Nursing Service administration

1
Course outlines

Unit 1- Introduction to Nursing Service Administration

- Management, Administration, Nursing administration, Management Vs administration

Unit -2 - Philosophy of nursing service administration

- vision, mission, organizational philosophy, goal (institutional and nursing), organizational

environment, characteristics organizational environment,

Unit 3- Nursing staff organizational structure

- Nursing staff structure, Systems of Nursing Service Delivery methods /Nursing Care Delivery
Models, Managers Function associated with Organizing Pt Care, Factors affecting nursing Care
Delivery Model Selection, Evaluation Criteria of Nursing Care Delivery Models,

Unit-4 Function Of Nursing Managers

Types of managers with their duties, Delegation , Ways for nurse managers to successfully delegate,
Barriers to Delegating, Nurse role as a leader ( To get the job done, you must; Leaders use different
styles, Leaders tend to share some important qualities )

2
Material management (Expendable and non expendable), managing equipment, Important points in controlling and
maintaining equipment, how managers take care of equipment, models for receiving and issuing equipment), Managing
Time (how managers manage time properly, planning time arrangement-------

Unit -6 - Critical thinking

- Definition, Elements of critical thinking, Problem solving, Methods of Problem solving , Steps in Problem Solving, To
overcome barriers in problem solving, Decision Making, Types of decisions, classifications, Steps of logical Decision
Making, Factors Influencing Decision Making ---------

Unit -7 - Organizing patient care

- Principles of personnel assignment in pt care , Characteristics of effective assignment, Process of organizing patient
care: , staffing and scheduling, Staffing may be centralized or decentralized, Staffing models,-------
Unit - 8 - PROJECT PROPOSAL/PLAN

Methodolgy –
- Lecturing
- Group assignment and presentation
- Assignment on organization assessment and project writing

3
 Unit- One

Introduction to Nursing

Service Administration

4
 Introduction
Definition
 Different authorities define management differently but have
strong unifying similarities in all the definitions
 Management is the art of getting things done through people
 It is the process of reaching organizational goals by working
with and through people and other organizational resources.

5
 Introduction…
 It is the process of planning, organizing, leading and
controlling the work of organization members and
using all available organizational resources to reach
the stated goals.
 It is the process of directing, coordinating and
influencing the operation of an organization to
obtain a desired result and enhance total
performance.

6
 Introduction…
Administration is the direction, coordination
& control of many persons to achieve some
purpose or objective.
When General administration is applied to
nursing service it is called nursing service
administration.

7
 Introduction…
 Nursing service administration is a coordinated
activity, which provides all of the facilities
necessary for nursing service.
 It is directed towards the nursing care of clients
 it includes the establishment of over-all goals &
policies within the aims of the health agency

8
 Introduction…
provision of personnel & facilities to accomplish
this goals in the most effective & economical
manner through cooperative efforts of all members
of the staff and
 coordinating the service with other departments
of the institution.

9
 Introduction…
Nursing service administration is both an art & a
science.
 It is a science b/c one may systematically study &
analyze the behavior of people as a collective and
even their individual behavior & draw
generalizations from them.

10
 Introduction…
It is an art because it requires qualities of
dynamic character to make them effective.

11
 Introduction…
 Generally Nursing service administration
is the process of planning, organizing,
leading & controlling, that includes human,
material, financial and informational
resources to achieve the predetermined
objectives.

12
 Introduction…

The primary objective of the role of

nursing service administration is
provision of continuous individual, group
& community service.

13
 Management and Administration

Administration
Three views regarding management and administration:
• Management and Administration are the same: administration is
used for higher executives functions for government circles
while the term management is used for the same functions in the
business world

14
 Administration is above management: administrative is
determinative while management is executive function
 Administration is part of management: Management is the general
term used for the total process of executive control while
administration is concerned with the installation and following of
procedures
 Administration frames the objective policies of the organization.
Management implements these policies and objectives
 Management is responsible for carrying out the strategies of the
administration.

15
 Unit -2
Philosophy of nursing service
administration

16
 Vision

 It usually accompanies the statement of mission.

• It is “a strategic view of the future direction and a
guiding concept of what the organization is trying to
do and to become”.
• Clear description of the future that all stake holders want to
create .
• a concrete picture of the future that we wish to create
E.g.
We aspire to see healthy and productive inhabitants
in the city administration.

17
 Mission
 Mission is the purpose of the establishment of the
organization.
 A mission statement is a broad general goal of an organization
that describes its purpose in the community
 A mission statement identifies/states the purposes and
reasons for which the organization exists.
 It specifies the unique aim of the organization.
 The elements of mission are:
Who are you? What are we? Why do we exist? What is
our constituency? E.g.

18
 Mission…
 The mission statement of a small community hospital
may indicate that its purpose is to serve the health
care needs of the immediate community and
provide care for commonly occurring illnesses.
 A large university hospital may have a mission statement
that encompasses research, teaching & care for
complex problems.

19
E.g.
To reduce morbidity and mortality
through provision of quality and
equitable, promotive, preventive and
curative health services to the inhabitants
in the city administration.

