficulties with using incident reports to monitor patient safety
Tips for improving patient safety

Tip 1: Establish a Safety and Health Management System Tip 2: Build
a Rapid Response System
Tip 3: Make Sure That Employees Know and Understand Safety
Policies Tip 4: Develop a Safety Compliance Plan
Tip 5: Practice Patient-Centered Care
Tip 6: Communicate Safety Information to Patients Tip 7: Incorporate
Safe Hospital Design
Role of nursing for patient safety
1. Identify “wrong site, wrong procedure, wrong patient” errors
2. Catch medication mistakes
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3. Educate patients about their medications

4. Reduce patient falls
5. Monitor patients for deterioration.
Application
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Patient safety plan
Pt name: Date completed:

Collateral/family: clinician:
Step 1: Triggers & Stressors (behaviors, situations and circumstances that put you at
emotional risk):
1.
2.
3.
Step 2: Warning signs (thoughts, images, mood, situation, behavior) that a crisis may be
developing:
1.
2.
3.
Step 3: Internal coping strategies – Things I can do to take my mind off my problems
without contacting another person (relaxation technique, physical activity):
1.
2.
3.
Step 4: People and social settings that provide distraction:
1. Name Phone
2. Name Phone
3. Place 4. Place
Step 5: People whom I can ask for help:
1. Name Phone
2. Name Phone
3. Name Phone
Step 6: Professionals or agencies I can contact during a crisis:
1. Clinician Name Phone
2. Clinician Pager or Emergency Contact #
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3. ClinicianName Phone
4. Clinician Pager or Emergency Contact #
5. Suicide Prevention Lifeline Phone 1-800-273-TALK (8255) or call Sacramento
County Line (916) 368-3111
6. Text “CONNECT” TO 7417415.
7. Call 911 or go to Local Emergency room:
Step 7: Making the environment safe:
1.
2.
The one thing that is most important to me and worth living for is:
** Give copy to client, family members & put copy

in chart **
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(7)
Total quality management in education

and practice
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Goal:
To provide participants knowledge, skills, positive attitude toward
Total quality management in education and practice
Objectives:
At the end of this lecture the participant will be able to:
1) Define the quality& total quality management
2) Explain Benefits of total quality management
3) Explain Principles of TQM
4) Recognize total quality management tools
5) Recognize Advantages and disadvantages of total
quality management
6) Explain Six Sigma and Quality Management
7) Application
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 out lines:
1) Definition of quality& total quality management
2) Benefits of total quality management.
3) Principles of TQM
4) Total quality management tools
5) Advantages and disadvantages of total quality management
6) Six Sigma and Quality Management
7) Application
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 Definition of quality
The word “Quality” has a variety of meanings and definitions which
are mentioned below:
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 Definition of total quality management

Total—Made up of the whole.
Quality—Degree of excellence a product or service provides.
Management—Act, art, or manner of handling, controlling,
directing, etc.
 Short & Rahim define TQM is a proactive approach, to confirm
quality into the product, service and design of the process and
then to continually improve it. According to these definitions,
TQM is a plan, a systematic approach to ensure quality and
continuous improvement.
 TQM is a system and set of practices which are aimed at
relentless quality improvement and better business performance.
 Benefits Of Total Quality Management
 Strengthened competitive position

 Adaptability to changing or emerging market conditions and to
environmental and other government regulations
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 Higher productivity
 Enhanced market image
 Elimination of defects and waste
 Reduced costs and better cost management
 Higher profitability
 Improved customer focus and satisfaction
 Increased customer loyalty and retention
 Increased job security
 Improved employee morale
 Enhanced shareholder and stakeholder value
 Improved and innovative processes
 Principles of TQM:
1. Produce quality work of first time& every time.
2. Focus on the customer
3. Have strategic approach to improvement
4. Improve continuously
5. Encourage mutual respect &team work
 Seven Basic Tools of total quality management

1- cause and effect diagram.
2-Flowchart.
3-Check Sheet.
4-Pareto Chart.
5- Control Charts.
6. Histograms.
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7- Scatter Diagrams
8- PDCA
1- cause and effect diagram:

A cause and effect diagram, also known as a fish-bone diagram shows
the many possible causes of a problem.
To use this tool, you need to first identify the problem you are trying
to solve and simply write it in the box (head of the fish) to the right.
Next, you will list the major causes of the problem on the spine of the
fish.
Causes are typically separated into categories of people, process,

materials and equipment.
Causes are then identified through brainstorming with a group familiar

with the problem.
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2-Flowchart
Most of us are familiar with flowcharts. You have seen flowcharts of

reporting relationships in organizational structures.
Flowcharts are also used to document work process flows.
This tool is used when trying to determine where the bottlenecks or

breakdowns are in work processes.
Flow-charting the steps of a process provides a picture of what the

process looks like and can shed light on issues within the process.
Flowcharts are also used to show changes in a process when

improvements are made or to show a new workflow process.
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3-Check Sheet
A check sheet is a basic quality tool that is used to collect data. A check
sheet might be used to track the number of times a certain incident
happens.
As an example, a human resource department may track the number

of questions by employees, per category, per day.
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In this particular check sheet the tool shows the total number of
questions received by the human resources department.
This information helps that department identify opportunities to

