Professional Adjustment PDF

Professional Adjustment month of nursing in the Philippines declared by Pres. Professionalism Gloria Macapagal Arroyo Holistic process of growth and development of an A...

Professional Adjustment month of nursing in the Philippines declared by Pres. Professionalism Gloria Macapagal Arroyo Holistic process of growth and development of an Advocate for laws that support the welfare of the individual towards achieving a professional status nursing profession First stage or point of entry: EDUCATION o Congress – legislative department that creates A process of maturation – able to discern right from laws. Congressmen and senators vote to wrong and make decisions register an act. Lobby for laws that support nursing practice and for Who is a professional? better working conditions Sims, Price & Ervin (2000) Criterion to be a Professional (ABALACA) Levels of Nursing Professionals Autonomy – the most important characteristic. Includes Theoretical basis: Patricia Benner’s Levels of Skills Acquisition self-determination, self-decision making, self-regulation, (Novice to Expert) – claims that experience is the best teacher; able to perform independent functions higher the level of experience = higher level of professionalism Body of knowledge – utilizes the scientific method through experimentation and research. Begins with a 5 Levels of Skills Acquisition (NACPE) problem → hypothesis → data gathering → experiment Novice No professional experience yet; a rule-bound → results → conclusions practitioner; no initiative and inflexible; full Academic level of achievement – with a college degree supervision needed since nurse is prone to Long-term commitment – loyalty and fidelity to the mistakes; “tell me what to do and I’ll do it”. profession; promise-keeping Shadowing – following an expert or competent Association – a group of people with a common goal nurse with higher experience Code of ethics – source of guidance for ethical dilemmas Ex: fresh graduates, newly oriented nurses, Altruism – selflessness via service; to discipline oneself neophyte nurse which is a mark of a professional Advanced 1st year at work; with marginally acceptable *ALL REQUIREMENTS MUST BE MET TO BE A PROFESSIONAL Beginner performance; a mediocre or average Occupation – without a college degree practitioner; with little experience; practices with less supervision Is the nurse a professional? Competent 2-3 years at work; may start assuming positions Autonomy – independent nursing actions; with RA 9173, Ex: from staff nurse to head nurse or unit Article 6 which states the scope of practice: manager; independent practitioner practices collaborative role in the health-care team and without any supervision; “I can do things on my independent practitioner own now” Scientific – use of the nursing process (ADPIE) which was Proficient With 3-5 years of experience; holistic established by Lydia Hall practitioner that considers all aspects of care; College degree is required to be a registered nurse. delivers comprehensive approach; able to o CHED - regulates the nursing curriculum and discern and prioritize; “sees the big picture” able to open or close nursing programs Expert More than 5 years at work; a fluid practitioner; Loyalty – with the Nightingale Pledge for oath-taking. flexible and intuitive; with an air of arrogance License as proof of loyalty to the professions BUT DASURV; “I did it because it felt right” Association – Philippine Nurses Association (PNA) Ex: Chief nurse - requires 5 years of experience established in 1922 founded by Anastacia Giron Tupas as a unit manager and a master’s degree. Code of Ethics – BON Resolution # 220 series of 2004 Mentors – teach to share knowledge to make Altruism – nursing care offered to patients which should students a better version of themselves. Includes be patient-centered dean and chairperson positions *Transfer to a new department or unit will mean return to the Negative images of nursing portrayed in the media: which gives novice stage doubt on the nurse as a professional Handmaiden image – seen as a helper or maid; seen as Route to RN in the Philippines assistant of the physician; unable to function unless 3 basic requirements: there is a physician’s order. Affects autonomy criteria of 1. Physically and mentally fit or competent professionalism 2. BSN Degree – bachelor or baccalaureate degree with a duration of 4 years and 8 semesters. Purpose is to instill Angel of mercy – looked upon as sources of miracles; preparation for a profession by learning. affects being scientific. Miracles and science are two worlds apart jawards Core values of nursing education: Naughty nurse – sexualized, bordering pornographic a. Love of God image of the nurse. Affects code of ethics criteria b. Love of country Collective bargaining – “hangyo”; negotiation between c. Love of people employer and employee. When employee conditions are d. Caring – foundation of nursing profession not met (wages, workload, working conditions), a strike may happen (fighting for ourselves). Affects altruism Head of nursing education – DEAN. Qualifications include: criteria – can be misinterpreted as selfishness Registered Nurse Master of Arts in Nursing (MAN) – with thesis; oriented To improve the image of nursing: (EPAL) in administration. Note: MSN is more oriented in Educate the public that we are professionals, especially research (not qualified for dean’s position) when you have a platform With 5 years of teaching experience in the academe Participate in public activities that show nursing as a A member of the PNA profession – activities of the PNA. October is the official Good moral character – absence of conflict of interest  Implementers of BSN program: FACULTY NLE: limited to 3 takes NLE: no limit to NLE General Education – minor subjects that are not directly only. Refresher course (1 attempts, no refresher related to the profession; mandatory by law (ex: Life and semester) is required for course needed Works of Rizal) 