20
The mission, strategic plan, and vision
reflect a philosophy about the
organization and its roles.

 They are “the foundation on which the

rest of the strategic planning process is
built”, are the basis for other
organizational planning.

21
 Organizational Philosophy
Philosophy is defined as an explanation of the
systems of beliefs that determine how a
mission or a purpose is to be achieved.
 An organization's philosophy states the
beliefs, concepts & principles of an
organization.

22
 Organizational Philosophy…
Philosophy shows the desired nature of the
relationships b/n health service organizations &
its customers, employees & external bodies.
 It is a set of beliefs that determines how organizational
purposes are achieved & that serves as the
foundation for agency objectives, policies &
procedures.

23
 NURSING SERVICE PHILOSOPHY
It is a statement of beliefs that flows from &
is congruent with the institution’s
philosophy.
The nursing philosophy should reflect the
nursing division member’s ideas &
principles.

24
 Goals
Goals are the broad statements of overall
purpose of an organization or individual.
They are usually stated in general terms.
The purpose of writing goals is to identify where
you are going & to enable you to evaluate
when you have arrived there.

25
Is the purpose that an organization strives
to achieve.
Importance of goals
• Provide a sense of direction
• Focus our efforts
• Guide our plans and decisions
• Help us evaluate our progress

26
 Goals…
Several levels of goals: e.g.
 Institutional level, nursing department level
& the nursing unit level.
All level of goals need to be relate to the
health needs of the community.

27
 Institutional Goals
 Based on the community’s health needs, the institution

forms goals & objectives.

 An institution that focuses thinking on goals for the

future & activities that will move the organization toward

these goals is referred to as a proactive institution.

28
 Institutional Goals…
The managers of such institutions spend a
great deal of time, money & energy on
identifying possible future events.
Institutions that do not have specific or
future oriented goals are reactive
institutions/unthinking.

29
 Institutional Goals…
They spend their time reacting to events, that is,
“putting out fires” rather than “preventing
them.”
A reactive facility would wait until such
emergencies occurred and
Then handle them as a crisis rather than as an
anticipated event.

30
 Nursing Department Goals
The goals of the institution affect those of
nursing service. E.g.
In an institution with an overall goal of
developing a mental health program, a
nursing department goal may include
developing nurses in psychiatry.

31
 Nursing Department Goals…
The smart manager of a nursing department must
also be proactive about the national issues facing
nursing, community needs for nursing & the
needs within the institution itself.
This manager would formulate goals to help the
nursing department meet the challenges of care in
the future.

32
 Organizational Environment
 It is the work environment of an organization
 Refers to the existing feelings experienced by staffs
 The climate is stand on the official policies &
procedures of the organization & the feedback
provided within the organization

33
 Organizational Environment…

Includes the r/ship with staffs, supervisors,

bosses, organizational culture…
Positive work environment makes employees
feel good & this gives motivation.

34
Five characteristics of a Positive Working
Environment
1. Be transparent & make open Communication
It makes employees feel that they belong in the
organization.
It is essential for staff to discuss the organization’s
philosophy, mission and values from time to time
during meetings.
Having open discussions get people involved &
allow them to share their views on how to achieve
company goals.

35
 Five characteristics…
2. Give work vs life balance for workers
 Workers must balance organization’s work & their
personal work/life.
 B/C when workers fulfill their various needs &
goals in their life, they perform their work better.

36
 Five characteristics…
3. Give training for workers
 To move with technology, organizations should
train their employees accordingly.
A positive work environment should have routine
trainings.
4. Give recognition for Hard Workers
 Rewards are necessary to encourage certain
behaviors in workers.
This is known as positive reinforcement

37
 Five characteristics…

5. Build strong team spirit

 To achieve organizational goals groups should

accept & tolerate differences & should form
strong team.

38
 Unit-3
Nursing staff organizational structure

Structures in nursing staffs are:

Matron head nurses staff nurses

39
 Nursing staff structure…
Matron

Head Head Head

nurse nurse nurse

Staff Staff Staff

Figure 1: Nursing Nurses
Nurses staff organizational Nurses
structure

40
 Systems of Nursing Service Delivery
methods /Nursing Care Delivery Models

The nursing manager has a responsibility

of controlling nursing care delivery
systems/models.

41
 Managers Function associated with
Organizing Pt Care
1. Examines the unit to ensure any supports in patient
care delivery system.
2. Selects a patient care delivery system most
appropriate to the needs of the patients being
served.
3. Uses scientific research and current literature to
analyze future changes in nursing care delivery
models.

42
 Managers Function…
4. Uses a patient care delivery system that maximizes
human & physical resources as well as time.
5. Ensures that nonprofessional staff are
appropriately trained & supervised in the provision
of care.
6. Organizes work activities to attain organizational
goals.

43
 Managers Function…
7. Groups activities in a manner that facilitates
communication & coordination within & b/n
departments.
8. Organizes work so that it is as cost-effective as
possible.
9. Makes changes in work design to facilitate
meeting organizational goals.
10. Clearly delineates criteria to be used for
differentiated practice roles.

44
 Nursing service delivery…
In general there are 5 common types of nursing
service delivery models/methods /systems or
There are 5 common types of patient care
delivery methods

45
 Nursing Service Delivery methods…
1. Case method/total pt care
2. Functional method
3. Team nursing
4. Primary Nursing
5. Case Management

46
 1. Case Method/Total pt care
 Total patient care - nurses take total responsibility for
meeting all needs of assigned patients during their time
on duty

 Or Individuals are assigned to give total care to each

patient during their shift time e.g. 8 hour shift time

 The nurses report to their immediate superior, who

is the head nurse.

 The oldest form & still widely used today.

47
 Case Method…
Widely used method in hospitals
To maintain quality care, this method requires
highly skilled personnel & thus may cost more
than some other forms of patient care.
Some oppossers say some tasks performed by the
primary caregiver could be accomplished by
someone with less training & at a lower cost.

48
 Advantages
 Nurses give concentration of focus on the pt through out that shift.
 Provides nurses high autonomy with responsibility.
Disadvantages
 lack of communication & lack of continuity after shift
 all staffs might not have been qualified to deliver all aspects of care &
 Depending on the structure, too many people were reporting to the head
nurse.

49
 Total pt care…
Charge Nurse

Nursing Nursing Nursing

staff staff staff

Patients Patients Patients

Figure 2: Total pt care organizational structure

50
 2. Functional method
 Assignments of patient care are made by the level of
task/function; in other words, each person performs one
task or function according to the employees’ educational
experience.
 Or work assignment by functions or tasks
 For example Nurse Aides /Health Assistants/ give baths,
feed patients & take vital signs to all patients.

51
 Functional method…
Professional nurses are responsible for medications
& procedures for all patients.
The head nurse is responsible for overall
direction, supervision & education of the nursing
staff.
This method start during world warr II

52
 Functional method…
 There was a shortage of nurses at that time, so
unskilled workers were trained to do simple tasks &
gained skill by repetition.
 Registered nurses became the managers of care
rather than direct care providers and “care through
others’’ became the phrase, used to refer to this
method of nursing care during world war II.

53
 Advantages
 No role confusion. You know what you are doing.
 This method is cheap
Disadvantages
 Fragments nursing care
 May decrease staff job satisfaction
 Decreases personal contacts with client
 Pt can’t identify their caretaker, b/c there are so many
caretakers

54
 Functional …
Charge nurse

RN
Professional Licensed
nurse Health nurse
assistant
nurse

Figure 3: functional nursing organizational structure

Patients

55
 3. Team Nursing
A dramatic change occurred after World War II in
the years between 1943 & 1945.
The level & number of auxiliary personnel began
increasing &
the professional nurse was assuming more & more
of the management functions.

56
 Team Nursing…
 Team nursing was developed to deal with the
overflow of post war workers & the head nurse’s
overextended span of control.
 Due to this workers are arranged in teams.
 Group can be 4-5 nurses for 10-20 pt’s
 The team consists of the senior professional
nurse becoming the team leader.

57
 Team Nursing…
The other members of the team are registered
nurses (RNs), licensed practical nurses, vocational
nurses and nurses’ aides…
Each is given a patient assignment according to the
employee’s education and experience.
It uses a leader who coordinates team members in
the care of a group of patients.

58
 Team …
Advantage
 Share experience among staffs

 High quality complete care

 Giving team members autonomy results in high job

satisfaction.
Disadvantage
 Role confusion
 Decrease personal contact with the pt
 Team leader must have good leader ship skill

59
 Team Nursing…
Charge Nurse

Team leader Team leader

Nursing staffs Nursing staffs

Figure 4: Team nursing organizational structure

Patients Patients

60
 4. Primary Nursing
 It is an approach in W/C a nurse has a responsibility &
accountability for the continuous guidance of specific pts
from hospital admission to discharge

 Patient is managed for the entire 24-hour by one nurse

 Nurse assigned for pts & responsible for their entire

hospital stay.
 Uses some of the concepts of total patient care & brings
the registered nurse back to the bedside to provide clinical
care.
61
 Primary Nursing…
 During work hours, the primary nurse provides total
direct care for that patient. When the primary nurse is
not on duty, associate nurses (that follow the care plan
established by the primary nurse) provide care.
 The primary nurse has a responsibility to establish clear
communication among the patient, the physician, the
associate nurses & other team members.

62
 Primary nursing…
 A method of providing nursing care to inpatients in
which one nurse plans the care of specific patients
for a period of 24 hours.

 It is a philosophy & a structure that gives

responsibility & accountability for the planning,
communicating & evaluating of care for a group of
patients in one nurse.

63
 Advantages
 May increase job satisfaction
 Improves continuity of care
 Allows independent decision making
 Supports direct nurse-client communication
 Encourages discharge planning
 Improves quality of care

64
 Disadvantages

 Increases personnel costs

 Requires properly trained nurses to carry out

principles

65
 Primary nursing…
Charge
Physician nurse Resource

Primary nurse

pt

Health
Evening
Figure assistant
5: Primary nursing organizational structure
nurse

66
 5. Case Management
It is the latest work design proposed to meet
patient needs.

focuses on the achievement of client outcomes

within effective & appropriate time frames &
resources
– Also focus on health care costs first for the pt

67
 Case Management …
Case Management Society of America (CMSA) defined
as:
 It is a collaborative process that assesses, plans,
implements, coordinates, monitors, and evaluates
options & services to meet an individual’s health.
 Case manager nurses identifying the most cost-
effective providers, treatments & care areas for
individuals.

