CHAPTER I INTRODUCTION

A. Background
Additional demands on the quality of nursing care perceived as a phenomenon that should be in the response by the nurse. Nursing services in a professional need to get attention in the development of the nursing world. One strategy to optimize the role and functions of nurses in the nursing service is to perform nursing management in the hope of an optimal governance factors can increase the effectiveness of the division of nursing services as well as better ensure client satisfaction to nursing service. Management is the science or art of how to use resources efficiently, actively and rationally to achieve organizational goals previously set. Management activities include the coordination and supervision of staff, facilities and infrastructure in achieving its objectives. Nursing management is the process of working through members of nursing staff to provide nursing care in a professional manner. Room or ward as one of the smallest unit of health care is a place that allows for nurses to apply the knowledge and tricks optimally. But be aware, in the absence of adequate governance, willingness, and ability is strong, and the active role of all parties, the only professional nursing services will be mere theory. For that nurses need to pursue the implementation of the activities of Professional Nursing Practice Model (MPKP) which is an arrangement of nursing care delivery system through the development of a scientific model of nursing practice. This model places great emphasis on the quality of performance of nursing staff that focuses on nursing professionalism among others, through the arrangement and function of each level of nursing personnel, the system returns a decision, the assignment system and reward system is adequate. So also with the position of chief nurse as a room, the nurse executive team leader or in part, requires an understanding of how to manage and lead others in achieving the goals of quality nursing care. As a professional nurse, not just managing people, but an overall process
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that allows people to complete the task of providing nursing care and improve patient health outcomes toward recovery.

B. Goal
1. To describe what is management in nursing 2. To identify the process of management in nursing 3. To Identify the method of nursing practice 4. To give an example of the management in nursing by scenario

CHAPTER II
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MANAGEMENT IN NURSING

A.

Basic Concept

1. Definition of management

Management is defined here as the coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives. Management has been viewed in a variety of ways. Another definition of management is a process by which organizational goals are met through the application of skills and the use of resources. Hersey, Blanchard, and Johnson (1996, p. 7 ) defined management as the process of working with and through individuals and groups and other resources ( such as equipment, capital, and technology) to accomplish organizational goals. Management, the, applies to organizations. The leadership definition emphasis actions that influence toward group goals; the definition of management focuses on organizational goals through leadership and manipulation of the environment is management. In a systems approach to management, the inputs would be represented by human resources and physical and technical resources. The outputs would be the realization of goals. Koontz (1961) concluded that management is the art of:

Getting things done through and with people in formally organized groups Creating an environment in an organized group in which people can perform as individuals yet cooperate to attain group goals

Removing blocks to performance Optimizing efficiency in effectively reaching goals Thus management is a separate function with a specific purpose and related roles but

focused on organizations. Management is central to the work of nursing. Nursing management is

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defined as the coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives. 2. The Management Process An organization can be any institution. Working to achieve an organizations goals involves the process of management. The principles that guide the process of management need to be identified. A Frenchman named Fayol (1949) reasoned that management could not be taught because of the lack of basic principles, whereas physics can be taught because of Newton, and geometry can be taught because of Euclid. To understand the management process, therefore, Fayol formulated the principles that created a basis for management practice. He said that managers perform unique and discrete functions: they plan, organize, coordinate, and control. Thus managers of nurses do the work of management, whereas nurses do the work of nursing (Organizational Dynamics, 1975). The four steps of the management process are planning, organizing, coordinating or directing, and controlling (Fayol,1949). These functions comprise the scope of a managers major effort. Planning involves determining the long and short-term objectives and the corresponding actions that must be taken. Organizing means mobilizing human and material resources to accomplish what is needed. Directing relates to processes of motivating, guiding, and leading people through work process. Controlling has a specific meaning closer to the monitoring and evaluating actions that are familiar to nurses. The management process can be compared to performing an orchestra concert or playing a football game. There is a plan and an organized group of players. A director managers the performance and controls the outcome by making corrections and adjustments along the way. The management process is a rational, logical process based on problem-solving principles 2.1 Planning Planning is defined as determining the long and short term objectives and the corresponding actions that must be taken to achieve these objectives. Steiner (1962) described planning as the conscious determination of courses of action to achieve preconceived objective.

