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“When you fail to plan, you are planning to fail.

The quote stated above is largely true and it draws an image of what
might occur in case there is poor planning or planning wasn’t utilized at all.
Without planning even when something gets done it suffers to an extent because
something which is done which wasn’t established through planning, the pursuit
of any particular goal can be an expensive journey to chaos.

Planning is defined as the projection of actions intended to reach specific goals.
In other words a plan is a blueprint of the future; it is our expression of what we
wish to accomplish or our best description of what might occur in the future.

Benefits of planning

 Ensures that work is done effectively and efficiently.

 Reduces procrastination and ensures continuity.

 Provides intelligent use of resources.

 Puts everything under control and knowing what to do next.

 It is proactive.

Purpose of Planning:

 One of the purposes of planning is to establish the benefits and to express
an understanding of the implication of an unsuccessful plan.

 Planning will provide familiarization of the types of the plans employed in
the business activity and will identify and explain the key elements of it.

 Planning will established the importance of goals and objectives.

 Planning will label action plans and examine the elements of a typical
action plan.

 Planning will established its task in an organization’s vision and mission.

Characteristics of Planning

In an environment of changing technology, mounting costs, and multiple
activities, a need exists for professional nurses to plan. Planning, as an
elementary function of management requires selecting missions and objectives
and the actions to achieve them. It also requires decision making and choosing
future courses of action from among alternatives. In planning, the nurse would
avoid leaving events to chance; she or he would apply an intellectual process to
determine the course of action to take in accomplishing work.

A well developed plan should:

1. Have clearly worded objectives, including results and methods for
evaluation.

2. Be guided by policies and/or procedures affecting the planned action.

3. Indicate priorities

4. Develop actions that are flexible and realistic in terms of available
personnel, equipment, facilities and time.

5. Develop a logical sequence of activities.

6. Select the most practical methods for achieving each objective.

Planning involves the collection, analysis, and organization of many kinds of data
that will be used to determine both the nursing care needs of patients and the
management plans that will provide the resources and processes to meet those
needs.

Types of Planning

There are two major types of organizational planning:

1. Strategic Planning or long-range planning.

Domanico presented one of the earliest descriptions of strategic planning ion
hospitals as “the process whereby hospitals assess the total health care market
and their true competitive position within the market to determine future
directions while at the same time addressing community needs and satisfying
regulatory requirements.” Jones presented the first application to strategic
planning to nursing administration. She suggested that the nursing department’s
strategic plan is developed in the context of the needs of the total institution and
describes its newly defined missions.

Nursing administrators can increase effectiveness through strategic planning,
which can promote professional nursing practice and the long-range goals of the
organization and the division of nursing.

Strategic planning in nursing is concerned with what nursing should be doing. Its
purpose is to improve allocation of scarce resources, including time and money,
and to manage the agency for performance. Strategic planning provides strategic
forecasting from one year up to more than twenty years.

Strategic planning can foster better goals, better corporate values, and better
communication about corporate direction. It can lead to changes in operation
management and organization. Strategic planning can produce better
management strategy and analysis and can forecast and mute external threats.

Setting goals and objectives 6. Conducting the external assessment 4. Developing the implementation plan Purposes of Strategic Planning:  To clarify the beliefs and values of the organization  To give direction to the organization  To weed out poor or unused programs  To eliminate duplication of efforts  To concentrate resources on important services  To improve communication and coordination of activities  To allow adaptation to the changing environment  To ensure goal achievement . Planning the process 2. Selecting and developing strategies 8. 1995): 1.The Process of Strategic Planning (Whythe and Blair. Developing and/or assessing the mission statement 3. Conducting the internal assessment 5. Formulating strategic options 7.

new strategic objectives can emerge or old ones can be modified or discarded. Operational plans are everyday working management plans developed from both long-range objectives and the strategic planning process and sort-range or tactical plans. All aspects of an operational plan are based on goals and their achievement. . Strategic plans are made into operational plans and carried out at all levels of nursing management. In development of operational objectives. creating an effective organizational structure that encompasses a quality monitoring process. Their objectives can be more detailed and specific than the strategic objectives. objectives. They match each unit goal or objective to a strategic goal or objective. and targets to set the strategic plan in motion. and directing nurse leaders. and new programs. It includes such planning as creating a budget. 2. an administrative staff. Operational Planning Operational management is the organization and directing of the delivery of nursing care. strategies. Operational managers develop goals.

It acts as a flag around which the troops will rally. Philosophy. It is the best indicator of a certain group whether they are on their right tract in reaching their plans. For example. Setting the Vision. and it also . Goals and Objectives A vision is an image without great detail. and an awareness of how well the organization is doing may give the head the feeling of what is likely to happen in the future. it is not easy to convert a feeling about the future into a precise and useful number Forecasting is an element of planning which possesses the future aspects for every planning made. -Michael Hammer Vision describes the goals to which the organization aspires. a hospital renovated its facilities and hired newly registered nurses anticipating that they will have plenty of clients and patients through their newly adopted technological advancements in health. good judgment. Nevertheless. B. Mission. the long-term success of any organization is closely tied to how well the management of the organization is able to foresee its future and to develop appropriate strategies to deal with likely future scenarios. Intuition.ELEMENTS OF PLANNING A. it signifies that vision gives the group the sense of hope to surpass challenges for the triumph of reaching their goals. In fact. 2010. forecasting can be broadly considered as a method or a technique for estimating many future aspects of a business or other operation. Forecasting According to Sahu. From the quotation.

According to McConnell (2006). For example.provides a premise that leaders commit to and dramatize with others. it depicts that a institution envisions that in the future they want to attain the best of what they can give in the most easy yet effective ways in dealing with people. committed workforce that is efficient and effective in providing the highest quality health care service ”. It is not as easy to accept mission statements. “Our mission is to improve the health of the people and the communities we serve” . 2. The rule should be followed and to prevent the . high quality. they understand why the organization exists and what their work is all about. With the presented vision. mission statements should serve to define the organizations and inspire its employees. Do you know where you want to be in five years? This may want to clarify if the cited mission will be successful in the future with prolonged impact to people. there are four critical questions that must be answered to prove that mission statements are appropriate. stating why this entity exists. Like visions. Mission provides the outline of the purposes of the organization supported and gives a vivid picture of the expectations in the future. Mission statements are expressed clearly in one paragraph or less and in simple language. Example of the vision is “Our vision is to have fully staffed. Mission Mission proclaims the overall view of the purposes of an organization or department. 1. When workers participate actively in the formulation of mission statements. Is it clearly and definitely expressed in one paragraph or less? As stated previously that a mission statement should not be longer than a one paragraph.

ideas. . behavioural. Is it expressed in language that a 10th grade can understand? It means that it can be easily understood by everyone 4. Values are beliefs or attitudes one has about people. Will it believable to everyone in the organization? This may tell and confirm that the plan has clear goals and are possible to do. it should be clearly stated and has a point in which success is possible. It also describes the outcomes that are measurable and precise and are for the entire population. Philosophy is the reason for the purpose and may be a limitation for the actions made as these are standard followed by everyone. The characteristics of objectives are specific to an individual unit in which they are realistic. mission statement from looking boring because of the indirect point stated. it is a written statement that reflects the organizational values. mission and mission. objects or actions that for a basis of their action. 3. measurable. achievable and specific. Whether it is objective or a goal. Philosophy According to Sullivan and Decker 2009. Goals and Objectives Goals are generalized and give a broader perspective of the plan included. understandable.

