2. ● Hospitals, patient care units and ward managent
● Emergency and disaster management
● Human Resource management in hospital and community
services
● Categorising nursing personnel
● Patient/ population assessment and nursing care responsibilities
● Staff development and welfare
● Budgeting for hospital and community management
● Material management in hospital and community services
● Directing/ leading in hospital and community services
● Assignment, rotation and delegation
● Supervision and guidance
● Evaluation and documentation
● Performance appraisal
3. 3.1 Hospital, patient care units and ward management
● Definition
● Hospital is an institution for the
care, cure and treatment of the
sick and wounded, for the study
of diseases and for the training
of nurses and doctors.
4. ● Scope of a hospital
1. Coordinated health care team approach
2. Holistic care
3. Comprehensive or specialised care
4. Integrated care
5. Research or evidence based care
6. Continuous care
5. ● Organisation and functions of hospitals
Reception Operation theatre
Inpatient department BMW department
Outpatient department Isolation unit
Administrative department Forensic department
Nursing department Pharmacy
CSSD Physiotherapy
Diagnostic department Counseling department
Biomedical engineering Housekeeping
Dietary department Laundry department
Emergency or casualty Rehabilitation centre
6. ● Classification of hospitals
● Based on ownership
1. Public hospitals
2. Voluntary Hospitals
3. Private/ charitable/ nursing homes
4. Corporate hospitals
7. ● Based on the patient length of stay
1. Hospital for short term stay - for acute illness
2. Hospital for long term stay - for chronic illness
8. ● Based on the license to treat
1. General hospital has license to treat all illnesses
2. Nursing homes have license to treat some specific illnesses
10. ● Based on objective
1. Educating cum research hospital. eg, Ahmedabad cancer hospital
2. General Hospital - for all illnesses
3. Specialised hospital - for specific illnesses. eg, ENT
4. Isolation hospital- hospital for patients with infection and
communicable diseases
11. ● Based on administration
1. Hospital administered by union government - railway hospital
2. Hospital administered by state government - prison hospital
3. Hospital administered by Local bodies - corporation hospital
4. Independent or autonomous hospital - NIMHANS ( Bangalore)
5. Private Hospital - apollo hospital
12. ● Based on the indigenous system of medicine
1. Allopathic hospital
2. Ayurvedic hospital
3. Homeopathic hospital
4. Unani hospital
5. Siddha hospital
13. ● Role of nurse manager in hospital management
1. Maintain patient records
2. Administering medicines
3. Changing bandages and wound dressings
4. Checking vital signs
5. Collaborating with teams for patient care
6. Patient advocate
7. Assessment of medication history
8. Building trust with patients
9. Educate patients about management of illnesses
10. Interpreting care plans
11. Operating and monitoring medical equipment
12. Scheduling
13. Supervise
14. Give RT feeding to patients
14. ● Ward management
● Ward managers oversee the
delivery of patient care within
their wards. They ensure patients
receive the highest standard of
care, monitor patient progress
and coordinate with other
healthcare providers to develop
and implement care plans.
16. ● Objectives of ward management
● To provide highest quality nursing care for patient.
● To provide a clean, well ventilated environment for patient and
protect him from infection, accidents and hazards.
● To help the staff in achieving highest degree of job satisfaction.
● To provide facilities to meet the needs of patient and their
attendants.
● To provides accommodation for patients, who are prescribed
admission in the hospital and the nurses provide requisite but
routine care.
● To ensure maximum utilisation of hospital resources.
18. ● Criteria to be fulfilled for good nursing management
● Communication
● Mentoring
● Leadership
● Education
● Time management
● Critical thinking skills
● Delegation
● Organization
● Professional
● Set achievable goals
● Basic care techniques and knowledge
19. ● Responsibilities of the head nurse
● Assisting with and coordinating patient care
● Allocating nursing and healthcare resources where needed
● Organizing nurses' notes regarding patients
● Providing patient paperwork to doctors
● Coordinating patient payments with payments department or
process payments on their own
● Participating in the hiring of new nursing staff and training new hires
● Creating schedules for nursing staff
● Resolving employee conflicts
● Resolving patient issues
● Creating reports for facility management
● Placing orders for equipment and supplies
● Conduct nursing rounds with ward incharge
20. ● Responsibilities of the ward in charge
● Supervision: The ward incharge is responsible for supervising the nursing staff and other healthcare
professionals working in the ward. They ensure that the staff follows protocols and provides
high-quality patient care.
● Patient Care: The ward incharge ensures that patients receive appropriate care and treatment. They
coordinate with doctors, nurses, and other healthcare professionals to develop and implement care
plans for patients. They also monitor patients' progress and address any concerns or issues that
arise.
● Staff Management: The ward incharge is responsible for managing the staffing needs of the ward.
They schedule shifts, assign duties, and ensure adequate staffing levels to provide optimal patient
care. They also provide guidance and support to the staff, conduct performance evaluations, and
address any disciplinary issues.
● Administrative Tasks: The ward incharge handles various administrative tasks, such as maintaining
patient records, managing inventory and supplies, and ensuring compliance with healthcare
regulations and policies. They may also be involved in budgeting and financial management for the
ward.
● Communication and Collaboration: The ward incharge serves as a liaison between the ward and
other departments or units within the healthcare facility. They communicate with doctors,
administrators, and other healthcare professionals to coordinate patient care, resolve issues, and
ensure smooth operations.
● Quality Improvement: The ward incharge plays a key role in quality improvement initiatives. They
identify areas for improvement, implement evidence-based practices, and monitor outcomes to
enhance patient care and safety.
