Management Nursing Step 3 (Second Period)

FORM ASSESSMENT REPORT
MANAGEMENT ASSESSMENT REPORT

IN IRNAWARD FLOOR 3 GOTONG ROYONG HOSPITAL SURABAYA ON CLINICAL
PRACTICE OF NURSING MANAGEMENT
Created by:
(GROUP SECOND PERIOD)
1. Natalia Chrismonika (9103018002)
2. Yeni Pangestika (9103018003)
3. Carlin Kimang (9103018004)
4. Devita Serly (9103018016)
5. Inka Kristina (9103018039)
6. Meidiana (9103018050)
7. Noverianti (9103016064)
FACULTY OF NURSING
WIDYA MANDALA CATHOLIC UNIVERSITY
SURABAYA
2021
Nursing Management Practice | 1

APPROVAL SHEET
Management Assessment Report in Irna Ward Floor 3 Gotong Royong Hospital

Surabaya has been approved for presentation on 10 May 2021
Approved on 10 May 2021

Knowing by:
Group leader
(Noverianti)
Approve,
Acaademic preceptor Clinical Preceptor
(Made Indra Ayu.,S.Kep.,Ns.,M.Kep) (………………….)

PREFACE
We express our gratitude and blessings to God Almighty for His abundant grace
for the completion of the Management Clinical Practice Report. This report was made
to meet the requirements of the Nursing Management course, Faculty of Nursing,
Widya Mandala Catholic University, Surabaya. The purpose of this report is to report
everything that has to do with the existing nursing management at the Gotong Royong
hospital.
The author is aware of the imperfections of the preparation of this clinical
practice report, but the author still hopes that this report will be of benefit to readers.
For the sake of the writer's progress, the writer also expects input in the form of criticism
or useful suggestions. Thank you.
Surabaya May 11, 2021
Author

TABLE OF CONTENTS
PREFACE ...................................................................................................................... 3
CHAPTER I ................................................................................................................... 6
PRELIMINARY ............................................................................................................ 6
1.1 Background ........................................................................................................ 6
1.2 Purpose ............................................................................................................... 6
1.2.1 General purpose .......................................................................................... 6
1.2.2 Specific purpose .......................................................................................... 6
1.3 Benefits .............................................................................................................. 7
1.3.1 For Hospital and Nurse ............................................................................... 7
1.3.2 For college student ...................................................................................... 7
1.3.3 For patients and families ............................................................................. 7
CHAPTER 2 .................................................................................................................. 8
ASSESSMENT AND DATA ANALYSIS.................................................................... 8
2.1 Vision, Mission, and Motto of Hospital/ Ward ................................................... 8
2.2.1 Vision of hospital ........................................................................................ 8
2.2.2 Mission of hospital ...................................................................................... 8
2.2.3 Motto of hospital/ ward ............................................................................... 8
2.2 Data Collection ................................................................................................... 8
2.2.1 Employee and patient (M1/ Man) .................................................................... 9
1. Organization structure ................................................................................. 9
2. Employment data....................................................................................... 10
2.2.2 Building and facilities (M2/ Material) ...................................................... 19
1. Location and ward plan ............................................................................. 19
2. Number of bed .......................................................................................... 20
3. Equipment and facilities............................................................................ 20
4. Administration of nursing support ............................................................ 22
2.2.3 Method of nursing care (M3/ Method) ................................................. 22

1. Professional Nursing Care Methods (MAKP) .......................................... 22
2. Handover Method ..................................................................................... 23
3. Drug Centralization Method ..................................................................... 24
4. Nursing Round Data.................................................................................. 27
5. New Patient Admission Methods .............................................................. 28
6. Supervision methods ................................................................................. 28
7. Discharge planning method ...................................................................... 30
8. Nursing documentation methods .............................................................. 32
2.2.4 Hospital financing (M4/ Money) .......................................................... 35
2.2.5 Hospital Marketing and quality (M5/ Market) ..................................... 35
1. Bed Occupation Rate (BOR)..................................................................... 35
2. Level of patient satisfaction ...................................................................... 36
3. Average Length of Stay (AvLOS) ............................................................ 38
4. Patient safety applied at Irna Ward ........................................................... 38
2.3 Data Analysis ................................................................................................... 40
2.4 Problem Identification ............................................................................................. 50
2.5 Prioritize Problem .................................................................................................... 51
CHAPTER 3 ................................................................................................................ 52
STRATEGIC PLANNING .......................................................................................... 52
3.1 Organizing The Group Management ..................................................................... 52
3.2 Strategic Planning .................................................................................................... 54
Plan of Action (POA) .................................................................................... 54
CHAPTER 4 ................................................................................................................ 62
CLOSING .................................................................................................................... 62
REFERENCES ............................................................................................................ 63

CHAPTER I
PRELIMINARY
1.1 Background
Nursing management is the process of organizational planning, staff management,
leadership and control of nursing service activities through the efforts of nursing staff,
treatment and a sense of security to patients, families and communities. The inpatient
room is one of the health service centers including nursing services carried out by all
health teams where all personnel including nurses are responsible for solving client
health problems. Organizing nursing services optimally will determine the quality of
nursing services provided. An organization in achieving its goals needs to be supported
by a balanced management of factors, namely Man, Material, Method, Money, Market
in order to provide satisfaction to clients.
Every company must be able to create an appropriate marketing strategy and
be able to make a plan to be able to compete in the present and future. In companies
engaged in service marketing, a strategy is also needed to be able to increase
competitiveness among similar companies. This effort is not easy because companies
must have the right competitive strategy in their efforts to achieve competitive
advantage. The changing situation of the times can create opportunities. increase in
business or even become a threat to the company. One of the efforts to find the right
strategy for the company is a SWOT analysis.
In order to achieve optimal service quality and based on practical assignments
as nursing students at Widya Mandala Catholic University in Surabaya, we conducted
a study on the nursing process in the Irna ward floor 3 at the Gotong Royong Hospital.
1.2 Purpose
1.2.1 General purpose
Provide quality health services, quality and beneficial to health service users.
1.2.2 Specific purpose
1. Realizing health services in hospitals that are prime, affordable and of quality
to the community.
2. Have facilities and infrastructure in accordance with the growth of hospital
health services
3. Educating professional health workers with the support of adequate

equipment
4. The realization of a healthy work environment and culture
1.3 Benefits
1.3.1 For Hospital and Nurse
Hospitals can organize the quality of nursing care (standards of nursing care and
professional performance standards of nurses) in inpatient units, as well as the
attention of every business engaged in services or services, especially for
hospitals and provide recommendations to hospitals to provide quality care
services. As a reference for the hospital to organize the type of organizational
culture and the type of leadership of the inpatient unit head and the professional
performance of nurses in the hospital inpatient unit.
1.3.2 For college student
Students are able to collect data and find out the strengths and weaknesses of
the room. In addition, students are able to identify existing problems so that they
can determine problem priorities and improve existing methods.
1.3.3 For patients and families
Providing excellent and quality service to patients and hospitals through the
application of good quality nursing care so that indicators of patient satisfaction
can be achieved optimally.