Example: Goal: “Every patient will be satisfied with the care rendered” It can be seen that the example given has generalized purpose in which it is not specified whether what level or intent of care must be achieved by the patient. the patient will show an improvement in his/her respiratory status” It can be observed that the elements like specific. Objective: “After 4 hours of nursing interventions. attainable. familiarization with the program is a must. realistic and time bound can be seen in the example given. A good leader . Several questions are needed to satisfy the need for every goal as well as time management plays a big role with the group’s achievement of the plan made. Developing and Scheduling of Programs In achieving set goals. C.measurable. . There are goals made to be evaluated depending on the time set.

. Vivid objectives of what is to be done may guide people on their right tract of attaining the vision. Kron has published several questions on for the formulation of plans which are simplified to be known as 5w’s and 1 H. goals and objectives of the study. mission. should know how to distribute work and be smart in setting time frame. What- • What should be done? -Plans should be clear and concise to every individual involved. 1. supplies is always checked for adequacy and ways for easy access. • What steps are necessary in the procedure? -every members of the nursing team must be aware of the systematic steps when implementing programs for they may be guided of the right techniques in achieving the goals of their plan. • What equipment and supplies needed? -resources used for rendering care must be always available to prevent conflicts in nursing management and as a responsible nurse. • What efficient method may be used? -the faster and the effective ways to carry out the plans can help in easy attainment of goals and objectives of the formulated plan.

therefore a right path will be attained that would lead to the right outcome. Where- • Where is the job to be done? Better settings depending on the theme of the plan. Like in the community health nursing. 4. one of the criteria is that there the community is depressed. Why- • Why must it be done? . 2. There will also be no destructions in the flow of activities due to unorganized scheduling. and has health related problems. It may depict that there is a starting point giving the planners the stimuli to start their work and they may know when to end up at specific time or meeting their deadlines. deprived. Their knowledge and interest on the plan will bring out the best of what they can contribute. 5. the people in the settings chosen may benefit from the program to be implemented. 3. Who- • Who will do the job? People assigned to the designated plan may bring a great contribution if they are professional or well known in doing plans especially in the field of nursing. If all are present. When- • When should it be done? Setting time frame is useful in the attainment of the goals and objectives of the plan formulated. It is better has appropriate settings therefore it may help add impact with the objectives and goals cited.

There would be no wasted time if organizers will teach others with the systematic manner of instructions. in government and even to an individual. 6. objective and goals of the plan will bring the members of the organization the clearer picture of the expected outcomes of the presented plan of the organization. . Efficiency and effectiveness on the implementation may render the perspectives of the plan as easy and faster as possible.People may also understand the possible outcomes and what their work is all about. Is the process of planning and controlling future operations by comparing actual results with planned expectations. still it is budgeting. Budgeting may seem to be familiar in any kind of business. Preparing the Budget Budgeting . Though even budgeting occurs only in mind and does not have a concrete process. It is very important in one’s daily life since it is performed by almost everyone. How- • How will it be done? As said with the question that is “what steps are necessary in the procedure”. Explaining the purposes. Budget . which is also same with the above mentioned question which depicts that great flow of events will be helpful with the implemented to reach the desired goals and objectives of the program. D.

To coordinate efforts among organizational departments.range desired state or position in the future’. It is a quantitative statement. It is a complex process and an important aspect in organizational planning and control. They are:  Objective determination stage  Goal determination stages  Strategy formulation stage  Budget preparation stage Objective Determination Stage The first stage is setting the ‘Objectives’ which are defined as the ‘broad and long. To provide a criterion for evaluating managerial performance. They are motivational or directional in nature and are expressed in qualitative terms. To ensure the most effective use of scarce financial and non-financial resources. Formulate a new budget or financial plan The Budgeting process involves four stages. . 4. 2. Purposes of Budgeting: 1. of the plans and expectations of defined area over a specified period of time. Review financial performance b. . usually in monetary terms. Budgeting Process: Budget serves as guide of the managers or any individual who is in- charge to manage and evaluate financial performance of certain establishment. To establish a frame of reference for managerial decisions. 3. In preparing the budget the nurse manager is expected to: a.

Form a budget committee 3. purchase of new plant and machinery and expected rate of return are examples of time and quantity oriented goals. Write justification for all requested expenses. 4. • Phase III. Eliminate lowest priority objectives as necessary. The timing of introducing new products. promotion of sales through price reduction or aggressive advertisement and so on. specific in quantitative terms to be achieved in a specific period of time. Predict future costs and revenues. Present proposed budget. for instance.Modification and Approval . Translate objectives into projected costs and revenues. 3. • Phase II.Goal Determination Stage The second stage is specifying the goals The term goal represents targets.Preparation 1. Set short and long term goals. 6. Prioritize objectives. Develop budget guidelines. 4. 2. Analyze past performance.Planning 1. 2. Strategy Formulation Stage The next step involves laying down the strategies. Strategies denote specific methods or courses of action to achieve the goals. • Phase I. 5.

Readjust budget and/or improve performance as necessary. Compare projected costs with estimated revenues. Compare actual expenses with budgeted expenses. Zero-based Budget . The budget worksheet includes several columns such as budget amount for the current year. 4. Approaches to Budgeting 1.Monitoring 1. amount actually spent. Continue to monitor on monthly basis. the increase and decrease in the expense amount for the new budget and the request for next year’s budget with an explanation attached. 2. 2. 1. 2. Prepare preliminary master budget from all department requests. • Phase IV. 3. Incremental Budget The finance department distributes a budget worksheet with list of expenses of each item and separated into salary and non- salary items. Communicate final budget to all departments. Investigate any variance above 5%. 3. 5. projected total for the year. Prepare monthly summaries of departmental expenses and revenues. Approve master final budget. 4. Eliminate lowest priority items until budget is balanced. 5.

3. Operating Budget This budget includes purchase of minor equipment. repairs. Assumes the base for projecting next year’s budget is zero. 2. Fixed Budget Budgets that are set and not subjected to any change throughout the year. 4. Manpower Budget . It means that each activity is questioned as if it were new before any resources are allocated to it. Types of Budget: 1. Zero based budgets are designed to prevent budgets creeping up each year with inflation. Variable Budget Changes may be made even when the budget was already set. It is also known as the annual budget. supplies or overhead expenses. It is the organization’s statement of income and expenses for the coming year and coincides with the fiscal year of the organization.

This budget includes the wages, salaries and compensations paid
to permanent and casual employees. It depends on the manager’s
ability to handle and lead his staff. Better management would have
good staff that yields good service.

3. Capital Expenditure Budget

This type of budget meets the long term goals of the organization. It
includes upgrading and replacing equipment. Renovations and new
construction of infrastructures. Prioritization of items is very
important since allocation of funds or resources is needed in able to
provide quality of service.

E. Establishing Nursing Standards, Policies and Procedure

NURSING STANDARDS

Standards of care set minimum criteria for your proficiency on the job, enabling
you and others to judge the quality of care.

Example: minimal standards require that develop a nursing care plan for patient
based on the nursing process, including nursing diagnoses, goals, and
interventions for implementing the care plan. Standards also call for
documentation.

Source: Nurse’s Legal Handbook (5th edition)

NURSING POLICY

Nursing policies and procedures are an integral part of the strategic management
planning process of every health care facility and serve as guidelines for future
actions and decision.

Characteristics of good policy:

• Policy should be known to the people affected by it

• Should be flexible and stable so they can apply to different situation that
require another set of policy

• Policies should be consistent to avoid conflicts

• Policies must be precise and have a limitation

• Every policies should able to interpret by those responsible for it

Nursing Procedure

Nursing procedures are specific directions for implementing written
policies.