proactively share information with employees in an effort to reduce the
numbers of questions asked.
4-Pareto Chart
A Pareto chart is a bar graph of data showing the largest number of

frequencies to the smallest.
In this example, we are looking at the number of product defects in

each of the listed categories.
When you look at the number of defects from the largest to the smallest
occurrences, it is easy to see how to prioritize improvements efforts.
The most significant problems stand out and can be targeted first.
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5. Control Charts
Control charts or run charts are used to plot data points over time and
give a picture of the movement of that data.
These charts demonstrate when data is consistent or when there are

high or low outliers in the occurrences of data.
It focuses on monitoring performance over time by looking at the

variation in data points.
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Example Control (Run) Charts
6. Histograms
Histograms are bar chart pictures of data that shows patterns that fall
within typical process conditions.
Changes in a process should trigger new collection of data.
A minimum of 50-75 data points should be gathered to ensure an

adequate number of data points have been collected.
The patterns that are detected demonstrate an analysis that helps

understand variation.
In this example, it shows that the receptionist received the most phone
calls about contribution statements for that period.
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Example Histogram
7. Scatter Diagrams
Scatter diagrams are graphs that show the relationship between

variables. Variables often represent possible causes and effect.
As an example, a scatter diagram might show the relationship

between how satisfied volunteers are that attend orientation training.
The diagram shows the relationship between volunteer satisfaction

scores and volunteer orientation training.
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Example Scatter Diagram
Each of these quality tools has unique advantages for certain

situations. And, not all tools are used for all problem-solving.
Once a tool is learned, it can be adapted to different problem-solving

opportunities.
8- PDCA
◦ The PDCA-cycle is used to coordinate continuous improvement
efforts. It emphasizes and demonstrates that improvement
programs must start with careful planning, must result in effective
action, and must move on again to careful planning in a
continuous cycle – the Deming’s quality cycle is never-ending. It
is a strategy used to achieve breakthrough improvements in
safety, quality, morale, delivery cost, and other critical business
objectives.
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◦ A PDCA-cycle consists of four consecutive steps or phases, as

follows:
• Plan - analysis of what needs to be improved by taking into
consideration areas that hold opportunities for change. Decision
on what should be changed.
• Do - implementation of the changes that are decided on in the
Plan step.
• Check - Control and measurement of processes and products in
accordance to changes made in previous steps and in accordance
with policy, goals and requirements on products. Report on
results.
• Act - Adoption or reaction to the changes or running the PDCA-
cycle through again. Keeping improvement on-going.
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 Advantages of total quality management

1. Improve reputation-faults &problems are spotted and sorted
quicker.
2. Higher employee morale -workers motivated by extra
responsibility, team work and involvement in decision of
TQM.
3. Lower cost.
4. Decrease waste as fewer defective products &no need for
separate.
 Disadvantages of total quality management

1. Initial introduction cost
2. Benefits may not be seen for several years.
3. Workers may be resistant to change.
Six Sigma and Quality Management

The concept of Six Sigma was introduced by Motorola in 1986, but
was popularized by Jack Welch who incorporated the strategy in his
business processes at General Electric.
The concept of Six Sigma came into existence when one of Motorola’s
senior executives complained of Motorola’s bad quality. Bill Smith
eventually formulated the methodology in 1986.
Quality plays an important role in the success and failure of an
organization. Neglecting an important aspect like quality, will not let
you survive in the long run. Six Sigma ensures superior quality of
products by removing the defects in the processes and systems.
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Six sigma is a process which helps in improving the overall processes

and systems by identifying and eventually removing the hurdles which
might stop the organization to reach the levels of perfection.
According to sigma, any sort of challenge which comes across in an
organization’s processes is considered to be a defect and needs to be
eliminated.
Organizations practicing Six Sigma create special levels for employees
within the organization. Such levels are called as: “Green belts”,
“Black belts” and so on. Individuals certified with any of these belts
are often experts in six sigma process.
According to Six Sigma any process which does not lead to
customer satisfaction is referred to as a defect and has to be
eliminated from the system to ensure superior quality of products
and services. Every organization strives hard to maintain excellent
quality of its brand and the process of six sigma ensures the same by
removing various defects and errors which come in the way of
customer satisfaction.
The process of Six Sigma originated in manufacturing processes but
now it finds its use in other businesses as well. Proper budgets and
resources need to be allocated for the implementation of Six Sigma in
organizations.
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Following is Six Sigma method:
DMAIC
DMAIC has Five Phases:

1. D - Define the Problem. In the first phase, various problems
which need to be addressed to are clearly defined. Feedbacks are
taken from customers as to what they feel about a particular
product or service. Feedbacks are carefully monitored to
understand problem areas and their root causes.
2. M - Measure and find out the key points of the current
process. Once the problem is identified, employees collect
relevant data which would give an insight into current processes.
3. A - Analyze the data. The information collected in the second
stage is thoroughly verified. The root cause of the defects are
carefully studied and investigated as to find out how they are
affecting the entire process.
4. I - Improve the current processes based on the research and
analysis done in the previous stage. Efforts are made to create new
projects which would ensure superior quality.
5. C - Control the processes so that they do not lead to defects
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Application
In January 2020, our hospital (Zhongshan Hospital of Fudan
University) sent its aid team to Hubei Province to support the
prevention and control of coronavirus disease 2019 (COVID-19). The
team was designated to treat patients with severe COVID-19 admitted
to the intensive care unit (ICU) of the Department of Infectious
Diseases of Eastern Campus, Renmin Hospital of Wuhan University
(9,10). In order to effectively combat the epidemic and improve the
quality of nursing care for critically ill patients, a nursing management
team was established, which carefully analyzed the status quo of the
ICU and applied the PDCA Cycle to standardize and improve the
quality and performance of nursing.
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Identifying problems and proposing suggestions