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Planning can be detailed, specific, and rigid, or it can be broad, general, and flexible. Planning is deciding in advance what is to be done and when, by whom, and how it is to be done. Hersey, Blanchard, and Johnson (1996) described planning as involving the setting of goals and objectives and developing work maps to show how they are to be accomplished. The two types of planning are (Levenstein, 1985): 1. Strategic planning: more broad-ranged, this approach means determining the overall purposes and directions of the organization 2. Tactical planning: more short-ranged, this type means determining the specific details of implementing broader goals Levenstein (1985) identified three errors that can create planning flaws: 1. Errors of fact: the plan is based on misinformation 2. Errors in assumption: the plan is based on incorrect assumptions 3. Errors of logic: the plan is based on faulty reasoning Fayol (1949) identified planning as examining the future and drawing up a plan of action. Activities involved include the laying out of the work to be done, determining the use of resources, and establishing the standards for evaluation, 2.2 Organizing Organizing is defined as mobilizing the human and material resources of the institution to achieve organizational objectives. Fayol (1949) noted that organizing was building up the material and human structures. Organizing also be thought of as a process of identifying roles in relationship to one another. Organizing involves activities related to establishing a structure and hierachy of jobs and positions within a unit or department. For nurse managers the activities of budget management, staffing, and scheduling area all organizing activities that are interrelated and tied to role relationships (Kepler, 1980). Organizing nursing also relates to other human resources and personnel functions such as orientation and staff in service development.
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2.3 Directing Coordinating or directing is defined as motivating ad leading personnel to carry out the desired actions. Motivation is a complex activity, yet motivating and leading personnel to carry out the actions needed to achieve the objectives is a critical managerial responsibility. Fayol (1949) identified activities of binding together, unifying, and harmonizing the activity and effort of various personnel as part of coordinating or directing. 2.4 Controling The controlling aspect of the managerial process may appear at first to carry a word that conjures up a negative connotations. Fayol (1949) called this activity of seeing that everything occurs in conformity with established rules. In nursing the term evaluation is used to refer to similar actions and activities. Control or evaluation means ensuring that the flow and processes of work, as well as goal accomplishment, process as planned. Controlling is defined as comparing the result of work with predetermined standards of performance and taking corrective action when needed. This mean ensuring that the result are as desired, and if they are not up to standards, then taking some action to modify, remediate, or reserve the variances. 3. Management Role Diffusion Nurse have two major components to their role: care provider and care integrator. McClure (1991) called these the caregiver and integrator roles. The image of the bedside nurse emphasizes the care provider aspect of nursing. The integrator role is a complementary function that arises from nursings central positioning in the day-to-day coordination of service delivery and central location at the hub of information flow regarding care and service delivery. This linkage relationship is defected visually. Coordination of care has always been a key nursing function. It is becoming more visible and valued in a managed care management roles that focus on integrating clinical care. However, the relative proportion of the nurses role that is devoted to management and coordination functions varies within nursing according to the job category. At the lower levels of an organization, employers are hired for some technical or professional skill. In highly technical, constantly changing field such as nursing, it takes nearly all of a nurses time to be technically competent. Mintzberg (1994) compared management as
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cure, which is intermittent and interventionist, with management as care, which is continuous and involved. Management as care is thought to be more effective. N this modality, nurses are postulated to be able to move more easily and naturally into management because of nursings root in caring. In nursing the management process is directed toward the human element work, or the management of human resources. It is through this dynamic and interact; rive process that the work of nursing is accomplished. Nurse managers balance two competing needs: the needs of the staff, related to growth, efficiency, motivation, morale, and accomplishment and the needs of the employer for productivity, quality, and cost-effectiveness. Desired outcomes include staff satisfaction and productivity (kepler, 1980) 4. Management In Organization 4.1 The nature of management work Behavioral theory and its applications to the management of people focuses on organizing and processing work and accomplishing organizational objectives at a targeted minimum cost and minimum waste. The responsibility for doing that lies with management. Mintzberg (1973, 1975) reformulated Fayols ideas about the nature of managerial work. Mintzbergs synthesis of research findings about managers in general revealed the following: Managers work at an unrelenting pace at activities characterized by brevity, variety, and discontinuity. Manager handle exceptions and perform regular work, such as ritual and ceremonial duties, negotiation, and processing of soft information linking the organization to its environment. Manager prefer oral communication, especially telephone calls and meetings judgment and intuition describe the procedure managers use to schedule time, process information, and make decision