Example: pre-emptive and procedural pain management

The principle providing analgesia before tissue injury to minimize pain is
generally accepted as good practice. The management of procedural or
transitory pain can be achieved by a variety of techniques:

1. Blocking pain transmission with local anesthetics:

• Topical application of cream containing a mixture of
lidocaine

• Instillation of lidocaine gel into the urethra prior to
catherization

• Subcutaneous infiltration of lidocaine prior to suturing in
emergency department

2. Nitrous oxide 50%+ 50% oxygen inhalation by self- administration during
painful dressing.

Source: Foundations of Nursing Practice Fundamentals of Holistic Care

Scheduling

Is a function of implementing the staffing plan by assigning unit personnel to work
specific hours and specific days of the week.

Example:

Shift workers rank shift schedules using 10-hour shifts above every other shift
length. 10-hour shifts allow the workforce to work four days each week and have
three days off.

THE DECISION-MAKING PROCESS

Problems are inevitable when people work together. A well-managed team is not
described through the absence of problems but whether the problems they
encounter are properly resolved.

Rational decision-making model

In order to maximize the achievement of objectives one can use a rational
decision-making model. It is often used as the ideal model but often cannot be
fully used. This model is a step by step process used by managers to make
logical alternatives to achieve the set objectives.

Another decision-making strategy is Satisficing. If in the start the problem is inaccurately stated all things will follow. He must know the factors that he must limit and factors he must utilize. Many problems that are encountered in Nursing are ineffectively solved with Satisficing.making process in its simplest term can be defined as a process wherein a decision-maker chose between options or select between an alternative. corporate boards and regulatory bodies.Political Decision-Making model Political Decision-Making model is a process wherein it describes the interests and objectives of powerful stakeholders. Knowing what is really the problem is very important because the decision will surely be based on the problem. Third step: DEVELOP POTENTIAL ALTERNATIVES . Decision. Decision-making process involves seven easy steps that are important to come up with a good decision. It is where an individual chooses another option or alternative that is not ideal or not sufficing to meet the standards of the first choice. Problem recognition will start when the decision-maker was alerted by a sign that a decision is needed. Second step: IDENTIFYING THE LIMITING OR CRITICAL FACTORS The decision. First step: DEFINE THE PROBLEM Defining the problem is the first step that must be given attention because it is one of the critical steps of decision. The decision-maker must also identify the purpose why a decision must be made.making process. Resources are the most common limiting or critical factors that narrow down the set of potential options. such as medical staffs.maker must set criteria in line with deciding whether a factor will be chosen or will be eliminated.

A decision that is not put into action is useless. With the chosen options the decision-maker prefer it must be subjected for further research or experimentation making sure that it will best fit as a solution in the problem that must be given a decision. The purpose of this step is to decide the relative merits of each alternative. Fifth step: SELECT THE BEST ALTERNATIVE A good decision-maker does not easily goes at ease with a certain option. the decision-maker is now ready to identify. Fourth step: ANALYZE THE ALTERNATIVES Choosing alternative or an option doesn’t mean it is the solution already. he should pick the one that has many positive factors or has the greater strength in solving the problem and the one that everyone can agree with. Sixth step: IMPLEMENT THE SOLUTION Once the decision is picked. he must do . he is willing to explore and expect all the possible outcomes that he may encounter. The identified alternatives should have a factor that could eliminate. Once the decision.maker analyzes the solution. the decision-maker must implement it right away. In choosing alternative to solve the problem it is necessary to list down the positive and negative thing about that certain option or the strengths and weaknesses of it.After identifying all the possible factors that could affect the decision. the decision- maker can eliminate the solution that has more negative or the solution that is too weak to solve the problem making decision-making easy. In doing so. or at least neutralize the problem. correct. weighing all the characteristic of the given alternatives properly and fairly. With that list.making process. The decision-maker needs the cooperation of his colleagues or staff in implementing it. list and select alternatives or options that can solve the problem.

This step allows the decision maker to see what he did right and wrong when coming up. Seventh step: EVALUATE THE RESULT Lastly. This option will also speed time schedule preparation as nurse managers need only give a list of needs to Agency A. and putting the decision to use. ratings and rankings are tools that can be utilized to review and analyze the results. Bearing in mind the nursing personnel budgets. They have also decided that staffing levels are appropriate for the census and acuity of patients on each unit and would like to keep their personnel budgets on target with annual projections.The nursing administration staff would like to reduce the time needed to prepare a six-week time schedule to one week. and time commitment set for schedule preparation. Audit checklists. Agency A has the cheapest rates and nurses experienced in the specialties that CMH has the greatest need for. she chooses Agency A. A computerized staffing and scheduling system would take . Learn from. Example: Nurse administrators at Creek Memorial Hospital has been spending two full weeks preparing six-week nursing time schedule for all units the Department of Nursing. The nursing administrative staff identifies a nurse shortage as the problem at a meeting one morning. Some directors have noted that although they have permanent and part time staff members. She calls the three different nurse staffing agencies for skill levels and salaries of agency nurses and request information on a computerized nurse staffing and scheduling system. they still do not have enough members to cover all shifts for six-week period. staffing levels. and reflect on the decision making. who will guarantee staff for the next six weeks.it or explained it to them in a manner that they will understand and could win their cooperation. The director of nursing spends the next week searching for possible solutions to the nurse shortage. a decision-making process is not complete without knowing that it took effect effectively. The final step of decision making is evaluation of the results.

Everyone is pleased with the solution. and only the critical care area is left with vacancies. Decision making in both certain and uncertain times can be improved with the use of various tools. Yet. other decisions are more complex and may require thorough analysis. 1. The nursing administration staff are informed of the solution at the next morning meeting and instructed how to complete the next six week time schedules. The patient is a 65 year old man. Each day we find ourselves in situations where we have more than one alternative to choose from. Probability Theory This can be applied when risk or uncertainty is present in a decision. A probability is a number between 0 and 1 expressing the chance that an event will occur. DECISION-MAKING TOOLS Decision making is something with which we are all familiar. Most of our everyday decisions require little or no reflection. Probability theory is the language of uncertainty. budget projections are met. The director is pleased with being able to solve her department’s shortage and still meet the proposed annual personnel budget. which the nurse manager plans to cover herself. The nurse managers complete the schedules within one week’s time. His pain has been going on for six weeks. It does not radiate anywhere.six months to implement and staff to use. . It is sub sternal. 0 represents certainty that it will not occur and 1 represents certainty that it will occur For example: Consider the following case history.

3. The critical element of model building is conceptualization. War games are commonly used to train personnel and to test plans and equipment under field conditions. The pain didn't resolve any faster with the nitro-glycerine. . They are useful for training in decision making by simulating real-life operations in a laboratory setting. Gantt Chart Gantt Charts. Models and Games Simulation is a way of using models and games to simplify problems by identifying the basic components and by using trial and error to determine a solution. It is helpful when monitoring a project's progress. processes. or systems. It represents something else." The pain seems to come on at random. 2. regardless of what the competitor does. Models are developed to describe. named for their developer. It is unrelated to exertion or emotional stress. Henry Gantt. Simulation. For example. He has never smoked cigarettes and has never had a diagnosis of myocardial infarction or any heart disease. explain and predict phenomena.He characterizes it as "an ache. The player tries to develop a strategy that will maximize gains and minimize losses. models can provide abstractions that facilitate communication. He tried a friend's nitro-glycerine. Consequently. most commonly objects. events. Game theory is a simulation of system operations. He can continue what he is doing despite the pain. These are highly-developed schedules that allow one to visualize multiple tasks that have to be done. Models vary in degree of abstraction used. A Gantt chart is a type of bar chart that illustrates a project schedule.

resource costs. A line is drawn through the time frame while a task is in process. SN uses 3 days to collect the information and 1 day to type or word process it.A Gantt chart is a grid with columns for task. 4. A Nursing student is told on a Monday that a report regarding Decision-making tools is due on Friday at 4pm. revise her report and submit it. assigned responsibility. For example. and utility. An X is put at the point where the task is completed. type her report. Decision Trees A decision tree is a decision support tool that uses a tree-like graph or model of decisions and their possible consequences. including chance event outcomes. For Example. do any revision needed Friday morning and submit the report Friday afternoon. . incubate the ideas overnight. Decision trees are commonly used in operations research. the decision tree shown pertains for a person whether to stop smoking or not. specifically in decision analysis. to help identify a strategy most likely to reach a goal. and time frame depending on the longevity of the project. The SN needs to collect information.