Problems
Problems identified during the surveys included (I) contaminated areas
not being clearly defined, (II) the roles and responsibilities of nursing
staff being unclear, (III) the disorderly placement of items, (VI)
ineffective shift handover, and (V) long wait times for drugs.
Suggestions
To address these issues, the following countermeasures were
suggested: (I) defining the clean and contaminated areas, (II) use of
self-designed shoe storage cabinets, (III) defining the staff’s roles and
responsibilities, (IV) establishing the staffing structure, (V) carrying
out staff training, (VI) placing items at fixed locations, (VII) changing
the shift handover modes, (VIII) improving handover communication
by using bulletin boards, and (VIIII) using reserved drug cabinets.
PDCA cycle
Plan
I. The contaminated areas were not clearly defined: although the
ICU had been rebuilt as a quarantine ward, there was no clear
division of different areas; as a result, the contaminated area
was not clearly defined and the patient flow was poorly
designed. The countermeasure was to divide the ICU into
contaminated areas, semi-contaminated areas, and clean areas,
and to use self-designed shoe storage cabinets.
II. The roles and responsibilities of nursing staff were unclear: the
medical staff came from different places, with varied roles and
responsibilities; there was no clearly appointed managing staff,
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and the professional capabilities and skills also differed among

the staff members. The countermeasures adopted were to
clarify the roles and responsibilities of each nurse, establish
staffing structure, and conduct staff training.
III. Placemen of items was disordered: the items were placed
casually because there were no designated places for items.
The countermeasure was to place items at fixed locations.
IV. Shift handover was ineffective: the large amount of patients in
the ICU led to information being lost during shift handover. In
addition, communication was not efficient because there was
too much information. The new team changed the shift
handover mode and used bulletin boards to list the key points.
V. Drug transport was time-consuming: a lack of personnel led to
an inefficient transportation of drugs. Reserved drugs cabinets
were used to solve this problem.
Do
I. Regular updates were instituted. With a focus on the nursing
problems, regular meetings were held to propose measures for
increasing the management awareness of the nursing staff and
to define job responsibilities.
II. Specialist nursing teams were established. A detailed work
plan was developed for each group. Regular training sessions
were held to improve the professional skills for the
management of critically ill patients.
Check
I. The head nurse and quality control personnel ensured that the
quality inspection and nursing care for each patient could be
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fully implemented. The head nurse conducted ward rounds at

least once a week.
II. The performance of nursing staff was evaluated by
questionnaire-based survey, on-site survey, and written
examinations.
Act
I. Feedback including countermeasures and improvements were
offered for the existing problems. The head nurse and quality
control staff followed up the identified problems and took
measures to ensure the effectiveness of patient care and staff
training.
II. Any new or persistent problems were brought into the next
round of the PDCA cycle for improvement. For example, the
nursing department conducted timely discussions on the
problems in the work processes or policies and made
corresponding revisions.
Results:
◦ Defining clean or contaminated areas
The awareness of medical staff on the concept of contaminated area
was assessed within 2 weeks after the implementation of the
countermeasures.
◦ Use of self-designed shoe storage cabinets
waste cardboard boxes were used to make shoe storage cabinets, which
allowed the orderly storage and retrieval of working shoes and the
delineation of clean and contaminated areas.
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◦ Defining the staff’s roles and responsibilities

The workflow of each shift in the ICU was redesigned to ensure that
all the nursing work in the ward was carried out in an orderly manner.
The awareness of medical staff of their roles and responsibilities was
surveyed by using a self-designed questionnaire form within 2 weeks
after the implementation of the countermeasure.
◦ Establishing the staffing structure
specialist nursing groups were established based on the professional
background and skills of nursing staff. The awareness of medical staff
of their posts was surveyed by using a self-designed questionnaire
form within 2 weeks after the implementation of the countermeasure.
o Staff training
Staff members in all the intensive care rooms were trained on the first
aid operations and the use of special instruments/catheters. Small
training videos were recorded and shared in WeChat groups to ensure
the homogeneity among nursing staff. Patient safety and quality of
nursing care were always the top priorities.
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(8)
Documentation in Nursing
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OUT LINE
1-Introduction
2-Definition of documentation
3-Purpose of documentation
4-Principles of documentation
5- Consequences of Inadequate Documentation
6-Types of documentation.
7- definition of record
7-Methods of reporting and documentation.
8-Definition of reporting.
9-Purpose of reporting.
10- Criteria of good report.
11-Types of report.
12-Role of nurse manager during documentation.
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Introduction
Documentation as Communication Reporting and recording are the
major communication techniques used by health care providers.
Nursing documentation is a vital component of safe, ethical and
effective nursing practice, regardless of the context of practice or
whether the documentation is paper-based or electronic.
Definition of documentation:
-Any written or electronically generated information about a client

that describes the care or service provided to that client.
-The administration of tests, procedures, treatments, and client
education.
Purpose of health care documentation

1. Professional Responsibility and Accountability
2. To facilitate communication
3. To promote good nursing care
4. To meet professional and legal standards
5. Education 6. Research
7. Auditing and Monitoring.
Principles of documentation
1. DATE & TIME

-Document date and time of each recording.
-Record time in conventional manner (E.g. 9am, 6pm etc) or
according to the 24-hour clock (military clock)
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-Avoid recording in advance.