CHAPTER 2
ASSESSMENT AND DATA ANALYSIS
2.1 Vision, Mission, and Motto of Hospital/ Ward
2.2.1 Vision of hospital
Our vision is to make Gotong royong hospital a leading and trusted hospital in
medical services.
2.2.2 Mission of hospital
1. Providing complete patient-focused medical services that are affordable to all
levels of society.
2. Organizing medical services that are professional, of high quality and able to
compete globally.
3. Establishing cooperation for the development of hospitals and meeting the
expectations of related stakeholders
4. Developing more modern hospital facilities and infrastructure
5. Improve the welfare of all hospital employees
2.2.3 Motto of hospital/ ward

Healthy with gotong royong hospital
2.2 Data Collection
Data collection was carried out on Monday, May 10, 2021 at 10.00, the type of
data we collected was how the description of gotong royong Hospital which includes
the rooms in the hospital. The data we collected started from the workforce of nurses
and non-nurses in Irna's room which included the number of nurses and non-nurses, the
training that had been received by nurses was also asked, the answers obtained were
that the nurses in Irna's room Most of them had received proper training. includes
PPGD, ALS, BLS, AT, patient safety, nursing management, PPNI nursing care. We
also examined the level of dependence of the patient in the room, it was found that the
mean level of dependence of patients was partial.
We also assess the existing facilities in the hospital, the facilities in the hospital
are quite complete, all equipment related to nursing and medical services are available.
Supporting facilities are also complete, such as sinks and hand scrubs. Space utilization
is also quite good. Supporting documents are also complete, but some SOP are not yet
available in the hospital room. The supervision process has not been carried out in the
hospital because there is no standard format for supervision of each action, nurses have

also never received training and supervision socialization.
The method of nursing care carried out in the IRNA room is the primary MAKP,
and the implementation of the documentation flow of the patient entering until the
patient goes home uses the Review of System (ROS) nursing care format, then
documents through integrated notes about what implementations were carried out and
documents the evaluation for consideration through SBAR (Situation) communication
system. Recommended Background Assessment) among shift nurses. There is a
Standard Nursing Language (SNL) format which contains nursing diagnoses, nursing
interventions and nursing implementation and nursing evaluation columns. However,
based on the results of our observations on 10 (ten) medical records, it was found that
3 out of 10 medical records had no date and signature, PPB sheet 2 of 10 medical
records were not filled, inpatient assessment sheets 3 out of 10 medical records obtained
2 medical record. not filled in and 1 medical record does not exist.
The medical ward at Gotong Royong is led by NUM with NERS education and
has worked for 25 years. This room applies the primary method of providing nursing
care. The number of nurses is 21 people, with the title of Ners 16 people and vocational
5 people. The number of beds is 36 with an average BOR of 80%. The work
productivity of nurses in the morning is 95%, 90% during the day and 86% at night.
2.2.1 Employee and patient (M1/ Man)
1. Organization structure
NURSING MANAGER
PN 1 PN 2 PN 3 PN 4
AN
PATIENT

2. Employment data
1) Nursing staff
No Name Educat Working Training ever Current Employment
(initial) ion period followed position status
1. K S1 25 years PPGD, ALS, NUM Permanent
BLS, AT, Career employee
Paths in Nursing,
Management,
Palliative,
Oxygen
2. M S1 9 years PPGD, ALS, PP Permanent
Paths in Nursing,
Management,
Palliative,
Oxygen
3. A S1 5 years PPGD, ALS, PP Permanent
Paths in Nursing,
Management,
Palliative,
Oxygen
4. S S1 5 years PPGD, ALS, PP Permanent
Paths in Nursing,
Management,
Palliative,
Oxygen
5. D S1 2 years PPGD, ALS, PP Permanent
Paths in Nursing,
Management,
Palliative,

Oxygen
6. A S1 3 years PPGD, ALS, AN Permanent
Paths in Nursing
7. S S1 2 years PPGD, ALS, AN Permanent
Paths in Nursing
8. T S1 5 years PPGD, ALS, AN Permanent
Paths in Nursing
9. R S1 1 years PPGD, ALS, AN Permanent
BLS, AT employee
10. H S1 4 years PPGD, ALS, AN Permanent
Paths in Nursing
11. K S1 1 years PPGD, ALS, AN Permanent
Paths in Nursing
12. P S1 6 years PPGD, ALS, AN Permanent
Paths in Nursing
13. L S1 7 years PPGD, ALS, AN Permanent
Paths in Nursing
14. F S1 1 years PPGD, ALS, AN Permanent
Paths in Nursing
15. U S1 2 years PPGD, ALS, AN Permanent
Paths in Nursing
16. P S1 7 month PPGD, ALS, AN Permanent
Paths in Nursing

17. U DIII 1 years PPGD, ALS, AN Permanent
BLS, AT employee
18. K DIII 5 month PPGD, ALS, AN Permanent
BLS, AT employee
19. W DIII 1 years PPGD, ALS, AN Permanent
BLS, AT employee
20. A DIII 2 years PPGD, ALS, AN Permanent
BLS, AT employee
21. T DIII 6 month PPGD, ALS, AN Permanent
BLS, AT employee
2) Non nursing staff

No Qualification Number Employment status
1. Hospital helper 5 Non-nurse
2. Hospital technician 2 Non-nurse
3. Cleaning service 6 Non-nurse
3) Medical staff
1. Cardiac surgeon 2 Permanent employee
a. dr.Roni abednego, SP.JP
b. dr.Karina , SP.JP
2. Neurologist 1 Permanent employee
dr.Henny aurelia, Sp.S
3. Pulmonary Specialist 1 Permanent employee
dr.Yusuf immanuel, Sp.P
4. Internal Medicine Specialist 1 Permanent employee
dr. Angger Prasetya A.D, Sp.Pd
4) Practice student
1. Nursing academy students 5 Practice student

5) Staff development plan in 2021
No TRAINING. ADVANCED EDUCATION NAME (initial)
1. PPGD, ALS, BLS, AT T,W,A,K,U
2. career path H, K, P , L
3 Career Paths in Nursing, Management, Palliative, P, F, L, U
Oxygen
6) Percentages of 5 highest case in last 3 months
Month Diseases Number Percentage
January 1. Covid 19 27 34%

2. DHF 16 20%
3. Hipertention 16 20%
4. Anemia 12 15%
5. Diarrhea 9 11%
Number 80 100%
February 1. Covid 19 19 28%
2. DHF 17 25%
3. Diarrhea 15 22%
4. Bronkopneumonia 9 14%
5. Hipertention
Number 7 11%
67 100%
March 1. Covid 19 21 31%
2. DHF 19 28%
3. Hipertention 11 16%
4. Diarrhea 11 16%
5. Anemia 6 9%
Number 68 100%
7) Patient dependent level and Nursing staff needed . Based on WISN/ Gillies
formulation/ Douglas formulation, etc.
Number Patient Classification

of Minimal Partial Total

patient P S M P S M P S M
1 0,17 0,14 0,07 0,27 0,15 0,10 0,36 0,30 0,20
2 0,34 0,28 0,20 0,54 0,30 0,14 0,72 0,60 0,40
3 0,51 0,42 0,30 0,81 0,45 0,21 1,08 0,90 0,60
Dst
Date Minimal care Partial care Total care

10/05/2021 13 13 13 17 17 17 0 0 0
11/05/2021 12 12 12 19 19 19 0 0 0
‘
Nurse needs
10/05/2021 :
Qualification The amount of energy required
The degree of Number of Morning Day Night
dependability patient
Minimal 13 13x0,17 = 13x0.14 = 13x0.07=0.91
2.21 1.82
Partial 17 17x 0.27 = 17x 0.15 = 17 x 0.10 =
4.59 2.55 1.7
30 6.8 4.37 2.61
7 4 3
Nurse needs
11/05/2021
Qualification The amount of energy required
The degree of Number of Morning Day Night
dependability patient
Minimal 12 12x0,17 = 12 x0.14 = 12
2.04 1.68 x0.07=0.84
Partial 19 19 x 0.27 = 19 x 0.15 19 x 0.10 =
5.13 = 2.85 1.9

31 5.17 4.53 2.74
6 5 3
8) Nurse workload
Calculate nurse productivity using time motion study just in morning and
afternoon shift.
➢ Direct Morning shift
No Direct Times Frequency Total
1. Perform a round of 45 minutes Moment at any 45 minutes
nursing on the patient given moment
2. Validation and 5-10 minutes 3 times in one 30 minutes
patient interaction shift change
3. Perform nursing 5-10 minutes 8 hours / shift 80 minutes
actions to patients
(measure vital signs,
bathe, Give
medicine, Feed the
patient etc)
4. Centralizing drugs 10 minutes 1 time / patient 40 minutes
5. Carry out an 30 minutes newly arrived 30 minutes
assessment to the patient
patient
6. Discharge planning 45 minutes every patient 45 minutes
to the patient goes home
TOTAL 270 minutes
➢ Direct day shift

1. Perform a round of 45 minutes Moment at any 45 minutes
nursing on the given moment
patient

actions to patients
bathe, Give
medicine, Feed the
patient etc)
patient
TOTAL 240 minutes
➢ Direct night shift

actions to patients
bathe, Give
medicine, Feed the
patient etc)
patient
TOTAL 165 minutes
➢ Indirect morning shift

No Indirect Times Frequency Total
1. Lifting the patient's 5 minutes 8 hours / 40 minutes
nursing problem patient
diagnosis

2. Write and define 5 minutes 8 hours / 40 minutes
action interventions patient
for patients
3. Handover 25 minutes 1 times each 25 minutes
shift change
4. Doing 10-15 Every action to 60 minutes
documentation minutes the patient
TOTAL 165 minutes
➢ Indirect day shift

diagnosis
for patients
3. Handover 25 minutes 8 hours / 25 minutes
patient
4. Doing 10-15 1 times each 45 minutes
documentation minutes shift change
TOTAL 150 minutes
➢ Indirect night shift

diagnosis
for patients
3. Handover 20 minutes 8 hours / 20 minutes
patient

4. Doing 10-15 1 times each 60 minutes
documentation minutes shift change
5. Collaborate with 10 minutes According to 40 minutes
doctors by telephone patient needs
6. Complete medical 20 minutes If needed 20 minutes
records
TOTAL 220 minutes
➢ Non-productive morning shift

No Non-productive Times Frequency Total
1. playing handphone 10 minutes when not 10 minutes
taking action
2. Eat 5 minutes when not 5 minutes
taking action
3. Talking / discussion 5 minutes when not 5 minutes
taking action
TOTAL 20 minutes
➢ Non-productive day shift

taking action
taking action
taking action
4. Toileting / bath 15 minutes If needed 15 minutes
TOTAL 45 minutes
➢ Non-productive night shift

taking action

taking action
taking action
4. Toileting 5 minutes If needed 5 minutes
TOTAL 30 minutes
Type of Shift
activity Morning Day Night
Produktif
A. Direct 270 240 165
B. Indirect 165 150 220
Non- 20 45 30
Produktive
Total 455 435 415
Workload measurement
Criteria :
>85 % = Heavy workload
75-85% = Moderate workload
<75% = Low workload
Shift Precentage workload Criteria
Morning 455/480 x 100 = 94.79% Heavy
Day 435/480 x 100 = 90.6 % Heavy
Night 415/480 x 100 = 86.4 % Heavy
2.2.2 Building and facilities (M2/ Material)

1. Location and ward plan
Irna Ward Floor 3

IRNA 1
DOOR (18 BED)
NURSE
STATION
IRNA 2
(18 BED)
PUBLIC
TOILET
The Irna ward is located on the 3rd floor of the Gotong Royong Hospital which
consists of the Irna 1 room and the Irna 2 room.On the 3rd floor there is a nurse station
and also a public toilet and access to the entrance from the lift. The Irna ward have 36
bed.
2. Number of bed
Number of patient bed is 36 bed
3. Equipment and facilities
1) Facilities non-medical for patient
No Name of Equipment Number Condition Ideal Number
1. Toilet 9 Clean Normal
2. Bed 36 Good Normal
3. TV 16 Good Normal
4. Chair 36 Good Normal
5. Bell 36 Good Normal

2) Facilities medical for patient
1. Stethoscope 5 Good Normal
2. Blood pressure meter 5 Good Normal
3. Thermometer 5 Good Normal
4. Ambu bag 5 Good Normal
5. Infus pump 3 Good Normal
6. Nebulizer 5 Good Normal
7. Examinasion lamp 3 Good Normal
8. Bak instrument 3 Good Normal
9. Bak injection 3 Good Normal
10. Nierbeken 5 Good Normal
11. O2 transport 5 Good Normal
12. Suction portable 3 Good Normal
13. ECG 3 Good Normal
14. Handwash 5 Good Normal
15. Hand rub 6 Good Normal
16. washbasin 5 Good Normal
17. Medical waste 3 Good Normal
3) Facilities for the staff

1. Hand wash 5 Good Normal
2. Hand rub 6 Good Normal
3. Face mask 50 Good Normal
4. Gloves 50 Good Normal
5. Skort 5 Good Normal
6. Nurse locker 10 Good Normal
4) Ventilation and air setting

In observation, it was found that there were windows in each patient's room
and the nurse's room so that the air condition in Irna's room was in good

condition.
4. Administration of nursing support
1) Standart Operational Prosedur (SOP)
In this room, the nursing flow has been carried out according to the
established Operational Standards. As if doing a nursing round, the nurse must
know how to do the nursing round correctly and all other nursing actions.
2) Book handover
The implementation of the weigh receipts is documented in the weigh
receive book Implementation of weigh and receive at the change of morning to
evening and evening shifts is carried out simultaneously with validation to
patients.
3) Book of medical records
The medical record book is well equipped in this room
4) Discharge Planning Book
Discharge planning is carried out by the on duty nurse by filling out the
discharge planning form and explaining certain rules when the patient goes
home, such as control schedules, activities, and home care.
5) Waste management
The waste management mechanism in the Irna ward is good enough because
it is always maintained and a scale check is carried out. Medical waste (yellow)
is generated during routine surgical patient care and in high-risk units. Non-
medical waste (black) includes wrapping paper or bags and plastics that are not
in contact with bodily fluids. Kitchen waste includes food waste and dirty water.
2.2.3 Method of nursing care (M3/ Method)
1. Professional Nursing Care Methods (MAKP)
Doctor NUM
Dr.Tina Natalia S.Kep., Ns
Meidiana S.kep.,Ns Devitas S.kep., Ns

Yeni S. Kep., Ns Carlin S.Kep., Ns
Nove S.kep., Ns Natalia S. kep Ns

Patient
The nursing care method applied in the oversized room is good because it uses
MAKP. Where MAKP nurses are formed into 3 teams, each of which is the morning
shift service team that is responsible for NUM while for the afternoon and night shifts
the SBAR nurses. The MAKP model requires 4 nurses with primary nursing, not all
nurses who have experienced nursing education qualifications who have graduated
from Ners.
2. Handover Method
In theory, flow of handover:
Preparation
1. Weigh and accept carried out every shift change
2. The principle of weigh-accept, all patients who have just entered and patients
who have been weighed and received, especially patients who have problems
that have not been resolved and who need further observation
3. The nurse conveys a consideration to the patient (who receives the delegation)
next, things that need to be conveyed in the weigh receive:
▪ General aspects which include M1 to M5
▪ Number of patients
▪ Medical identification and diagnosis
▪ Data (complaints / subjective and objective)
▪ Nursing problems that still arise
▪ Nursing interventions that have been and have not been implemented (in
general)
▪ Collaborative and dependent interventions
▪ General plans and preparations that need to be done (preparation for
operations, supporting examinations, and other programs)
Implementation (Nurse Station)
1. The three service groups are ready (shift watch)
2. The group that will be in charge of preparing the notebook
3. The head of the room opens the weigh-receive activity
4. Delivery that is clear, concise, and concise by the nurse on duty

5. The next shift nurse can clarify, ask and answer, and validate things that have
been weighed and have the right to ask questions about things that are less
clear
Implementation (Patient Bed)
1. The head of the room conveys greetings and asks the patient's basic needs
2. The on-duty nurse then fully examines the nursing problems, needs, and
actions that have been / have not been carried out, as well as other important
things during the treatment period.
3. Matters that are special in nature and require careful details should be noted in
a special manner and then handed over to the next officer.
Post-Weigh accept
1. Discussion
2. Reports for weighing receipts are written directly in the weigh receipts format
signed by the nurse on duty at that time and the nurse on duty next to be
known by the Head of the Room
3. Closed by the Head of the Room
The weighing and receiving processes carried out in the room are already
running quite well, but there are still some flows that have not been implemented. As
the reports read out in the consideration that is carried out in this room, only the identity
of the client, the client's bed number, medical diagnoses, general conditions, main
complaints, objective and subjective data, nursing problems, both independent and
collaborative intervention. At the time of weighing the reports that must be read are
nursing problems that are still emerging, nursing interventions that have been and have
not been implemented (generally collaborative and dependent interventions, general
plans and preparations that need to be done (preparation for surgery, supporting
examinations, and other programs) during weighing However, the handover has been
communicated by SBAR but the time for the receipt is quite long. The validation
process for patients at the change of evening to night shifts is not carried out.
3. Drug Centralization Method
Doctor giving
prescription
Order from
pharmacy

Management by
nurse with double
cheker
Parenteral Enteral
Giving to the patient with

signature and information
about this drug
Drug management techniques (centralization), in theory are as follows:

Dispensing and dispensing of drugs are fully carried out by the nurse
1. Person in charge of drug management is the head of the room who can
operationally be delegated to appointed staff.
2. Families must know and participate in controlling drug use.
Drug acceptance.
a. The medicine that has been prescribed by the doctor is given to the nurse and
the nurse gives the medicine to the family by receiving the medicine receipt.
b. The nurse writes the patient's name, register, type of medicine, amount and
preparation (if necessary) on the control card, by the family or patient in the
drug entry book. The family or patient then gets an explanation when or when
the drug will run out, as well as an explanation of the 5T (type, dose, time,
patient, and method of administration).
c. The patient or family then gets a copy of the medicine that must be taken
along with a drug preparation card.
d. The medicine that has been submitted is then stored by the nurse in the drug
dispensing box.
e. Drugs that have been received are then copied in the drug administration list
book.
f. The medicine that has been stored will then be given by the nurse by paying
attention to the flow listed in the drug administration list book.
g. At the time of administering the drug, the nurse explains the types of drugs,
the use of the drugs, the amount of the drugs, and the side effects of the drugs.

h. The existing drug preparations are then checked every morning by the head
of the room or the appointed officer and documented in the drug entry book.
i. The family will inform the family about running out of medicines and ask for
a prescription (if it still needs to be continued) from the doctor in charge of
the patient.
The addition of new drugs.
▪ If there is an addition or change in the type, dose or change in the flow of drug
administration, this information will be entered in the drug entry book and at
the same time changes will be made in the drug preparation card.
▪ When administering drugs that are not routine (at any time), documentation
is only carried out in the drug entry book and then the family is informed with
a special drug card.
Special medicine
▪ Drugs are categorized specifically if the preparation has a fairly expensive
price, uses a fairly difficult route of administration, has significant side
effects or is only given for a certain time / time.
▪ Information given to patients or family, name of drugs, use of drugs,
In this ward the nursery applies the UDD method for drug centralization. There is
no written flow regarding drug centralization. The flow of drug administration from the
doctor prescribing the drug is then given to the nurse. Previously, the drug
administration system was prepared and used a double checker pattern, one nurse would
prepare the medicine then another nurse would check its suitability, after the drug
preparation was appropriate then the nurse would give it to the patient. Medication chart
contains drug names and administration doses separated between parenteral drugs and
enteral drugs, besides that there is a signature column for the nurse who acts as provider,
checker and giver. At the time of administering the drug, the nurse previously explained
to the family and the patient about the kinds of drugs, the uses of the drugs, the number
of drugs and side effects of the drugs. Then before giving the medicine, the nurse pays
attention to the correct 6, namely by asking the name first, adjusting the medicine that
has been prepared with the one listed on the medication chart, then the medicine is
given on time and the documentation is done properly

4. Nursing Round Data
Steps for nursing round activities according to theory :
Pre
1. PP determines the patient who will be carried out the nursing round
2. Preparing the patient: informed consent that a round of nursing will be carried
out on the patient, the results of the assessment / data validation
Implementation (nurse station)
1. Together with nurses and other health teams, PP presents problems, namely
discussing the patient's background and condition, such as the patient's nursing
diagnosis, supporting data, interventions that have been carried out to patients,
what obstacles are found.
Implementation (patient room)
1. Conduct data validation directly to patients and families, which is carried out
by PP, counselors, KARU and other health teams
Post round
1. Continue discussions at the nurse station together with other health teams
regarding the patient's problems and conditions
2. Conclusions and recommendations for problem solutions
The nursing round is carried out incidentally according to the patient's condition
due to the limited number of specialists and experience. In the case of patients who
have a long hospitalization time and have not shown improvement in their condition or
in a death case, a case meeting will be held by a specialist as the person in charge by
bringing in all health workers who are responsible for the patient to then carry out a
discussion on the resolution of the case.

5. New Patient Admission Methods
In theory, the admission of new patients is carried out with the following flow:
Preparation
1. The NUM notifies the preparatory nurse that there will be a new patient
2. Nurses prepare things needed in admitting new patients, including hospital admission
sheets, assessment sheets, informed consent sheets, patient status, nursing kits, patient
discipline sheets, and patient satisfaction sheets, bed preparation.
3. NUM asks the nurse again about the completeness for admission of new patients and
checks the completeness of the documents that have been prepared.
4. Nurse mentions things that have been prepared.
Implementation
NUM and the nurse visit the patient and family by greeting and introducing themselves to the
patient / family.
1. Fill in the patient admission sheet and explain some of the things listed in the new patient
admission sheet, the nurse explains the patient's illness, explains the doctor who handles the
patient and explains the existing facilities, as well as the existing rules in the hospital. The
nurse orientates the patient to the hospital room / environment.
2. The nurse asks the patient and family again about things that have not been understood.
3. The patient nurse, and the family signs a new patient acceptance sheet.
4. NUM Pearawat returns to the nurse station
Closing
1. NUM rechecks the completeness of filling in new patient admission documents
2. Through planning nursing interventions
From the data we have obtained, the admission of new patients in the room has been done well,
but this room does not yet have guidelines / standards for admitting new passports. The new patient
admission sheet is complete, but many patients who are at risk of falling do not wear a fall risk
bracelet. The act of signing on important sheets which shows that the patient / family is clear and
understands and agrees with what has been explained by the nurse, especially the letter of consent for
drug centralization is complete. The NUM must always be with the nurse to prepare or accept new
patients.
6. Supervision methods
In theory, supervision is a process of providing the various resources needed by nurses to
complete tasks in achieving organizational goals. The objectives of supervision are:
1. To support the development of science and the ability to play a role as a nurse in clinical
practice, the focus is on safe and effective practices and benefits for patients.
2. Support the non-clinical role of the nurse by providing an opportunity to discuss issues
concerned with providing safe and effective care, and / or professional issues.
3. Support the development of competencies, knowledge and abilities by facilitating personal
and professional development.
Supervision requires someone who is right in its implementation. The following are
individuals who are capable of supervising:
1. Direct supervisor or other staff who have authority and responsibility
2. Knowledge and abilities in accordance with what is being supervised
3. Knowing the principles of supervision and supervision techniques
4. Have enough time
In supervision, what will be supervised is the activities of the members under the leadership
of the supervisor. Supervision is carried out at least formally given to members at least 2 times per
year.
Supervision stages
Preparation
1. Set goals
2. Establish the appropriate method
3. Define outcome criteria
Implementation
1. Create and establish a plan for supervision
2. Supervise
3. Review supervision
Problem solving
1. Gather information
2. Identify the problem
3. Analyze the problem -
4. Look for and decide on alternative solutions
5. Doing problem solving
Pre supervision flow
1. Supervisor determines the actions to be supervised
2. The supervisor will determine the objectives and competencies to be reviewed
Implementation
1. Supervisor reviews the performance of the nurses who are supervised in accordance with the
existing SOP
2. Supervisors review things that need to be given training
3. Supervisors ask PP and PA for training and clarification of problems
4. Supervisors supervise by observing, interviewing, and validating supporting data
Post (3F)
1. Fair, the supervisor shows the assessment that has been done
2. Feedback, the supervisor provides feedback and clarification
3. Follow up, supervisors provide support and follow up to solve problems
The nurse stated that supervision had not been carried out by the nurse, there was no standard
format for supervision of every action, had never received training and socialization on supervision,
had complete tools (instruments) for supervision, the results of the supervision had been conveyed to
the nurse, there was always feedback from the supervisor For each action, the nurse was satisfied
with the results of the feed back, there was a follow-up for each result of the supervision. Some nurses
stated that they did not know the flow of supervision and there was no supervision format that was in
accordance with nursing standards. The nurse stated thatsupervision was carried out unscheduled and
rarely was supervised. PJ Unit or PP which supervises.
7. Discharge planning method
In theory, the discharge planning method is as follows: Discharge planning or discharge
planning is a dynamic and systematic process of assessment, preparation, and coordination carried
out to facilitate supervision of health services and social services before and after returning home.
Purposeful return planning
1. Prepare the patient and family physically, psychologically and socially
2. Increasing the independence of patients and families
3. Promote continuous care of patients
4. Helping patient referrals to other service systems
5. Helping patients and their families have the knowledge and skills and attitudes in improving
and maintaining the patient's health status
6. Carry out a range of care between the hospital and the community.
Home planning principles
1. The patient is the focus of discharge planning so that the value of the wants and needs of the
patient needs to be assessed and evaluated
2. The needs of the patient are identified and then linked to problems that may arise when the
patient goes home, so that possible problems that arise at home can be immediately anticipated
3. Return planning is carried out collaboratively because it is a multidisciplinary service and
each team must work together
4. Actions or plans that will be carried out after returning home are adjusted to the knowledge
of the manpower / resources and facilities available in the community.
5. Return planning is carried out in each system or community service setting.
The return planning component consists of:
Home care includes teaching or health education about diet, mobilization, control time, and place of
control. The teaching of lessons is adjusted to the level of understanding and family regarding care
while the patient is in the hospital.
1. Medicines that are still being taken and their quantity, including dosage, method of
administration, and the right time to take the drug.
2. Discontinued drugs
3. The results of the examination
4. Letters, such as sickness certificates, control letters.
Factors that need to be studied in planning to go home
1. Patient and family knowledge about the disease, therapy and necessary care
2. Psychological needs and interpersonal relationships in the family
3. The desire of the family and the patient to receive assistance and their ability to provide care
4. Help the patient needs
5. Fulfilling the needs of daily life activities such as eating, drinking, eliminating, resting and
resting, dressing, personal hygiene, safety from harm, communication, religion, recreation and
school.
6. Resources and support systems that exist in the community
7. Financial resources and employment
8. Existing facilities at home and patient expectations after being treated
9. Needs for care and supervision at home
Nursing actions that can be given to the patient before the patient is allowed to go home are as
follows:
1. Health education: expected to reduce relapse rates or complications and increase patient and
family knowledge about postnatal care
2. Survival discharge program: aims to train patients to return to their family and community
environment. This program covers what the patient should do in the hospital and should be
done by the family
3. Referral: the integrity of health services must have a direct relationship between community
nurses or independent practice nurses and hospitals so that they can find out about the progress
of patients at home
Here, the primary nursing duties are:
1. Make a discharge planning plan
2. Making leaflets - Providing counseling
3. Providing health education
4. Provide discharge planning format
5. Documenting discharge planning
Based on the observation in this ward discharge planning has been implemented and there is a
discharge planning format in the patient's medical record, however, discharge planning is only carried
out when the patient is leaving. Discharge planning is carried out verbally and in writing by giving
discharge instructions / instructions to go home / follow up which includes time for re-control by
giving control cover letters, an explanation of when to return immediately in case of an emergency,
and care instructions at home in accordance with the patient's medical diagnosis. The results of the
interview for the discharge planning implementation by the nurse, the nurse said that by providing
counselling and health education in accordance with the available discharge planning format and the
hospital had not yet provided leaflets for patients to take home.
8. Nursing documentation methods
In theory, documentation is a record of the application of professional nursing care, an
important component of documentation, namely: communication, nursing processes, and nursing
care standards. Effectiveness and efficiency are very useful in gathering relevant information and
will improve the quality of nursing documentation.
Benefits of nursing documentation:
1. As a means of communication between nurses and other health workers
2. As legal documentation and has legal value
3. Improving the quality of nursing services
4. As a reference for learning in improving nursing science
5. Has the value of nursing research and development research
Nursing assessment
For data grouping, the criteria are as follows
Biological data:
1. Observation of vital signs and physical examination by inspection, percussion, palpation,
auscultation.
2. Diagnostic / supporting examinations, namely laboratory and X-rays.
▪ Psychological, social, and spiritual data through interviews.
▪ The initial data review format uses the ROS (review of system) model which includes
format, documentation, nursing diagnoses, nursing evaluation
Nursing diagnosis
The criteria include the following.
▪ Health status is compared against standards to determine gaps.
▪ Nursing diagnoses are linked to the causes of the gap and meeting the patient's needs.
▪ Nursing diagnoses are made in accordance with the authority of the nurse.
Planning
The nursing planning component consists of:
• Priority problems Criteria, among others, are as follows
a. Life threatening issues are a top priority.
b. Problems that threaten a person's health are the second priority.
c. Problems affecting behavior are a third priority.
• The criteria include the following.
1) Based on the goals of nursing care.
2) Is an alternative action appropriately.
3) Involving the patient / family.
4) Considering the socio-cultural background of the patient / family.
5) Considering the prevailing policies and regulations.
6) Ensuring a sense of security and comfort for the patient.
7) Compiled by considering the existing environment, resources and facilities.
8) Must be in the form of a sentence of instruction, be concise, firm, and written using language
that is easy to understand. Using a standard form.
Nursing Intervention / Implementation Nursing intervention is the implementation of a defined
action plan with the intention that the patient's needs are met optimally which includes aspects of
health improvement, maintenance and recovery by involving the patient and family. Nursing
interventions are oriented towards 15 basic components. nursing which was developed with the
technical procedures of the sergeant.
The criteria include:
• Implemented according to the nursing plan
• Observing the patient's bio-psycho-socio-spiritual condition
• Explain each nursing action to the patient / family
• In accordance with the predetermined time
• Using existing resources
• Shows a patient and friendly attitude in interacting with patients / families
• Washing hands before and after carrying out nursing actions
• Applying aseptic and antiseptic principles
• Apply nursing ethics
• Applying the principles of safe, comfortable, economical, privacy, and prioritizing patient safety
• Implement corrective actions based on patient response
• Refer immediately to problems that threaten patient safety
• Record all actions that have been carried out
• Tidy up the patient and equipment after each action
• Carry out nursing actions on predetermined technical procedures
• General and special nursing procedures are carried out in accordance with established routines.
Evaluation
Performed periodically, systematically and plans to assess the patient's progress after nursing
actions. The criteria include:
▪ Each nursing action is evaluated
▪ Evaluation of results using indicators of physiological changes and patient behavior
▪ The results of the evaluation are immediately recorded and communicated for further action
▪ Evaluation involves clients and other health teams
▪ Evaluation is carried out with standards (objectives to be achieved and standards of nursing
practice).
The decisions in the evaluation are as follows.
• The issue is resolved.
• The problem is not resolved, it must be reviewed and re-planned for action.
• The problem is partially resolved, requires modification of the action plan.
• New problems arise.
From the data there is an operational standard for the implementation of nursing
documentation, technical instructions for filling in detail, but not yet complete, no drafting rules and
not yet neatly organized. Nursing documentation flow is carried out when the patient begins to enter.
Furthermore, the nurse conducts nursing assessments with the Review Of System (ROS) format, then
documents through an integrated note about what the implementation was carried out and documents
the evaluation for consideration through the SBAR communication system (Situation). Background
Assessment Recommendation) among shift nurses. There is a Standard Nursing Language (SNL)
format which contains nursing diagnoses, nursing interventions and nursing implementation columns
and nursing evaluations. The results of observations are that some medical records have been filled
in completely and there are some parts that are not completely filled in and on the integrated note
sheet there are already signatures of medical personnel who have filled in, but there are still many
medical records that have no stamps that are read back for messages via electronic media and have
not. there is a signature of the doctor in charge of the patient. Based on the results of observations of
10 (ten) medical records, it was found that 3 out of 10 medical records had no date and signature,
PPB sheet 2 out of 10 medical records were not filled, inpatient assessment sheets 3 out of 10 medical
records obtained 2 medical records. not filled in and 1 medical record does not exist.
2.2.4 Hospital financing (M4/ Money)
1. Income.
2. RAB, which includes funds for the following activities.
a. Operations (service activities).
b. Management (employee payments, electricity, water, telephone, and others).
c. Development (infrastructure and human resources)
Table 4.1 Room Maintenance Rates
No Information Doctor Nurse Rates amount
1 Class III Rp. 50.000 Rp. 15.000 Rp. 45.000 Rp. 110.000
2 Class II Rp. 50.000 Rp. 15.000 Rp. 55.000 Rp. 120.000
3 Class I Rp. 50.000 Rp. 15.000 Rp. 110.000 Rp. 175.000
Table 4.2 Hospital Financing Sources

No Information Source
1 Space Financing Hospital annual budget
2 Employee Training Financing Hospital annual budget
3 Client Financing BPJS (PBI and non –PBI)
and independent fees
2.2.5 Hospital Marketing and quality (M5/ Market)

1. Bed Occupation Rate (BOR)
No Date Shift Number Bed filled Empty BOR (%)

of bed bed
1. 10/05/2021 Morning 36 30 6 83%
Day 36 30 6 83%
Night 36 30 6 83%
2. 11/05/2021 Morning 36 31 5 86%
Day 36 31 5 86%
Night 36 31 5 86%
3. 12/05/2021 Morning 36 28 10 77%
Day 36 28 10 77%
Night 36 28 10 77%
4. 13/05/2021 Morning 36 27 9 75%

Day 36 27 9 75%
Night 36 27 9 75%
TOTAL 963%
AVERAGE 80%
2. Level of patient satisfaction
Service: Medical
Patient Satisfaction Questionnaire
We would love to hear what you think about us! Please take a few minutes to complete this form and
tell us what we did well and what we need to do better. It will help us to continually improve our
service to everyone we care for in the community.
If you would like more information or have questions on how to complete the questionnaire, please
contact the Patient Experience Service on Freephone 0800 694 5530 or email
Irnawardquestionnare@gmail.com
Please tick () Are you filling this questionnaire for:

Yourself  Your child □ Your spouse or partner □ Another relative or friend □
Question 1: The length of time that I had to wait to be seen was reasonable
Agree  Disagree □
Comments:
Question 2: I was involved and informed in decisions about my care

Comments:
Question 3: I was involved in the planning of my care (or my child’s care if applicable)
Agree  Disagree □ Not applicable □
Comments:
Question 4: The health care person listened to me

Comments:
Question 5: The health care person explained the treatment / health advice in a way that I could
understand
Comments:
Question 6: I was given enough privacy when treated or advised

Comments:
Question 7. I was seen in a clean and safe environment

Comments:
Question 8: I had confidence and trust in the health care person who was treating / advising me
Comments:
Question 9: I was treated with dignity at all times

Comments:
Question 10: The information I received about my health care helped me to understand my
condition / my family’s health
Comments:
Question 11: My family/carer were involved by staff in planning my care (with my consent)
Comments:
Question 12: My personal information was treated confidentially

Comments:
Question 13: The treatment (or advice/ support) that I received was effective
Comments:
Question 14 I would recommend the service to my family and friends

Comments:
Please add any other comments or suggestions that you would like to make below:
If you are happy for our Patient Experience Officer to contact you about your responses,
please enter your contact details below:
Name:
Contact telephone number:
Gotong Royong Hospital Trust will hold your information securely in accordance with the Data
Protection Act (2021).
We may share information you provide with our services as part of our ongoing commitment to
improving the quality of the services we deliver.
Please tick here if you are NOT happy for us to use your feedback in this way. □

Please tick here if you are NOT happy for your feedback to be used anonymously on service
information leaflets and webpages □
3. Average Length of Stay (AvLOS)
NO Length of stay Number of patient Formula

1. 3 36 108
2. 6 120 720
3. 10 98 980
TOTAL 1808
Formula : Patient leave (alive or die) : 258
Number of length of stay
Number of patient leave (alive or die)
1808 / 361 = 5 days (Ideal)
4. Patient safety applied at Irna Ward

1) Patient identification
Target Assessment Element :
1. Patients are identified at least 2 out of 3 identities (name, date of birth and medical record
number) may not be identified using the patient's room or location
2. Patients are identified in 2 ways, namely verbally by asking for their name, date of birth and
seeing visually by looking at the bracelet including name, date of birth and medical record
number.
3. Patients are identified prior to administration of drugs, blood or blood products, or all the
actions to be performed
From the data we have found, Irna Ward did or did the identification according to our
assessment targets. But the nurse identifies the patient but immediately mentions the name without
confirming the patient's wristband.
2) Effective communication
1. Complete orders verbally and by telephone or the results of the examination are written and
read out in full by the recipient of the order.
2. Re-verify orders that have been submitted to the order giver
3. Using SBAR communication
From the data we have found, Irna ward already using SBAR communication in their room.And
the SBAR communication very helpful in communicating and making error reduction.
3) Adherence to labeling high alert drug
1. Special labeling of high alert drugs includes using combination letters (lowercase and
uppercase = TALL-MAN).
2. High alert drug storage is placed in a special place separated from other drugs
3. Before giving to the patient, double check and double check must be done with a different
officer (including patient identity, drug identity, drug concentration to be given, rules and
how to use the drug).
4. Every nurse who gives high alert medication to the patient must sign and bright name on the
drug delivery sheet.
From the data we have found , this room or Irna Ward have carried out high alert drug handling
procedures properly. They double check before it is given to the patient and also sign the drug
dispensing sheet to minimize errors.
4) Exact location certainty, precise procedures, precise patient surgery.
1. There are 3 elements of service that must always be ineffective and efficient, namely the
operation room or procedure room, the patient himself, the surgical team.
2. Surgical services can be performed by means of a surgical safety checklist
3. In a marking the location of the operation must involve the patient / family
4. Use a checklist to perform preoperative leverage, precise location, procedure, and patient
accuracy and all documents and equipment required are available precisely / correctly and
functionally
5. The fully equipped operating team implements and records / documents the procedure before
the incision / discharge time, right before the start of a surgical procedure.
In our observations, the surgical team at the mutual aid hospital has carried out the procedure
properly and according to the flow. such as a surgical checklist, surgical markings must involve the
patient and family, and there is an appropriate timestamp.
5) Risk infection related on care delivery
1. The organization adopted or adapted the latest published and generally accepted hand
hygiene guidelines (i.e. the WHO Guidelines on Patient Safety.
2. The hospital applies an effective hand hygiene program.
3. Policies and or procedures are developed to direct the continuous reduction of the risk of
infection associated with health services.

From our observations, Irna Ward has adopted or adapted the latest published and generally
accepted hand hygiene guidelines (i.e. from the WHO Guidelines on Patient Safety), namely 6 steps
for washing hands that are good and correct. But Nurses do not wash their hands prior to the patient
but always wash their hands after leaving the patient
6) Prevent incident of fall risk
a. The hospital implements an initial assessment process of the patient for the risk of falling
and conducts a re-assessment if the patient is indicated that there has been a change in
condition or treatment, etc.
b. Measures are in place to reduce the risk of falls for those who are considered to be at risk
of falling on the assessment results.
c. The measures are monitored for outcome, both success, reduction in injury from falls and
the impact of adverse events.
d. Policies and / or procedures are developed to direct the continuous reduction of the
patient's risk of injury from falls in the hospital.
In our observations, this room has established a procedure for approaching patients with the risk
of falling well, but there are several drawbacks, namely the nurse does not give a drop risk bracelet
to patients with physical signs of weakness
2.3 Data Analysis
Analysis using SWOT method and arrange start from M1-M5 and create thekite diagram.
No Data M1 (Man) Weight Ranting Weight x Formula
Ranting
Internal Factor (IFAS)
1. Strength: S-W= 3.1-3.4
1. Nurses attend PPGD, ALS, BLS, (-0.3)
AT, Patient Safety,
Management, LSH, PPRA, RAS 0.4 3 1.2
Drugs, ASKEP, Oxygen, Fluid,
Blood Transfusion, Nursing
Career Paths
2. Num with Ners education has 0.3 4 1.2
worked for 25 years.
3. 16 nurses with the title Ners. 0.3 3 0.9
TOTAL 1 3.1
Weakness:
1. The productivity of the 0.2 4 0.8
performance of nurses in the
morning is 95%, during the day
90% and at night 86% (high
workload)
2. The interest of nurses is still 0.2 3 0.6
low.
3. Nurses are still confused with 0.2 3 0.6
jobdesc, especially when the
main nurse is not on duty.
4. The medical ward has 4 primary 0.2 4 0.8
nurses
5. High workload so that seminar 0.2 3 0.6
activities are low
TOTAL
External Factor (EFAS)

Opportunity: 0.6 2 1.2 O-T=2.4-2
1. There are nursing students (+0.4)
doing clinical practice.
2. Lack of job desc training to do 0.4 3 1.2
TOTAL
Threat: 1 2
1. The level of dependence of the
patient increases every day. 0.5 2 1
2. Competition between
hospitals.
TOTAL
0.5 2 1
1 2
No Data M2 Weight Ranting Weight x Formula

Ranting
Internal Factor (IFAS)
1 Strength S-W = 4.6-4 =
1. Hospital health equipment facilities +0.6
are quite complete, starting from 0.30 3 0.9
medical equipment to wastafle and
hand wash
2. Irna's room has a nurse station room
that is used optimally 0.30 3 0.9
3. Supporting documents are also
complete
0.40 2 0.8
TOTAL
1 4.6
Weakness
1. some SOPs are not yet available
1 4 4
TOTAL
1 4
Opportunity O-T = 3-2.5 =
1. There are nursing students doing 0,5 3 1,5 +0.5
clinical practice
2. The existence of higher demands 0,5 3 1,5
from patients to obtain professional
nursing services
TOTAL 1 3
Threathened
1. The level of dependence of the 0,5 2 1
patient increases every day.
2. Competition between hospitals. 0,5 3 1,5
TOTAL
1 2.5

Ranting
Internal Factor (IFAS) MAKP
Strength: 0.5 3 1.5 S-W = 3.5-3 =
1. All nurses already know about the +0.5
primary method 0.5 4 2
2. The organizational structure is
there
TOTAL 1 3.5
Weakness
1. Sometimes they are still
confused with their job disc 0.3 3 0.9
especially when the primary
nurse is not in service
2. The medical ward has 4 primary
nurses 0.3 3 0.9
3. The organizational structure is
there, but it still looks like the 0.4 3 1.2
combined structure of the
Primary-Team model
1 3
TOTAL

Opportunity O-T = 3-2 =
1. There is good communication 0.5 3 1.5 +1
between patients and nurses
2. There are nursing students doing 0.5 3 1.5
clinical practice
TOTAL 1 3
Treathened
1. There are demands from the
community for professional 1 2 2
service
TOTAL 1 2

Ranting
Internal Factor (IFAS) HANDOVER
Strength: S-W = 2.6-2 =

1. The process of hand over has 0.5 3 1.5 +0.6
been carried out on every
shift.
2. The handover has been 0.3 2 0.5
communicated by SBAR
3. NUM is accompanying hand
over on the morning and 0.2 0.3 0.6
afternoon shift. In the night
shift, we are led by the
person in charge of the night 1 2.6
shift.
TOTAL 0.5 2 1
Weaknes:
1. The time for the receipt is quite
long. 0.5 2 1
2. The validation process for
patients at the change of 1 2
evening to night shifts is not
carried out.
TOTAL
Opportunity 1 3 3 O-T = 3-2 =

1. There are students who run +1
clinical practice in the hospital 1 3
TOTAL
Treathened: 1 2 2
1. Many people who already
understand about the law 1 2
TOTAL
Ranting
Internal Factor (IFAS) SO
Strength S-W = 3.15 –
1. The nursery applies the UDD 0.25 3 0.75 3=
method for drug centralization. +0.15
2. The drug administration system 0.15 3 0.45
was prepared and used a double
checker pattern
3. One nurse would prepare the 0.15 4 0.6
medicine then another nurse
would check its suitability.
4. Medication chart contains drug
names and administration doses 0.15 2 0.3
separated between parenteral
drugs and enteral drugs.
5. The nurse previously explained to
the family and the patient about 0.15 3 0.45
the kinds of drugs, the uses of the
drugs.
6. Nurse pays attention to the correct 0.15 4 0.6
6
TOTAL 1 3.15
Weakness
1. There is no written flow regarding 1 3 3
drug centralization.
1 3
TOTAL
Opportunity 1 3 3 O-T=3-2=
clinical practice in the hospital
TOTAL 1 3
Threatened
1. 1. There are demands from the 1 2 2
community for professional service
TOTAL 1 2

Ranting
Internal Factor (IFAS) NURSING ROUND

Strength S-W = 3-2 =
1. Availability of nurse and doctor 1 3 3 +1
documentation formats
1 3
TOTAL
Weakness
1. The nursing round is carried out 1 2 2
incidentally according to the patient's
condition due to the limited number
of specialists and experience
TOTAL 1 2

1. There are students doing clinical 1 3 3 +1
practice in the hospital
TOTAL 1 3
Treathened: 1 2 2
1. Many patients already understand 1 2
the law
TOTAL
Ranting
Internal Factor (IFAS) New Patients admission
Strength S-W = 4- 3.5 =

1. Admission of new patients has +0.5
been carried out according to the flow 1 4 4
TOTAL
Weaknesses 1 4
1. The room does not yet have
standards/guidelines in providing
new patient admissions services. 0.5 3 1.5
2. some patients do not wear the risk

bracelet to fall even though the patient
is weak. 0.5 4 2
TOTAL
1 3.5

Opportunities O-T = 3-2 =
1. There are nursing students doing 1 3 3 +1
clinical practice.
TOTAL 1 3
Threats
1. The existence of higher demands 1 2 2
nursing services
TOTAL
1 2
Ranting
Internal Factor (IFAS) SUPERVISION