4th attempt. Professional Education – major subjects directly related * RA 9173 is more lenient since 2002 was the boom era of nursing to the profession due to the increased demand for nurses all over the world Qualifications: RN + Master’s Degree (MAN, MSN, MPH, MBA, PhD in Salient Features of RA 9173: Philosophy) 9 - # of units in masters required to be a nurse manager. At least 1 year of clinical experience Not necessary to finish your master’s degree. This is A member of the PNA reflected in the clinical ladder (hierarchy of positions in Good moral character nursing) 3. License – a privilege bestowed upon an individual granted by the Clinical Ladder state as represented by the government (PRC) Staff nurse 9 units of master’s degree + 2 Purpose: to protect the public from malpractice years of experience to Can be revoked when there are violations to the law upgrade to unit manager Lifetime validity; does not expire. License ID expires and Unit manager or head nurse upgrade depends upon needs to be renewed and updated every 3 years. facility Supervisor not present in all institutions Procurement of license: Chief nurse or Nurse VII with MAN and 5 years of 1. Citizen or Dual Citizen – pass the NLE; 75% passing rate managerial experience with no grade lower than 60%. 2. Foreigner – priority check: should have reciprocity based 1 - # of accredited professional nursing organization on the principle of “do ut des” or mutual granting of (PNA). Membership is not mandatory but is compulsory opportunities. Can apply for 2 types of licenses: for practice. a. Temporary License – given by BON; no NLE 7 – # of officials in the BON (members + chairperson) needed but with specific amount of time to practice. Should be and RN in his/her own Board of Nursing nation before application of temporary AKA “alter ego of the president” when it comes to license. Ex: medical missions, volunteer work, nursing issues in the country exchange programs Members are nominated by the PNA and appointed b. Permanent License – acquire for Filipino by the president of the Phils. citizenship FIRST to take and pass the NLE. 3 1 term = 3 years. Term can be extended for up to 2 ways to be a Filipino citizen: terms only (6 years) “jus soli” - by place of birth “jus saguini” – by blood; parent/s Powers of the BON: are Filipinos 1. Executive – creates board exams Naturalization – give up foreign 2. Quasi-legislative – creates resolutions. Ex: passport to DFA and be a resident requirements for board exam for 10 consecutive years in the 3. Quasi-judiciary – issue subpoenas (a summon from Philippines. the court), hold court trials, hold litigation process Nursing Law (RA 9173) 2 types of subpoenas: RA 9173 - Philippine Nursing Act of 2002 1. Duces tecum – to bring documentary evidence in court RA 7164 – previous nursing act 2. Ad testificandum – called to be a witness and testify in court. Priority: state the truth Legislative track: Must have at least 2 versions of the bill before signed 3 - # of years of validity of PRC ID into law o Upper house – senate. Authored by Hon. Sen. Juan Identification Card Certificate of Registration Flavier, also a previous DOH secretary. Campaigns: Card form which is carried A paper document for HIV program and iodized salt anywhere. safekeeping. Request for 2 o Lower house – house of representative With logo of the PRC. copies. (representatives of districts and party lists). With signature of PRC Indicates NLE grade. Authored by Rep. Carlos Padilla chairperson Needed for job application o Signed into law/ratification by Pres. Gloria With seal of the PRC. Non-transferable Macapagal Arroyo Validity: 3 years during the With signatures of officials birthday of applicant of BON. BON Resolution No. 425 Series of 2003 – implementing rules and Validity: no expiration date regulations of RA 9173 Violations which lead to revocation of license: RA 7164 RA 9173 Gross negligence and malpractice BON: 5 members, no chair BON: 1 chairperson with Fraud– ex: falsification of ID, signature (forgery), identity BSN: college applicant 6 members and educational attainment (misrepresentation). must be part of upper 40% BSN: no requirement if Possible criminal charges may apply for fraudulence. of graduating high school high school graduate Acts of moral turpitude – should be a guilty criminal (ex: class murder, arson)  Practicing while under suspension Ex: Robin Hood, placebo effect to maintain internal Return of revoked license: validity 4 years has passed since revocation Nurse applies both methods since patient care is DYNAMIC. reason for revocation has been resolved. Ethical Principles: Note: NOT all licenses can be returned, it will depend on Autonomy the reason for revocation. Ex: murder – reclusion Self-determination and self-regulation; ability to decide perpetua or lifetime imprisonment on one’s own without coercion Foundation: respect for human rights which universal. Ethics Article 3 - Bill of Rights found in the Philippine About moral philosophy, the study of norms, standards, Constitution rules, and principles to help determine right from wrong Autonomy is subjective to: A source of guidance rather than a solution itself 1. Age o Age of majority - > 18 y/o Morals vs Ethics o Age of minority - < 18 y/o; with the right to Morals – depends upon individual or specific beliefs, decide culture, and religion o Legal basis: RA 6809 – Emancipation Law Ethics – depends upon societal or general beliefs o Minors can decide when they are emancipated (minors who are orphaned, pregnant, marriage) Metaparadigms of Ethics 2. Mental capacity 1. Metaethics – study of the origin of words or terms. Diminished capacity - cannot decide for their Provides vocabularies and establish its definitions. own 2. Normative ethics – establishment of ethical principles; what is normal, standard, fundamental; should be Advanced Directives – preserves autonomy; instructions made in followed advance about health care and are implemented once patient is 3. Applied ethics – application of the ethical principles into unable to decide on his own. This is recommended for all people, real life situation not only those who are terminally ill or dying. Includes: Ex: Living Will Meta: truth - what is right; a fact Durable Power of Attorney – person appointed by the Norm: veracity – principle of truth-telling patient to decide on their behalf Applied: patient had Western blot test and results were DNR – reversible do not resuscitate order which expires positive. Principle of veracity is applied when the nurse within 24 hours; but can be requested to have it tells the real diagnosis permanent. Doctor discusses DNR order with patient. Branches of Ethics: (according to application) Informed Consent 4. Bioethics – application principles concerning issues Obtaining permission from a client by means of about life explanation about a certain procedure 5. Healthcare ethics – application of principles concerning Applicable in all fields of nursing. Nurses CAN obtain human healthcare informed consent 6. Nursing ethics – application into nursing care 2 parts in obtaining informed consent: 7. Descriptive ethics – a bottom-up approach wherein 1. Full disclosure - elements include: society defines what is ethical via applications (applied Purpose ethics → normative ethics → metaethics). There should Methods be caution in applying this method. Ex: homosexuality Benefits Risks and Complications Common Ethical Issues Right to refuse Ethical Issue Bioethics Healthcare Nursing 2. Consent proper – asking for permission Abortion of fetus Yes Yes Yes Consent – permission from an adult Animal cruelty Yes No No Assent – permission from a pediatric Medical Malpractice Yes Yes No client/minor *All nursing issues are healthcare issues. But not all healthcare *In acquiring consent for a pediatric px, consent is issues are nursing issues. more important *All healthcare issues are bioethical issues. But not all bioethical Ex: issues are healthcare issues MCN = In a vasectomy or BTL for a married person, the couple should BOTH sign the consent. If not married, Two Methods of Applying Ethical Principles: whoever goes through the procedure signs the consent. Teleological Method Deontological Method Psych = For voluntary admission, the patient signs the “telos” – results. The ends The action/means itself will consent. For involuntary admissions, the guardian signs will justify the means make the nurse ethical the consent. DAMA is only applicable for voluntary Action is ethical based on regardless of the results admissions. the results regardless of The means will justify the Research = A participant can withdraw from the study the means to achieve it ends even if they have signed the informed consent. Priority Proponent: Aristotle Proponent: Immanuel Kant action when a participant withdraws is to respect the Idealisms: Idealisms: patient’s right to refuse. Consequentialism Kantianism o Attrition – decreased amount of data due to Utilitarianism Principalism the withdrawal of a participant from the study Ex: Emergency triage, Catholic CHN = Courtesy call during the entry phase is a form of church consent. Veracity Violation: discrimination (prejudice or a pre-formed Principle of truth-telling or honesty (an attitude). It is notion) or bias. Ex: sexism or bigotry, racism, ageism the patient’s basic right to know the truth. Violation: Lying. Types include: o Intentional lying – purposeful lying despite Fidelity knowing the truth Principle of loyalty and keeping true to one’s oath o Incomplete information – the truth should Nurse’s oath – Nightingale’s Pledge. No oathtaking, no always be whole initial registration o Lying by omission – lying by not saying Violation: client abandonment anything about the truth despite knowing the Examples: truth Client advocacy – speak and act on their behalf, In the case when family requests that patient will not be especially the most vulnerable ones (e.g., referring the informed of health information for their benefits, the patient to social workers, NGOs, or foundations when nurse can participate. Nurse can withdraw from patient- unable to pay). care if they cannot tolerate lying for the benefit of the patient. Solidarity “solid” – being united; the principle of unity Confidentiality Collaboration and teamwork results to something good The principle of honoring privacy All individuals have a right to privacy Totality Confidentiality transcends death Principle of preserving human dignity by keeping the Avoid talking about patient data in public areas. physical body parts together Prioritize the good of the entire person including Two types of privacy: physical psychological, and spiritual factors 1. Solitude – right to be alone. In the case of invasion of Also applies to elimination of a diseased body part to privacy, apologize first. preserve the whole (e.g., amputation) 2. Data privacy – right to secrecy of personal information to keep the patient safe Stewardship Principle of caretaking (supervision or assistance); taking Beneficence and Non-maleficence good care of God’s creations “Twin sisters” of ethics Related to: Beneficence Non-maleficence o Beneficence To do good Do no harm o Non-maleficence Priority: client’s best Priority: safety of the o Fidelity interest patient Examples: Ethical Dilemma 1. Nurse instructs patient with COPD to stop smoking – A problem/situation wherein ethical principles in NON-MALEFICENCE since smoking is harmful to the conflict with each other; a universal experience patient Nurse is torn between two or more ethical principles or 2. Vaccines outweigh the risks by its benefits – beliefs (intrapersonal conflict) BENEFICENCE No clear solution but requires a choice between two principles. Outcome scenario is WIN-LOSE. Restraints – object given to the client to prevent movement of a body part or the entire body which can only be used upon a Examples of ethical dilemmas: standing order of the physician. Order expires within 24 hours. Autonomy vs Beneficence Types: o Medical Paternalism – “behaving like a parent”; 1. Physical – siderails (prevents ambulation). Complication: results to coercion in terms of decision-making for impaired skin integrity. Prevent this by releasing the medical procedures; pressuring the patient to restraint q2h for 30 mins per extremity choose the nurse’s preferred choice (violates 2. Chemical – sedatives and major tranquilizers. client’s autonomy) Complications: falls. Prevent by assisting when ambulating. Anticholinergic effects include (BUCO Beneficence and Non-maleficence PANDAN): o Euthanasia – mercy-killing. Violates Blurred vision ▪ Active euthanasia – deliberate ending of Urinary retention patient’s life. Patient is functional but with a Constipation terminal condition. Ex: assisted suicide with Orthostatic hypotension high doses of sedatives (Dignitas in Photosensitivity Switzerland) Amnesia – temporary ▪ Passive euthanasia – dies a natural death by Dryness of mouth not performing any life-saving measures. Ex: Ataxia DNR, removing patient from life-support Nighttime disturbance of sleep – insomnia machines o Therapeutic Abortion – for cases of ectopic Justice pregnancies (teleological method) Principle of fairness and equality Fair distribution of burdens and opportunities which is Veracity vs Confidentiality usually tested when there is scarcity of resources o HIV diagnosis – right to keep the diagnosis confidential but sex partners should be aware of the diagnosis Follow the patient’s  confidentiality since they are under your direct B. According to Statutes (ranked) care. If partner asks, tell them to ask the 1. Constitutional Law – highest form of law in the patient themselves (lying by omission). land. All other laws are based on the constitutional Violates veracity stipulations (abortion and divorce are not supported in the Philippine constitution). Changing HIV diagnostic test: Western Blot the constitution will require 2/3 vote from the HIV Screening test: ELISA (at least 2 tests) senate and president’s confirmation Mode of transmission: sex and body fluids (except saliva) 2. Statutory/Regulatory/Legislative – all republic acts AIDS Dx: CD4 test (< 200 cells) with at least 2 opportunistic (ex: RA 9173) infections 3. Administrative – with local or exclusive clout; small coverage. Ex: Administrative order 2009-0025 – Justice vs Beneficence Unang Yakap campaign, city ordinances o Organ Donation (RA 7170) – scarcity of resources leads to unfair distribution of organs (violates justice). C. According to Relationships Governed/Application donation process should involve 2 teams: ▪ Donor – either live or cadaver. Donation should Civil Law Criminal not lead to the disability of the live donor. Most Involves private Public relationship with the common donated organ: KIDNEY. Most common relationships with another state as represented by the donated tissue: BLOOD. individual or group government (involves the ▪ Recipient – either willed or non-willed (waiting Nurse-patient, nurse-peer society) list) relationships People of the Republic of Civil Code: RA 386 the Philippines vs Criminal Veracity vs Beneficence (public enemy) o Placebo effect in research – to maintain internal Revised Penal Code: RA validity; giving a false medication or telling a lie to 3715 the patient to find a cure or answer Tort – civil violation. Evidence Crime – violation of the required: Preponderance of criminal law. Evidence Steps in Solving Ethical Dilemmas: (Follow Nursing Process) evidence – burden of proof; required: Proof beyond 1. Assess the situation and gather data about the dilemma. greater weight of evidence is reasonable doubt 2. Diagnosis – identify the problem and establish the more likely than not to have Ex: Murder – death dilemma (which principles are at conflict) occurred. 3. Planning – perform values clarification (self-awareness) Both can be grounds for revocation of license, but criminal a. Choose the value that you resonate with violations has severe consequences. b. Cherish the value c. Act based on the chosen value Civil Law Violations 4. Intervention – recommend action Intentional Unintentional 5. Evaluate if the action solves the dilemma with evil, malicious intent without evil intent but “dolo” – deceit results to harm Other Resources to Solve Ethical Dilemmas (Counseling): With heavier “culpa” - fault Immediate superior Ethics committee – last resort; refer problems that are consequences; may be a complicated. Also involved in research as the criminal act institutional review board by evaluating research Types of Intentional Torts: proposals for approval 1. Assault – an actual threat that results to anxiety; either verbal or non-verbal. Ex: “If” statements, cussing, body Jurisprudence language, insulting gestures Law – rule of the land as mandated by the state; policies or norms 2. Battery – actual physical contact without consent resulting set to keep the peace and order in a jurisdiction to harm. Ex: CPR on a DNR patient, blood transfusion on Jurisdiction – a particular place where a particular law is Jehovah’s witness (in emergency, exercise protocol by implemented verifying identity first then document). Prevention: Ask for consent!! Why do nurses study the law? 3. False imprisonment – a form of battery wherein restraints and isolation procedures result to harm. Ex: restraints Ignorantia legis neminem excusat – ignorance of the law without order (most common). Prevention: always check excuses no one; leniency can lead to violations order and its validity (24 hrs) To protect the patient’s rights 4. Illegal Detention – unlawful non-discharging of a patient To protect the self from injustice despite signing appropriate forms (ex: promissory note, DAMA). A violation to the right of habeas corpus (right to Classifications of Law lawful admission and detention in the hospital) A. According to Source: 5. Oral Defamation or Slander–malicious intent of destroying Divine Human one’s reputation (what people think you are). Requires From an omnipotent and Created by legislators to witnesses to the act. omniscient being (all keep peace and order 6. Published/Written Defamation or Libel – requires knowing, all powerful) “statutes” – pieces of published evidence of calumny (ex: broadcasted “Mandate of the legislation interviews, posts, heavens” 7. Invasion of Privacy Supreme source of laws 8. Fraud  Borrowed servant doctrine – employer is held liable for acts of a Types of Unintentional Torts: temporary employee Negligence Malpractice Criminal Law Violations Carelessness professional violation; breach in professional duty Crime – violation of the law of the land which destroys Failure of a nurse to act in relationships with the state (criminal = enemy of the the same manner a overstepping beyond one’s prudent/careful nurse job description resulting to state) would do, resulting to injury, harm, or death 2 Basic Elements of a Crime: damages or injury exclusive to professionals 1. Mens rhea – criminal intent; a dangerous mind can happen to anyone (ex: (nurses, physicians) 2. Actus reus – the criminal act nursing aid, UAP) legal context: the name of *both should be present for it to be considered a crime. You legal context: wrongful act the lawsuit cannot sue for a criminal intent alone. or failure to act Ex: 3 Degrees of a Crime Giving a wrong medication. The act itself is negligence. Degrees Mens rhea Actus reus When patient files a lawsuit, it is called professional Consummated Present and Successful Heaviest malpractice – since it is the direct fault of the nurse fulfilled and executed punishment Failure to report a possible case of sexual abuse - given Negligence since the abuse is not the direct fault of the Frustrated Present Executed but nurse unsuccessful (I did my best, Preponderance of Evidence for Civil Liability: (4Ds) but it wasn’t 1. Duty – under the scope of practice enough ☹ = 2. Dereliction or breach of duty – neglect, failure to act, frustration) breach of standards Attempted Present but Unsuccessful Least 3. Damage – physical, emotional, mental injury, harm, or unfulfilled and stopped punishment death Ex: 4. Direct causation or proximation – direct relationship of Homicide – murder without intent to kill dereliction and damage Parricide – murder of a family member Ex: A nurse administers Propofol (anesthetic) instead of Infanticide – murder of an at least 3-day old newborn Propranolol (beta blocker) which results to comatose. Abortion – murder of a fetus; worst form of killing since Duty = rights of drug administrations the victim is defenseless Dereliction = failure to give the right drug Arson – intentional burning of property Damage = comatose condition Robbery – stealing with force (holdup with a gun to the Direct causation = administration of Propofol results to head) comatose condition of the patient Theft – stealing without force; lack of or late awareness Therefore, nurse is guilty of MALPRACTICE. Burglary – breaking into a property; can be both theft and robbery Ex: A nurse administers Vit C instead of Vit D. No untoward effects Simulation of birth – switching the identity of infants happened. Rape – RA 8353 (Anti-rape Law). With 3 elements: no consent, carnal knowledge (criminal intent), penetration Duty = rights of drug administrations or attempt to penetrate an orifice (actus reus) Dereliction = failure to give the right drug o Statutory rape – consensual rape with a minor Damage = NONE o Marital rape – rape between couples. 3 Direct causation = No damage but mistake has been attempts of refusal to engage in sexual activity made. = RAPE Therefore, nurse is NOT GUILTY but has to make an o 3 degrees of rape: consummated (with incident report within 24 hours from the period of the penetration), attempted (no penetration) event and submitted to the supervisor (private o Grave Coercion – rape of a male without document). Do not put in the chart that IR has been penetration written. Do not place a copy of the IR in the chart. IR can o Incestuous rape – worst form; rape by a family be used for research for quality improvement. member Respondeat superior – superior is liable to the action of the Conspiracy of a Crime – 3 characters: subordinate. Grounds include: 1. Principal – mastermind; with primary gain if crime is Culba in eligiendo – fault in delegation committed. Receives highest form of punishments Culba in vigilando – fault in supervision 2. Accomplice – partner in crime Liability: vicarious liability – more than one person is liable for the 3. Accessory – hides or destroys the body of evidence breach of duty. Circumstances affecting Criminal Liability (JEMA) Ex: Operating Room = Surgeon as captain of the ship doctrine. 1. Justifying circumstance – to rationalize the criminal act. When one of the members of the OR team commits a mistake Case will be dissolved. Ex: self-defense, defense, or (e.g., instrument or sponge left in the body cavity), the captain is protection of the patient also held liable. 2. Exempting circumstance – absence of criminal intent. Ex: too young (< 9 y/o; considered juvenile delinquency) Res ipsa loquitor – “the thing speaks for itself”; evidence speaks and too old ( 1 year). Done at duties, 1. Unity of command – one source of instruction. Multiple least once a year, either sources of instruction can be confusing. Ex: one chief during January or nurse in the hospital December 2. Unity of direction - one common goal. Reflected in the Activities: planning institution’s mission, vision, and goals hierarchy 3. Subordination – being under a superior to work towards Should be planned FIRST to a common goal, a form of altruism (putting orders of guide operational planning manager before your own) 4. Esprit de corps – teamwork; pride in belonging to one’s group Steps in Strategic Planning: (use nursing process) 5. Initiative – ability to start a task automatically 1. Assess the status quo of the organization. Use the SWOT 6. Authority – right to command; not applicable to technique: everyone. Overall authority = top level management (+) Factors (-) Factors (chief nurse) Internal Strengths Weakness 7. Order – proper chronology or sequence of tasks; being External Opportunities Threats systematic. Best basis = nursing process *can also be used for people or staff 8. Discipline – self-control; ability to follow rules and abide by them 2. Establish/diagnose priorities according to the SWOT 9. Equity – fair treatment at work; no favoritism pls. There findings. should be no conflict of interest. Promote strengths 10. Remuneration – source of motivation for working in an Eliminate weakness organization. Ex: salary Exploit opportunities 11. Stability of tenure – non-existence of a threat to one’s Remove threats job status. Illegal dismissal – violation 3. Perform planning hierarchy – a set of statements that 12. Centralization/Decentralization – distribution of power provide direction and authority in an organization Mission – a broad statement of action; the reason a. Centralized – power from the top (autocratic) why the organization exists b. Decentralized – power is well distributed to Vision – a broad statement of ambition; what the the lower areas; applied in the Philippines organization sees itself in the future. Ex: PHC vision: 13. Scale of Chain/Chain of Command – functions: a Health in the Hands of the People by 2030 method of communication, distribution of authority, Philosophy – statement of beliefs and values, delegations. Reflected in the organizational chart. where decisions are based on 14. Division of labor - delegation Goals – general actions Functions of a Manager Objectives – specific actions; should be SMART Planning (specific, measurable, attainable, realistic, time- o output = goal setting in the form of a plan bound). Should NOT be GLOBE (general, lengthy, o the brain of management out of reach, bogus, elusive) o most important step/function and the driving Policies stimulus Rules and regulations Organizing 4. Implement the planning hierarchy – distribute the plan o output = group of people to help in carrying towards lower-level managers. out the plan Most important role: middle-level management o the backbone of management – the who bridges the gap between top and low levels. organization as the support of the manager Best way to distribute the plan is through a Directing memorandum or announcement. o delegation of tasks 5. Evaluate the understanding of the members of the o the heart of management organization about the strategic plan. Controlling o ensuring that the activities being done are Budgeting – AKA fiscal planning; not only about money but also within standards includes multiple resources to realize a plan o the conscience or super ego of management Purpose: proper allocation of resources (justice) Duration: budgeting process takes about 3-6 months Planning Included in planning phase for proper allocation of a future-oriented activity, a predetermined action resources which is important in carrying out the plan (set/bound to do it) a means of preparation for success One should be familiar of the total institutional budget deciding in advance: what to do, who will do it, how to elements: do it o Capital budget – starting money; for major a plan not put into action is useless investments and usually a one-time big-time expense. Covers heavy-duty equipment 2 Types of Planning: (diagnostic department), infrastructures, land  titles, documentation software, renovations areas of responsibility and Able a channel of communication o Personnel budget (33%) – allocated for *an informal organization can exist inside a formal organization manpower (staff). Covers the employees’ but NOT vice versa salary, wages, benefits, stipend. Comprises the major (highest) component of the institutional 2. Create an organizational design (blueprint of the budget d/t labor-intensive nature of nursing organization) which reflects the overall look or o Operational budget – allocated for supplies structure. 4 basic elements: for daily use (central supply room) which are a. Division of labor replenished monthly or weekly. Includes b. Centralization/Decentralization and COC– safety and security equipment (CCTV, fire distribution of power extinguishers, paraphernalia) c. Span of control – pragmatic concern of the o Utility budget – covers electricity and water manager over the subordinates; # of people bills under the direction of the manager Wide - > or = 4 subordinates 2 types of expenditures: Narrow - < 4 subordinates 1. Directs costs – crucial to operate or offer services d. Organizational structure offered; “must buys”. Includes PPEs, medications, staff salary and benefits, online communication Tall/Centralized Flat/Decentralized 2. Indirect costs – not related to the main services but vertical in nature; Horizontal in nature has a specific purpose; organization can still function “pyramidal” wider span of control without these factors. Ex: fire extinguishers and CCTVs with narrow span of shorter chain of command control; with better (faster and direct Types of Budgeting: supervision communication) 1. Incremental budgeting – raising the budget allocation with multiple levels of with better delegation based on the current inflation rate (affected by internal communication (difficult) opportunities revenue, import-export, investments). Considered as workers may be boss- the easiest type of budgeting oriented d/t close contact 2. Zero-based budgeting – AKA sunset budget; manager with supervisor needs to justify all budget allocations for the upcoming fiscal year (presentation and defense of the budget 3. Establish and identify organizational relationships proposal). Budget starts from scratch/zero instead of Formal Relationships Informal Relationships basing it from the previous year 3. Ceiling budget – setting of limits for each allocation of with a classic command coordinating or resources. Budget should not go beyond the maximum relationship (superior- consultative relationship limit set by the source of budget subordinate pairing) – may represent temporary 4. Standard budget – fixed set of budgets; not symbolized by a solid relationships with the recommended since nursing is variable straight line in the organization organizational chart symbolized by a broken or Responsibilities of the manager during budgeting process: dotted line Budgeting is done annually Timeframe for budget-making is 3-6 months 4. Identify organizational culture based on the philosophy Transparency is encouraged. of the organization. Prioritize budget monitoring once it is used Staffing – a major activity in organizing involved in human resources; the process of assigning competent and qualified When there is excess money from the budget, inform the source. people to fill in job descriptions Organizing Staffing Considerations: Formation of a group of people (organization) with the 1. Regulatory requirements – supported by the law same goals to execute the plan employee must work for 40 hours/week (8 A manager cannot do without an organization and vice hours/day for 5 days) – 104 days in a year versa. Manager supplies direction to the org, and the (excluding holidays) according to RA 5901 org gives support to the manager in the actualization of affects # of employees/unit and the scheduling the goal (mutual relationship) of shifts Steps in Organizing: 2. Benchmarking – seeking the best practice and applying 1. Choose the type of organization you want to build. 2 it into the organization to improve performance types of organization in terms of management 3. Patient Classification System – classifying patients Formal Organization Informal Organization based on the amount of nursing workload with position, title, and job people do not have Patient acuity – measure of nursing workload description assignments; positions; people are generated for each patient (high-acuity = more built by the manager together because the share work) communication through a similarities (e.g., friendly Classification of Description Patient Care chain of command – relationships) Self-care or Capable of ADLs, usually for discharge. unbroken like of reporting communication through a minimal care Able and ambulatory creation of an grape vine (chismis) Moderate care Stable but with special treatment organizational chart which procedures (ex: px with colostomy) depicts the formal structural relationship, Total care Bedridden and lacks strength and mobility to perform ADLs  Intensive care Highest acuity; critically ill and in constant Elements of Directing: danger of death. Patients in the ICU, Communication PACU, ER, OR a must; the process of relaying messages from the sender *level of patient acuity dictates the type of staff need. Ex: ICU = to the receiver. Goal: understanding expert nurses. DR = female nurses. Elements of Communication: 4. Staff support – number of personnel needed for Sender or encoder operations to occur. Message a. Shifting of staff - 45% staff needed in the AM Medium or channel of communication shift; 37% staff in PM, 18% staff in NOC Receiver or decoder Ex: 20 staff in total: 9 in AM, 7 in PM, 3 in NOC. Response or feedback 5. Skill mix – ratio of professionals to non-professionals (aids, UAP, auxiliary worker) Steps in Staffing: Levels of Communication: 1. Determine the number and type of personnel needed 1. Verbal – use of words. Includes oral and written (job description and staff calculation) communication 2. Recruit personnel – hiring process 2. Paraverbal – characteristics of speech. Includes tone, a) Advertisement - most efficient is through word sounds, speed, vocabulary. of mouth 3. Nonverbal – use of kinesics. Includes body language, b) Application – applicant passes curriculum vitae actions, gestures. More powerful than verbal with cover letter which presents intention of *communication is 93% nonverbal, 7% verbal. Managers should interest for available job vacancy. Includes always strive for congruence of all 3 levels to deliver a good (contact details, 2 levels of educational message attainment, NLE rating, job experience, character references) Directions of Communication: c) Sorting of qualified applicants 1. Vertical – between superior and subordinate; a formal 3. Interview of applicants – wear business or corporate attire command WOMEN: sleek hairstyle with ears exposed, a. Upward – subordinate to superior light makeup, simple jewelry, collared blouse b. Downward – from superior to subordinate with blazer, just above the knee skirt, skin- 2. Horizontal – between colleagues or peers (same level of tone stocking, closed-shoes with heels position); can be informal in nature MEN: sleek and styled hair, clean shave, tie up 3. Diagonal – talking with someone who is not part of the to the buckle of the belt (same color as shoes), organization (ex: nurse’s communication with patients tucked in polo, slacks, black socks or physicians) If you do not know the answer to the question: do not pretend. apologize and admit Delegation that you don’t know the answer and ask for main activity of directing characterized by division of another question labor Tell me about yourself: answer with things not the process of assigning tasks to competent staff with found in your CV corresponding ARA: Why should we hire you: contribute to the o Authority culture of excellence of the company o Responsibility – concerned with accepting and Why this company: state mission, vision, goals completing a task of the company o Accountability – concerned with the If you are given a chance to ask questions, do results/outcome of the completed task not ask HR about the salary. Expected amount of salary – give a range, not an exact amount Common Errors in Delegation: (minimum wage) 1. Overdelegation – too much task given which results to Upon entering, do not sit right away, wait to burnout (holistic overexhaustion) be seated. After the interview, stand and offer 2. Underdelegation – too little task is given which happens to shake hands. when someone is over delegated. This results to 4. Induct or orient the personnel redundancy. A redundant employee is a waste of 5. Give the job offering (employment contract) organization funds 3. Improper Delegation – delegating to a wrong person. Directing Results to negligence and malpractice. Steps taken by the manager to ensure that tasks are being distributed appropriately among the members of Prevention of Delegation Errors: (5 rights) the organization in completion of the plan Right task Main activity: to give good directions Right person Right direction Elements of a Good Direction: (4 Cs) Right circumstances Clear – well understood instructions Right supervision Concise – less words, lesser mistakes Consistent - reliable Complete – all required details are given in full  Things you cannot delegate to a nursing aid/unlicensed o Nurse is called the case manager – no direct care personnel: given, only health teaching and directions given. Nursing process activities. Gathering of data can be Patient becomes independent with the support done but no interpretation should occur. system – promotes continuity of care to the home. Admission and discharge (rigorous assessment and o Ex: IMCI by WHO which covers common childhood discharge teaching done by the nurse) illnesses Health teaching Medication administration Highly invasive or sterile procedures IMCI (Integrated Management of Childhood Illnesses) High-risk and unstable patients o Identify the age of the child to identify which chart to Formal documentation use (0-2 mos. old or 2 mos. – 5 y/o) o Identify the chief complaint Modalities/Models of Care o Assess general danger signs (convulsions, lethargy, method of health care delivery; manner in which the staff and the unable to breastfeed/drink/eat, vomiting) tasks available in the unit will be divided; basis of delegation o Triage Total Patient Care or Case Method o Green – health teaching of mother o Total patient care: perform all aspects of nursing care o Yellow – needs treatment with medications are done by one RN to/for a patient or group of by the mother clients o Pink – needs referral to other HCPs o considered as the best modality because it is the original as established by Florence Nightingale Controlling o Advantage: 1 RN: 1 patient; typically used in nursing Mistakes are prevented by means of imposing norms and school standards o Uses: RLE, ICU, OR Manager monitors the quantity and quality of work and evaluates whether both meet the expectations according to Functional Method plan o Task-based nursing: tasks available in the unit is Priority activity: establish standards divided among available staff, each performs one task for the whole shift (1 nurse: 1 task) Standard is defined as the: o Strengthens the skills of the nurse through repetition Minimum requirement o Ex: Medication nurse administers medications for all Means of comparison to evaluate the performance of patients in the station tasks o Popularized during the 1940’s – World War II Measured in numbers o Use: high-census patients, emergencies or disasters, Applicable to all members concerned mass casualties 3 types of standards: Team Nursing Structure standards – means of comparison for systems o “partners in care”; 1 group of RNs (at least 4 of operations; usually personnel-related (ex: shifting, members) take care of a patient/s hours of work) o Composed of a team leader (TL) who delegates the Process standards – for procedures (ex: manual of tasks to the members procedures for suctioning, blood transfusion) o Puts back the nurses to the patient’s bedside by hiring Outcome – for evaluation of a performance (ex: ward clerks satisfaction survey upon discharge usually in Likert scale o Use: tertiary-level or large-scale hospitals (adequate format) staff) Steps for Controlling: Primary Method 1. Establish standards o Autonomous and authoritative method of patient 2. Measure the performance of tasks care wherein in the care; level of accountability of the 3. Compare performance with the standard nurse is increased in the care of a patient/s by 4. Identify corresponding action: formulating a 24-hr based NCP. Care is assumed by a a. If above average = praise, reward, recognize, reliever once the shift if done. and promote o Nurse decides and is responsible for how the patient b. If below average = train the employee (staff will be taken care of (decentralized decision-making) development efforts) o Advantageous and satisfying because holistic Methods of Staff Development: to improve performance (SKA) approach provides therapeutic relationship, In-Service Education Continuing Education continuity of care, and efficient nursing care. Focused on skills Focused on career o Use: hospice care px with terminal conditions (< 6 development development months to live) where consistent care is needed Informal: usually right Formal and planned after the evaluation; Responsibility of the staff Case Management incidental and unplanned themselves o Collaborative management of a patient with various Responsibility of the CPD: Continuing HCPs and the patient’s family or support system agency/hospital professional development. o Most efficient (multi-disciplinary approach) and Needed for renewal of satisfying (presence of support system) license (45 units in 3 o Utilizes scientific protocols that aid in managing years) particular conditions: CLINICAL PATHWAYS (evidence- based) When should a manager perform controlling:  Before the task – feed forward control; checked before the procedure to prevent mistakes (ex: vehicle check-up of ambulance) During the task – concurrent control After the task – feedback control Ex: Operating room control measures: Before the operation: pre-operative checklist which checks for allergies (latex and anesthesia), blood tests and types, consent, CP clearance During the operation: checking the sterility of instruments, sponge count (simultaneous and concurrent; at least 3x) After the operation: post-operative assessments (PACU or RR). Patient usually positioned supine without head elevation with side rails up. Check ABCs first especially for those under GA.