21. ● Responsibilities of the senior staff nurse
● Administering medication
● Educate patients
● Operate Medical equipment
● Monitoring patient Health
● Perform diagnostic tests
● Perform physical examinations
● Recording medical information
● Recording vital signs
● Coordinating with physicians
● Patient advocate
● Provide support and advice
● Wound care
● Assessing patients
● Interpreting care plans
● Patient care
● Checking and counting
medication
● Drawing blood samples
● Emotional support
● Implementing and assessing
care plans
● Preparing patients for
operations
● Changing dressings
● Client education
● Communication
23. ● Emergency and casualty services
● The primary role of casualty and
emergency services is to
respond to emergency calls and
provide medical care to those in
need. This can include treating
individuals who have suffered a
heart attack, stroke, or other
life-threatening medical
condition.
27. ● Disaster management
● Disaster is a catastrophic
occurrence that has profund
implications on public health. It
is a destructive event that results
in the need for wide range of
emergency resources to assist
and ensure the survival of
disaster/ disease stricken.
28. ● Definition of disaster
● A disaster is a serious problem occurring over a period of
time that causes widespread human, material, economic or
environmental loss which exceeds the ability of the affected
community or society to cope using its own resources.
● disaster, any natural or human-generated calamitous event
that produces great loss of human life or destruction of the
natural environment, private property, or public infrastructure
32. ● Psychological reactions to a disaster
● confusion,
● fear,
● despair,
● helplessness,
● insomnia,
● physical pain,
● anxiety and anger,
● grief,
● shock,
● violence and mistrust, guilt and shame,
● and loss of trust and self-confidence.
35. ● Role of nurse during disaster management
● Examining patients
● Caring for injuries
● Stabilizing critical patients
● Providing first aid and CPR
● Giving IV fluids
● Administering medications
36. ● National and international agencies in disaster
management
● Red Cross society
● District Hospital
● UNICEF
● WHO
● voluntary organisations
● Local government
38. ● Definition of HRM
● Human resource management is the strategic and coherent approach
to the effective and efficient management of people in a company or
organization such that they help their business gain a competitive
advantage. It is designed to maximize employee performance in
service of an employer's strategic objectives.
● Human resource management is the strategic approach to nurturing
and supporting employees and ensuring a positive workplace
environment.
● Human resources (HR) is the division of a business that is charged
with finding, recruiting, screening, and training job applicants.
41. ● Role of a nurse manager in HRM
● Human Resources and Financial Management. Nurse leaders
make hiring and firing decisions. They also organize staff training,
foster professional development, and prepare budgets.
● Quality-of-Care Standards. Nurse leaders oversee nursing units,
ensuring nurses follow established protocols and procedures that
maintain patient safety and high-quality care.
● Organizational Goals. Nurse leaders set goals for patient outcomes.
They align nursing units’ goals with their healthcare organizations’
larger strategic objectives.
● Patient and Nurse Advocacy. Nurse leaders communicate nursing
units’ needs to management. They represent nurses in meetings
with their healthcare organizations’ executive leaders. They also
advocate for patients, working to improve their satisfaction and
ensure a safe environment.
43. ● Definition
● Human Resources planning is the process by which an
organisation ensures that it has the right number and kind of
people, at right place, at right time, capable of effectively and
efficiently completing those tasks that will help the organisation to
achieve its overall objectives.
● HRM includes estimation of how many number of qualified people
necessary to carry out the assigned activities, how many people
available and the number of steps to be taken to ensure that
personnel supply equals personnel demand at the appropriate
point of future.
44. ● Steps involved in manpower planning
Recruitment
Selection
Job analysis
Training and development
Retaining
Demotion
49. ● Retaining
● Employee retention involves taking measures to encourage employees to
remain in the organisation for the maximum period of time.
50. ● Promotion
● Employee Promotion means the
ascension of an employee to
higher ranks. It involves an
increase in salary, position,
responsibilities, status, and
benefits. This aspect of the job
drives employees the most—the
ultimate reward for dedication and
loyalty towards an organization.
51. ● Demotion
● Breach of discipline
● Inadequacy of knowledge
● Unable to cope with change
● Reorganisation
Reasons of demotion
52. ● Deployment
● Deployment is the movement
of staff from one work
assignment to another to
meet operational needs.
Deployment may take the
form of work assignments
within the current job, lateral
transfers, relocation, or
temporary assignments.
54. ● Superannuation
● A superannuation scheme refers
to a pension scheme granted by
a company or employer to its
employees for their welfare. Also
known as a company pension
plan, superannuation involves
accumulating funds in
employees' accounts until their
retirement without any tax
implementation.
56. ● Job analysis
● Job analysis is the process of
gathering and analyzing
information about the content
and the human requirements
of jobs, as well as, the
context in which jobs are
performed.
57. ● Job description
● A job description is a written explanation that outlines the
essential responsibilities and requirements for a vacant
position. Job descriptions should be thorough, clear, and
concise and include: A brief introduction to the company and
its mission. An overview of the job responsibilities.
● A job description is a document that clearly states essential job
requirements, job duties, job responsibilities, and skills
required to perform a specific role. A detailed job description
will cover how success is measured in the role so it can be
used in performance evaluations.
● Job descriptions are also known as job specifications, job
profiles, JDs, and position descriptions (job PD).
60. ● Staff nurse / nursing officer
● Educational qualifications
1. General : Pre-university course /10+2 or equivalent
examination
2. Professional : Three years general nursing (GNM) / 6-9 months
midwifery / psychiatric nursing diploma certificate, recognised
by Indian nursing council (INC), or revised general nursing and
midwifery / psychiatric nursing diploma / certificate
recognised by INC, or basic b.sc nursing from a recognised
university according to INC norms.
3. Registration : Registered with the state nursing council / Indian
Nursing Council.