2. Legibility
- Entries must be legible and easy to read.
- Writing must be clear.
• Very important in recording numbers and medical terms
3. Correct Spelling
-Correct spelling is essential for accuracy.
4. Permanence
- Entries should be done in dark ink.
-It helps to identify changes and allows duplication
5. Accepted Terminology
- Use commonly accepted abbreviations, symbols and terms that are
specified by the agency.
6. Factual
- Descriptive objective information about what nurse sees, hears,
feels and smells.
- Use of inference without supporting data is not acceptable.
-Vague terms like appear, seem or apparently is not accepted.
- Include objective signs of problems.
- Subjective data is documented in client’s exact words within
quotation marks.
7. Accurate
-Use of exact measurement establishes accuracy.eg. Intake 450ml
of water than writing adequate amount of water.
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- Clients name and identifying information is written on each page. -

Before making any entry in the chart makes sure that it is correct. -
Chart only your observations and actions to be accountable.
• If any mistakes occur while recording, draw a line through it and
write above or next to original entry with your initials or name. Do
not erase, blot or use correction fluids.
8. Appropriateness
- Record information's pertaining to the client health problems& care
only.
9. Completeness
- Document all necessary information's.
- It should give a clear picture of what took place Complete pertinent
assessment data such as vital signs, wound drainage, client
complaints, which was notified and what interventions are carried out
are recorded.
10. Current
- Timely entries are must Keeping record at bed side may facilitate
immediate documentation
11. Conciseness
- (BRIEVITY)Recording need to be brief as well as complete to save
time in communication
- Client’s name and the word client can be omitted E g. “perspiring
profusely. Respiration shallow. 28/mt ” Use accepted
abbreviations18. 13
12. Organized
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-Information should have logical manner. E g. description of pain,

nurse’s assessment and interventions and the client response
-This helps in preventing any omission of information. Easy to read.
13. Signature
- Each recording is signed by the nurse Signature includes the name
and the title in computerized charting nurse will have his or her own
code.
14. Confidentiality
- All the client’s record are confidential files
- The information in the chart is personal as well as legal.
- Record shouldn't be copied without the permission of the client.
- Nurse should not allow any outsiders to verify the client record.
Consequences of Inadequate Documentation

- Fragmented care
- Repetition of tasks
- Delayed therapy
- Omitted therapy
- Delayed recovery
Types of documentation:
1-Record
2-Report
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1-RECORD
 Record is a permanent written communication that documents
information relevant to a client’s health care management, e.g. a
client chart is a continuing account of client’s health care status and
need.
- Conduct training and research work
- Assess health problems.
Methods of record and Documentation:

1-Source Oriented Medical (traditional) client Record
2-Problem Oriented Medical Record (POMR):
 Data base
 Problem list
 Nursing care plan
 Progress notes (This are Major section of POMR)
 kardex
 flow sheet
 discharge summary
 ISBAR
 isoBAR
3- Charting by exception (CBE)
4-Case management plan and critical pathways
5- Electronic Documentation
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Method of reporting and documentation:

1-Source Oriented Medical (traditional client) record
-Organized according to source of documented information -Contain
separate forms for physicians, nurses, dietitians, physical therapists to
make written entries about their specific activities in relation to
client’s care
This record provides fragmented documentation Consider of
traditional type of record
- e.g. if a patient had left hemi plegia, data about this problem must
be found in the physician history sheet, in the nurse’s notes, in the
physical therapist record and in the social service record.
Narrative charting is a traditional part of the source – oriented
record. It consists of written notes that include routine care, normal
findings, and client problems.
• Components of a source oriented record: Admission sheet (face)
– initial nursing assessment – graphic record – daily care record –
special flow sheets - medication record –nurse’s & physical
examination findings – physician order sheet – physician progress
notes – consultations record – diagnostic reports –– referral summery
– patient consent.
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2) Problem Oriented Medical Record (POMR):

- In the POMR, established by Lawrence weed in the1960s, data
arranged according to the problems the client has rather than the
source of information.
- The POMR is a method of documentation that emphasize the
client’s problems.
■ Data are organized by problem or diagnosis
■ Basically each member if the health care team contributes to a
single list of identified client problems.
The POMR Sections / Basic component of POMR
*Database – problem list – plan of care – progress notes.
• In addition, flow sheets & discharge notes added to the record as
needed
1- DATA BASE
■ The data base is foundation for identifying client problems and
planning of care.
(e.g all available assessment information pertaining to the client such
as history &physical assessment, nutrition assessment, nurse’s
admission history, ongoing assessment and laboratory reports etc)
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2-PROBLEM LIST
A) After analyzing data, health care team members identify problems
and make a single problem list
B) The problem list includes the client’s both physiological,
psychological, social, cultural, spiritual, developmental, and
environmental needs.
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3-Nursing care plans

■ Develop a care plan for each problem
■ Nurses document the plan of care in variety of formats
■ Generally these plans of care include nursing diagnosis, outcomes,
and interventions.
4-Progress notes
■ Health care team members monitor and recorded the progress of a
client’s problems.
■ Progress notes come in different formats or structured notes.
218 | P a g e
- One method formerly known as “SOAP” stands for

• Soap Used for Problem-Oriented Charts
• S – Subjective. What Pt Tells You
• O– Objective. What You Observe, See
• A – Assessment. What You Think Is Going On Based On Your
Data.
• P – Plan. What You Are Going to Do.
A second progress note method is the PIE format.