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The skill needed by nurse managers include conceptual or thinking skills, technical skills in nursing method and techniques, and group and human relation skills (Katz, 1955). Mintzberg suggested a number of important managerial skills: Developing peer relationships Carrying out negotiations Motivating subordinates Resolving conflicts Establishing information network and disseminating information Making decisions in conditions of extreme ambiguity Allocating resources 4.2 Managing difficulty people All human working environment experience the management problem of working with difficult people. Lewis-Ford (1993) offered the following categories to describe such people : Sherman thanks Abusive, abrupt, and intimidating, they charge down on people with a themedous show of power.

Snipers : Hostile aggressive , they use innuendos and digs to take pot-shots at people Exploders: they suddenly break into temper tantrums to get their way Bulldozers : they are condescending know it all who are competent but do not easily entertain other peoples judgments

Balloons : they like to be in the know but are full of hot air

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Clams: they react to any disagreeable situation by closing down . they use silence as a weapon

Negative nabobs : they are negative , naysayers and skeptical pessimist Complainers ; they whine and find fault with everything , they want you to fix it for them.

Stallers : they agree with plans only to let you down by doing nothing to realize them.

B. Method of Nursing Practice

1. Team nursing Team nursing is a care model that uses a group of people led by a knowledgeable nurse. It is a delivery approach that provides care to a group of clients by coordinating a team of registered nurses (RNs), licensed practical nurses (LPNs), and aides under the supervision of one nurse, called the team leader ( Glandon, Colbert, & Thomasma, 1989; hegyvary, 1977). Team nursing has been defined as the assignment of a group of clients to a small group of workers under the direction of a team leader. Each team member would provide most of the care to his or her assigned clients, although some tasks (e.g., medications) may be assigned separately (Mccloskey, Blegen, & gardner, 1991). Team nursing is designed to make use of each members capabilities to meet the nursing needs of his or her group of clients. It is a delegation of care to a designated team of staff members. The staff members have various levels of expertise, but they are formed into a team. The nurse leader takes info account the level of expertise, and then divides the assignments accordingly so that a group of clients who are assigned to a team of caregivers have their needs appropriately met. Team nursing developed in the early 1950s in response to a shortage of RNs and in reaction to the dissatisfaction with functional nursing. The advantages of team nursing are that each members particular capabilities can be used to the maximum. This model supports group productivity and the growth of team members.
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Communication is vital. A sense of contribution via the team can be fostered. However, it takes a skilled registered nurse to be a team leader. Further, an registered nurse team member may not be functioning up to his or her full potential because of being assigned an ancillary role. This creates some underutilization of the registered nurse personnel. 2. Primary nursing Primary nursing began in 1970s as a way to overcome the discontent with functional and team nursings emphasis on tasks and discrete functions that directed nurses attention away from holistic care of the client. This matched a societal trend toward accountability and nursings rising level of professionalism. Primary nursing is an approach in which a nurse has responsibility and accountability for the continuous guidance of specific clients from hospital admission through discharge. Thus the primary nurse provides for total nursing process for the client during a period of hospitalization (Glandon, Colbert, & Thomasma, 1989; Hegyvary, 1977). Primary nursing has been defined as the assignment in a hospital of each client to a primary nurse who plans,delivers, and monitors care under a 24-hour responsibility from admission to discharge (McCloskey, Blegen, & Garner, 1991). The hallmark of the primary nursing concept is the 24-hour accountability in the primary nurses role are basic to primary nursing. The advantages of primary nursing include a focus on the clients needs, greater nurse autonomy, and greater continuity of care. Primary nursing came to be associated with allregistered nurse staffing but has moved away from that position. Problems I the implementation of primary nursing include the wide variation in its operationalization and implementation. The result has been confusion and lack of structure to enable primary nurse autonomy. Total accountability may create burnout, and a poorly prepared registered nurse may feel threatened by primary nursing. Research conducted to compare team nursing to primary nursing care models has found higher quality of nursing care, higher levels of nurse satisfaction increased continuity of care, improved nurse retention, and positive client outcomes with primary nursing. Levels of client satisfaction were equal, and cost comparisons were inconclusive between the two models ( Gardner, 1991; Lang & Cliton, 1984; Lee, 1983).
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C. Management in Pediatric Room

Traditionally, effort to improve child health in the developing world have focused on primary health care. This approach concentrates on improving public health and basic health care at the community level, usually by training village health workers to recognize and manage childhood illnesses such as diarrhea and pneumonia. The primary health care approach is essential in developing countries, where access to basic medical facilities and trained health care professionals is often lacking and where the majority of childhood diseases are preventable. However, the primary health care approach includes teaching village health care facilities. Currently, there are inadequate resources devoted to training health professionals and establishing such referral centers in most developing countries; they often do not exist and, therefore, sicker children suffer or die. Depending on the resources available and the socioeconomic situation of a given country, these outcomes may be unavoidable. Pediatricians and child health professionals can contribute to improving both primary health care and higher levels of medical care for children in developing countries. The field of pediatric has excelled at integrating primary health care and preventive care into the practice of curative medicine.

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D. Scenario
PRECONFERENCE PAGI Di suatu rumah sakit T. Di bagian ruang anak yang terdiri dari 1 Perawat Primer, 5 Perawat Asosiate ( PA1, PA2, PA3, PA4, and PA5) dan 3 pasien anak. Setiap hari dilakukan preconference sebelum dinas dan postconferance setelah dinas untuk melaporkan apa yang sudah dilakukan. Pada saat dines pagi terdiri dari 1 orang perawat primer, 2 perawat asosiate dan 3 pasien yang akan dilanjutkan dengan Perawat yang dines sore yang terdiri dari 3 perawat asosiate. An. A, perempuan, 8 tahun sudah dirawat di rumah sakit T selama 3 hari di ruang anak karena dengan diagnosa medis DHF. Kesadaran pasien compos mentis, keadaan umum pasien terlihat lemah. Pasien dianjurkan untuk bed rest total. Pasien mengatakan tidak nafsu makan, terasa mual, dan pasien hanya makan makanan yang di berikan pihak rumah sakit sebanyak 3 sendok makan. Pasien tampak lemas, tidak bertenaga, wajahnya masih terlihat pucat, tercium bau mulut dan badan pada pasien. Bibir pasien tampak kering. Terpasang infus di tangan kiri NaCl 0,9%. Tekanan darah : 80/60 mmHg, Nadi : 136 x/m, Respiratory rate : 16 x/m, dan suhu tubuh pasien : 380C, minum 450cc/ 24 jam, urine 200cc/ 24 jam, . An. B, perempuan, 9 tahun sudah dirawat di rumah sakit T selama 2 hari di ruang anak karena Diare berat. Kesadaran : compos mentis,, keadaan umum : lemah. Pasien mengatakan sebelum masuk rumah sakit pasien buang air besar dalam sehari hingga 15-20x dan feces cair. Pasien mengatakan tidak nafsu makan, badan terasa lemas, pasien tampak gelisah dan rewel, merasa haus, BAK mulai berkurang, berat badan menurun dari 30kg menjadi 20 kg . Terpasang infus di tangan kiri 0,9%. Tekanan darah 100/60mmHg, Nadi 100x/menit, respiratorty rate : 16 x/ menit dan suhu tubuh pasien : 38OC, minum 400cc/24jam, urine 200cc/24jam. An. C, perempuan, 8 tahun dirawat di rumah sakit T selama 6 hari di ruang anak karena fraktur tibia distal sinistra. Pasien sudah dilakukan operasi ortopedi 2 hari yang lalu. Kesadaran : compos mentis,, keadaan umum : lemah. Pasien tampak lemas dan tidak nafsu makan karena mual. Pasien mengatakan tidak bisa buang air besar semenjak kakinya patah. Pasien mengatakan mengeluh nyeri pada kaki. Terpasang traksi dan infus RL di tangan kanan pasien, tekanan darah
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pasien 90/ 60 mmHg, nadi 80 x/ menit, suhu badan 37,5OC, pernafasan 16x /menit, pasien terpasang kateter dan sudah lebih dari 3 hari belum diganti. [ di nurse station; PN dan 2 PA melakukan preconference sebelum dines pagi] PN : Assalamualaikum Wr. Wb., alhamdulillahhirobilalamin pada hari ini kita semua dapat kembali berkumpul untuk menjalankan aktivitas kita pada pagi hari ini dengan sehat walafiat. Seperti biasa sebelum memulai kerja pada pagi ini saya akan membacaka tugas yang akan kita jalankan dari pukul 7.00 sampai dengan pukul 14.30. Pagi ini jumlah pasien pada saat ini masih sama dengan sebelumnya, ada 3 pasien. An. A, perempuan, 8 tahun sudah dirawat di rumah sakit T selama 3 hari dan hari ini merupakan hari ke 3 nya dia di rawat. Kesadaran : compos mentis, keadaan umum : lemah, pasien tidak nafsu makan, mual serta muntah terpasang infus di tangan kiri, infusan botol yang ke 6, jumlah trombosit masih rendah < 150rb, tercium bau yang kurang sedap pada badan dan mulut pasien. Tekanan darah : 80/60 mmHg, Nadi : 136 x/m, Respiratory rate : 16 x/m, dan suhu tubuh pasien : 38,50C. Untuk diagnose keperawatan pada An.A, yaitu (1) hipertermi berhubungan dengan proses infeksi virus dengue, (2) resiko deficit volume cairan b/d intake cairan yang tidak adekuat. (3) gangguan pemenuhan kebutuhan : personal hygiene : mandi dan mulu (4) gangguan pemenuhan kebutuhan nutrisi : kurang dari kebutuhan berhubungan dengan nutrisi tidak adekuat. Untuk PA1 tindakan keperawatan yang sudah saya rencanakan adalah (1) monitor tanda-tanda vital dan keadaan umum pasien, (2) kompres An dengan air hangat, (3) pertahankan pemberian cairan intravena,