61. ● Standard norms and INC (nurse : patient ratio)
● Normal ward 1 Staff Nurse/Nursing Sister for
every 6 beds
● Special Wards;
● I) Paediatrics
● II) Burns/Burns Plastic
● III) Neuro Surgery
● IV) Cardiothoracic
● V) Neuro Medicine
● VI) Nursing Home
● VII) Tetanus
● VIII) Spinal Injury
● IX) Emergency Wards attached to
casualty
1 Staff Nurse/Nursing Sister for
every 4 beds
● Nursery 1 Staff Nurse/Nursing Sister for
every 2 beds
62. ● ICU/ICCU/ICCR Nephrology
● (AK Dialysis)
1 Staff Nurse/Nursing Sister for
every bed
● Labour Room 1 Staff Nurse/Nursing Sister for
every labour table
● O.T.I) Major
● II) Minor
2 Staff Nurse/Nursing Sister for
every functional operation table
including recovery room.
1 Staff Nurse/Nursing Sister for
every functional operation table
● Casualty 3 Staff Nurse/Nursing sister for 24
hours
● Opd 1 staff nurse / opd
63. ● Role and responsibilities of staff nurse ( job description)
● Maintaining care for all patients during their shift
● Recognising the change in a patient's health conditions and
responding appropriately
● Recording and monitoring a patient's vital signs
● Promoting well-being by educating patients on self-care techniques
● Consulting with doctors and other medical staff to determine the
optimal treatment plan
● Administering over-the-counter and non-intravenous medications
● Changing dressings of the wounds
● Nurturing a compassionate environment by providing emotional and
psychological support to the patient and their family members
● Operating medical equipment with accuracy
64.
65. ● Job description of head nurse
● Assist with patient care as needed
● Hospital nursing supervision
● Monitoring all the medical records
● Observing nurses providing patient care
● Reviewing daily and weekly nursing procedures
● Collaborating with other health care professionals
● Educating new nurses
● Forming nursing teams
● Guide staffing procedures
● Overseeing department budgets
● Providing patient paperwork to doctors
● Report to upper management
66. ● Job description of nursing superintendent
● Formulating nursing services policies & procedures and keeping them up to
date.
● Selection of nursing staff and assessment of individual training
requirements.
● Delegation of duties and responsibilities to nursing personnel at various
levels.
● Maintaining a stable staff pattern at all times.
● Carrying out daily ward rounds to ensure that all procedures are being
carried out as per policy.
● Conducting routine meetings at different levels to monitor the service
delivery levels.
● Investigation of complaints from patients and their resolution.
● Provide timely reports and feedback to the management on any issues
related to patient care.
67. ● Principal , college of nursing
● Education qualifications
1. General : As prescribed for staff nurse
2. Professional : M.sc nursing or equivalent degree , PhD in nursing
or other equivalent doctorate degree
3. Registration : Registered with state nursing council/ INC
4. Experience : Should have minimum 12 years teaching and
administration experience not less than 5 years’ teaching
experience in a college.
68. ● Roles and functions
1. General Administration of School/College of Nursing.
2. General administration and overall supervision of teaching programmes.
3. Supervision of students welfare, health and security services.
4. Supervision and guidance of teaching staff including organization of in-service education of staff.
5. Responsibility for organizing workload of staff including teaching assignments.’
6. Guidance and counselling of students.
7. Administrative arrangements for students’ clinical experience and teaching in hospital and public health field.
8. Recruitment of staff and admission of students.
9. Responsibility for conduct of examinations.
10. Supervision of living conditions of students in hostel.
11. Maintenance of permanent records of students.
12. Preparation of reports (School/College reports, progress reports).
13. Review and revision of policies, rules, regulations & philosophy of the School/College.
14. Performing public relations duties for the School/College.
15. Procurement of School/College equipments, supplies, stationery.
16. Preparation of budgetary proposals.
17. Supervision of hostel and office staff.
18. Participation in the school’s/College’s committee work.
19. Participation in teaching programmes.
20. Supervision of library services.
21. Planning for development of the school/college.
69. ● Professor, college of nursing
● Education qualifications
1. General : As prescribed for staff nurse
2. Professional : M.sc nursing or equivalent degree , PhD in nursing
or other equivalent doctorate degree
3. Registration : Registered with state nursing council/ INC
4. Experience : Should have minimum 10 years teaching and
administration experience not less than 5 years’ teaching
experience in a college.
70. ● Roles and functions
● Develops curriculums
● Interviewing potential students
● Participate in collegiate faculty
meetings
● Publishing research
● Attending faculty meetings
● Keeping student records of
achievement
● Mentor teaching assistants
● Pastoral care of students
● Teach advanced classes
● Attending conferences
● Presenting lectures
● Presenting research
● Creating supplemental
instructional materials
● Demonstrate excellence in
teaching
● Mentoring students
● Monitor student
performance and provide
feedback
● Participate in committees
● Publish their findings
● Writing proposals to
secure research funding
● Conducts research
● Delivering presentations
● Plan lessons and
assignments
71. ● Assistant Professor, college of nursing
● Education qualifications
1. General : As prescribed for staff nurse
2. Professional : M.sc nursing or equivalent degree , PhD in nursing
or other equivalent doctorate degree
3. Registration : Registered with state nursing council/ INC
4. Experience : Minimum 3 years of teaching experience in a
recognised institution.
72. ● Roles and functions
● Teaching: Delivering lectures and lessons, preparing course materials,
and evaluating students’ performance through exams, assignments,
and other assessments
● Research: Conducting original research in their area of expertise,
publishing academic articles and books, and presenting their findings at
conferences
● Mentoring: Advising students and serving as role models to assist in
directing their professional and academic development
● Service: Participating in departmental and institutional activities, serving
on committees, and helping in recruitment and mentor new faculty
members
● Professional Development: Expanding professional development, going
to conferences and workshops, and collaborating with peers to advance
their research and teaching objectives
73. ● Nursing tutor / clinical instructor , college of nursing
● Education qualifications
1. General : As prescribed for staff nurse
2. Professional : B.sc nursing (postgraduate) or M.sc nursing or
equivalent examinations
3. Registration : Registered with state nursing council/ INC
4. Experience : any fresher can apply
74. ● Roles and functions
● Lecturing and guiding class discussions
● Maintaining clinical skills and certifications
● Guiding students through clinical rotations
● Designing and evaluating program curricula
● Effectively assist and assess student learning
● Interprets test results with students
● Planning and developing curriculum
● Prepare lesson plans
● Supervising lab and clinical work
75. ● Nurse manager’s job description
● Promotes and restores patients’ health by developing day-to-day
management and long-term planning of the patient’s care.
