IN THE FIELD OF HEALTH CARE EVIDENCE BASED PRACTICE IS MOST IMPORTANT FOR MOST ACCURATE CARE AND TREATMENT.FOR THIS PURPOSE RESEARCH IS COMPULSORY.THIS PRESENTATION TELLS ABOUT THE IMPORTANCE OF RESEARCH,LEADERSHIP AND MANAGEMENT IN NURSING.
THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
IN THE FIELD OF HEALTH CARE EVIDENCE BASED PRACTICE IS MOST IMPORTANT FOR MOST ACCURATE CARE AND TREATMENT.FOR THIS PURPOSE RESEARCH IS COMPULSORY.THIS PRESENTATION TELLS ABOUT THE IMPORTANCE OF RESEARCH,LEADERSHIP AND MANAGEMENT IN NURSING.
THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
Linear Programming is a vital section of Mathematics which allows you to obtain the optimal solution (i.e Maximum Profit or Lowest Cost) of a mathematical model where the requirements of the problem are given by linear relationships.
In addition to its vast number of real world applications, Linear Programming can also be used to determine the optimal number of workers that should be used in a given instance. Here, we have been asked to determine the workforce scheduling roster of a nursing staff so as to minimize the cost of labor (while adhering to constraints)
This presentation gives an insight on how Linear Programming techniques can be used to achieve our goal.
Staff Management: The Care and Keeping of Your Principal's EstateINGUARD
How to run an estate like a business. This free staff management ebook offers tips on:
• How to assess staffing needs and recruit domestic personnel.
• What legal and tax regulations are required for employers
• Why risk management is a critical component of estate management.
SCOPE OF NURSING , ROLES & RESPONSIBILITIES OF VARIOUS NURSING PERSONNEL, QUA...Krishna Gandhi
COMMUNITY HEALTH NURSE
TEACHING IN NURSING
SCOPE OF NURSING
ROLES & RESPONSIBILITIES OF VARIOUS NURSING PERSONNEL
QUALITIES OF A NURSE
INDUSTRIAL NURSE
MILITARY NURSE
NURSING SERVICE ABROAD
NURSING SERVICE ADMINISTRATIVE POSITION
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Staffing
• Process of determining and
providing the acceptable number
and mix of nursing personnel to
produce a desired level of care to
meet the patient's demand.
MJCN2014
3. Factors Affecting Staffing
• The type, philosophy, and objectives of
the hospital and the nursing service;
• The population served and the kind of
patient served, whether pay or charity;
• The number of patients and severity of
their illness
• Availability and characteristics of the
nursing staff, including education, level
of preparation, mix of personnel,
number and positions.
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4. • Administrative policies.
• Standards of care desired which
should be available and clearly
spelled out.
• Layout of the various nursing units
and resources available within the
department
• Budget
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5. • Professional activities and priorities in
non-patient activities
• Teaching program or the extent of staff
involvement in teaching activities.
• Expected hours of work per annum of
each employee. This is influenced by
the 40=hour week law; and
• Patterns of work schedule – traditional 5
days per week, 8 hours per day; 4 days
a week, ten hours per day and three
days off; or 3 ½ days of 12 hours per
day and 3 ½ days-off per week.
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6. PATIENT CARE
CLASSIFICATION SYSTEM
• A method of grouping patients
according to the amount of
complexity of their nursing care
requirements and the nursing time
and skill they require.
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7. Requirements
• The number of categories into
which the patients should be
divided;
• The characteristics of patients in
each category;
• The type and number of care
procedures that will be needed by
a typical patient in each category;
and
• The time needed to perform these
procedures that will be required by
a typical patient in each category.MJCN2014
8. Classification Categories
• Level I – Self Care or Minimal Care
Average amt of NCH/pt/day = 1.5
Ratio of Prof to NonProf = 55:45
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9. Classification Categories
Level I-Self
Care or
Minimal Care
-NCH
1.5/pt/day
- Ratio 55:45
-Can take a bath on his own; feed himself; perform his
own ADL.
-For discharge pt; non-emergency, newly admitted
don’t exhibit unusual s/s;
- requires little treatment and observation
Level II –
Moderate
Care or
Intermediate
Care
-NCH 3/pt
- Ratio 60:40
-Need some assistance in bathing, feeding, ambulating
for short period.
-Extreme s/s of illness must have subsided or have not
yet appeared
-May have slight emotional needs
-v/s taking ordered 3x/shift; with IVF/BT; are semi-
conscious and exhibiting some psychosocial or social
problems;
- periodic treatments and/or observations and
/instructions
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10. • Level II – Moderate Care or
Intermediate Care
Average NCH/pt/day = 3
Ration or Prof to NonProf = 60:$0
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11. Classification Categories
Level III –
Total,
Complete or
Intensive
Care
-NCM
6hrs/pt/day
-Ratio 65:35
-Patient are completely dependent upon
the nursing personnel.
-They are provided complete bath, are
fed, may or may not be unconscious,
with marked emotional needs; with v/s
monitoring more than 3x/shift
-Maybe on continuous oxygen therapy,
with chest or abdominal tubes
-They require close observation at least
every 30 minutes for impending
hemorrhage, with hypo or hypertension
and/ or cardiac arrhythmia
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12. • Level III – Total, Complete or
Intensive Care
Average NCH/pt/day = 6
Ratio of Prof to NonProf = 65:35
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13. Classification Categories
Level IV-
Highly
Specialized
Critical Care
-NCH 6-9 or
more /pt/day
- Ratio 70:30
or 80:20
-Need maximum level of nursing care
with a ratio of 80 professionals to 20
non-professionals.
-Needs continuous treatment and
observation
-With many medications, IV piggy
backs; v/s monitoring every 15-30
minutes; hourly output.
-There are significant changes in
doctor’s orders
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14. • Level IV – Highly Specialized
Critical Care
Average NCH/pt/day = 6-9 hours
Ratio of Prof to NonProf = 70:30 or
80:30
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15. Categories of Level of Care of Patients: Nursing Care
Hours/Pt/Day & Ratio of Prof-Non Prof
Levels of Care NCH Needed Per
Pt./Day
Ratio of Prof to
Non-Prof
Level I – Self-Care
or Minimal Care
1.50 5:45
Level II Moderate
or Intermediate
Care
3.0 60:40
Level III Total or
Intensive Care
4.5 65:35
Level IV Highly
Specialized or
Critical Care
6.0
7 or higher
70:30
80:20
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16. Percentage of Nursing Care
Hours
Type of
Hospital
Minimal
Care
Moderate
Care
Intensive
Care
Highly
Spcl Care
Primary Hosp 70 25 5 -
Secondary
Hosp
65 30 5 -
Tertiary Hosp 30 45 15 10
Spcl tertiary
Hosp
10 25 45 20
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17. Nursing Care hours per patient/day according
to classification of patients per units
Cases/Patients NCH/Pt/Day Prof to Non Prof
Ratio
1. General Medicine 3.5 60:40
2. Medical 3.4 60:40
3. Surgical 3.4 60:40
4. Obstetrics 3.0 60:40
5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
7. ER/ICU/RR 6.0 70:30
8. CCU 6.0 80:20MJCN2014
18. Computing for the number of
Nursing Personnel Needed
• Consider sufficient staff to cover all
shifts, off-duties, holidays, leaves,
absences and time for staff
development programs.
• R.A. 5901 – Forty-Hour Week Law
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19. Total No. working-Non working days & hours of
nursing personnel per year
Rights & Privileges Given Each
Personnel Per Year
Working Hours Per Week
40 hours 48 hours
1. Vacation Leave
2. Sick Leave
3. Legal Holidays
4. Special Holidays
5. Special Privileges
6. Off-Duties as per R.A. 5901
7. Continuing Education Program
Total Non-working Days per year
Total working days per year
Total working hours per year
15
15
10
2
3
104
3
152
213
1,704
15
15
10
2
3
52
3
100
265
2,120
MJCN2014
20. Relievers Needed
- To compute for relievers needed, the following should
be considered;
1. Average number of leaves taken each year------ 15
a. vacation 15
b. sick leave 5
2. Holidays -----------------------------------------------------12
3. Special Privileges as per CSC MC#6 s. 1996-------3
4. Continuing Educ. Prog. For professionals------------3
Total Average Leave-------33
MJCN2014
21. To determine the relievers
needed
- divide 33 by number of working days per year
each employee served (whether 213 or 265)
- result will be 0.15 per persons works for 40
hour/week
- result will be 0.12 per persons works for 48
hour/week
- multiply the computed reliever per person by the
computed number of nsg personnel
- this will give you the total number of relievers
MJCN2014
23. Staffing Formula
To illustrate: Find the number of nursing according to levels
of care needed.
1. Categorize the patients according to levels of care
needed
250 pts x 0.30 = 75 pts needing minimal care
250 pts x 0.45 = 112.5 pts needing moderate care
250 pts x 0.15 = 37.5 pts needed intensive care
250 pts x 0.01 = 25 pts need highly specialized
250 nsg care
MJCN2014
24. 2. Find the number of nursing care hours (NCH) needed
by patients at each level of care per day.
75 pts x 1.5 (NCH needed at Level I) = 112.5 MCH/day
112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day
37.5 pts x 4.5 (NCH needed at Level II) = 168.75 NCH/day
25 pts x 6 (NCH needed at Level IV) = 150 NCH/day
Total 768.75 NCH/day
3. Find the total NCH needed by 250 patients per year.
768.75 x 365 (days/yr) = 280,593.75 NCH/year
MJCN2014
25. 4. Find the actual working hours rendered by each
nursing personnel per year.
8 (hrs/day) x 213 (working days/year) = 1,704
(working hours/year)
5. Find the total number of nursing personnel
needed.
a. Total NCH per year = 280,593.75 = 165
Working hrs/year 1,704
b. relief x total nsg. Personnel = 165 x 0.15 = 25
c. total nursing personnel needed 165 + 25 = 190
MJCN2014
26. 6. Categorize to professional and non-professional
personnel ratio of prof to non-prof in a tertiary hospital
is 65:35
190 x .65 = 134 professional nurses
190 x .35 = 66 nursing attendants
7. Distribute by shifts
124 nurses x .45 = 56 nurses on AM shift
124 nurses x .37 = 46 nurses on PM shift
124 nurses x .18 = 22 nurses on night shift
Total 124 nurses
66 nsg attendants x .45 = 30 nsg. attendants on AM shift
66 nsg attendants x .37 = 24 nsg attendants on PM shift
66 nsg attendents x .18 = 12 nursing attendants on noc
Total = 66 nursing attendants
MJCN2014
27. Placement
• Advantages
–Fosters personal growth
–Provides motivating climate for
the employee
–Maximizes productivity
–Organizational goals have better
chances of being met.
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28. • Results of Inappropriate
placement
–Frustration
–Poor quality of work
–Reduced organizational
efficiency
–Rapid turn-over
–Poor image of the agency
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29. Factors to consider
• Inherent in the employee
• Past experience and training
• Culture of the clientele
• Decision-making skills
• Communication skills
MJCN2014
32. Factors considered in Making
Schedules
• Different levels of the nursing staff;
• Adequate coverage for 24 hours,
seven days a week;
• Staggered vacations and holidays;
• Weekends and long stretches of
consecutive working days;
• Evening and night shifts; and
• Floating.
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33. Assessing a scheduling
system
• Ability to cover the needs of the
unit.
• Quality to enhance the nursing
personnel’s knowledge, training
and experience.
• Fairness to the staff
• Stability
• Flexibility
MJCN2014
35. Advantages of Cyclical
Schedule
• It is fair to all
• It saves time
• Enables the employee to plan
ahead for their personal needs
• Scheduled leave are more stable
• Productivity is improved.
MJCN2014
37. Assessing a Scheduling System
1. Ability to cover the needs of the unit
2. quality to enhance the nursing personnel's
knowledge, training and experience
3. fairness to the staff – fair share of
weekends, holiday offs, rotation patters for the
whole year including assignment to “difficult”
or “light” or “undesirable” units or shifts
4. stability – the schedule must be harmonized
with their family or social activities of the
nurse staff
5. flexibility – ability to handle changes brought
by emergency leaves.
MJCN2014
38. Make a schedule in a weekly or
monthly basis and do cycle
system with the staff under the
area assigned for fairness and
flexibility.
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39. A one-week cyclical schedule
Personnel S M T W T F S
7/3 Headnurse/Senior Nurse x x
Staff Nurse x x
Nsg. Att. x x
3/11 Staff Nurse x x
Nsg. Att. x x
11/7 Staff Nurse x x
Nsg. Att. x x
Gen. Rel. 3/11; 11/7 S. nurse 3/11 3/11 11/7 x x 3/11 11/7
N. Att. 3/11 11/7 x 7/3 3/11 11/7 x
MJCN2014
41. • What is our focus……
• Why are we here…….
• ….patients now more than ever
need reassurance that they are
indeed the focus of the
healthcare team - Joan
Shinkus Clark
MJCN2014
42. Traditional Modes of Care Delivery
• Total Patient Care
• Functional Nursing
• Team and Modular Nursing
• Primary Nursing
• Case Management
MJCN2014
43. • Care delivery modalities (modes)
affect autonomy and job
satisfaction.
• Direct pt care functions are actually
caring for pt.
• Indirect pt care functions are like
being able to self schedule,
charting
MJCN2014
44. Total Patient Care
• Total patient care - nurses assume total
responsibility for meeting all needs of assigned
patients during their time on duty
– ICU
– Form of primary nursing
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45. Functional Method
• Functional nursing - work assignment by
functions or tasks, such as passing medicine,
doing dressing changes, giving baths, or taking
vital signs
• Assignment by function.
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46. Team Nursing
• Team nursing - a team of RNs, and aides
under the supervision of one nurse, called the
team leader
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47. Primary Nursing
• Primary nursing is an approach in which a
nurse has responsibility and accountability for
the continuous guidance of specific clients from
hospital admission through discharge
MJCN2014
48. Case Management
• Case management in acute care hospital
nursing has been defined as a system of client
care delivery that focuses on the achievement
of client outcomes within effective and
appropriate time frames and resources
MJCN2014
49. CASE MANAGEMENT SERVICE
AREAS
MJCN2014
Category Service Setting
Acute
Orthopedics, cardiovascular, critical care, high-risk perinatal, oncology,
emergency department
Subacute Skilled nursing centers, rehabilitation units
Ambulatory Physician's office, clinics
Long-term care Nursing homes, group homes, assisted-living facilities
Insurance
companies
Health maintenance organizations (HMOs), preferred provider organizations
(PPOs), workers' compensation, Medicaid, Medicare
Community
Nurse-managed centers, home health agencies, urgent care centers, schools,
rural settings
50. Disease Management
• Common high-cost, high-resource utilization
diseases
• Population-based health care
– Covered lives
• Continuous health improvement
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51. Job descriptions
• It is a written statements, found in
policy manuals that describe the duties
and functions of the various jobs
within the organization.
• They outline the scope of authority,
responsibility, and accountability
involved in each position.
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52. Job descriptions
• It should provide
1. the broad general
guidelines under which the
individual will function
2. the basis for performance
evaluation of the person
working in that role
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53. Contents of a Job
Description
• 1. Identifying Data
• 2. Job Summary
• 3. Qualification Requirements
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54. Uses of Job Description
• 1. For recruitment and selection
of qualified personnel
• 2. To orient new employees to
their jobs
• 3. For job placement, transfer or
dismissal
• 4. As an aid in evaluating the
performance of an employee
MJCN2014
55. Uses of Job Description
• 5. For budgetary purposes
• 6. For determining departmental
functions and relationships to
help define the organizational
structure
• 7. To serve as channel of
communication.MJCN2014
56. Uses of Job Description
• 8. For classifying levels of nursing
functions according to skill levels
required.
• 9. To identify training needs
• 10. As basis for staffing
MJCN2014
57. Developing Job descriptions
• Contents
– Identifying data
– Job summary
– Qualification requirements
– Job relationships
– Specific and actual functions and
activities
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58. Uses of Job Description
• For recruitment and selection of
qualified applicants
• To orient new employees to their
jobs
• For job placement, transfer or
dismissal
• As an aid in evaluating the
performance of an employee
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59. • For budgetary purposes;
• For determining departmental
functions and relationships to
help define the organizational
structure;
• For classifying levels of nursing
functions according to skill levels
required;
• To identify training needs;
• As basis for staffing; and
• To serve as channel of
communication.
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65. Causes of indiscipline:-
• Non-placement of the right person
on the right job
• Undesirable behaviour of senior
officials.
• Faulty evaluation of persons and
situations by executives leads of
favoritism.
• Lack of upward communication.
• Leadership which is weak, flexible,
incompetent and distrustful.
66. • Defective supervision and an absence of good
supervisors who know good techniques, who
are in a position to appreciate critically the
efforts or their subordinates.
• Lack of properly drawn rules and regulations.
• Workers’ personal problems, their fears,
apprehensions, hopes and aspirations; and
their lack of confidence in and their inability to
adjust with their superior and equals.
• Worker’s reactions to rigidity and multiplicity of
rules and their improper interpretation.
• Intolerably bad working conditions.
67. • Inborn tendencies to flout rules.
• Absence of enlightened, sympathetic
and scientific management.
• Errors of judgement on the part of the
supervisor or the top management.
• Improper co-ordination, delegation of
authority and fixing of responsibility.
• Discrimination based on caste, colour,
creed, sex, language, and place in
matters of selection, promotion,
transfer, placement and discrimination
in imposing penalties and handling out
rewards.
68. APPROACHES TO DISCIPLINE:-
The different approaches to
discipline include;
• Human relation approach: In
human relation approach the
employee is. helped to correct his
deviations
• Human resources approach:
Under the human resources
approach, the employee is treated
as resource and the act of
indiscipline are dealt by
considering the failure in the area
of development, maintenance and
utilization of human resources.
69. • Group discipline approach: The
group as a whole sets the standards
of discipline, and punishments for
the deviations. The individual
employees are awarded
punishments for their violation under
the group discipline approach.
• Leadership approach: In this
approach, every supervisor
administers the rules of discipline
and guides, trains and controls the
subordinates regarding disciplinary
rules.
70. • Judicial approach: In judicial
approach, indisciplinary cases
are dealt on the basis of
legislation and court decisions.
The Industrial Employment Act,
1946, to a certain extent,
prescribed the correct procedure
that should be followed before
awarding punishment to an
employee in India.
71. PRINCIPLES FOR MAINTENANCE OF
DISCIPLINE:-
The most important principles to be
observed in the maintenance of
discipline have been outlined by
Yoder, Heneman, Turnbull and
Harold Stone. They are:
All the rules should be framed in co-
operation and collaboration with the
representatives of employees.
All the rules should be appraised at
frequent and regular interval to
ensure that they are, and continue to
be, appropriate, sensible and useful.
72. Cont.. Rules should vary with changes in
the working conditions of
employees.
Rules should be uniformly enforced
if they are to be effective.
Penalties for any violation of any
rules should be clearly stated in
advance.
A disciplinary policy should have as
its objectives the prevention of any
infringement rather than the simple
administration of penalties; however
it should be preventive rather than
punitive.
73. Extreme caution should be exercised to
ensure that infringements are not
encouraged.
If violations of a particular rule are fairly
frequent, the circumstances surrounding
them should be carefully investigated
and studied in order to discover the
cause or causes of such violations.
Recidivism must be expected. Some
offenders would almost certainly violate
rules more often than others. These
cases should be carefully considered so
that their causes may be discovered.
Definite and precise provisions for
appeal and review of all disciplinary
actions should be expressly mentioned in
the employees’ handbook or collective
agreements.
74. ASPECTS OF DISCIPLINE:-
Positive aspect: Employees believe in and support
discipline and adhere to the rules, regulations and
desired standards of behaviour. Discipline takes the
form of positive support and reinforcement for
approved actions and its aim is to help the individual in
moulding his behaviour and developing him in a
corrective and supportive manner. This type of
approach is called positive approach or constructive
discipline or self-discipline.
75. Positive discipline takes place
whenever the organizational climate is marked
by aspect such as payment of adequate
remuneration and incentives, appreciation of
performance and reinforcement of approved
personnel behaviour or actions etc.
which will motivate employees to adhere to
certain rules and regulations or exercise self-
control and work to the maximum possible
extent.
76. Negative aspect: Employees sometimes do not
believe in and support discipline. As such, they do not
adhere to rules, regulations and desired standards of
behaviour. As such, disciplinary programme forces and
constraints the employees to obey orders and function
in accordance with set rules and regulations through
warnings, penalties and other forms of punishment.
This approach to discipline is called negative
approach or corrective approach or punitive
approach.
77. • This approach is also called autocratic
approach as the subordinates are
given no role in formulating the rules
and they are not told why they are
punished. Punishment, penalties,
demotions and transfers provide or
establish a climate which demotivate
and delead the employees.
78. The highest level
and most effective
form of discipline
is self-discipline.
Ideally, all
employees should
have adequate
self-control and
should be self-
directed in their
pursuit of
organizational
goals.
79. Definition:
Self discipline is best defined
as the ability to regulate
ones conduct by principle
and sound judgment, rather
than by impulse, desire, or
social custom.
Self discipline can be
considered a type of
selective training, creating
new habits of thought,
action, and speech toward
improving yourself and
reaching goals.
80. The Five Pillars of self
discipline
Acceptance
Willpower
Hard work
Industry
Persistence.
If you take the first letters of each word
you get the acronym “A WHIP”- since
many people associate self discipline
with whipping themselves into shape.
81. To be self disciplined:
• Get yourself organized
• Don’t constantly seek to be entertained
• Be on time
• Keep your word
• Do the most difficult tasks first
• Finish what you start
• Accept correction
• Practice self denial
• Welcome responsibility
82. Health Care Education Associates (1987) identified
four factors that must be present to foster a climate
of self-discipline.
• Employee awareness and understanding of rules
and regulations that govern behaviour- The rules
and regulation must be clearly written and
communicated. Young and Hayne (1988) stated that
the most common reason for unsatisfactory work
performance is that the employee thinks they are
performing satisfactorily. In other words the employee
does not know there is a problem.
83. • There must exist an atmosphere of mutual trust-
Manager must believe that employees are capable of and
actively seeking self-discipline. Likewise employees must
perceive the manager as honest and trustworthy.
Employees lack the security for self-discipline if they do not
trust their manager’s motives.
• Formal authority must be used judiciously-
Approximately one-half of grievance cases appealed before
an arbitrator by labour unions involved disciplinary action. In
about one-half of those cases, management either reversed
or modified its decision when the individual’s appeal was
upheld.
• Employees should identify with the goals of the
organization- When the employees accept the goals and
objectives of an organization, they are more likely to accept
the standards of conduct deemed acceptable by the
organization.
84. DICIPLINARY PROCEDURE:-
The following steps should be taken into consideration:
• Accurate statement of the problem- The first step is
to ascertain the problem by seeking answer to the
following questions:
– Does this case call for a disciplinary action?
– What exactly is the nature of the violation or offence?
– Under what condition did it occur?
– Which individual or individuals were involved in it?
– When or how often, did the violation occur?
• Collecting facts bearing on the case- Before any action is
taken in a case, it is essential to gather all the facts about it.
A thorough examination of the case should be made within
the stipulated time limit.
85. • Selection of tentative penalties- The kind of penalty to be
imposed for an offence should be determined beforehand.
• Choice of Penalty- When a decision has been taken to
impose a penalty, the punishment to be awarded should be
such as would prevent a recurrence of the offence.
• Application of the Penalty- The application of the penalty
involves a positive and assured attitude on the part of the
management. If the disciplinary action is a simple
reprimand, the executive should calmly and quickly
dispose of the matter.
• Follow-up on disciplinary action- The ultimate purpose
of disciplinary action is to maintain discipline, to ensure
productivity, and avoid a repetition of the offence. A
disciplinary action should, therefore, be evaluated in terms
of its effectiveness after it has been taken.
86. BASIC INGREDIENT FOR A DISCIPLINARY
ACTION:-
The principle ingredients of a sound
disciplinary system are:
Location of responsibility
Proper formulation and communication of rules
Rules and regulations should be reasonable
Equal treatment
Disciplinary action should be taken in Private
Importance of promptness in taking
Disciplinary action
87. Innocence is presumed
Get the facts
Action should be taken in cool
atmosphere:
Natural justice
After a disciplinary action has been taken
the Supervisor should treat his
subordinate in a normal manner
Don’t back down when you are right
Negative Motivation should be handled in
a positive manner
88. TYPES OF PUNISHMENT:-
When the delinquent employee is going to be
punished, the type of punishment should be a
commensurate with the severity of the omission or
misconduct.
Different types of punishment resulting from various
types of omission or misconduct are as follows:
– Oral warnings
– Written warnings
– Loss of privileges and fines
– Punitive suspension
– Withholding of increments
– Demotion
– Termination
All of these depend on what mode of care you are using, and on how or when you get to use them
For the entire shift nurse takes care of pt. Initially occurred in ICU units Advantages – intensity of focus on the pt thru-out that shift Disadvantages – lack of communication and lack of continuity over time. Just meeting daily needs, not trying to make a plan and get them out
Everybody has a task. Norm in the US hospitals from late 1800’s til the end of WWII. There was a shortage of nurses at the time, so we put people in who can do things, like a team who went thru and checked dressings, a team that took vital signs, etc. Advantage – no role confusion. You knew what you were doing. This method is efficient and cheap. Disadvantage – client couldn’t identify who their caretaker was, because there were so many caretakers.
Group can be 10-20 pt’s to 4-5 nurses. Over each group of teams is a charge nurse. Has evolved into modular nursing (more of a spacial thing). Clients are grouped by a floor plan, happens a lot in ED’s. We’re in pod A, which has 10 beds, it’s intermediate care, and we’re in pod A all day. RN assigns work on team members expertise. Who’s good at what, what can this person do, and where do you want to put them. You’re accountable for delegating things to people who are trained to do them.
She would be assigned a group of pt’s (kind of like a nurse manager) and she’s responsible for them their entire hospital stay. Ponder thinks it sounds very challenging. Hallmark to this is that you have autonomy/accountability 24 hours a day. You make treatment decisions and what not
Also focus on containing health care costs first for the pt, then for the facility. Practicing case manamgement can also be- I get this pt and I check him and I consult all these specialists (like neurologist and social workers) about his condition and checking his discharge stuff and looking over everything. Sometimes hospitals don’t have specific case managers, but every nurse is expected to be their pt’s case manager…
A population with a costly disease, people who are on outpt dialysis. Focus is on the population. We want to provide optimal, cost effective care. By doing this we can actually do a lot of prevention (hopefully). Going to diabetic clinic and teaching them so we can hopefully prevent them from reaching the need for outpt dialysis.
Megginson offer three distinct meaning of the word discipline: Self-discipline Necessary condition of orderly behavior Act of training and punishing .
In self controlled discipline the employee brings her or his behavior in to agreement with the organizations official behavior code, ie the employee regulate their activities for the common good of the organization. As a result the human beings are induced to work for a peak performance under self controlled discipline. Is a managerial action enforces employee compliance with organization’s rules and regulations. ie it is a common discipline imposed from the top here the manager exercises his authority to compel the employees to behave in a particular way
The symptoms of indiscipline are change in the normal behaviour, absenteeism, apathy, go-slow at work, increase in number and severity of grievances, persistent and continuous demand for overtime allowance, and lack of concern for performance.