68
 Case Management …
Case management nurses are nurses who
coordinate all aspects of the care of individual
patients.
Nurses work closely with patients & their loved
ones to evaluate patients' needs & come up with
a complete healthcare plan.
This is an all-inclusive & full model & is not
restricted to the hospital setting.

69
 Advantage
 Improves nurse responsiveness to clients
changing needs
 Improves continuity of care
 May increase nurse’s job satisfaction
Disadvantage
 Increases personnel costs

70
 Case mx…
Collaborates
With pt &Family

Onset of NURSE CASE Resolution

Illness MANAGER of Illness

Collaborates with
Other health
workers
Figure 6: Case management organizational structure

71
 Factors affecting nursing Care Delivery
Model Selection
Health care setting
Ambulatory care, home care and hospital care
Organizational structure and resources
Management, staffing, supplies and physical layout
Patient needs
Acute & long-term need

72
 Evaluation Criteria of Nursing Care
Delivery Models
 Time, cost-effective & outcomes achieved?
 Patient and families happy with care?
 Team members satisfied with care?
 Good communication among all team members?

73
Matron (director of nursing service)- the
administrative head of the total nursing service of
the hospital.
Matron is the job title of a very senior or the chief
nurse in several countries.

74
 Matron…
Assistant matron (Assistance director of
nursing service) - act as assistant as a director
of nursing and act on behalf of a matron on
abscents.

75
 Function of nurse manager…
Supervisor nurse (departmental nurse)-
administer a group of wards.

Head nurse (ward Nurse)- administrative head

of one ward e.g. medical ward

76
Duties & Responsibilities of head Nurse
Head nurses manage all the administrative tasks
of the ward which they are assigned to work
They schedule shifts for the nurses & assign duties
to them
They collect work reports from all the nurses
They assist & give training programs for nurses
who are new & need help
They also solve any issues related to the patients

77
 Head Nurse…
Head nurses often make round with doctors
They maintain a record of the file of patients in their
wards
Head nurses also look for the hygiene in the hospital
& in the rooms & make sure that the patients are
provided enough facilities

78
 Delegation
Delegation is the process of assigning part or all
of one person’s responsibility to another person
or persons.
is an effective management competency by which
nurse managers get the work done through the
employees.

79
 Delegation…
As nurse managers learn to accept the
principle of delegation

They become more productive & come to

enjoy relationships with the staff

80
 Ways for nurse managers to
successfully delegate
 Train & develop subordinates
 Control & coordinate the work of
subordinates, but do not go over their
shoulders
 Follow up by visiting subordinates
frequently.

81
 Cont’d…
 Encourage employees to solve their own problems &
give them the autonomy & freedom to do.
 Assess results &
 The nurse manager should accept the fact that
employees will perform delegated tasks in their own style.
 Give appropriate rewards

82
 Barriers to Delegating
Barriers in the Delegator
 Preference for operating by oneself
 Require that everyone “know all the details”
 “I can do it better myself” fallacy
 Lack of experience in delegating
 Insecurity
 Fear of being disliked

83
 Delegator…
 Refusal to allow mistakes

 Lack of confidence in subordinates

 Perfectionism, leading to excessive control

 Lack of organizational skill in balancing workloads

 Failure to delegate authority commensurate with

responsibility

84
 Delegator…

 Uncertainty over tasks and inability to explain

 Disinclination to develop subordinates

 Failure to establish effective controls and to

follow up

85
 Barriers in the Delegate
Lack of experience
Lack of competence
Avoidance of responsibility
Over dependence on the boss
Overload of work

86
 Nurse role as a leader

Leaders make things happen.

 As a leader, your first priority is to get the Job

done.

87
 To get the job done, you must:
1. Know your objectives & have a plan for
reaching them
If you are unclear about your goals, clarify them
with your manager.
On planning, list everything you have to do both
short & long-term goals.

88
 Cont’d…

Set priorities. Decide which tasks are the most

important in achieving your objectives.

Decide how much time you will need to

complete each task.

89
 Cont’d…

Check that resources needed to complete the

task are available.

Use calendars & other aids to help you

develop a plan.

90
 Leader…
2. Build a team committed to achieving those
objectives
Achieving goals depends on teamwork.
You simply cannot do everything on your own.
 As a leader, it is your Job to build a team

91
 Cont’d…
Set clear standards for the team

Tell your team exactly what you expect from

the team.

Attempt to maintain high but realistic

standards.

92
 Cont’d…
Explain the "Why" as well as “How"
It is important for team members to understand
why a task is necessary &
why it must be done in a certain way & how it
will be achieved.

93
 Cont’d…
Encourage Involvement in the team
Whenever the situation allows, ask for team
member's ideas & opinions.
Team members who are involved in the decision
making process are more likely to feel they have a
part in achieving goals.

94
 Cont’d…

• However, be sure your team understands that

you are responsible for making the final
decision.

95
 Cont’d…
3. Build positive working relationships
 To build positive working relation ship:
a. Strive to be fair with all employees at all times.
b. Be understanding
 Keep in mind that everyone makes mistakes occasionally.
 When you must criticize, be constructive and tactful.

96
 Cont’d…
c. Build an atmosphere of respect among team
members.
d. Put the team first.
 Make it clear that you are more interested in
the group's achievements than in the personal
achievement.

97
 Cont’d…
Leaders use different styles
In general, your leadership style will depend on
your personality,
 when you feel comfortable with the abilities of
your team members & the situation at hand. For
example, you may use a:

98
 Cont’d…
 Participative style
 When it is appropriate involve members of your
team in making decisions
 Directive style
 When a situation requires, you give specific
instructions e.g. when training new employees.

99
 Cont’d…

 Flexibility & good judgment are essential to

successful leadership.

Leaders tend to share some important qualities

 While no two leaders are exactly similar, in
general, leaders are:

100
 Cont’d…
1. Positive- they believe in themselves and others
2. Enthusiastic - they're willing to tackle tasks that
others may dismiss as possible
3. Committed to excellence - they're always
looking for new & better ways to do things

101
 Cont’d…
4. Self confident- they're willing to make decisions
even when these are unpopular
5. Sincere - when they make a promise, they do all
they can.
6. Open to new ideas - they realize they do not
have all the answers.

102
103
 Material management
Material management is the integrated
function of purchasing &

Related activities to achieve the maximum

coordination & optimum expenditure in the
area of materials.

104
 Material…
One of the objectives of it is to have the right
materials at the right place at the right time.
This depends on effective policies of forecasting,
inventory and materials distribution.

105
 Materials/equipment
can be divided into:
1. Expendable/consumable/ non-recurrent
 are those materials/items that should not
be reused &
 are used within a short time.

106
 Material …
2. Non-expendable/capital/ recurrent
 are those materials that are required only for specific
purposes or jobs and
 they are not to be automatically removed
 used for several years and needs care and maintenance.

107
 Managing equipment
Managing equipment includes:
Ordering- obtaining equipment from shops or
request equipment from shop.
 Storing- recording, labeling and holding equipment in a
stock or store room
 Or put equipment in the store

108
 Managing equipment…
 Issuing- giving equipment from a stock or store
room or the act of providing an item from store
 Controlling- monitoring expendable
equipment, maintaining and repairing non-
expendable equipment.

109
Important points in controlling and
maintaining equipment
Convincing staff that equipment must be
cleaned, inspected & kept in good order.
Defects must be reported immediately.
Equipment must always be returned to its
correct place after use.

110
 Cont’d…

Use inspection check list & inspection

schedule
Detecting discrepancies and explaining
them

111
 Good management takes care of
equipment by:
Motivating staff to feel responsible for
the equipment they use
 Ordering supplies when needed
Storing supplies safely
Controlling the use of supply

112
 Cont’d…
In most of the government sectors in
Ethiopia, receiving & issuing (giving) of
materials/equipment/items are
carried out using the following
models .

113
 Cont’d…
 Model 19- model confirming delivery of items/drugs
 Model 20- Model for requesting items/drugs
 Model 21- Model for approving item delivery by person in
authority
 Model 22- Model for issuing/giving items

114
 Managing Time
 Time is a non-renewable resource
To manage time properly:
1. Set goals- determines short, medium and long-
range goals i.e. based on:-
 Which goals must be completed before
others?
 Which will take the longest to achieve?

115
 Time …
 Giving priorities of goals, helps to resolve goal
conflict.
2. Once you have determined & ranked your goals,
plan activities to achieve them
3. Plan schedule i.e. put activities done with time

116
 Planning time arrangements
Events are arranged in daily, weekly,
monthly or yearly time periods.

The periodicity depends on the frequency or

regularity of particular events.

Time plans are written in 3 common forms:

117
 Time …
 Timetable: used for daily or weekly regularly recurring
events. This is a schedule listing activities & the times at
which they will take place.
 Schedule: used for intermittent or irregular events &
where they take place E.g. a time & place for exam.
 Roster: tasks planned for different staff members for
different times. Or a schedule of time for members of an
organization to do tasks.

118
 Preparing a health unit time table

List all activities that happen regularly each

week.

Then arrange them in an appropriate

timetable.

119
 Preparing health unit schedule
 A schedule is required when a different activities
or the same activity in a different place is given
at intervals over time.
 To make a schedule, each different activity or
 each different place is listed & describe with time.

120
 Preparing duty roster
A duty roster is a time plan for distributing
work among staff members
Duty rosters are needed for 3 purposes:

121
 Cont’d…
1. To distribute work fairly & evenly outside
normal working hours, e.g. night duty,
weekend duty, holiday duty…

2. To distribute uninteresting or difficult work

& interesting work.

3. To divide extra duties among the whole

staff. 122
 Unit -6
Critical thinking

What is It?

123
 Critical thinking
Definition- is the ability to think clearly and
rationally about what to do or what to believe.

It includes the ability to engage in deep and

independent thinking.

Critical thinking is not a matter of accumulating

information.
124
 Cont’d…
Critical thinking should not be confused with
being argumentative or being critical of other
people.

Some people believe that critical thinking

hinders creativity b/c it requires following the
rules of logic & rationality but creativity might
require breaking rules
125
 Someone with critical thinking skills is
able to do the following :
understand the logical connections b/n ideas
detect inconsistencies & common mistakes in
reasoning
solve problems systematically
identify the relevance & importance of ideas
reflect on the justification of one's own beliefs &
values

126
 Elements of critical thinking
1. Reflection /careful thought

2. Analysis

3. Acquisition of information

4. Creativity

5. Decision making

6. Commitment

7. Debate/talk bout something 127

 Problem solving

A problem is a deviation from the

standard/normal.

Problem solving means finding of

solutions to problems.

128
 Methods of Problem solving
Analogy: using a solution that solves an
analogous problem

Brainstorming: (especially for group of people)

suggesting a large number of solutions or ideas
and combining and developing them until an
optimum solution is found

129
 Methods…
 Divide and overcome: breaking down a large,
complex problem into smaller, solvable
problems

Hypothesis testing: assuming a possible

explanation to the problem and trying to
prove (disprove) the assumption

130
 Methods…
Lateral thinking: approaching solutions
indirectly and creatively

Means-ends analysis: choosing an action at

each step to move closer to the goal

Morphological analysis: assessing the problem

and interactions of an entire system

131
 Methods …

Proof: try to prove that the problem cannot be

solved. The point where the proof fails will be
the starting point for solving it

Research: develop solutions from research, to

similar problems

132
 Methods …
Root cause analysis: identifying the cause of a
problem

Trial-and-error: testing possible solutions until

the right one is found

Reduction: transforming the problem into

another problem for which solutions exist

133
 Steps in Problem Solving
1. Finding the right problem to solve
2. Defining the problem
3. Analyzing the problem
4. Developing possibilities
5. Selecting the best solution
6. Implementing
7. Evaluating and learning
134
 To overcome barriers in problem
solving
1. Setting priority

2. Acquiring relevant information

3. Proceeding methodically and carefully

135
 Decision Making
Decision making-is a choice made between
two or more alternatives.

It is choosing the best alternative to reach the

predetermined objective.

136
 Types of decisions
Decisions in nursing service can be categorized
depending upon the following criteria:

How much time the manager spends in making

decision?

What proportion of the organization must be

involved in making decision?

137
 On the basis of these there are 3
classifications:
1. Ends -Means

2. Administrative-Operational

3. Programmed-Non-programmed
 Ends -Means
 Ends: deals with the desired individual or
organizational results to be achieved.

138
 Types of decisions…
Means: decisions that deals with activities that
will accomplish desired results.

2. Administrative-Operational

Administrative: made by superior management,

which have significant impact throughout the
organization.

Usually this type of decision is concerned with

policy, resource allocation and utilization. 139
 Types of decisions…
Operational: are generally made by mid level
and first line managers &
address day to day activities of a particular
organization.
3. Programmed-Non -programmed
Programmed- these are repetitive & routine in
nature.
Non-programmed: unique & non- routine

140
 Ways of Decision Making
1. Relying on tradition: taking the same
decisions that had been undertaken when similar
problem arouse in the past

2. May appeal to authority and make decisions

based on suggestions from an expert/a
higher level management

141
 Cont’d…
3. Priori reasoning: based on assumption/
reasoning without reference

4. Logical decision making: is a rational,

intelligent and systematic approach to
decision making

142
 Steps of logical Decision Making
1. Investigating the situation i.e. includes

 Identify the problem

 Define the problem

Diagnose the cause

2. Develop alternatives

3. Evaluate alternatives

4. Implement and follow up

143
 Factors Influencing Decision Making
1. Decision makers attribute
 Knowledge, experience and judgment

 Perception and personality

Values and philosophy

144
2. The Situation
 I.e. Urgency of the solution

 Magnitude and importance of the event

Cost benefit of the event

3. Environmental Constraints

 External

Internal

145
 Unit -7
Organizing patient care
 Organizing is an important management
function.
Work must be organized to achieve
organizational goals.
Activities must be grouped so resources,
people, materials & time are used fully.
146
 Organizing …

Nurses as a manager should:

Organize the activities of the staff into a
workable pattern to meet patient needs.
 She/he should establish effective r/ships
between the activities to be performed & the
workers to perform them.

147
Principles of personnel assignment in
pt care :
1- Made by the head nurse or nurse in charge for
each individual nurse.

2- Based on :

a- Nursing needs of each patient & approximate

time required to care for him.

b- The capabilities, skill level, previous experience &

the interest of the staff members.
148
 Principles…
c- Job description.

3- Planned weekly & revised daily if necessary to

assure continuity of care.

4- Take into account all the direct , indirect & unit

activities

149
 Principles…
5- Consider the geographical location of the unit
& the assigned duties to save nurse’s time and
effort.