● Directs and develops nursing staff by creating schedules, offering
advice, and answering any health-related questions.
● Collaborates with physicians and multidisciplinary professional staff.
● Provides physical and psychological support for patients, as well as
their friends and families.
● Maintains the nursing guidelines by writing and updating policies and
procedures.
● Assures quality of care by developing and interpreting hospital and
nursing divisions.
● Enforces adherence to the state board of nursing and state nurse
practice requirements.
76. ● Maintains nursing staff by recruiting, selecting, orienting, and
training nurses and auxiliary staff.
● Completes patient care requirements by scheduling and assigning
nursing and staff.
● Maintains nursing staff by coaching, counseling, and disciplining
through monitoring and appraising nurses’ job performance.
● Provides information to patients and the health care team by
answering questions and requests.
● Maintains a safe and clean working environment by designing
health procedures and protocols.
● Maintains a cooperative relationship among health care teams by
communicating information and participating in team-building
exercises.
78. ● Introduction
● The term Patient Classification Systems refers to
measurement systems in nursing that reflect actual patient
care needs for staffing purposes.
● A patient classification system, which quantifies the quality of
nursing care, is essential to staffing nursing units of hospitals
and nursing homes. In selecting or implementing a pcs, a
representative committee of hospital administration, nurse
managers, and clinical nurses should be used.
● Patient classification systems (PCS) assist nurse managers in
controlling cost and improving patient care while appropriately
using financial resources.
79. ● Objectives
1- Staffing : The system will establish a unit of measure for nursing
that is ; time which will be used to determine numbers and kinds of
staff needed.
2- Program costing and formulation of the nursing budget .
3- Tracking changes patient care needs .
4- Determining values for the productivity equation .
5- Determining quality .
81. ● Types of patient classification system
1. Factor evaluation system :
Patient needs are scored on
multiple care descriptors
2. Prototype eva system :
Describes typical patient and
varying need levels
3. Diagnostic related group :
Grouping patients for
prospective payment
82. ● Most health care agencies use PCS, where several care elements
or descriptors are identified, each element being divided into sub
elements with a standard time being determined for
accomplishing each subelement.
● The descriptors used to measure a patient's dependency needs
are activities of daily living: feeding, grooming, toileting, comport
measures and mobility. The requirement to assist a patient with
each activity is quantified from the least amount of time required
to the greatest amount of time required, e.g. self-feeding vs tube
feeding.
● Factor evaluation system
83. ● Common care descriptors
● Hygiene, nutrition, medications, fluid management, skin
and wound care, respiratory care, circulatory care,
elimination, mobility, special diagnostic and treatment
procedures, health teaching and daily activities of living.
● After the care descriptors have been selected, the levels
of care are defined for each descriptor. The level is
differentiated by the amount of nursing time and
frequency of each care measure.
● The factor system is referred to as objective because
specifying particular indicators or factors associated with
patient care helps to ensure objectivity by the rater.
84. ● Prototype evaluation system
● Category I: Patients with acute illness wherein the disease has affected the body. They
need immediate treatment so that their health can be restored quickly in short period
since the illness is identified in the early stages.
● Category II: Patients with illness in the chronic stage. The treatment is given to reduce
the complication and prevent the duration of chronic illness. The health of the patient
can be restored back if appropriate antibiotic treatment is given at the right time by the
right physician.
● Category III: Patients with long duration of chronic illness. The patient needs 1 live life
with disability caused by the disease. Therefore, the patient needs the right type of
rehabilitation to restore the maximum functioning level so as to meet the daily needs
with his/her disability.
● Category IV: Patients with illness wherein the disease has reached the terminal stage
and the patient cannot be cared for in the house and needs special health centre's
assistance to survive without any complications.
● Category V: Patient with end stage of illness. However, the most effective PCS is one
that is specifically tailored to the clinical situation where it will be used.
85. ● Diagnosis related groups
● This is a prospective payment system. It has a predetermined price
for patient hospital care for Medicare recipients according to the
patient's placement in 1 of 467 DRGs.
● The DRG system is a strategy for grouping patients according to
demographic, diagnostic and therapeutic characteristics that
correlate with their use of hospital facilities.
● Under this prospective payment system, hospitals are paid a fixed
price for all inpatients, according to the DRGs into which the
patients are classified at time of discharge from the hospital. If the
hospital cost for the patient care is less than the fixed rate, the
hospital gets a profit. If the cost exceeds the fixed rate, the hospital
is at a loss. The DRG system provides incentives for early hospital
discharge but the quality of care is affected.
86. ● Patients assignment and nursing care responsibilities
● Functional Nursing
● Team Nursing
● Primary Nursing
● Case Management
● Critical pathways and Care MAPS
● Differentiated Nursing Practice
● Case Method
● Partnership Models
● Modular Method
88. ● Staff development programme are designed to motivate learner in
the way of the train and education to improve their knowledge,
skills and attitudes.
● Staff development is a sufficiently complex concept to dety a
simple definition, it is generally accepted, however, that staff
development refers to the process whereby employees of an
organization enhance their knowledge and skills in directions that
are advantageous to their role in the organization
● Staff development programme are designed to motivate learner’s ,
and train and educate them in order to improve their knowledge,
skills and attitudes .
● Definition
89. ● Importance of staff development
1. It is focus on developing nursing skills and knowledge.
2. Introduce the employees to new situations and orientated to
philosophy, soils, politics, and physical sanities
3. It provider job-relate counseling, which involves promoting the
professional growth of employees.
4. It provider learning experiences in the work setting for the
purpose of refining and developing new skills and knowledge
related to job performance.
5. It is planned and organized around learning experiences in
variety of setting.
6. To reduce staff turnover and absenteeism.
91. ● Philosophy of staff development
● The staff development programme philosophy
based on nursing organization. It includes
1. How learning takes place
2. Various teaching methods
3. Responsibility for their learning
4. Rights of the clients
93. ● Staff welfare
● Frustrations, conflicts, resignations and frequent resulting for
transfer can often be reduced when there are clearly defined
policies related to hours of work, teaching load, welfare of the
staff and other benefits,
● The policies should be written down known to everyone. the
following are some of the these employee welfare;
94. 1. Hours of work: Direction should be given on the following:
a. Maximum number of hours to be worked per week
b. The number of days per month
c. Procedure to be followed regarding public holidays
Hours to be worked on evening and night duty, i.e. schedule of classes for evening
hours, and provision made for supervision of students
2. Teaching load and time for preparation of class and laboratory sessions:
a. Student guidance and counselling
b. Evaluation of students' assignments
c. Committee work
d. Record keeping
e. Formal teaching hours should not exceed 20h per week
3. Residence: Accommodation for some staff is essential if the student curriculum
and extracurricular activities are to be implemented satisfactorily. The
accommodation for married and unmarried staff, including family quarters, depends
on the institution's policy.
95. 4. Leave: The institution should have a clear policy regarding the following:
a. Time of year during which annual leave may normally be taken
b. How much leave can be taken at a time
c. The purpose for which the casual or special leave may be granted
d. Provision for maternity leave
5. Sickness: The policy should include the following clarifications:
a. Who will be responsible for medical treatment
b. The kind of accommodation that will be given private, semi private or general ward
c. Financial responsibility to be borne by the staff member
6. Attendance: At conferences and study courses, policies regarding selection and
deputation of the staff for further education include attendance at formal courses, refresher
courses, workshops and conferences. This may depend upon the following:
a. Educational qualifications
b. Years of experience
c. Any mandatory period of work after return from study
d. Rotation of staff and numbers who may attend at one time
e. Periodic compulsory refresher courses for particular grades of staff
96. 7. Continuing education and in-service education
a. Employment uniformity in procedures, recruitment
according to education and experience
b. Job description
c. Working hours-40 h per week; extra working hours to be
compensated either by leave or extra emoluments; weekly
off; and gazetted holidays
d. Workload and facilities
i. CSSD, central linen and drug supply system.
ii. Policies for breakage and losses to be developed, and
nurses not to be made responsible for breakage and losses.
97. 8. Pay and allowances
a. Uniformity of pay scales
b. Special allowances for uniforms, washing, mess, etc.
9. Promotional opportunities
a. Merit cum seniority
b. Open selection
10. Career development
a. Provision for higher studies
b. Refresher
11. Accommodation
a. Near working place
b. Hostel-housing colonies
12. Transport facilities
99. ● Purpose of budget
1. Indicating the lines on which money raised or received will be spent
2. Assisting in assessing the financial requirements of an agency
3. Guiding the staff of voluntary agency/hospital in spending money
allocated on various schemes
4. Providing an adequate reporting system for a measure of
performance
5. Providing participation of staff members in the preparation of the
budget
6. Informing the community about sources of income and the plan of
incurring expenditure
7. Facilitating comparison of actual performance with the budgeted
targets and thereby help the controlling function
100. ● Steps in budget
1. Ask the subordinates, preferably those in the supervisory cadre, to
present their needs for the coming year.
2. Review the budget appropriation and actual expenditure for the
ongoing year with statistical data available.
3. Determine whether any changes are contemplated, e.g. starting a
new programme, etc.
4. Prepare the programme with the new budget.
5. In the budget, determine the percentage of salaries of personnel
who are already in the team.
6. Assess the requirements for the coming year on the basis of the
information supplied, e.g. expenditure for supplies, equipment and
repair.
101. ● Budget preparation
Budgets are generally developed for a 12-month period, or yearly cycle.
Fiscal year is determined by the organization, e.g.,
September 1 through August 31.
Calendar year is the regular year on the calendar,
January 1 through December 31.
Shorter- or longer-term budgets also may be developed.
102. ● Budget preparation phase
Gather information about elements that can influence the
organization's future spending and income.
• Demographic information : Determine client characteristics and
health care needs.
• Competitive analysis : Examine characteristics of other health care
providers.
• Regulatory influences : Determine financial impact of regulatory
requirements and reimbursement rates.
• Strategic initiatives: Develop strategic plans to map out the direction
for the organization over several years.
104. ● NonRecurring expenditure
1. DME endowment.
2. Endowment fund (property or income left to someone like
insurance)-Rs. 20,00,000 in two instalments (before first year Rs.
10,00,000 and second year Rs. 10,00,000) which is paid to the DME
office.
3. Security fixed deposit Rs. 10,00,000 with the joint account of
registrar of the university and trustees.
4. Solvency certificate (state of having more money than one owes) for
Rs. 30,00,000 from nationalized bank for a period of 5 years.
5. University endowment.
6. Approximately the revenue is Rs. 2,124,000, whereas the
expenditure is Rs. 2,052,859. Annual auditing is done to plan for the
next year budget and to evaluate the current year budget.
106. ● The first step in developing a system for material management is
to choose the right type of classification for the materials and then
apply appropriate technique.
● Selective controls are;
1. ABC Analysis
2. VED Analysis
3. HML Analysis
4. XYZ Analysis
5. FSN Analysis
6. SDE Analysis
7. GOLF Analysis
8. SOS Analysis
● Selective control in material management
107. ● ABC analysis
The main objective of ABC analysis is to frame policy guidelines
regarding control of items.
First of all the items are classified into three classes viz A items, B
items and C items. Expensive items are to be branded as A items ,
which constitute 10% of overall items but whose percentage in terms
of value is around 70%.
The least expensive items are to be branded as C items, whose
number items will be 70% of total number of items but its value will be
around 10% of the total items of inventory.
The in-between are to be branded as B items whose number of items
will be around 20% and its values will be around 20% of the total value.
108. ● VED analysis
VED analysis - Vital, Essential and Desirable.
• The vital items are stocked in abundance, essential items, safety
stocks and very strict control.
• Essential items are moderate controls, purchase based on rigid
requirements and reasonably striet watch.
• Desirable items are ordinary control, safety stocks high, purchase
based on usage estimate.
109. ● HML analysis
● As the name itself indicates materials are classified according to
their unit value as high, medium and low.
110. ● XYZ analysis
● X items are those whose stock value is high, while Z items are
those stock values are low. Understandably Y items fall between
the two categories.
111. ● FSN analysis
Movement analysis forms the basis for this classification. The items
are classified as fast moving, slow moving and non moving based on
their consumption pattern.
Fast Moving : Items which have moved at least once in a year.
Slow- Moving: Items which have moved at least one in a period of one
to two years.
Non-Moving : Items which have not moved even once during two-year
duration.
112. ● SDE analysis
● Classification methods based on source of supply, SDE
classification is a system where materials are sorted out as ;
1. scarce to obtain,
2. difficult to obtain
3. easy to obtain.
113. ● GOLF analysis
● In the GOLF system, classification is based on the availability and
nature of supplies.
1. Government suppliers,
2. Ordinary Suppliers,
3. Local Suppliers,
4. Foreign Suppliers.
114. ● SOS analysis
● Raw materials can be classified into seasonal or off season items.
115. ● Hospital supplies and equipment
● Hospital supplies and equipments are dealt with under material
management. Supplies are those items that are used up or
consumed; hence the term consumable is used for supplies. The
supplies in hospital include drugs, surgical goods (disposables,
glass wares), chemicals, antiseptics, food materials, stationeries,
the linen supply etc.
1. General store
2. Dietary department and
3. Pharmacy department
116. ● Selection of articles
● while buying articles it has to meet the standards. Indian
Standards Institution is the national agency set up to bring
standardisation of articles in India. Articles that meet the criteria
specified by the Indian Standard Institution will be marked by ISI
markings. The articles bought should provide safety to the patient
and personnel. Faulty instruments and equipments cause not only
inconvenience in the patient care, but also it may cause the loss of
life.
117. ● Purchasing articles
• The material used for any equipment should be durable,
non-corroding, non toxic and safe for use.
• Should have standard shapes and dimensions to fit into various
situations
• Reparability and spare part availability of the article
• Interchangeability of the article
• All surgical instruments used in a hospital should be sterilisable
and they should stand the tests for leakage, hydraulic pressure tests
for bursting etc
• Should have accuracy in measurements
• Should have the ease of operation
118. ● The central supply service
● Most hospitals have a central department where equipments and
supplies are stored and from which they are distributed to the units.
The type of materials that is kept in the central supply room varies from
hospital to hospital. In some hospital the central soppy room deals with
only the sterile supplies and ward trays. In other hospitals all types of
equipment such as oxygen, suction, ward trays, catheters, syringes etc
are stored here.
● Linen supply: Methods of handling linen supply include;
a) Departmentalised system: Here the supply of linen for each department
of the hospital is marked for that department. The head of the department
is responsible for making a linen standard for his own department.
b) Centralised linen supply: Under centralised system, linen is issued on
exchange basis, that is clean linen is exchanged for soiled linen.
119. ● Factors to be considered
1. Type of service provided by the hospital: a maternity hospital
requires more equipment related to gynaecological procedures than a
cardiac hospital.
2. Age of patients: children need different type and amount of
equipments than adults.
3. Sex- men and women sometime require different type of equipment.
4. Degree and type of illness- neurologic patients sometimes require
more bedsides, rubber mattress and linen than patients with other type
of illness.
5. Cost of items- cost of
120. ● General utility services in the hospital
1. Electric supply and installation
2. Water supply
3. Disposal of waste
4. Refrigeration
5. Transport
6. Supply of medical gases
7. Laundry
8. Fire hazards
9. Communication
10. Repairs workshop
121. ● Material used in hospital
Hospital material medical side Hospital material management
side
● Perfusion materials
● Surgical disposables
● Instruments
● Drugs, medicine, oxygen,
● linen
● Biomedical equipment
● Disinfecting items
● Computers, telephone and fax
● Food and beverage materials
● Anaesthetic equipment
● Electro medical equipment
● Glass ware, dental machines
● Surgical dressing utensils
● Artificial limbs, bandages, cots for
patient, furniture
● Engineering items and many others
● Computer, fax , telephone, stationary
items
● Public address items overhead
projector
● Audiovisual systems
123. ● Definition
● It is the directing style wherein managers tell their personnel what to
do, how to do it and when to have it completed by. They assign roles
and responsibilities, set standards, and expectations.
● Direction the fourth phase of the management process. This phase
could also be referred as coordinating, or activating. It is the action
phase of management, requiring the leadership and management
skills necessary to accomplish the goals of the organization
● It is the issuance of orders, assignments and directions that enable
the nursing personnel understand what are expected of them.
Direction includes supervision and guidance so that in doing their job
well, nurses can maximally contribute to the organization's goal in
general and into nursing service objective in particular.
● Direction includes delegation of work to be performed, utilization of
policies and procedures, supervision of personnel, coordination of
services, communication, staff development, and making decisions.
124. ● Communications - It is one way. The manager speaks, employees listen
and react. The only feedback managers ask for is - "Do you understand
what needs to be done?"
● Goal-Setting - The manager establishes short-term goals with specific
deadlines.
● Decision-Making - The manager makes most if not all decisions. When
problems arise the manager evaluates options, makes decisions and
directs employees as to what actions to take.
● Providing Feedback - The manager provides candid, detailed instructions
as to what changes the employee needs to make.
● Rewards and Recognition - Managers reward and recognize people for
following directions.
125. ● Elements of directing
1. Delegation
2. Supervision
3. Leadership
4. Motivation
5. Communication
6. Coordination
7. Orientation
126. ● Delegation definition
● It is the process by which the manager assigns specific tasks/duties
to workers with commensurate authority to perform the job.,
● By delegating well defined tasks and responsibilities, the nurse
manager can be freed of valuable time that can well be spent on
planning and evaluating nursing programs and activities.
● Delegating a technique of time management is a major element of the
directing function of nursing administration.
● Delegation (or deputation) is the assignment of authority and
responsibility to another person (normally from a manager to a
subordinate) to carry out specific activities, However the person who
delegated the. work remains accountable for the outcome of the
delegated work. Delegation empowers a subordinate to make
decisions, i.e. it is a shift of decision-making authority from one
organizational level to a lower one.
127. ● Leadership
● Leadership is the
ability of an
individual or a
group of people to
influence and
guide followers or
members of an
organization,
society or team.
132. ● Leadership theories
1. The great man theory
2. Trait or attribute theory
3. Behavioural theory
4. Situational and contingency theory
5. Path goal theory
6. Charismatic theory
7. Interactional leadership theory
8. Transformational theory
143. ● Define assignment
1. An assignment is a certain type of work given to do especially as
part of the job.
2. Assignment refers to a documented delegation of duties given for a
group of clients by trained personnel assigned to the unit'.
144. ● Define job rotation in nursing
● Job rotation is a management process approach where all
required nurses are transferred between two or more tasks or jobs
at regular intervals of time in order to expose and aware of all
verticals of an firm.
● It is a pre planned approach with a specific goal to check the
talented nurses to place in proper area of care.
146. ● Definition of supervision
● The word supervision is derived from two words: super meaning
above' and video meaning 'I see' Thus it means 'superior powers of
perceiving', 'overseeing" or 'superintending the work of others'. The
term supervision conveys different ideas to different people.
1. Supervision is working together to achieve organizational goals.
2. Supervision can be defined as a process by which the subordinates
are appointed by their immediate superiors to make the best use of
their abilities, efficiently and effectively and with increasing
satisfaction to themselves and the organization in which they function.
147. ● Definition of decision making
● Decision making can be regarded as the mental processes (cognitive
process) resulting in the selection of a course of action among several
alternatives. Every decision making process produces a final choice. The
output can be an action or an opinion of choice.
● Decision med as choosing a particular course of action. Webster's
definition- to "judge or settle" - is another view of decision making.
● Problem solving is a part of decision making.A systematic process that
focuses on analyzing a difficult situation, problem solving always includes
a decision making step.
● Critical thinking, referred to as " reflective thinking, is related to evaluation.
Critical thinking is purposeful, outcome-directed thinking that is based on
a body of knowledge derived from research and other sources of
evidence". -ignatavicius 2001
148. • Decision is a course of action that is consciously chosen
from available alternatives for the purpose of achieving a
desired result.
• It involves a choice utilizing mental processes at the
conscious level and is aimed at facilitating a defined
objective.
• Problem Solving is part of decision making, a systemic
process that focuses on analyzing a difficult situation.
149. ● Definition of guidance
1. Jones (1951): Guidance involves giving personal help, which is
designed to assist a person in deciding where he wants to go, what he
wants to do or how he can best accomplish his goals. It assists him in
solving problems that arise in life.
2. Crow and Crow: The fundamentals of all guidance include the
assistance given by a competent person to an individual so that the
latter may make his own decisions and carry them out.
151. ● Definition of evaluation / controlling
1. Wrightstone: Evaluation is a relatively new technical term introduced
to designate a more comprehensive concept of measurement than is
implied in conventional tests and examination.
2. Clara M. Brown: Evaluation is essential in the never-ending cycle of
formulating goals, measuring progress towards them and determining
the new goals that emerge as a result of new warnings.
3. L.E. Heidgerken: Evaluation in education is a process of judging the
effectiveness of educational experiences through careful appraisal.
4. John W. Best: Evaluation is a process used to determine what has
happened during a given activity or in an institution.
152. ● Nursing and evaluation
● The very essence of nursing requires the nurse to evaluate
constantly the patient's needs as well as her own activities in
meeting these needs; to guide the patient to evaluate his own
health needs; to determine how well he is meeting them; and to
plan with him how to maintain an optimal level of health.
● All of these require continuous evaluation. Nurses must evaluate
the results of the interventions they perform for their patients. By
evaluating the condition of patients, they can provide better care
for them.
153. ● Evaluation methods
1. Nursing rounds
2. Nursing protocols
3. Nursing manuals
4. Quality Assurance model
5. Documentation
6. Records and reports
7. Performance appraisal
8. PERT
154. ● Nursing rounds
Nursing rounds making rounds to visit all patients and discussion
pertaining to each patients care.
Purposes
1. To provide effective care
2. To establish good rapport with other members
3. To know new patients and patient care plans
Conducting rounds
Head nurse lead the group {other nursing personnel} and act as
teacher Clinical instructor led the group {student nurse} Group
discusses patient care with patient and outside patient room. Before
entering patient room should know his problem, what is care taking
etc.In front of patient not discuss legal aspects of patient care.
155. ● Types of rounds
1. Ward rounds
2. Rounds with the doctors
3. Social service rounds
4. Nursing rounds
5. Round with the physical therapist
6. Rounds with other team member.
156. ● Nursing rounds
● Nursing rounds deals with
patient history and medical
aspects of the care. The nurse
who has been caring for the
patient during the week may
present the background
information of nursing care.
● She is responsible to provide all
information about patient. Head
nurse and other members clarify
their doubts about the Particular
patient.