■ Similar to SOAP charting both are problem- oriented PIE comes
from the Nursing Process; SOAP comes from a Medical Model.
P – Problem
I – Interventions
E - Evaluation
219 | P a g e
A third progress note format is focus charting.

- A method of identifying and organizing the narrative documentation
of all client concerns.
- Uses a columnar format within the progress notes to distinguish the
entry from other recordings in the narrative notes (Date & time;
Focus; Progress note)
The progress notes are organized into: D A R.......
D– Data ( subj &obj)
A- Action or Nursing interventions
R- Response of the client *effectiveness
Example of focus charting
• Date & Time • 09. /5/.2019
Focus Progress notes: Acute pain related to surgical incision
- D: Patient reports pain as 7/10 on 0 to 10 scales.
• A: Given morphine 1mg IV at 23: 35.
• R: Patient reports pain as 1/10 at 23 :55.
220 | P a g e
5- The Carded/ kardex

• is used as a reference throughout the shift and during change- of-
shift reports.
- Client data (e.g. name, age, admission date, allergy)
- Medical diagnoses and nursing diagnoses
- Medical orders, list of medications
- Activities, diagnostic tests, or specific data on the pt.
- Provides a concise method of organizing and recording data about a
client, making information recording data about a client, making
information readily accessible to all members of the health team.
221 | P a g e
6- Flow Sheets
- The information on flow sheets can be formatted to meet the
specific needs of the client.
-(e.g.: graphic sheets for vital signs, intake & output record, skin
assessment record).
222 | P a g e
223 | P a g e
7. Discharge Summary
-Client’s status at admission and discharge.
- Brief summary of client’s care.
- Interventions and education outcomes.
- Resolved problems and continuing need.
- Referrals
- Client instructions.
224 | P a g e
225 | P a g e
8.ISBAR
a standardized approach to communication which can be used in any
situation. It stands for
Introduction, Situation, Background, Assessment and
Recommendation
226 | P a g e
227 | P a g e
9. IsoBAR:
the mnemonic used to guide the structure and content of
clinical. handovers initiated within CAHS. Includes the
components of Identify (i), Situation. (S), Observations (o),
Background (B), Agreed Plan (A), and Read back (R)
228 | P a g e
3. Charting by exception
Uses flow sheet emphasis on abnormal (what is abnormal for this
patient. Although it may be abnormal for the “normal” person, if it is
abnormal for your patient on a consistent basis, it is no longer
considered an “exception.
■ CBE focuses on documenting deviations from the established norm
or abnormal findings.
■ This approach reduces documentation time and highlights trends
4.Case management plan and critical pathways
■ The case management model of delivering care incorporates a
multidisciplinary approach to documenting client care.
5. Electronic Documentation
Definition
-It allows nurses to use computers to restore client data (client
assessment, medication administration, client teaching, progress
notes, care plan updating, and client acuity).
Electronic documentation in hospital

Nurse Electronic documentation
Nurse interaction for patient care delivery
Patient health status at discharge or transfer from hospital

Guidelines of using of electronic documentation:
229 | P a g e
1. Must be comprehensive, accurate, timely, and clearly identify who

provided what care.
2. Never reveal or allow anyone else access to your personal
identification number or password as these are, in fact, electronic
signatures.
3. Inform your immediate supervisor if there is suspicion that an
assigned personal identification code is being used by someone else.
4. Change passwords at frequent and irregular intervals (as per
agency policy).
5. Choose passwords that are not easily deciphered.
6. Log off when not using the system or when leaving the terminal.
7. Maintain confidentiality of all information.
Advantage and Disadvantage of electronic documentation.
Advantage
• 1-different electronic documentation:
• 2-Facilitate quickly
• 3-Providers at different locations.
• 4-Access by different providers at the same time.
• 5-Increases accuracy and legibility
• 6-Reduced error or omission.
• 7-Enhance quality of documentation
• 8-Improve communication between health care providers.
230 | P a g e
Disadvantage
1-Computer downtime: systems can crash or break down, making
information temporarily unavailable.
2-Computerized systems can threaten a patient’s right to privacy,
Confidentiality may be a problem.
3-Cost: includes the cost of software and hardware, cost of the
training, and cost of supervisory involvement during the transitional
period of change.
REPORT
• Definition:
- Reports are oral or written exchanges of information shared
between care givers of workers in a number of ways.
- A Report Summarize the service of the personnel and of the
agency.
Purpose of Report
1. Report is an essential tool to communication
2. To show the kind and amount of services rendered over a specific
period.
3. To illustrate progress in teaching goals.
4. As an aid in studying health condition.
5. As an aid in planning.
231 | P a g e
6. To interpret the services to the public and to the other interested