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(4) lakukan personal hygiene : mandi dan sikat gigi (5) lakukan kolaborasi dengan dokter dalam pemberian obat dan nutrisi untuk mengatasi mualnya (6) ajarkan pada keluarga untuk mempertahankan cairan yang adekuat (7) anjurkan paisen untuk banyak minum dan mohon dilakukan semaksimal mungkin agar pasien puas dengan pelayanan yang kita berikan. Catat segala perubahan pasien sekecil apa pun itu. Apabila ada yang kurang jelas, bisa di tanyakan kembali kepada saya. PA1 : baik bu terima kasih saya akan lalukan asuhan keperawatan sesuai dengan yang direncanakan. PN : ya sama-sama. Oke kita masuk ke pasien berikutnya An. B, perempuan, 9 tahun di rawat di rumah sakit semenjak 2 hari yang lalu karena diare berat, sebelum masuk rumah sakit dalam sehari pasien bisa 15-20 kali BAB dan fecesnya cair. Hari ini hari kedua dimana An. B dirawat. Kesadaran : compos mentis dan keadaan umum : lemah. Berat badan belum bertambah. Terpasang infus di tangan kiri 0,9%. Tekanan darah 100/60mmHg, Nadi 100x/menit, respiratorty rate : 16 x/ menit dan suhu tubuh pasien : 38OC, urine 200cc/ 24 jm dan minum 400 cc/ 24 jam. Diagnosa untuk An. B adalah (1) Gangguan nutrisi kurang dari kebutuhan tubuh berhubungan dengan absorbs nutrient dan peningkatan peristaltic usus. (2) Kekurangan volume cairan berhubungan dengan intake cairan yang tidak adekuat (3) Resiko peningkatan suhu tubuh berhubungan dengan insepsis sekunder pada diare Intervensi : (1) Monitoring tanda-tanda vital

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(2) Kolaboratif pemberian nutrisi parenteral (3) Kolaboratif nutrisi dengan konsul gizi pada pukul 09.30 (4) Anjurkan pasien untuk banyak minum (5) Kolaborasi pemberian obat (6) Monitoring intake dan outpun dalam 24 jam (7) Berikan kompres hangat Untuk PA2 ini rencana asuhan keperawatannya, tolong di baca dan dilakukan dengan baik. Apabila ada yang kurang jelas mohon ditanyakan dan perubahan pada pasien sekecil apa pun jangan lupa didokumentasikan. Bagaimana ada yang ingin di tanyakan ? PA2 : Hmmmmm sejauh ini jelas bu. Nanti klo memang ada yang kurang jelas saya akan bertanya PN : oke untuk selanjutnya pasien An. C nanti saya yang akan menanganinya. Kondisi An. C, perempuan, 8 tahun dirawat di rumah sakit sudah 6 hari dan sudah dilakukan operasi ortopedi 2 hari yang lalu. Kesadaran : compos mentis dan keadaan umum : lemah. Kurang nafsu makan, hingga saat ini belum dapat buang air besar. Terasa nyeri pada kaki kiri. Terpasang terpasang alat traksi dan infus RL di tangan kanan pasien, tekanan darah pasien 90/ 60 mmHg, nadi 65 x/ menit, suhu badan 37,5OC, pernafasan 16x /menit. Diagnose keperawatan pada An. B : . (1) Gangguan rasa aman dan nyaman : nyeri berhubungan dengan cidera fisik (2) Gangguan pemenuhan kebutuhan eliminasi : konstipasi berhubungan dengan kelemahan fisik (mobilisasi) (3) Gangguan mobilitas fisik berhubungan dengan kerusakan musculoskeletal (4) Resiko infeksi berhubungan dengan kerusakan integritas kulit (5) Resiko cidera berhubungan dengan Imobilitas
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Intervensi : (1) Kolaborasi pemberian obat dengan dengan dokter dalam pemberian obat (2) Berikan laksative sesuai dengan anjuran dokter (3) Anjurkan keluarga untuk support pasien makan makanan berserat (4) Anjurkan pasien untuk banyak minum (5) Lakukan Range of Motion (ROM) Masih ada yang ingin di tanyakan ? PA1 dan PA2 : tidak bu PN : baik kalau tidak ada pertanyaan lagi mari kita tutup preconference ini dengan doa. Bagi yang muslim doa akan saya pimpin dan bagi yang non muslim silahkan berdoa seuai dengan kepercayaannya masing-masing. [setelah dilakukan preconference, perawat melakukan tindakan keperawatannya masingmasing. Pada pukul 14.00 dilakukan postconferance] PN : alhamdulillahirobilalamin puji syukur kita panjatkan pada ALLAH SWT karena telah memberikan kekuatan kepada kita untuk melaksanakan dinas pada pagi hari hingga berakhir di siang hari ini. Untuk yang dinas sore saya ucapkan selamat datang dan selamat bekerja. Sebelumnya kami yang dinas pagi akan menyampaikan laporan terlebih dahulu. Dipersilahkan kepada PA1 untuk menyampaikan laporan tentang kondisi An. A PA1 : An. A dengan diagnose medis DHF. Sebagian intervensi telah dilakukan. Setelah dilakukan intervensi kondisi pasien saat ini suhu tubuh terakhir 37,5 o C, nafsu makan pasien belum membaik dan hanya menghabiskan 1/2porsi lebih baik dari pada yang kemarin. Infuse masih terpasang NaCl 0.9% di tangan kiri.

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PA2

: An. B dengan diagnose medis Diare berat. Sebagian intervensi telah dilakukan. Kondisi pasien sekarang : suhu tubuh pasien terakhir normal, bab mulai berkurang yang tadinyah 15x sekarang 10x.

PN

: An. C dengan diagnose medis fraktur tibia distal sinistra. Sebagian intervensi telah dilakukan. Kondisi pasien saat ini rasa nyeri berkurang, gangguan mobilisasi belum ada perubahan, suhu tubuh sudah menurun. Pasien sudah dapat buang air besar.

[setelah itu perawat yang dinas pagi telah meninggalkan ruangan. Perawat Primer pun mengalihkan semua intervensi ke dines sore. Perawat sore pun melakukan preconference sebelum dines] PN : puji syukur kehadirat tuhan yang maha esa karena berkat rahmat dan hidayahnya kita bisa berkumpul dan melanjutkan tugas dinas pada sore hari ini. Untuk PA 3 akan melanjutkan tindakan pada pasien An. A dengan diagnose medis DHF, untuk PA4 melanjutkan tindakan keperawatan pada pasien An. B dengan diagnose medis Diare dan untuk PA5 melanjutkan tindakan keperawatan pada pasien An. C dengan diagnose medis fraktur tibia distal sinistra. Untuk mempersingkat waktu, tindakan yang akan dilakukan dapat di baca di asuhan keperawatan yang sudah saya buat. PA3 : agar tidak terjadi mis persepsi saya akan mengulang intervensi yang akan dijalan kan : (1) monitor tanda-tanda vital dan keadaan umum pasien, (2) pertahankan pemberian cairan intravena, (3) ajarkan pada keluarga untuk mempertahankan cairan yang adekuat (4) anjurkan paisen untuk banyak minum

PA4

: Intervensi yang akan saya lakukan untuk An. B : (1) Monitoring tanda-tanda vital (2) Kolaboratif pemberian nutrisi parenteral

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(3) Anjurkan pasien untuk banyak minum (4) Kolaborasi pemberian obat (5) Monitoring intake dan outpun dalam 24 jam PA5 : untuk An. C tindakan selanjutnyah : (1) Kolaborasi pemberian obat dengan dengan dokter dalam pemberian obat (2) Anjurkan keluarga untuk support pasien makan makanan berserat (3) Anjurkan pasien untuk banyak minum PN : baik untuk memudahkan kita dalam dines sore ini kita mulai dengan doa. Bagi yang muslim doa akan saya pimpin dan bagi yang non muslim silahkan berdoa seuai dengan kepercayaannya masing-masing.

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CHAPTER III CLOSING

CONCLUSION A managers job is to coordinate and integrate resources Classical management theory defined the management process as planning, organizing, coordinating or directing, and controlling Mintzberg developed a model of managerial work that elaborated on managerial roles Managers are challenged by people who exhibit difficult behaviors All nurse are managers; they coordinate and deliver health service to clients In pediatric room the efficient method usually is the primary nurse than use the team method

REFERENCES
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Huber, Diane. Leadership and Nursing Care Management. Second Edition. W.B. Saundres Company. Behrman, Kligman, Jenson. Textbook of Pediatric vol 1. 17th edition. Nelson.

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