Nodes (circles) symbolize . sequencing the activities in a flow diagram. It involves identifying the key activities in a project. Arrows represent "tasks" or "activities. The Pert technique involves the diagrammatical representation of the sequence of activities comprising a project by means of a network consisting of arrows and circles (nodes). PERT is a network system model for planning and control under certain conditions. and assigning the duration of each phase of the work. 5." which are distinct segments of the project requiring time and resources. Program Evaluation And Review Technique The Program (or Project) Evaluation and Review Technique.

. An important aspect of PERT is the Critical Path Method (CPM). paperwork. It is an important tool for effective project management." or milestone points in the project representing the completion of one or more activities and/or the initiation of one or more subsequent activities. and production. These are calculated using this formula: 6. Critical Path Method The critical path method (CPM) is a mathematically based algorithm for scheduling a set of project activities. Three projected times are determined: 1) Optimistic Time. PERT also deals with the problem of uncertainty with respect to time by estimating the time variances associated with the expected time of completion of the subtasks. ( ) which estimates the completion time without complications. inspections. ( ) which estimates the completion time given numerous problems."events. Manufacturing industry uses CPM to plan and control the complete process of material deliveries. 2) Most Likely Time. Planning and control technique that optimizes the order of steps in a process given the costs associated with each step. An event is a point in time and does not consume any time in itself as does an activity. ( ) which estimates the completion time with normal problems and the 3) Pessimistic Time.

Linear programming is dependent on linear relationships. the expected number waiting or receiving service. Linear Programming is a sophisticated short-cut technique in which a computer can be used to determine solutions. full. . Linear Programming Linear programming (LP) is a mathematical method for determining a way to achieve the best outcome (such as maximum profit or lowest cost) in a given mathematical model for some list of requirements represented as linear equations.e. being able to come to an equitable decision as efficiently as possible is important for the functioning of the group. and the probability of encountering the system in certain states. 7. and the hours available to conduct the course. relationships where a constant ratio exists between the change in one variable and the change in another.i. or queues. and being served at the front of the queue. the number of tutors qualified to teach the course. GROUP DECISION MAKING Because the performance of a group involves taking into account the needs and opinions of every group member. waiting in the queue (essentially a storage process). a school of nursing might use this technique to determine the size of classes. For Example. such as empty. The theory permits the derivation and calculation of several performance measures including the average waiting time in the queue or the system. Queuing Theory Queuing theory is the mathematical study of waiting lines. the number of students. and the number of tutors feeding into the computer equations containing such variables as the students need to enrol in particular classes. 8. The theory enables mathematical analysis of several related processes. including arriving at the (back of the) queue. having an available server or having to wait a certain time to be served. the number of students.

analyze problems or situations. • Nominal Group Technique In Nominal Group Technique group members are required to compose a comprehensive list of their ideas or proposed alternatives in writing. The number of people involved in group decision-making variesgreatly. each group member is asked. • Delphi Technique The Delphi Technique can be used by decision-making groups when the individual members are in different physical locations.Group decision making is a type of participatory process in which multiple individuals acting collectively. Group Decision –Making Technique There are many methods or procedures that can be used by groups. to provide one item from their list until all ideas or alternatives have been publicly recorded on a flip chart or marker board. each group member is asked to independently provide ideas. Statistical Aggregation and Brainstorming. in turn. Each is designed to improve the decision-making process in some way. and select from among the alternatives a solution or solutions. input. Delphi technique. Some of the more common group decision-making methods are Nominal group technique. consider and evaluate alternative courses of action. Once finished. In the Delphi technique. The individuals in this technique are usually selected because of the specific knowledge or expertise of the problem they possess. • Statistical Aggregation . and/or alternative solutions to the decision problem in successive stages.

and their responses are tallied. The members of the group are polled regarding a specific problem. group decision help to get a broader perspective owing to differences of perception between individual in the group. Disadvantages of Group Decisions: . Once the ideas of the group members have been exhausted. but does not offer much in the way of process for the evaluation of alternatives or the selection of a proposed course of action. Advantages of Group Decisions: • Group decisions help to combine individual strengths of the group members and hence has a set of varied skill sets applied in the decision making process. • A group decision always means enhanced collective understanding of the course of action to be taken after the decision is taken. • Brainstorming Brainstorming involves group members verbally suggesting ideas or alternative courses of action.This technique does not require group meeting. the group members then begin the process of evaluating the utility of the different suggestions presented. • Individual opinions can be biased or affected with pre-conceives notions are restricted perspectives. • Group decisions imbibe a strong sense of team spirit amongst the group members and helps the group to think together in terms of success as well as failure. • A group decision gains greater group commitment since everyone has his/her share in the decision making. Brainstorming is a useful means by which to generate alternatives.

• Social Pressure .People may aim at winning the argument at the cost of finding the best answer. • Individual Domination . For example.The risk of not getting their own way can prevent people from fully participating in the discussion. • Risk Taking . • Time . The constructive use of disagreement conflict 3. The enhancement of creativity LEADERSHIP STYLE In leadership leader have to be more effective and have to take care of many things. In choosing a thesis title in a research subject. Appropriate leadership style 2. • Conflicting Secondary Goal . the leader . Reaching agreement in a group often is confused with finding the "right answer".Listening and considering all points of view in order to arrive at the best solution takes time.Skilled manipulators or dominant individuals can emerge and capture more than their share of influence on the outcome. There are three factors for effectively managing group decisionmaking: 1. even when these opinions are correct ones.Minority opinions in groups can have little influence on the solution reached.

listen to what employees have to say. For example. Thereby. For example. Authoritarian Leadership. perceptions. recognition. As a Staff Nurse in a Hospital would be more motivated to work if he/she receives pay. this means the leader must deliberately asks and encourages others to participate by giving their ideas. Participative leaders believe that people want to work and are willing to assume responsibility. They are task oriented rather than people oriented. benefits. Authoritarian leaders believe that people must be controlled closely and provided with external motivation.this style is often described as task oriented. group members are losing sight for the primary objective to come up with the best possible solution to the problem. They do not invite input from their people and may in fact even discourage input. knowledge. and respect their opinions. and good working conditions. Dissenting views of the majority opinion are suppressed and alternative courses of action are not fully explored. and praise for what h/she has done well.this style is often referred to as people oriented. or autocratic. They delegate wisely and effectively. There are basic Leadership Styles: 1. They believe that. people can be trusted and will put forth their best efforts. task satisfaction. They tell employees what they want but do not necessarily tell them why.should involved also the other group members in doing decision making. and information concerning the decision. paternalistic. Participative Leadership. . self-esteem. At the same time the leader should not allow the group to pressure people into conforming that could result to satisficing and group think which occurs when individuals in a group feel pressure to conform to what seems to be the dominant view in the group. They explain why things must be done. if treated properly. 2. Participative leaders motivate by means of internal factors.