agencies.
Criteria for good Report
1-Made promptly.
2-Clear, concise, and complete.
3-If it is written all pertinent, identifying data are included-the date
and time, the people concerned, the situation, the signature of the
person making the report.
4-It is clearly stated and well organized
5-Important points are emphasized.
6-In case of oral reports they are clearly expressed and presented in
an interesting manner.
Types of report
 Oral reports: Oral reports are given when the information is for
immediate use and not for permanency. E.g. it is made by the nurse
who is assigned to patient care, to another nurse who is planning to
relieve her.
 Written reports: Reports are to be written when the information
to be used by several personnel, which is more or less of permanent
value, e.g. day and night reports, census, interdepartmental reports,
needed according to situation, events and conditions.
Reports used in hospital setting:
1) Change-of-shift reports or 24 house report:
2) Transfer and discharge reports:
232 | P a g e
3) Telephone report:
4) Incident report
5) Census report
6) Birth and death report
7) Anecdotal report
1) Change-of-shift reports:
-The face-to-face report permits the listener to ask questions during
the report; written and tape-recorded reports are often briefer and less
time consuming.
- Reports are sometimes given at the bedside, and clients as well as
nurses may participate in the exchange of information.
233 | P a g e
2) Transfer discharge reports

-Nurse report a summary of patient’s condition and care when
transferring patients from one unit or institution or agency to another
(e.g., from the post anesthesia care unit to a surgical floor) and when
discharging patients. The nurse making the report should concisely
summarize all the patient data that care givers nee to provide
immediate care.
234 | P a g e
3) Telephone report:
- Telephones can link health care professionals immediately and
enables nurses to receive and give critical information about patients
in a timely fashion.
- Reporting Telephone Reports and Orders Report transfers,
communicate referrals, obtain client data, solve problems, and inform
a physician and/or client’s family members regarding a change in the
client’s condition.
• Telephone orders are documented in the nurses’ progress notes
and the physician order sheet.
4) Incident report:
It is also a variance or occurrence report, is a tool used by health care
agencies to document the occurrence of anything out of the ordinary
that results in or has the potential to result in harm to a patient,
employee, or visitor.
- These reports are used for quality improvement and shouldn’t be
used for disciplinary action against staff members.
-They are a means of identifying risks.
- Incident reports improve the management and treatments of patients
by identify high-risk patterns and initiating in-services programs to
prevent future problems.
235 | P a g e
• While incident reporting, the following points are to be kept in

mind:
- The nurse who witnessed the incident or who found the patient at
the time of incident should fill the report.
-The report should be completed as soon as possible.
- The nurse describes in concise what happened specifically objective
terms.
- The nurse doesn’t interpret or attempt to explain the cause of the
incident.
- The nurse objectively the clients, conditions when the incident was
discovered.
- Any measures taken by the nurse, other nurses, or doctors at the
time of the incident are reported.
- No nurse is blamed in an incident report.
-The report is submitted as soon as possible to the appropriate
authority.
• The nurse should never make a photocopy of the incident report
• The nurse includes the following information in an incident
report:
- Identify the client by name, initials, and hospital or identification
number.
- Give the date, and place of the incident.
236 | P a g e
-Describe the facts of the incident. Avoid any conclusions or blame.

Describe the incident as you saw it even if your impressions differ
from those of others.
- Incorporate the client's account of the incident.
- State the client’s comments by using direct quotes.
-Identify all witnesses to the incident.
• Identify any equipment by number and any medication by name
and dosage.
SAMPLE OF AN ACCIDENT REPORT
Name: Age: Address:
Bed no.: Ward no.: C.R.No.:
Date & time of accident:
Description of how the accident occurred:
Safety precautions:
Condition of the patient before and after the accident:
Doctor’s examination findings:

Treatment ordered:
witness to accident:
Signature of the doctor:
Signature of the nurse Unit:
Date of report:
237 | P a g e
5. Census report:
- This is a report compiled daily for the number of patients.
Very often it is done at midnight and the norms are collected by the
night supervisor.
- The report will show
the total number of patients, the number of admissions, discharges,
transfers, births and deaths. The nurses should remember that a single
mistake in the census figures made buy one of the nurses make the
census report of the entire institution incorrect.
6) Birth and death report

The nurses are responsible for sending the birth and death reports to
governmental authorities for registration within the specified time.
7)Anecdotal report
An anecdote is brief account of some incident. Incident reports and

reports on accidents, mistakes and complaints are legal in nature. A
written record concerning some observation about a person or
about her work is called an anecdote note.
Role of nurse manager in documentation:

1. A nurse manager must assume responsibility for ensuring
complete and accurate documentation.
2. Assist staff in adhering to both clinical and documentation
standards.
3. Provide continuing education, professional feedback, and input
into policy and documentation-system changes whenever possible
238 | P a g e
4. Must ensure that nursing staff comply with up-to-date standards, it

is equally important to ensure that they document that compliance
accurately and completely.
5. Ensure that the nursing staff follows the established policies of the
organization.
6. Emphasizing the importance of documentation through written
guidelines, policies, job descriptions, and performance appraisals.
239 | P a g e
(9)
Leadership
240 | P a g e
Goal:
To provide participants with knowledge, skills, and positive attitude
toward leadership.
Objectives:
At the end of the lecture participants will be able to:
Define key terms
Discuss the importance of leadership.
Enumerate the characteristics of leadership.
Differentiate between manager and leader.
Discuss leadership styles.
Apply of leadership styles.
241 | P a g e
OUTLINES:
Definition (leader, leadership. manager)
- Difference between manager and leader
- Importance of leadership
- Characteristics of leadership & leader skills.
- Leadership styles
1-Traditional style
(definitions. advantages, disadvantages)
2-Advanced style (definitions. advantages, disadvantages)
- Difference between transformational style and transactional style
- factors that influence which leadership style to use.
- Application.
242 | P a g e
Define key terms:

leader: -
The person who is able to lead and influence other.
what is leadership?
Influencing people
Leading people
Commanding people
Guiding people
Leadership:
It is the process of influencing and directing the behavior of others
toward the accomplishment of objectives.
Three key components to this definition:
1-An interpersonal process between one
person and a group.
2- can't have 'leaders' without 'followers’
3-Criterion for effective leadership goal achievement.
Definitions of Manager:
A manager is an individual employed by an organization who is
responsible for efficiently accomplishing the goals of the
organization through implementing of management process. A
manger makes sure that a job gets done.
243 | P a g e
Difference between Manager& Leader:

Manager s Leader
Administer innovate
A maintain develop
.A manager gives A leader works with the
instructions to the groups. team
Control inspire
Have a short term view Have a long term view
Ask how and when Ask what and why
They instruct the They motivate workers for
subordinates to perform performance improvement.
better.
Enable others to understand Influence people towards
information instructions or objectives and a desire to
idea achieve
Importance of Leadership:
1-Initiating Action:
Leadership starts from the very beginning,
even before the work actually starts. A leader is a person who
communicates the policies and plans to the subordinates to start. the
work
244 | P a g e
2-Providing Motivation:
A leader motivates the employees by giving them financial and non-
financial incentives and gets the work done efficiently.
Motivation is the driving force in an. individual’s life
3-Providing guidance:
A leader not only supervises the employees but also guides them in
their work. He instructs the subordinates on how to perform their
work effectively so that. Their efforts don’t get wasted.
4-Creating confidence:
A leader acknowledges the efforts of the employees, explains to
them their role clearly and guides them to achieve their goals. He also
resolves the complaints and problems of the employees, thereby
building confidence in them. regarding the organization.
5-Building work environment
A good leader should maintain personal contacts with the employees
and should hear their problems and solve them. He always listens to
the point of view of the employees and in case of disagreement
persuades them to agree with him by giving suitable clarifications.
6-Co-ordination:
A leader reconciles the personal interests of -6 the employees with
the organizational goals and achieves co-ordination in the entity
7-Creating Successors:
A leader trains his subordinates in such a manner that they can
succeed him in future easily in his. absence. He creates more.
245 | P a g e
Characteristics of an efficient leader:

Active listening
▪ Empowerment of employees
▪ Effective communication
▪ Team building
▪ Goal setting
▪challenge the process
▪Enabling others to act
▪ Decision making
▪ Motivation
▪ Providing guidance
▪ Creating confidence
▪ Co-ordination
▪ Effective planning
Leader skills:
1-Technical skills
2-Analytic skills
3-Strategies skills
4-Financial –information technology skills
5-Personal and self –development skills
246 | P a g e
Leadership style:
Definition of Leadership styles: Leadership style was defined as the
manner in which the leader influences the group member's behaviors
in various situations.
Classification of leadership styles:
I-Traditional styles
1- Autocratic Leadership"
2- Democratic Leadership
3- Laissez-Faire Leadership
II-Advanced styles
Transactional Leadership
Transformational Leadership
I-Traditional styles
1- Autocratic Leadership"
Autocratic leadership style (Directive or authoritarian) In which there
are a maximum control for the leader with minimum freedom for the
group members.
Leader in this style:
-Make all work-related decision and order subordinate to carry them
out.
- Uses minimal group participation, may listen to his subordinate's
direction but is not influenced by them
247 | P a g e
-Puts high concern for task accomplishment and low concern for
people who perform the task.
-Uses the effort of employees to the best possible advantage without
regard to their interests
Advantages:
-Less time consuming for decision emergency situations or
crisis.
-making in Useful when group member are inexperienced, and
the leader is the one who has information and skills
Disadvantaged:
- Does not encourage individual initiation or cooperation between
group members.
-Emphasizes negative reinforcement, top-down
communication.
-Gives feedback to members in the form of personal praise or
criticism.
-firm personality, insistent, self- assured, highly directive
2- Democratic Leadership (participative)
Democratic leadership, encourage staff nurses to openly
communicate and contribute to decision-making. A democratic leader
focuses on building relationships with an eye on job satisfaction and
staff development. Democratic leadership aims to improve systems
and processes, rather than blame individual team members for
mistakes. It encourages consensus building.
248 | P a g e
In this style, the leader:

- Interact openly and friendly with people.
-Use two-way communication (upward and downward
communication.
- Work through people by suggestion not by order
-Give feedback to the member in a factual and objective
manner about the work
advantages of Democratic leadership style -:
-Permits and encourages all employees to participate in
decision making.
-Greater commitment of the employees to their work, so it
increases job satisfaction and productivity.
-Decision made by the group are more effective.
Disadvantage of Democratic leadership style
-Lack of efficiency when group members are lacking
maturity and skills
-Time consuming for taking decision.
3-Laissez-Faire Leadership (permissive, let alone)