6- Must be balanced among nursing staff.

7- Never to assign the same task to more than

one nurse.
150
 Characteristics of effective
assignment:
It should be

1. Clear cut & easily understood

2. Simple

3. Written

5. Signed &

6. Posted in advance
151
 Process of organizing patient care:

The head nurse or the nurse in charge should

carry out their duties & responsibilities
through applying the following steps:

Planning Assigning Leading

Evaluating Reporting

152
 Planning

Is a process of developing a course of action

for meeting the needs of patient.

 In planning, the head nurse decides what

should be done, when, how, where, by whom
& to whom.

153
 Assigning

Assignment of patient & nursing activities are

written in the assignment sheet by

 the head nurse/nurse in charge, based on the

principles of assignment.

154
 Leading

Includes issuing/giving instructions, motivation

& coordination of activities,

by making rounds, checking performance &

conducting conferences.

155
 Evaluating

By reviewing nursing performance &

 patient progress compared with the

assignment & nursing care plan.

156
 Reporting

The head nurse prepares a nursing unit report

“ e.g. shift report ” which includes patient’s
needs, special observations, bed number, all
critically ill &

157
 Reporting…
 post operative patients, special preparation
on the on-coming shift, abnormal change in
patient’s condition, data concerning
admission, discharge, transfer & death.

158
 staffing and scheduling
Staffing is the number of people working in the
organization.

ANA defines appropriate staffing as:

 “a match of registered nurse expertise with

the needs of the recipient of nursing care
services’’.

The provision of appropriate nurse staffing is

necessary to reach safe & quality outcomes. 159
 Staffing considers:

Patient needs

Staff satisfaction

Organizational needs

160
 Staffing may be centralized or
decentralized
• With centralized staffing, one department is
responsible for staffing all units.

• With decentralized staffing, unit leaders

(charge nurses or managers) determine the
level of staffing needed

161
 Staffing models
The three main models of nurse staffing are:
1. budget based- in which nursing staff is
allocated according the budget

2. nurse-patient- ratio, in which the number of

nurses per number of patients or patient days
determines staffing levels

162
 Staffing model…
3. patient acuity (patients’ level of care complexity)

 In which pt characteristics are used to determine a

shift’s staffing needs

consider that how long it takes to do certain nursing

tasks, such as administer medication, perform
assessment, or take vital signs

It must give nurses time to perform all functions

within their scope. 163
 Unit - 8
PROJECT PROPOSAL/PLAN
• A project is a set of planned activities within a given
time and resources, to produce results in order to
achieve a previous set project objective(s).

• Project can be:

 Mega or

 Mini project
164
 Project …

A project is a set of coordinated & controlled

activities with start &finishing dates.

A Project has time, cost, quality and resource

constraints

165
 Project proposal…
• A project is a set of activities:

– with clearly defined objectives

– following a plan

– requiring time

– financial resources and

– a team of project participants

166
 Project proposal…
• Therefore, project proposal is a clear, concise,
and convincing description of the project. It
has:
– Introduction
– Objectives
– Work plan and time frame
– Required resources and
– Team
167
Example of Mega project

168
169
 Project proposal…
A good project plan provides the structure for
implementing the program, serves as a guide
for effectively using human, material and
financial resources &

creates a common understanding of program

goals & objectives among staffs.

170
 Project proposal…
A good plan should describe the type of project
that you intend to implement, the expected
results, the plan of activities &

The plan of implementing the project, the way

that the progress will be followed, the reporting
system & the cost of carrying out the project.

171
 Project Management
It is the art of organising, leading, reporting
and completing a project through people
A project manager is a person who causes
things to happen or
A project manager is a person who controls
the project.

172
 Good Project Manager Role
A Good Project Manager
Takes ownership of the whole project
Is proactive not reactive
Adequately plans the project
Is democratic (NOT Authoritarian)
Is Decisive
Is a Good Communicator

173
 Project Manager Role...
Manages by facts

Leads by example

Has sound Judgement

Is a Motivator

Is Diplomatic

Can Delegate
174
 Stakeholder in a project
“A person or group of people who have an
interest in the success of a project” e.g.
Funding Body
Customer
Suppliers
End User
Government
Neighbours/Community

175
 Project proposal contain different
sections:
Title=topic, groups, submitted to, project area

project summary= project title, duration, area/

location, total budget, total beneficiaries
Summary= about the topic clearly
Introduction= about your topic

176
 Statement of the problem
Shows the severity and extent of the existing
problem that the project will address & the
planned solution.

The goals &objectives of the project & the time

frame for achieving the objectives.

177
 Cont’d…
Activities to be done to achieve each
objective

A plan for monitoring progress & evaluating

the results of the project

A reporting plan & schedule

178
 cont’d…
A work plan for the term of the project:

Including all the activities to be done,

Who will be responsible for each activity, and

when each major activity will be done;

A detailed project budget & a summary of

budget for the life of the project.

179
 Explaining the Purpose of your
project

Each new project should be created to

respond to documented needs or

problems in the community or region your

program done.