Head nurse
⬇
Others -Nurses
⬇
Discuss about patient and his care
⬇
Group provide additional
information
⬇
More to next patient
⬇
Discussion
⬇
Afterward rounds
158. ● It can be defined as a benchmark of achievement, which is
based on desired level of excellence. As such standards
become model to be initiated and may serve, in turn, as
basis of comparisons.
● NURSING PRACTICE, STANDARD ARE DESCRIPTIVE
STATEMENTS THAT AFFECT THE NATURE OF CURRENT
NURSING PRACTICE , CURRENT KNOWLEDGE AND
CURRENT QUALITY OF NURSING CARE. AS SUCH THEY
ARE A MEANS OF ESTABLISHING ACCOUNTABILITY OF
NURSING CARE RENDERED BY THE PROFESSIONAL
NURSE.
● Nursing standards
159. ● Characteristics of standard
● Standards statement must be broad chough to apply to a wide variety of
settings.
● Standards must be realistic, acceptable, attainable.
● Standards of nursing care must be developed by members of the nursing
profession; preferable nurses practising at the direct care level with
consultation of experts in the domain."
● Standards should be phrased in positive terms and indicate acceptable
performance good, excellence etc.
● Standards Of nursing care must express what is desirable optional level.
● Standards must be understandable and stated in
● unambiguous terms.
● Standards must be based on current knowledge and scientific practice.
● Standards must be reviewed and revised periodically.
● Standards may be directed towards an ideal,ie, optional standards or may
only specify the minimal care that must be attained, ie, minimum standard.
160. ● Purpose of standard
Setting standard is the first step in structuring evaluation system. The
following are some of the purposes of standards.
• Standards give direction and provide guidelines for performance of
nursing staff.
• Standards provide a baseline for evaluating quality of nursing care
Standards help improve quality of nursing care, increase effectiveness
of care and improve efficiency.
• Standards may help to improve documentation of nursing care
provided.
• Standards may help to determine the degree to which standards of
nursing care are maintained and take necessary corrective action in
time.
• Standards help supervisors to guide nursing staff to improve
performance.
161. ● Sources of standard
● It is generally accepted that standards should be based on agreed up
achievable level of performance considered proper and adequate for
specific purposes.
● The standards can be established, developed, reviewed or enforced by
variety of sources as follows:
• Professional organisation, e.g. Associations, TNAI,
• Lieensing bodies, e.g. Statutory bodies, INC,
• Institutions/health care agencies, e.g. University Hospitals, Health Centres.
• Department of institutions, e.g. Department of Nursing.
• Patient care units, e.g. specific patients' unit.
• Government units at National, State and Local Government units.
• Individual e.g. personal standards
162. ● Classification of standard
1. Normative and empirical standards
● Standards can be normative or empirical. Normative standards
describe practices considered 'good' or ideal' by some authoritative
group. Empirical standards describe practices actually observed in
a large number of patient care settings. Here the normative
standards describe a higher quality of performance than empirical
standards.
● Generally professional organisations (ANA/ TNAI promulgate
normative standards whereas low enforcement and regulatory
bodies (INC/MCI) promulgate empirical standards.
163. 2. Ends and means standard
● Nursing care standards can be divided into ends and means standards.
The ends standards are patient-oriented; they describe the change as
desired, in a patient's physical status or behaviour. The means standards
are nursing oriented, they describe the activities and behaviour designed
to achieve the ends standards. Ends (or patient outcome) standards
require information about the patient. A means standard calls for
information about the nurse’s performance.
164. 3. Structure, process and outcome standard
A. Structure standard
● A structural standard involves the set-up' of the institution. The philosophy,
goals and objectives, structure of the organisation, facilities and
equipment, and qualifications of employees are some of the components
of the structure of the organisation, e.g. recommended relationship
between the nursing department and other departments in a health agency
are structural standards, because they refer to the organisational structure
in which nursing is implemented. It includes people money, equipment,
staff and the evaluation of structure is designed to find out the
effectiveness ,degree to which goals are achieved and efficiency in terms of
the amount of effort needed to achieve the goal.
● The structure is related to the framework, that is care providing system and
resources that support for actual provision of care. Evaluation of care
concerns nursing staff, setting and the care environment. The use of
standards based on structure implies that if the structure is adequate,
reliable and desirable, standard will be met or quality care will be given.
165. B. Process standard
● Process standards describe the behaviours of the nurse at the
desired level of performance The criteria that specify desired method
for specific nursing intervention are process standards. A process
standard involves the activities concerned with delivering patient
care, These standards measure nursing actions or lack of actions
involving patient care. The standards are stated in action-verbs, that
is in observable and measurable terms.eg the nurse assesses" "the
patient demonstrates" The focus is on what was planned, what was
done and what was communicated or recorded.
● Therefore, the process standards assist in measuring the degree of
skill, with which technique or procedure was carried out, the degree of
client participation or the nature of interaction between nurse and
client.In process standard there is an element of professional
judgment determining the quality or the degree of skill. It includes
nursing care techniques, procedures, regimens and processes.
166. C. Outcome standard
● Descriptive statements of desired patient care results are
outcome standards because patient's results are outcomes of
nursing interventions. Here outcome as a frame of reference
for setting of standards refers to description of the results of
nursing activity in terms of the change that occurs in the
patient. An outcome standard measures change in the patient
health status. This change may be due to nursing care, medical
care or as a result of variety of services offered to the patient.
● Outcome standards reflect the effectiveness and results rather
than the process of giving care.
168. ● Nursing audit, is a review of the patient record designed to identify,
examine, or verify the performance of certain specified aspects of
nursing care by using established criteria.
● Nursing audit is the process of collecting information from nursing
reports and other documented evidence about patient care and
assessing the quality of care by the use of quality assurance
programmes.
● Nursing audit is a detailed review and evaluation of selected
clinical records by qualified professional personnel for evaluating
quality of nursing care.