In which there is a maximum freedom for the group members with
minimum leader control.
Also called the absence of leadership, promotes a hand off approach
to personal management, allowing to personal management allowing
individual to work without direct supervision or guidance
249 | P a g e
In this style the leader:

-Leaves group members free to set their own goals, take
decision and determine their own activities without his/her
participation.
- Exhibits lack of control, direction, supervision and coordination.
-Give the group total responsibilities without any standard
behavior available
Advantage of Laissez-Faire leadership style:
In a limited situation creativity may be encouraged highly qualified
people plan a new approach to problem.
Disadvantage of Laissez-Faire leadership style:
-No unity of action leading to decreased productivity and satisfaction.
-Group members will lose all sense of initiative and desired for
achievement.
-Leads to instability, disorganization and inefficiency
II-Advanced styles
4- Transactional Leadership:
transactional leadership: motivate employees through a system
of rewards and punishments (or transactions) to get daily tasks
accomplished. Also called managerial leadership, transactional
leadership focuses on getting specific tasks completed by managing
each portion.
250 | P a g e
transactional leaders are mainly focused on getting the job done

without significant change. They believe in extrinsic motivation
(either positive or negative), rules, standards and procedures to gain
compliance
Advantages VS Disadvantage:
5-Transformational Leadership:
Make change happen in:
Self,
Others,
Groups, and
Organizations
Is a theory of leadership where a leader works with teams or
followers beyond their immediate self-interests to identify needed
change, creating a vision to guide the change through influence,
251 | P a g e
inspiration, and executing the change in tandem with committed

member
advantages:
Lowe the turnover cost
motivating employees
open communication system
create an ethical environment
flexible
boost morale
treat employees individually s of a group
Disadvantage:
negative leaders-negative impact
put pressure on employees
employee burnout
need continuous communication
need continuous feedbacks
loss individual focus
252 | P a g e
Difference between transformational style and transactional style :
Three factors that influence which leadership style to use:

1-The leader personal background:
What personality, knowledge, values, ethics, and experiences does
the manager have. What does he or she think will work?
2-Staff being supervised:
Staff individuals with different personalities and backgrounds; The
leadership style used will vary depending upon the individual staff
and what he or she will respond best to
253 | P a g e
3-The organization:
The traditions, values, philosophy, and concerns of the organization
influence how a manager acts
Application:
A client is received into the emergency department after getting
shot in the chest. The client is hemorrhaging profusely and is in
hypoglycaemic shock.
The nurse calls a code blue. What type of leadership style will
be most effective during the management of the code? Autocratic
leadership will be most effective in this scenario. Autocratic
leadership involves the leader assuming control over the decision and
activities of the group. During code blue, a leader is needed to direct
the actions needed and make quick decisions to positively affect the
client.
254 | P a g e

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Faculty of Nursing Helwan University

Master of nursing administration 2022/2023

Prof/ Lamiaa Esmail

NO Title Prepared by Page No

Collected by Abdelrahman yahia

To Provide the Participants with Knowledge Skills and

Hierarchy of planning in management:

Healthcare organization Philosophy.

of Management, like, organization, direction, coordination,

3- Evaluating and selection of alternatives

● Not recognizing organizational goals and needs

How to overcome barriers of planning?

Application of nursing planning

-After completion of this course the students will be able to:

1. Apply modern learning teaching outcomes strategies of the

2. Support the enhancement of clinical skills in students from basic

3. Motivate students to become professional nurses who are self-

4. Participate in preparing graduate nurses to be professional and

5. Promote professional development through continuing nursing

6. Contribute to the Faculty/University Ministry of Health plans for

improve the quality of nursing care through faculty development

7. Extend services to the community to attain, maintain or regain

Type 1-Trouble shooting

problem solving process

First Step: Define the problem

Second Step: Determine the root cause(s) of the problem

Fifth Step Implement the solution. It’s

Final Step Evaluate the outcome

Problem Solving Methods

The steps: Plan, Do, Check, Act

solution, do not forget to change the standard work and

»Define phase: where you understand the problem you want to

Advantages of the DMAIC method are:

This methodology was developed by ford motors and widely used by

D1 Establish the Team: Establish a small group of people with the

D3 Develop Interim Containment Actions: Isolate the effects of the

Advantages of 8D Problem Solving

1- To start with, the system is focused on getting to the root

Disadvantages of 8D Problem Solving

There are relatively few disadvantages of using the 8D problem

It is widely used by Toyota Motors and its suppliers.

1- Clarify the issue

Sources of problem solving.

Barriers of problem solving:

Problem solving application

2-Conducting training programs on how to deal with personal

Importance of Decision making

Steps of Decision making process

Step 2: Gather relevant information Collect information before

Step 6: Take action Ready to take some positive action by

Patience is an exercise of self-control that shows ability to handle life

Barriers of effective decision making.

Overwhelming volume of information can drown out any ability

Applying decision making in nursing situations:

C) Identify the alternatives:

2-Gather relevant information:

* Patient transferred to ICU to be under close observation.

Importance of time management:

Common time wasters include: