DIRECTING

DIRECTING
Is the issuance of orders, assignments and instructions that enable the nursing personnel to understand what are expected of them.

Directing actuates efforts to accomplish goals. It is the connecting link between organizing for work and getting the job done.

Directing includes supervision and guidance so that in doing their jobs well, nurses can maximally contribute to the organizations goals in general and to the nursing service objectives in particular.

The manner in which verbal orders are given also determines to a large extent their acceptability and the extent to which the workers will challenged to exert effort to do their job. Giving directions in courteous manner encourages cooperation, interest, and better performance in their jobs.

ELEMENTS OF DIRECTING
1. DELEGATION 2. SUPERVISON 3. STAFF DEVELOPMENT 4. COORDINATION 5. COMMUNICATION

1. DELEGATION
DELEGATING is the process by which a manager assigns specific tasks/duties to workers with commensurate authority to perform the job. The worker in return assumes responsibility for its satisfactory performance and held accountable for its results.

Principles of delegation:
1. Select the right person to whom the job is to be delegated. - Make sure that the employee is capable of doing the job. Give the employee the accountability and authority to do the job. 2. Delegate both interesting and uninteresting tasks. - uninteresting job can be used to challenge, motivate and increase a persons performance and commitment. Interesting jobs draw out the best among employees and inspire them to higher achievement.

3. Provide subordinates with enough time to learn. - expertise can be achieved through training and experience. 4. Delegate gradually. - new employees may not be able to assume full responsibilities as employees who have stayed longer on their job.

5. Delegate in advance. - specify goals and objectives to be met within a set time frame. Describe the specific results expected out of the activities to be performed. 6. Consult before delegating. - clarification minimizes problems and promote teamwork. 7. Avoid gaps and overlaps. - a gap occurs when a job is left out with no one taking responsibility; an overlap happens when two or more people have responsibility for the same job, causing confusion and low morale.

NURSING CARE ASSIGNMENT

1. FUNCTIONAL NURSING 2. TOTAL CARE (formerly termed as case nursing) 3. Team nursing 4. Primary nursing

FUNCTIONAL NURSING
this kind of nursing modality is task-oriented in which a particular nursing function is assigned to each worker. One registered nurse may be responsible for giving medications, another nurse for admission and discharges while nursing attendants change linens, provide hygienic care or do simple nursing procedures for which they have trained.

HEAD/SENIOR NURSE

R.N medication

R.N. treatment

NSG. ATT. Hygienic care

HOUSEKEEPER Linen attendant

PATIENTS

TOTAL CARE or CASE NURSING

In the total or case method of nursing care, one nurse is assigned to one patient for the delivery of total care. The nurse plans, coordinates, evaluates and documents the nursing care she has given during her shift. The one-on-one pattern is a common assignment for PRIVATE DUTY NURSES, for nurses in SPECIAL CARE UNITS such as the critical care units or those in isolation, and for NURSING STUDENTS.

HEAD/SENIOR NURSE

STAFF NURSE

PATIENT

TEAM NURSING
Team Nursing is a DECENTRALIZED SYSTEM of care in which a qualified professional nurse leads a group of nursing personnel in providing for the nursing needs of a group of patients/clients through participative effort.

The TEAM LEADER assigns patients and tasks to the team members according to the job descriptions. The team leader is responsible for coordinating the total care of a group of patients.

The heart of team nursing is team conference. Through supervision, the team leaders identifies the nursing care goals and focuses on attaining them through guidance and setting of high standards of care. However, if not fully implemented, team nursing can lead to fragmentation of care. Also, finding time for team conferences and care planning is sometimes difficult to attain.

CHARGE NURSE

TEAM LEADER

NURSING STAFF

PATIENT

PRIMARY NURSING
PRIMARY NURSING is a form of assigning responsibilities for patient care, is an extension of principle of decentralization of authority. Each registered nurse is responsible for the total care of a small group of patients from admission to discharge.

The primary nurse assesses the patients needs for care, sets care goals, writes a nursing care plan, administers care according to plan, evaluates the outcomes of care, and makes the necessary changes or adjustments as necessary. He/she provides pre-discharge planning and teaching.

Since the primary nurse assumes a 24hour responsibility for nursing care, secondary or associates nurses execute the nursing care plan during the afternoon and night shifts and on days when the primary nurse is off-duty. The primary and secondary nurses are freed from administrative and housekeeping responsibilities to maximize their time for patient care. Authority, accountability, and autonomy rest with the primary nurse.

PHYSICIAN

HEAD NURSE

HOSPITAL and Community resources

PRIMARY NURSE PATIENT/CLIENT

SECONDARY PM

SECONDARY NIGHT

SECONDARY RELIEF

OTHER NURSING ASSIGNMENTS

MODULAR METHOD- a modification of a team and primary nursing. It differs from team nursing in that the registered nurse provides direct nursing care with the assistance of aides. The professional nurse provides leadership, support and instructions to the non-professional nursing personnel. The greatest responsibility falls on the registered nurse who assesses the patients needs, plans and implements care. It may therefore be observed that the role of the nurse in the modular form of assignment is more difficult than in primary nursing.

OTHER NURSING ASSIGNMENTS

CASE MANAGEMENT- is a system of patient care delivery that focuses on the achievement of outcomes within effective and appropriate time frames and resources. It focuses on an entire episode of illness, crossing all settings in which the patient receives care. Care is directed by a case manager who ideally is involved in a group practice.

2. SUPERVISION
The word supervise comes from the word supervide which means to oversee or view directly. The result is the attainment of service that is both efficient and effective.

SUPERVISION is providing guidelines for the accomplishments of a task or activity with initial direction and periodic inspection of the actual accomplishments of the task or activity. It is the active process of directing, guiding and influencing the outcome of a persons performance of an activity.

QUALITIES OF GOOD SUPERVISION

1. Good technical, managerial and human relation skills. 2. Ability to communicate well in both spoken and written language; ability to listen. 3. Firmness with flexibility to adjust to the needs of the situation. 4. Fairness in dealing with employees. 5. Familiarity with hospitals and nursing policies that affect patient care.

6. Good decision-making skills. 7. Willingness to grow and develop. 8. Ability to accept changes and consider them as challenges. 9. Dignified and pleasing personality 10. Ability to motivate employees and provide opportunities for continuing professional growth and development 11. Advocacy for nurses and nursing.

3. STAFF DEVELOPMENT
STAFF DEVELOPMENT in nursing is one aspect of human resource management. The major task of staff development is to provide structure and assistance to employees to learn in greater depth and to translate the knowledge , skills, abilities, and principles learned into nursing practice within their institution of employment.

Major staff development activities include orientation, in-service education, continuing education, and organizational development.

Staff development is geared ultimately to organizational development (Jennigan, 1988). It assists each employee to improve performance in his present position and to maximize possibilities for career advancement.

4. COORDINATION
COORDINATION unites personnel and services toward a common objective. Synchronization of activities among the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious flow of work.

Coordination also prevents overlapping of functions, promotes good working relationships and work schedules are accomplished as targetted.

At the unit level Supervising Nurse and Head Nurses coordinate their work with the other departments, services or units by conveying clearly-defined policies, standard operating procedures, and guidelines using the proper channels of communications.

COORDINATION WITH THE MEDICAL SERVICE

All nurse should know the Medical Staff in their respective units, their services and scheduled time of medical rounds. Also nurses should know the patients in the units, their diagnosis, actual conditions, and the programmed medical plan of care and treatments so that they can participate intelligently in planning the care of each individual patient.

COORDINATION WITH THE ADMINISTRATIVE SERVICE

Coordination with the administrative service pertains to both human and material resources. At the unit level, nurses participates in budget planning for staffing, adequate facilities, and material resources. Layout of work areas should be carefully planned to ensure smooth workflow and work simplification.

Requisitions for supplies, linen and equipment pass through the administrative service. Monthly inventories should be done for evaluation purposes. Overstocking of supplies should be avoided to prevent pilferage and wastage. There should be training on the use of new equipment to maximize the efficient utilization and prevent costly repairs or replacements.

COORDINATION WITH THE LABORATORY SERVICE

Requests for laboratory examinations are forwarded to the laboratory unit. Medical Technologists usually come to the units for routine blood examinations. Nurses should direct them to where the patients are located and provide the necessary assistance.

Patients needing special preparations should be given specific instructions relevant to the examination to be done such as fasting blood sugar. Reminders are attached to the patients chart or a special bed tag is made indicating the reminder.

COORDINATION WITH RADIOLOGY SERVICE

Request for x-ray examinations are likewise forwarded to the x-ray service for proper scheduling and specific instructions. A patient who has been given instructions about the procedure and reasons why it is necessary becomes more cooperative and less fearfull during the procedure.