adaptive.terms descriptive of this style include rules oriented. the leadership style changes from highly directive to supportive. and “different strokes for different folks” leadership. It features guaranteed employment. and orders from upper management. and strong reliance on team mechanisms such as quality circles. As the name suggests. If one has had previous experience and the other has had none. 4. Theory Z leadership. Verbally. Laissez-faire managers avoid giving orders. flexible leaders adapt their approach to specific situations and to the particular needs of different members of the team. Laissez-Faire Leadership. A show-and-tell approach is required by the beginner but the same may not be appropriate for the experienced person. maximum employee input. or making decisions. 5. Some would rather please and accommodate instead of .this kind of leadership is described as hands off. different directive styles are needed.3. CONSTRUCTIVE CONFLICT Many of us are not really comfortable getting involved in a disagreement with another individual. They tend to be buck- passers who take little or no responsibility for directives and who often experience near paralysis of thought and action when encountering a situation for which no rule exists. solving problems. fence-straddling. For example. As employees gain experience and confidence. they are often masters of double-talk. and “not me” management. absentee. Bureaucratic managers act as monitors or police. Bureaucratic Leadership.terms used to describe this style include contingency based.originated by the Japanese. procedures. They enforce policies. rules. two new nurses may start work on the same date. Situational Leadership. Theory Z is characterized by employee participation and egalitarianism. flexible. They are physically evasive and are sometimes nowhere to be found when needed. 6.

A key to a healthy and productive conflict is giving importance on the process and not just the desired end result of one party. let us face it. Let the other party speak for what they think is right. On the other hand affective conflict is based on . but allow a give and take process in the exchange of ideas. The cognitive conflict is the type of constructive conflict it takes place when the people have different perspectives or judgment on a particular issue which organization wants to resolve by the help of discussions or meetings. Just refrain from being aggressive and unforgiving. the group should discuss their different overview about the topic to be choose that is according to the interest of the whole group. When we sense that conflict is starting to build up. there are people who just walk away from it. face conflict with grace and maturity. Constructive conflict is geared toward mutual understanding. it balances the interests of the individuals or groups involved. thus. For example. In a choosing a thesis title. Reaping the benefits of constructive and productive conflict in an organization is truly satisfying.engaging themselves in a heated discussion. But in a way of being professional. be compassionate and understand that people make mistakes. Do not attempt to monopolize the conversation. Strive for a positive outcome instead of attempting to worsen the situation. It means that both parties should be able to find a common denominator in order to achieve a consensus and arrive at a shared decision. There should be some procedure through which organization can increase the constructive conflict: • Cognitive conflict. Since we cannot avoid conflict. It is not difficult to achieve a constructive nature of conflict and get the glitches resolved in no time. Instead.

Feel that that decision-making process has been transparent. that deliberations of the nursing students who have failing grades have been relatively free of secretive. For example. it means creating a process in which leaders have demonstrated authentic consideration of other’s views. while other proposals garner little support. Perceive that they had a genuine opportunity to influence the leader’s final decision. to build buy-in. leaders also need to devise a fair process. All people involved in the debate need to feel that the process used to come to the decision were transparent and fair. Constructive conflict requires a fair decision making process. Believe that the leader listened carefully to them and considered their views thoughtfully and seriously before making a decision. • Devils advocate.emotional disagreement directed towards other people it will negatively effect the organization and may result in the rejection of good decisions and accept bad decisions. some individuals will have their views accepted by the group. Conflicts create in the organization by structured processes. Keeping conflict constructive helps to build decision commitment. But. behind-the-scenes maneuvering. they must: Have ample opportunity to express their views and to discuss how and why they disagree with other group members. People in the organization assign the job to criticize the people ideas it will help to provide best solutions and fully explored the different viewpoints. and therefore facilitates implementation. Have a clear understanding of the rationale for the final decision. During a decision-making process. Instead. ENCOURAGING CREATIVITY . For people to believe that a process is fair. Leading a fair process does not mean trying to satisfy everyone in terms of the ultimate decision that is made.

effective decisions. after reviewing the situation the director calls a special administrative meeting for the nursing administration staff to brainstorm alternatives. the group verifies the flexi-pool alternative as the cheapest. This time the group comes up with the same list of alternatives and one additional alternative concerning initiation of a hospital flexi-pool. Understand the nature and characteristics if the decisions he or she faces. all staffing levels were met. openness to new and seemingly strange ideas. Creativity demands a certain amount of exposure to outside contracts. least time consuming. 2. YOU SHOULD REMEMBER Managers are likely to make sound. All group members come to the same conclusion on off-duty time. Realize that perfect rationality is usually unattainable. 3. a certain amount of freedom. and the critical care nurse manager does not need to cover shifts. a nurse shortage. Be “rational” in making decisions. During the evaluation two time periods later.With an appropriate leadership and constructive conflict techniques will help enhance creativity. For example. The efficient manager strives to: 1. but bounded rationality is not. budget projections were met. . and some permissive management. The meeting convenes and all the staffs are asked to consider the alternative for the next monthly meeting. The nursing administration staff creates a time-line and assigns responsibilities for establishing the flexi-pool before the next time schedule preparation is due. Brainstorming can be useful method to the group members in generating as many ideas about the topic or problem as they can. Creativity is the ability to develop and implement new and better solutions. The assistant director conducts a review of the literature on the shortage. the nursing administrative staff identifies the same problem. and the best match for nursing specialty needs. At the next meeting. the staff assesses that only one week was spent on time schedule preparation.

6. Understand and take steps to counteract the biases that affect decision making. Most other resource required in operating an organization can be renewed. 9. Time management is basically how we use or allocate our time in accomplishing or doing the tasks that we need or we want to do. 5. 4. recovered or replaced but a moment of time once it’s gone is gone forever. Accept and deal with the political and other realities of decision making in complex organizations. . 7. Know the potential advantages and disadvantages of using groups to make decisions. From here we could say that discipline is the key. using appropriate leadership style. creating constructive conflict. Know how to manage a decision. 8. Time Management Time is the ultimate non renewable source.making group. Know the seven stages of decision making and execute them carefully. Exhibit attention and other appropriate behaviors when making important decisions. and encouraging creativity. Experts can tell us how we can save time but the success of it depends on how one commits to reaching a goal and sticks to that commitment.

Time Wasters  Internal sources  External sources .Principles of time management • Communication competency: this prevents misunderstandings mistakes. • Planning effectively: establishing goals priorities schedules and deadlines are all major issues. In doing so time is not only saved but it also enables other members to grow and develop. Give them the chance to do their part. If you are a manager you do not only manage your time but that also of others. Procrastination is a No-no for it tends to waste time on doing tasks that have lower priority you are stuck at a particular task thus wasting a portion of your time which could’ve been utilized for other important tasks. • Responsibility: doing something that one should do. Do only what you have to do and let others accomplish the tasks they could do. all of which are major time wasters. and the need for repeats. It is really their role or an obligation. • Accountability: when one is dependable or liable onto something. • Authority: it is when you have the right decide upon a matter and the power to ask other members to do something. • Proper delegation: it is said to be one of the greatest time savers.

 Keep a copy of necessary files which are needed often.  Reduce wasted time at meetings. Do not let others manipulate you or take advantage of you.  Study and streamline workflow patterns. organizing and scheduling.  Interruptions particularly drop in visitors.Principal time offenders:  Doing things you do not need to do.  Keep workstation and equipment and/or files ready.  Learn how to delegate tasks and empower the staff.  Improve communication skills.  Ask for help when you need it. unexpected problems and telephone calls.  Unnecessary or poorly run meetings.  Monitor time usage. What to do about them?  Avoid over commitment of your time. including tasks that could be delegated. .  Learn to prioritize and avoid procrastination.  Be aware of your time. trivial things that could be eliminated and excessive socializing.  Inefficient planning.

. 2.Time Management Strategies Strategies have been devised to help managers and professional staff to use their time wisely and productively. Time Analysis It is a somewhat like a personal diary in which all activities are recorded which later becomes a basis for evaluation on how time is spent and how essential time is wasted. 1. Daily Planning When goals and priorities have been established you can concentrate on scheduling activities so that you can be more productive as to less time is wasted doing and thinking what will be the next thing to be done. Flexibility is a skill that must be a major consideration in planning as to compensate to unexpected emergencies and crises that would impair your productivity and eventually in the long run affect the outcome of the activities and work you’ve done. In time analysis the 1st step is to know how time is being used and the 2nd is to determine if task to be done utilizing the time is appropriate to your role and the task your about to do would benefit you. The use of time logs would be beneficial because it can review and determine which activities are essential and which activities can be delegated to others or eliminated.

These concept is usually negotiable or optional and requiring commitment.The use of Delegation can be helpful and effective to help you do task and activities efficient and less timely. responsibility and accountability. 2. . Delegation .  S pecific  M easurable  A ttainable  R ealistic  T ime bound . Is the transfer of authority. or they can be a time waster The formulation of a SMART or better a SMARTER plan to control unwanted and unexpected hindrance would be efficient to minimize and reduce its effect to you and the task you are involve with. Also the these concept is a double-edge sword as to it can increase productivity. better time management and improve motivation thru participation. Task are activities that delegator was previously doing or had expected to do should arise. Crisis Control Refers to the communication and delegation of a new plan recognized around priorities to manage an unexpected and untoward event. and vice versa if the chosen delegate is inappropriate and fit for the task. Interruptions can be essential part of your job.

3. By reviewing tasks. Problem Analysis As crises are met unwanted and requires immediate action and thorough analysis and planning for it not to further impair work and if encountered in the future problems solved before would not cause any more hindrance to task and activities to be done. topics involve and time saving actions to be taken. how long it lasted. This enables you to ferret out your wasted time and alter your time schedules. when it occurred.  E thical  R ecorded By integrating this concept to your plans much of the problems you encounter can be dealt with a less timely manner and with reduced effort to save energy to further be productive in task and work. considered or delegated. A brief evaluation of what can you do can also help in determining task you are efficient and task that you would have a hard time executing. Task Analysis One of the most efficient ways to save time is to evaluate the tasks that are performed. you may discuss which of them are of low value and could be eliminated. Keeping an “interruption log” may be helpful to show who interrupted. 5. To avoid over commitment of your time and other resources. 4. say “NO” diplomatically but emphatically. work would be properly done once you focused on those things you can accomplish. By doing this you can identify weakness and strengths that you can focus to avoid encountering such problems. nature of interruption. . Time Control Use a time log to determine how you spend your time.

Remake or update the list daily. particularly. TIPS FOR SAVING TIME • Avoid procrastination or perfectionism • Delegate what others can do or can be trained to do • Plan. Group similar tasks together on a “To-do” list.Here are some examples of time wasters: • Doing things you do not need to do. unexpected problems and telephone calls. Number the actions of importance and urgency. Label each item as must. should. organizing and excessive socializing • Unnecessary or poorly run meetings • Interruptions. including task that could be delegated • Inefficient planning. schedule and set priorities • Improve your communication skills • Learn to say “NO” • Reduce wasted time at meetings • Plan calls • Decrease your socializing time . Do not expect to accomplish everything on your list everyday. or maybe. drop-in visitors. At the end f the day items you did not get to should be low priority ones that you can transfer to the next day’s list.

“What is the best use of my time right now?” and should answer in three ways: • For myself and my goals • For my staff and their goals • For the organization and its goals Any activity that helps set goals. and minimize interruptions will pay off in increased efficiency and effectiveness. Respecting Time The key to using time management techniques is to respect one’s own time as well as that of others. The ability to organize and use time effectively is the hallmark of good management. The same values and attitudes indicate respect for one’s own time and for that of others. People who respect their time are likely to find others respecting it also. Time Evaluation Periodic evaluation of how time is spent is a helpful technique to assess the use of time. . One should always ask. determine. organize the workday. priorities. • Use dictation instead of doing the typing yourself • Ask for help if you need it 6.

so the bicarb was stopped yesterday. Here is an incident of a very tough decision in an ICU. so I checked that thought in the middle of the night that she wasn't oxygenating better. In the ICU the task is aimed at both (a) understanding the patient condition and (b) implementing treatment for patient stabilization. You can't regulate as much if you don't know what it is. which is not the right thing to do. so I increased the pressure support to get it oxygenating better. but it doesn't manage. trying to fix this and that.Advanced Nursing Practice Nursing Care Plans Psychiatric Nurses Nursing Case Studies Free Nursing Essay Samples Decision-Making Process in Health Practice The Incident of Decision-Making Making a decision in the Intensive Care Unit of a hospital is very tough. in a form. It is more variable. they are not working as hard to take a breath. Just one wrong move and something will happen to the patient. I left the pressure support on and put it back up at 10. the task mostly consists of implementing a course of action for . then I have to be put it back to 45. But the pressure supported. I knew you were more negative than that. so they become more tolerant. There was no blood gas for some time and the patient was on bicarb and all kinds of stuff. so they have no appetite. The [patient's] PO2 dropped to 75 … 74. and the nurse sort of felt uncomfortable. at least not with that kind of data. both the nature of the task and the structure constrain of decision making and problem solving. it is not as important to him as if you don't have control over what he's getting out of it. I gave the patient 10 breaths In summary. There were sort of changes my idea about SIMV. which was just below what he was doing.

Given the complexity of cases seen in the ICU. determining what procedure to follow. the nature of the problem is typically known in the ICU.stabilizing the patient. However. the patients are often undiagnosed. In contrast.. the decision makers). so the task becomes one of determining what the problem is (i. The task usually consists of keeping the patient sufficiently stable that he or she can be sent back to the general ward. which may involve running mental simulations of potential courses of action to select the most effective treatment and management plan. the solution consists of deciding what to do. management becomes more efficient and effective if the patient problem has been identified. This leads to great effort in problem solving. that is.. which may involve mental simulations of the possible mechanisms underlying the disorder. This is always done dynamically. Although the patient is treated and managed regardless of whether a diagnosis is known. This is in keeping with the complex RPD strategy described by the recognition-primed decision making model. the diagnosis) to stabilize the patient. Decision making in the ICU can be viewed in terms of the recognition- primed decision (RPD) model. such as attending physicians and residents. As long there are no major uncertainties in any complication. as any selected plan can be changed rather opportunistically. triggered by observation. These different tasks lead to differences in the team members' reasoning process it is not surprising the ICU team members' use of forward-driven reasoning. decision making takes place by simple pattern matching. the major team members (i. The "solution" is seen almost immediately. if complications arise. Solving and managing such complex uncertain problems requires generating backward-driven inferences. especially in urgent situations where other strategies may not be.e. In the ICU.e. This often requires redefining the problem in search of an adequate explanation of the patient problem. make .

with the former determining the critical decisions. in a form. so they have no appetite. although any critical information is communicated to the residents who. management becomes more efficient and . He can't regulate as much if he don't know what it is. this article striking because at some point in time we will surely be exposed in such situation that requires tough decisions like the one portrayed in the article. so he checked that thought in the middle of the night that the patient wasn't oxygenating better. The next section attempts to discuss the role of tacit knowledge in the ICU. in turn. REACTION: As a feature nurse. communicate with the attending physician who makes the final decision. Although knowledge plays an important role in patient care in both ICU settings. Team members in the ICU settings often make decisions that they are not able to explicitly state. Although the patient is treated and managed regardless of whether a diagnosis is known. the type of knowledge required is not always explicit. not all patients in the ICU are diagnosed at an early time. 74. then he have to be put back to 45. they become more tolerant. He left the pressure support on and put it back up at 10. verbalizable knowledge. so he increased the pressure support to get it oxygenating better. but it doesn't manage. He gave the patient 10 breaths. The nurses. There was no blood gas for some time and the patient was on bicarbonate. trying to fix the problems. His patient’s PO2 dropped to 75. which is not the right thing to do. The pressure supported are not working as hard to take a breath. As we all know.most of the decisions. in this setting. the nurse sort of felt uncomfortable. typically make day-to-day decisions. SUMMARY: This article is an essay written by a nurse who had an incident of making a tough decision. which was just below what he was doing.

To the nursing administration. the Nightingale’s pledge is sworn and all decision making during the extent of care for each patient. They are given less or even no margin for error because they are handling and caring for the life of a person. They must weigh all the possible factors that could affect their decision equally and fairly. In nursing education. Decision-making for them are tough that must require series of steps so that they will not commit any error. first.effective if the patient problem has been identified. RECOMMENDATION: Decision. that this will lead the students to think on how to determine the level of care that must be rendered for every patient depending on the health alteration acquired. I will not be hesitated to tell many nurses and recommend to them that the life of every patient is important since before becoming a registered nurse. . They must take all the necessary step or process to have a definite answer. Nurses must make an extra effort to choose between an alternative that best answers his quest or solve the problem. Additional equipments and specialized rooms for the complicated situations are required to lessen the burden of the decision making process. that they may give additional seminars and awareness to their nurses regarding dealing during times of difficult decision making and teach them the way on how will they intervene the situation. It is also important to inform the students on how they may deal with the diagnosis of the patient and the ability to decide if the worst happened like signs of dying.making for a nurse is very crucial especially if the situation is about the life of the person he/she is handling. Nurses are required to give care and do no harm with their patient. This leads to great effort in problem solving which in turn needs a decision to be made.

. As early as possible. prevention from complications and that easy recovery will be achieved by every patient admitted in the intensive care unit. We nurse are known to be flexible and can easily adapt to difficult situations. Also to be well prepared with the needed services and decision during those periods. Its implication to nursing service is to make nurses be productive in rendering care to every patient experiencing the problem. prevention of its complication must be achieved to prolong the life intended for them and if there are emergency situations. It would still be on a higher priority that the patients will receive the enormous care needed. The nurses needs to anticipate when there will come a time for them to decide for greater benefits of the patients. decision making plays a vital role when rendering care for the patients.

earwax. Average costs of all visits to a freestanding outpatient clinic were $70 per visit compared to $170 for nonurgent care in an ER three miles away (Kelley. Kinser. Hamilton. head and backaches. analyses revealed that excess charges for treating this narrow set of nonurgent cases in ERs was approximately $840 million in 1987 dollars. This narrow set of nonurgent cases represents only 10% of all 1987 NMES ER visits. a 1992 report by the Office of the Inspector General found that ER charges for treatment of Medicaid recipients for nonurgent conditions in nine states were 1 to 5 times the average charge for a Medicaid visit to a clinic or physician's office (Kusserow. Conditions included in the study were limited to a narrow set of nonurgent diagnoses including superficial injuries. After controlling for patient characteristics and severity. IN A 5-year prospective study on nonurgent ER use by Derlet. or $1. Cost Analysis of Emergency Room Use by Low-Income Patients The excess cost for nonurgent visits to ERs in the United States is striking. hiccoughs. and McKenzie (1995). Using 1987 National Medical Expenditure Survey (NMES) data. and heartburn. all patients who presented at a university . uncomplicated fractures. upper respiratory tract infections. 1994).3 billion in 1993 dollars. Baker and Baker (1994) and Kelley (1994) estimate that ER use for nonurgent care costs two to three times as much as the cost of comparable care in clinics or other nonurgent care settings. Ray. 1994). excess charges for all nonurgent ER care in the United States is $5 to $7 billion (Baker & Baker. pharyngitis. 1992). Baker and Baker (1994) estimated the excess cost of treating nonurgent patients in ERs by examining charges for visits in ERs and projected charges for comparable care in nonemergency care settings. skin disorders. Similarly. gastroenteritis. and miscellaneous symptoms such as conjunctivitis. The study found that the use of an ER costs an average of $144 for a first visit compared to $43 for a first visit in a nonemergency department setting.

Prior to establishing a clinic-hospital partnership in a low socioeconomic county in California. were not treated at the ER. . that unless the marginal cost for a visit to a physician's office or outpatient clinic is less than the marginal cost for a nonurgent visit in the ER.. Williams (1996) argues. and a decrease in the complications related to delayed care (Derlet et al. thus making the potential cost savings from utilizing other sources a mute point. 1995). 1994). For nonurgent visits the average cost was $159 and the marginal cost was only $24. costs. the hospital ER patient mix is only 9% nonemergent and the partnership loss is just over $400. and were referred elsewhere for care. improved well-child care and patient education.000. Williams acknowledges that many ER users do not have access to sources of care other than the ER.735. Findings revealed that the average cost for urgent visits was $312 and the marginal cost was $67. the hospital's ER patient mix was greater than 28% nonemergent and the ER sustained an annual loss of over $1 million providing nonemergency care to patients (Kelly.696. night. Additional benefits to the partnership include: a more manageable ER census. Additionally. Since establishing a partnership with an outpatient clinic in which nonemergent patients are triaged to the clinic.ER were evaluated by the triage nurse. Although evidence of marginal costs for office visits is lacking in the literature. and marginal costs of ER visits in six community hospitals. no cost savings will be realized. Williams (1996) examined charges. Other potential benefits of the triage system are decreased patient waiting time. Williams states that estimated marginal costs for office visits made during the weekday may result in a cost savings but that weekend. and an emphasis on health prevention and promotion with a more comprehensive and accessible health care system (Kelly. and/or holiday visits may not be less costly than ER care during those times. therefore. Eighteen percent were identified as nonemergent. The 5-year cost avoidance to this institution for nonemergent triaging was $3. 1994). reduction in the number of unseen patients.

minorities and those with unstable family situations or without social support" (pp. Costs per visit are examined by service. the uninsured and people on Medicaid (McNamara. 1993). and an unwillingness to continue to use the ER if a $25 co-payment were required.com/p/articles/mi_m0FSW/is_3_17/ai_n18608642/ . this subgroup "is identified as a medically and socially vulnerable population . 11 Nov. Nadel. 2010.and alcohol dependent. those of low socioeconomic status (Padgett & Brodsky. Malone (1995) describes a subgroup of ER users responsible for a disproportionate amount of ER visits and costs.com. Karen MacDonald Thompson "Cost Analysis of Emergency Room Use by Low-Income Patients". 1993. Misperceptions among the public about the costs of ER services may contribute to misuse of this service.. those with low family income. & Koning. (1997) identified factors. 469.. Nursing Economics. the perception that an ER visit costs less than a visit in an office setting. Referred to as "heavy users" of the ER. Determining costs associated with heavy use of the ER for nonurgent care in vulnerable populations will provide data to assist in developing models of more efficient and cost-effective delivery of care. [including] the mentally ill. Indeed. and diagnosis. 470). those with welfare as a source of income. having been refused care in a clinic or office setting in the past. http://findarticles. Witte. O'Brien et al. Costs per individual (aggregated by person for those who made multiple visits) are also examined as are costs of "heavy users" of the ER. In a cross-sectional survey of people who identified the ER as their usual source of care. the poor. 1994). This study evaluates service utilization and costs of ER care for residents of public housing. FindArticles. 1992). including low income. adults with less than a high school education. the literature abounds with descriptions of those who use the ER for nonurgent care: members of racial and ethnic minority groups. acuity. the drug. and children of single parent households (Brown & Goel.

and digestive problems. the range extended from 1 visit to 41 visits. • Among the most common heavy users of ER services for no urgent conditions are: Medicaid and Medicare recipients. injuries. • Finding a way to provide no urgent health care access to patients who inappropriately overuse the ER has become a national health care priority as ER costs per-visit are generally three times higher than comparable care in an outpatient clinic.Summary: The success of current efforts to reform the health care system depends upon developing more efficient and cost-effective models of providing appropriate health care. Inappropriate use of health care resources contributes billions of dollars to the nation's health care budget annually. • High-frequency health problems among the heavy users in this study included: respiratory problems. waste. the drug and alcohol dependent.554 ER visits in the 2-year sampling period. While the mean number of visits per patient was 3. and those without families or adequate social support. • The 453 residents in the sample made 1. the uninsured. . Successful development of new models of health care delivery will be contingent upon identifying and analyzing the factors that drive the inefficiency. psychiatric and substance abuse problems. the mentally ill.4. One setting in which notable inefficiency occurs is through use of emergency rooms (ERs) for no urgent care. • The authors report here on their study sample of 453 individuals who came from two public housing units close to the hospital. and unnecessary costs in the current system.

And those who utilize the services should be conscientious of their actions use it when really needed. I just hope that quality health care would still be available to everyone. It is necessary to keep an organization a business alive. A fund is an invested sum. It is good that people are also aware of the services that they avail and how the government provides for it. Since everything is given almost for free we should be thrifty upon usage of resources. • Appropriate use of the facility should be observed.R should serve its purpose by treating cases in urgent treat of care rather than non urgent ones.R being utilized and costs being neglected there is really a great challenge on how to sustain the resources of the facility. In the health care sector specifically in this article which talks about the resources or the E. whose income is devoted to a specific object. • Budgeting should be given a focus since there isn’t unlimited resources they should know how to budget it and properly allocate it. .Reaction: We got this journal because it mainly involves budgeting and funding and these elements particularly undergo planning. the fund of an ecclesiastical society. as. money systematically collected to meet the expenses of some permanent object. The best thing about this issue is that experts are trying to find ways on how to provide a solution for it. Recommendation: • There should be a sure source of funding so that needs and resources of the E>R could be sustained. The E. also. a fund for the maintenance of lectures or poor students.

and levels of stress. and depression in surviving relatives. 2010) — Advance care planning improves end of life care and reduces stress. Advance care planning has the potential to improve end of life care by enabling patients to discuss and document their future health wishes.sciencedaily. according to new research on the British Medical Journal website.address: http://www. 23.com/releases/2010/03/ 100323212154. . anxiety and depression in surviving relatives. . Web. anxiety. thus increasing the likelihood of patient wishes being known and respected at the end of life. So researchers based in Australia set out to test the theory that coordinated advance care planning would improve end of life care.htm Advance Care Planning Improves End of Life Care and Reduces Stress for Relatives ScienceDaily (Mar. But no randomised controlled trials have investigated whether advance care planning improves end of life care. and appoint a substitute decision maker (surrogate). the perceptions of the quality of care.

and diminishes the likelihood of stress. Patient and family satisfaction was also much higher in the intervention group. and respected at end of life. conclude the authors. Their study involved 309 competent patients aged 80 or more who were admitted to a large university hospital in Melbourne between August 2007 and March 2008. In the intervention group. to appoint a surrogate. and depression in surviving relatives. This trial shows that advance care planning carried out properly by trained non-medical staff improves end of life care by enabling patients' wishes to be determined. values. end of life wishes were much more likely to be known and followed in the intervention group (86%) compared with the control group (30%). All patients were followed for six months or until death. viaEurekAlert!. to consider future medical treatment preferences. documented. Advance care planning aimed to assist patients to reflect on their goals. and to document their wishes. Of the 56 patients who died by six months. and beliefs. anxiety. . Story Source: The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by BMJ-British Medical Journal. family members of patients who died had significantly less stress. and depression than those of control patients. It also improves such care from the perspective of the patient and the family. anxiety. a service of AAAS. A total of 155 patients received usual care (control group) and 154 received usual care plus advance care planning from trained non-medical facilitators (intervention group).

All patients were followed for six months or until death. gender or age. Researchers based in Australia made a study on patient aged 80 or more who were admitted to a large university hospital in Melbourne between August 2007-March 2008. Advance care planning aimed to assist patients to reflect on their goals. to consider future medical treatment preferences. We are our patient’s advocates regardless of their status. anxiety. and depression in surviving relatives. and levels of stress. The study will test if Advance Care Planning would improve end of life care. and to document their wishes. the perceptions of the quality of care. and beliefs. As a Future Nurse. After conducting the study. the safety and security of our patients is our priority. results show that of the 56 patients who died by six months. end of life wishes were much more likely to be known and followed in the intervention group (86%) compared with the control group (30%). Summary: The article emphasizes on the potential effect of Advance care planning towards Geriatric patients to improve end of life care. Reaction: The article relates to us the practice and outcome of Advanced Care Planning towards individuals at the end of life. After reading the article. and respected at the end of life. they chose a total of 155 patients who received usual care (control group) and 154 received usual care plus advance care planning (intervention group). Among the respondents. The authors concluded that advance care planning on end of life care improves the patient’s outlook toward death by enabling patients' wishes to be known. values. I was pleased to know that Health Care Providers and Researchers still give importance to patients who . to appoint a surrogate.

not only focusing on the physical aspect but also giving emphasis on their emotional and other special needs. . that they may be updated on the latest trends in the field of End of Life Care. especially at this time of their lives.  To the nurses. and appoint a substitute decision maker (surrogate). thus increasing the likelihood of patient wishes being known and respected at the end of life. individuals and groups:  To the physicians.are near death. their attitude in facing or preparing for their death would improve. Recommendation: This exceptionally informative article may be recommended to the following entities.  To student nurses. and depression on the patient’s impending death. These individuals and their relatives have high levels of stress. May they give these people importance and love. that they may conduct seminars and future studies on this matter to augment knowledge and discover further ways on giving care to patients at the end of their life. that they may have enriched awareness on giving care to their loved ones who are near death. Advance care planning has the potential to improve end of life care by enabling patients to discuss and document their future health wishes. They must still receive nursing care.  To the DOH. especially those belonging to the that they may be able to reinforce their knowledge on the Advanced Care Planning towards individuals who are near death. As Future Nurses. Through this. that they may be able to disseminate proper health teachings concerning end of life care to the patients and their relatives.  To the general public. the government agency dedicated in promoting the health of the Filipinos. may they be able to give holistic nursing care based on the patient’s needs. anxiety.

M. . Calma. Micah Clarisse E. SUBMITTED TO: Maria Luisa D.N. Michael Angelo Cunanan. Armon Jay G. Jade Justin M. Kathleen Erin M. Bondoc. ANGELES UNIVERSITY FOUNDATION COLLEGE OF NURSING MODULE III (PLANNING) SUBMITTED BY: Anicete. R.N.. Manalo. Supan. Mercado. Nico N.. Maridhel P. Verwasa. Galang. Guzon. NIcca Angelica O. Donell M. Remelyne S. Zita. Roxas.A. Erica B.

BSN IV-8 November 12. 2010 .