Directing is the fourth phase of the management process, it can also be called as coordinating or activating *Here the leadership and the management skills are both required in order to accomplish the goal of the organization. *It consists of 2 major components like guidance and supervision which is to be done during job process which help the nurses to utilize their total skills and knowledge in providing the quality care.

1. MANAGEMENT OF NURSING
SERVICES IN HOSPITAL AND
COMMUNITY-
DIRECTING/LEADING IN
HOSPITAL AND
COMMUNITY SERVICES
KULDEEP VYAS
ASST.PROF
HOD – COMMUNITY HEALTH NURSING
DSSNI

2. Directing is the fourth phase of the management
process, it can also be called as coordinating or
activating
*Here the leadership and the management skills are
both required in order to accomplish the goal of the
organization.
*It consists of 2 major components like guidance
and supervision which is to be done during job
process which help the nurses to utilize their total
skills and knowledge in providing the quality care.
ELEMENTS OF DIRECTING IN HOSPITAL AND
COMMUNITY HEALTH SERVICES
1.Leader ship:-
Leadership involves an unequal distribution of
authority between leaders and group members.
They can direct some activities of group members,
but group members cannot direct the leader's
activities, though they will obviously impact on these
activities in a number of ways.
2.supervision:-
Supervision can be defined as a process by which
subordinates are required by their immediate
superiors to make the best use of their abilities so as
to do their jobs efficiently and effectively, with
increasing satisfaction to themselves and to the
organization in which they function. Following are
the purposes of supervision:

3. a.To understand the duties and responsibilities of
one's position
b. lo plan the execution of work
c.To divide the work among subordinates and to
direct and assist them in doing it
d.T
o improve one's own knowledge as technical
expert and leader to improve one's work methods
and procedures
f. To train the personnel g. Io evaluate the
performance of the employees
h. Io correct mistakes, solve employees problems
and develop discipline
3.delegation:-
Delegation is one of the most important methods of
organizing and also a skill required of a manager.
Through process, a manager assigns specific task or
duty to workers. By dividing his work and sharing
his responsibilities with others, a manager can
function more effectively. By delegating well-defined
tasks and responsibilities to the subordinates, the
nurse manager can be freed of valuable time that
can well be spent on planning and evaluating
nursing programmes and other important activities.

4. 4.communication:-
Communication forms the basics of all human
interactions. It is one of the most vital components
of all managerial practices. A great deal of
management involves interpersonal communication
skills. Communication is also an essential component
of health care. Nurses who communicate effectively
can bring about change that promotes health, build
up a trusting relationship with patients and with
other staff, and prevent legal i problems associated
with nursing practice.
5.coordination:-
Coordination is the orderly synchronization of the
interdependent efforts of individuals so as to attain a
common goal. In a hospital, the activities of doctors,
nurses, ward attendants and lab technicians must be
efficiently synchronized if the patient is to receive
good care.
6.Decision making:-
Decision making can be regarded as a mental process
that results in the selection ot a course of action. It
produces a final choice; the output can be an action
or an opinion.

5. 7.motivation:-
Motivation channelizes a person's inner drive so that
she or he tends to accomplish their goals of the
organization. It concerns those dynamic processes
that produce a goal-directed behavior. A goal-
directed behavior begins with the individual feeling
certain needs; these needs give a thrust to the
individual towards his goals or incentives.
ROLE OF COMMUNITY HEALTH NURSE IN
DIRECTING:-
1.programme director:-
Programme director's role is vital in community
health nursing. It is a purely administrative role. The
core function in community health care should be to
adapt preventive strategies that will have a large
impact on the population. As programme director,
she or he should focus on the health status,
environment, sociocultural practices, physiology.
physical and biological status of the community and
should coordinate the requisite functional activities
within the framework of the programme
2.planner:-
Since community health nursing planners have the
responsibility of planning day-to-day activities, fixed
programmes should be prepared well in advance
with the coordinators, block health education
officers, senior health assistants, junior health
assistants and other staff.

6. 3.Programme organizer:-
In community health settings, the programme
organizer can find out which programmes may be
directed to prevent disease or eradicate the same, or
which can be motivational programmes. According
to the goals and objectives of a programme, the
community health nurse has to organize it well in
advance for future generations. She or he should
have an idea about the programme, assessthe
settings and persons through whom it is to be
implemented, what is the expected objective of the
functions and what are the requirements.
4.Decision maker:-
She or he should make the key decisions about how
the programme should start, how it should proceed,
what should be the activities, what is the expected
outcome, what strategies are to be adapted for
better preventive care and who all will implement
the activities. The delegation of powers needs to be
decided in advance.
5.supervisor:-
A community health nurse supervisor should have
the knowledge and responsibilities for the
programme from start to finish. She or he should
have the qualities of supervision, such as good
judgment, impartiality in understanding others
emotions and attitudes, full awareness of their
existing situations and various settings of community
health services.

7. 6.investigator:-
As a community health nurse, she or he should
investigate the health needs of the individual, family,
groups and society. As an investigator, she or he
should identify present and potential problems and
resources related to the community. She or he
should gather the data through interviews,
observation, laboratory analysis, epidemiological
surveys and census. She or he should analyze the
health care services by the government and private
organizations, and attitudes of the people related to
health services, and also evaluate the effectiveness of
services.
7.evaluator:-
As a community health nurse, she or he should
ensure the value of health activities through the
behavioral changes of the consumer or by assessing
the status of overall health of the individual, family
or society. This can be assessed through various
indicators of health-infant mortality rate, maternal
mortality rate, crude birth rate, crude death rate, life
expectancy, female educational status, average
marriage age for male and female, etc.

8. OBIECTIVES OF DIRECTING
1.Diagnosing and investigating health problems and
health hazards in the community.
2.Monitoring health status to identify community
problems.
3.Informing, educating and empowering people
about health issues.
4. Developing policies and plans that support
individual and community health efforts.
5.Mobilizing community partnership and actions to
solve health problems.
6.Linking people to needed personal health services
and ensuring the provision of health care when
otherwise unavailable.
7. Enforcing laws and regulations that ensure health
and safety.
8.Researching for new insights and innovative
solutions to health problems.
9.Evaluating effectiveness, accessibility and quality
of health services.

9. SUPERVISION IN COMMUNITY HEALTH SERVICES
Supervision of Staff in the Community
* Home visiting along with the staff is one of the
best ways of supervision.
* The purpose of visits is to help and guide the staff.
*The frequency of visits will depend on the need or
requests of the individual and the amount of time
available for visiting.
During home visit, the supervisor is expected to
make observations on:
1.The approach to the family
2.Actions and nursing techniques followed by the
nurse to meet the problem
3. Following the standing orders
4 The response of health care teaching done
previously
5.The plan made with the family regarding future
course of action
6.Whether all aspects of health problems are being
dealt with or not
Clinic Visit
The supervisor is also expected to visit the clinic,
where she or he has to make observations on:
1. Clinical set-up

10. 2. Sterilization of equipment
3. Nursing procedures
4. Maintenance of clinical records
5. Whether health teaching is being carried out
6.Supply, storage, and maintenance of drugs and
supplies
Visit to School and Community
The supervisor is also expected to visit schools and
related community organizations to:
1.Help in identifying needs/problems of the people
2. Assist in planning the programme
3. Guide in maintaining the records
4. Conduct individual and group conferences
5. Appraise the efficiency and effectiveness of
services being rendered
DELEGATION IN HOSPITAL SERVICES
1.Delegation frees the manager or superior from the
overwork. It is neither advisable nor feasible to stick
to a 'do it yourself attitude'. The executive cannot
answer a phone call, sign a cheque, conduct an
interview and supervise medical stores, all at the
same time.

11. 2.Delegation saves time. By assigning less important
work to others, the manager has more time to
attend to important activities. Even some of the
important activities can be passed on to other
trusted colleagues. In addition to saving time, delays
are also prevented.
3.Delegation expedites decision making. The
required information and other inputs are received
from different individuals and collective decisions are
taken after discussing the alternatives.
4.Delegation expedites implementation of the
decisions taken. Depending on the efficiency and
knowledge of skills, various activates could be
delegated to different individuals. By coordinating
their activities, the desired goal is achieved much
faster.
5.Delegation develops subordinates. In the absence
of the boss or manager, a vacuum is not felt.
Activities do not come to a halt. In the event of
retirement, resignation, transfer or death, trained
subordinate take up the responsibility either
temporarily or on a permanent basis.
6.Delegation improves motivation, as the
employees feel trusted and empowered. i In spite of
there being many advantages of delegation, there
are nevertheless many organizations that are
reluctant to delegate.

12. 6. Delegation improves motivation, as the
employees feel trusted and empowered. i In spite of
there being many advantages of delegation, there
are nevertheless many organizations that are
reluctant to delegate
ROLE OF NURSE MANAGER IN LEADING
QUALITY PATIENT CARE
The nurse manager is responsible for providing
quality care to the patient by assigning proper staff
to the patient, supervising the patent care and
evaluating the care rendered by the staff nurses, The
nurse manager needs to motivate the staff nurses to
provide holistic care to the patient.
Leadership Role
1. Assigning patients to the staff nurses.
2. Preparing duty roster for staff nurses.
3. Motivating the staff nurses for high quality care.
4.Providing adequate supplies and equipment for
patient care.
5. Maintaining patient-nurse ratio.

13. Managerial Role
1.Supervising nursing care providers.
2.Evaluating care provided to the patients.
3.Maintaining the standards and policies of the
organization.
4. Providing safe and effective patient care.