180
 Cont’d…

Thus, the first part of the plan should

justify the need for the project.

This part of the plan can be divided into

two sub-sections; the problem
statement & your proposed solutions.

181
 The Problem Statement
This is a statement of the specific problem to
be addressed by the project.
It includes
A description of the extent & severity of the
problem.

A description of the geographic area and

182
 Cont’d…
demographic characteristics of the population
in the area in which the problem exists.

An analysis of the causes of the problem.

The results of the previous efforts, by your

program or other programs, to solve the
problem.

183
 The Proposed Solution
In this section of the plan you should
explain the design of your project,

Emphasizing those aspects of your

approach that you think best to address
the problem you have described.

184
 The project design should answer
the following questions:
What approach will you use & why you
chosen this approach over other
possibilities?

What other local programs are addressing

this problem & how does your proposed
approach complement their activities? 185
 Cont’d…
What changes do you expect will result
from this project?

How does this project fit in your

organization’s overall strategic plan?

186
 Cont’d…
 What sources of support are likely to be
available to you for continuing the
project in the future?

In what ways is the project designed so

that it can be replicated in other areas?

187
 Being Specific about what the New
proposal will accomplish
A well-designed project should have both
overall goals & specific objectives.

Once the objectives have been determined, a

set of activities that describe how each
objective will be achieved should be specified.

188
 Goals
Goals: The overall goals should describe in a
broad way i.e. the long-term changes that will
result from your project's work.

 Normally one or two general statements

describing the proposed long-range benefits
to the target population are sufficient to
describe the overall project goals.
189
 Objectives …

Objectives: for each overall goal that you

develop, there should be several specific,
measurable objectives.

Your objectives should be SMART.

190
 Objectives …

Specific - avoid different interpretations

Measurable - measurable in #,
observable, or otherwise documentable.
It allows for monitoring & evaluation.

191
 Objectives …
 Appropriate - to the problems, goals &
strategies

Realistic – achievable

Time bound - with a specific time period

for achieving them

192
 Examples of specific objectives:
To select and train a network of 60 family
planning promoters by the end of the first year
of the object.

To attract 4,000 new family planning

acceptors during the first year of operation of
the project & an additional 9,500 during the
second year of the project.
193
Developing Detailed project Activities

plan of activities constitutes the core of your

proposal & should describe the major
activities needed to accomplish each project
objectives.

To success in your project, you should list

the key activities that must be carried out
in order to achieve each objective. 194
 Activities…

One or more individuals should be assigned to

each activity & these people will be responsible
for carrying out the activity.

The plan of activities can be divided into two

sub-sections: a detailed description of project
activities & a project activity timeline.

195
 Monitoring the progress of the
project
 Plan for monitoring & evaluating the project
should be included in the initial project design.
 Monitoring - is the process by which project
activities & the budget are regularly reviewed
/checked. Monitoring helps to ensure that the
activities planned in the work plan are being
completed & that the costs are in line with the
budget. 196
 The monitoring plan should include :

A list of personnel who will be involved

in monitoring the project & their specific
monitoring responsibilities

How & when project managers will

monitor activities

197
 Cont’d…
A plan for the development of criteria
that will be used to monitor project
activities, including measures of service
quality

A plan for the development of forms that

will be used for monitoring activities
198
 Evaluation
The evaluation of the project should
analyze the implementation process (i.e.
whether the planned activities were carried
out & completed)

as well as the impact (long-term effect) that

the project has had on the target population.

199
 Evaluation…
Or Project Evaluation is the periodic, systematic
assessment of an on-going or completed project,
its design, implementation and results. It aims to:

– Compare actual results with those planned /

expected
– Determine the relevance and fulfilment of
objectives
– Measure effectiveness, impact and sustainability

200
 Evaluation…

Evaluation allows other project staffs know

in advance what aspects of the project will
be evaluated & how & when the
evaluations will be conducted.

201
 Your evaluation should describe:
 How the evaluation criteria will be developed
 Who will perform the evaluation & when the
evaluations will occur
 How evaluation data will be collected &
submitted, including how qualitative data will be
collected.
 How evaluation data will be analyzed & reported
 How the evaluation findings will be used 202
 Reporting Your Achievements
You should have forms for reporting on both
programmatic achievements & financial
activities.

 If you do not already have reporting forms,

you will need to develop new forms or

modify existing forms used by your program

or other similar programs.
203
 Programmatic reporting
provides detailed information on the
activities under taken in the project.

The narrative reports should refer to the

stated objectives, activity plan, and
evaluation criteria to be used in analyzing
project progress.

204
 Financial Reporting
shows how much money has been expended
during a specific reporting period and

 for what purpose and whether the money

that was spent was in line with the budget.

205
 Sample project proposal outline
1. Project title
2. Table of content
3. Project summary
4. Summary= about the problem
5. Introduction
6. Statement of the problem
7. Justification
8. Goals & Objectives
9. Activities to be done for each objective
206
 Cont’d…
10. Project Sustainability

11. Monitoring & Evaluation

12. Reporting- Financial & Programmatic

13. Work plan in table

14. Budget break down & total budget

15. References

207
208