COORDINATION WITH THE PHARMACY SEVICE

Policies regarding the procurement of drugs are formulated jointly by the administrative, Medical and Nursing Services, and the Pharmacy. The Pharmacy should also provide all nursing units with an established Hospital Drug Formulary including the efficient and effective administration of drugs through the Unit Drug Dose System (UDDS)

COORDINATION WITH THE DIETARY SERVICE

The Head is responsible for forwarding the diet list of the patients in the units, taking into consideration the prescribed special diets, the patients food allergies, food preferences and religious restrictions. Patients needing special instructions in their diets are referred to the Nutritionist for counseling.

5. COMMUNICATION
COMMUNICATION is the transmission of information, opinions and intentions between and among individuals. Communication facilitates work, increases motivation, effects changes, optimizes patient care, increase workers satisfaction and facilitates coordination.

PRINCIPLES OF EFFECTIVE COMMUNICATION

1. Clear lines of communication serve as the linking process by which parts of the organization are unified toward goal achievement. 2. simple, exact, and concise messages ensure understanding of the message to be conveyed. 3. Feedback is essential to effective communication. 4. Communication thrives best in a supportive environment which encourages positive values among its personnel. Communication is used to support the vision, mission and goals of the organization and the nursing service

5. A managers communication skill is vital to the attainment of the goals of the organization. 6. Adequate and timely communication of work-related issues or changes that may affect jobs enhance compliance.

TYPES OF COMMUNICATION
VERBAL COMMUNICATION involves spoken words. The speaker must be able to speak slowly, enunciating the words clearly. WRITTEN COMMUNICATION must be clear, correct, complete and concise.

NON-VERBAL COMMUNICATION is transmission of message without the use of words. People oftentimes unconsciously use facial expressions, gestures, touch, body language, or vocal tones.

LINES OF COMMUNICATION
Communication is described as a twoway process, yet in an organization, it is four-dimensional.

DOWNWARD COMMUNICATION
The traditional line of communication is from superior to subordinate which may pass through various level of management.

UPWARD To superior

HORIZONTAL To peers and Members of health team

NURSES

OUTWARD To patient, family And community; To workers family & friends

DOWNWARD To subordinates

UPWARD COMMUNICATION
Upward communication emanates from subordinates and goes upward. This is usually in the form of feedback to show the extent to which downward communication has bees received, accepted and implemented.

HORIZONTAL COMMUNICATION
HORIZONTAL or LATERAL COMMUNICATION flows between peers, personnel or departments on the same level. It is used most frequently in the form of endorsement, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services.

OUTWARD COMMUNICATION
OUTWARD COMMUNICATION deals with information that flows from the caregivers to the patients, their families, relatives, visitors and the community. Outward communication also involves how employees value their work.

THANK YOU

CONFLICT MANAGEMENT
CONFLICT is as inevitable as change in any organization because of the complexity of relationships within the organization, the interaction among its members or their dependence on one another. Conflict means a clash between two opposing and oftentimes hostile parties.

CONFLICT
The internal or external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people.

Categories of Conflict
Interpersonal
Intrapersonal Intergroup

Interpersonal Conflict
Also known as horizontal violence or bullying.

SOURCES OF CONFLICT
Human interactions that relate to conflict are characterized by competition, domination and provocation. It arises from differences in knowledge, skills, values, interest; scarcity of resources; intergroup rivalry for rewards, unworkable organizational structure; and shift in organizational power base and organizational climate; and unacceptable leadership styles.

TYPES OF CONFLICT
Conflict is a dynamic process. It is a type of behavior involving two or more parties in opposition to each other. It can be OVERT or COVERT. COVERT conflict is more dangerous because it is not it appears on the surface. It results in harbored feelings that drain both physical and psychological energy.

According to hierarchical relationships, conflict is either VERTICAL or HORIZONTAL. In vertical conflict, differences in opinions between superiors and subordinates are caused most often by inadequacy in communication , opposing interest and lack of shared perceptions and attitudes.

Horizontal or line and staff conflict arises as a common struggle between departments or services wherein the degree of interdependence and collaboration determines the success in achieving shared goals and objectives.

Common Conflict Resolution Strategies

Avoiding Compromising Competing Accommodating

Smoothing
Collaborating

AVOIDANCE- is the method commonly used by groups who do not want to do something that may interfere with their relationships. Neutrality is maintained at all cost. ACCOMODATION- means self sacrifice. The person neglects his own needs to meet the goals of the other party.

Avoiding
Parties are aware of a conflict but choose not to acknowledge it or attempt to resolve it.

Accommodating
One party sacrifices his or her beliefs and wants to allow the other party to win.

COLLABORATION- inspires mutual attention to the problem and utilizes the talents of all parties. It focuses on problem-solving to find mutually satisfying solutions. In a COMPROMISE, both parties seek measure, acceptable answers for short periods when the goals are only moderate important and the parties have equivalent power.

Collaborating
An assertive and cooperative means of conflict resolution whereby all parties set aside their original goals and work together to establish a supraordinate or common priority goal.

Compromising
Each party gives up something it wants.

In COMPETITION, the supervisor or nurse manager exerts power at the subordinates expense. It is expressed through suppression of conflict through authority-obedience approach. Other methods include SMOOTHING where disagreements are ignored so that surface harmony is maintained in a state of peaceful coexistence.

Competing
One party pursues what it wants regardless of the cost to others.

WITHDRAWING from the conflict simply means that one party is removed thereby making it possible to resolve the issue. FORCING is a method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved.

Smoothing
An individual attempts to reduce the emotional component of the conflict.

Conflict Resolution Outcomes

WinLose WinWin

LoseLose

Winning and losing are goals for games, not for conflicts.

The optimal goal in resolving conflict is creating a winwin solution for all involved.

MOTIVATION
All human beings are motivated by different goals, ambitions, and aspirations. A motive is a need or desire that incites and directs a persons actions. MOTIVATION according to Mills, is a force within the individual that influences strength or direction of behavior.

INTRINSIC MOTIVATION comes from within the person driving him to be more productive. EXTRINSIC MOTIVATION is enhanced by the environment or external rewards. This may come in form of promotions, increases in salary, added benefits or external rewards.

MOTIVATIONAL THEORIES

A. NEED THEORY
1. ABRAHAM MASLOWS HIERARCHY OF NEEDS shows that people are motivated to satisfy certain needs beginning from basic physiological needs to complex psychological needs. He contends that people seek higher level needs only when the lower needs have been met.

2. THE TWO FACTOR THEORY FREDERICK HERZBERG (1991) is credited with developing a two-factor theory of motivation which was first published in 1968. hygiene factors relate to the working conditions such as salary, quality of supervision, job security, interpersonal relations policies, and supervision.

3. McCLELLANDS THREE BASIC NEEDS THEORY DAVID McCLELLAND identifies three basic needs that people posses in varying degrees: - achievement - power - affiliation

The need for ACHIEVEMENT is a strong desire to overcome challenge, to excel, to grow, to advance, or to succeed. The need for POWER is the desire to be in control and to get others to behave contrary to what they would naturally do. The need for AFFILIATION is the desire to work in a pleasant environment and the desire for friendly, close relationships.

B. EXPECTANCY THEORY
VICTOR VROOMS expectancy theory of human motivation indicates that felt needs of individuals in work setting are increased if a person perceives positive relationship between effort and performance. Motivated behavior is further increased if there is positive relationship between good performance and outcomes or rewards particularly when these are valued.

Applied to nursing, expectancy is the perceived probability of satisfying a particular need based on past experience. Therefore, managers need to provide specific feedback about positive performance.

C. OPERANT THEORY
B.F. SKINNERS operant theory suggests that an employees work motivation is controlled by conditions in the external environment instead of internal needs and desires. Humans exhibit two types of behaviorrespondent and operant.

RESPONDENT BEHAVIOR results from direct stimulation. OPERANT behavior occurs in the absence of any apparent external stimulation.

D. EQUITY THEORY
JO STACY ADAMS and others studied perceptions of equity and inequity. They found that employees assess fairness by considering their input and the psychological, social and financial rewards in comparison with those of others.

PERCIEVED INEQUITY causes tension which is found to be proportioned to the magnitude of the perceived tension. These feelings motivate an employee to resolve the inequity by reducing input, changing the basis of comparison or by resigning. If the comparison is equal, the person feels he/she is treated fairly.

The aforementioned motivational theories differ in their power of influence to the work drive of the managers and the workers. Competent managers decide what theory to follow under the circumstances to increase the motivation and effectivity of their workers in an environment that they helped create-challenging, exciting, satisfying and fulfilling.

END