Strength: S-W=3.5 - 3
1. For each action, the nurse was 0.5 4 2 =+0.5
satisfied with the results of the
feed back 0.5 3 1.5
2. There was a follow-up for each
result of the supervision
TOTAL 1 3.5
Weakness
1. The nurse stated that
supervision had not been carried 0.25 3 0.75
out by the nurse
2. There was no standard format 0.15 3 0.45
for supervision of every action
3. Had never received training and 0.15 2 0.3
socialization on Supervision
4. Some nurses stated that they did 0.15 3 0.45
not know the flow of
supervision
5. There was no supervision 0.15 4 0.6
format that was in accordance
with nursing standards.
6. The nurse stated that 0.15 3 0.45
supervision was carried out
unscheduled and rarely was
supervised
TOTAL 1 3

1. There are students who run 1 4 4 +2
1 4
TOTAL
Treathened: 1 2 2
understand about the law
TOTAL 1 2

Ranting
Internal Factor (IFAS) DISCHARGE PLANNING
Strength S-W = 2.6- 4 =

1. Discharge planning has been 0.3 3 0.9 -1.4
implemented and there is a
discharge planning format
2. Discharge planning is carried
out verbally and in writing 0.3 0.9
3. Providing counselling and
health education in accordance
with the available discharge 0.4 2 0.8
planning format
TOTAL 1 2.6
Weakness
1. Discharge planning is only 0.5 4 2
carried out when the patient is
leaving.
0.5 4 2
2. The hospital had not yet
provided leaflets for patients to 1 4
take home
TOTAL
Opportunity O-T =3-2 =

1. There are students who run 1 3 3 +1
TOTAL 1 3
Treathened:
1. Many people who already 1 2 2
understand about the law
2
TOTAL 1

Ranting
Internal Factor (IFAS) Nursing Documentation
Strength 0.4 3 1.2 S-W = 3-2.7 =

1. Nursing documentation flow is +0.3
carried out when the patient
begins to enter. 0.9
2. Nursing assessments with the 0.3 3 \
Review Of System (ROS)
3. Format, then documents through 0.9
an integrated note about what the 0.3
implementation was carried out
and documents the evaluation for
consideration through the SBAR
communication system
(Situation).
TOTAL 1 3
Weakness
1. The documentation is detailed 0.15 3 0.45
but incomplete 0.45
2. Docoumentation is not neatly 0.15 3
organized
3. Many medical records that have
no stamps that are read back for 0.15 3 0.45
messages via electronic media
and have not
4. It was found that 3 out of 10 0.2 3 0.6
medical records had no date and
signature
5. PPB sheet 2 out of 10 medical
records were not filled 0.15 2 0.3
6. Inpatient assessment sheets 3
out of 10 medical records
obtained 2 medical records. not 0.15 3 0.45
filled in and 1 medical record
does not exist
TOTAL 1 2.7
Opportunity 1 3 3 O-T= 3-2 =

TOTAL 1 3
Treathened:
understand about the law 1 2 2
TOTAL 2
1

Ranting
Internal Factor (IFAS) M4 (Money)
4. Strength S – W= 3,7 – 2
1. Funding for children's wards is 0,4 4 1.6 + 1,7
obtained from the hospital year
budget and from BPJS funds
2. Room tariffs are in accordance with 0,3 3 0,9
the facilities
3. Maintenance fees that apply 0,3 4 1,2
according to the class of treatment
TOTAL 1 3,7
Weakness
1. Nursing rounds have not been going 0,6 2 1,2
well
2. there are still a number of cases that
occur and there is a shortage of 0,4 2 0,8
specialists and experience
TOTAL 1 2

Opportunities O – T= 4 – 2=
1. The hospital fully supports the 1 4 4 +2
needs of wards which can be
submitted annually for service
development
Total 1 4
Threats
1. There are some patients who are not 1 2 2
attached to the fall identification
bracelet, and the bed fence is not
attached
Total 1 2

Ranting
INTERNAL FACTOR (IFAS)
5. Strenght S-W = 3-3.6
1. Using SBAR methods 35 3 1.05 =+0.6
2. The nurse keeps the high alert
medicines properly 0.35 3 1.05
3. BOR is ideal (80%)
0.3 3 0.9
TOTAL 1 3
Weaknesess
1. AvLos not ideal 5 days 0.2 3 0.6
2. Some patients who were not attached
to fall identification wristbands 0.2 4 0.8
3. The bed fence was not attached
4. Identifies the patient but immediately 0.2 4 0.8
mentions the name without confirming
the patient's wristband 0.2 3 0.6
5. Nurses do not wash their hands prior
to the patient but always wash their
hands after 0.2 4 0.8
leaving the patient
TOTAL
1 3.6
Opportunities
1. Patient satisfaction is high. 1 4 4
TOTAL 1 4
O-T=4-3=
Threats
+1
1. The existence of higher demands 1 3 3
nursing services
TOTAL 1 3

DIAGRAM
1. M1 (-0.3, +0.4)
2. M2 (+0.6, +0.5)
3. M3
a. MAKP (+0.5, +1)
b. HO (+0.6, +1)
c. SO ( +0.15, +1)
d. NR (+1, +1)
e. New Patient (+0.5, +1)
f. Supervision (+0.5, +2) M5 (0.6, 1)
g. DP (-1.4, +1) DOC (+0.3, +1)
h. Documentation (+0.3, +1)
NP (+0.5, +1)
4. M4 (+1.7, +2)
5. M5 (+0.6, +1) MAKP (+0.5, +1)
O SO (+0.15, +1)
M2 (0.6, 0.5)
DP (-1.4, +1)
NR (+1,+1)
3.5
M1 (-0.3, 0.4) 3 HO (+0.6, +1)
2.5
2 M4 (1.7, 2)
1.5
SUP (+0,5, +2)
1
0.5
w S
-3.5 -3 -2.5 -2 -1.5 -1 -0.5 0.5 1 1.5 2 2.5 3 3.5
-1
-1.5
-2
- 2.5
-3
-3.5
T
Problem Identification
1. The productivity of the performance of nurses in the morning is 95%, during the day 90% and
at night 86% (high workload)
2. The development of nurses and the opportunity to take part in seminars and further studies is
wide open, but the interest of nurses is still low.
3. Nurses are still confused with jobdesc, especially when the main nurse is not on duty.
4. The nursing round is carried out incidentally according to the patient's condition due to the
limited number of specialists and experience specialists and experience.
5. Some SOPs are not yet available
6. Sometimes they are still confused with their job disc especially when the primary nurse is not
in service
7. The medical ward has 4 primary nurses
8. The organizational structure is there, but it still looks like the combined structure of the
Primary-Team model
9. The handover has been communicated by SBAR but the time for the receipt is quite long.
10. The validation process for patients at the change of evening to night shifts is not carried out.
11. There is no written flow regarding drug centralization.
12. The nursing round is carried out incidentally according to the patient's condition due to the
limited number of specialists and experience
13. Long hospitalization time and have not shown improvement in their condition or in a death
case
14. The room does not yet have standards / guidelines in providing new patient admissions
services.
15. some patients do not wear the risk bracelet to fall even though the patient is weak.
16. The nurse stated that supervision had not been carried out by the nurse
17. There was no standard format for supervision of every action
18. Had never received training and socialization on Supervision
19. Some nurses stated that they did not know the flow of supervision and there was no
supervision format that was in accordance with nursing standards.
20. The nurse stated that supervision was carried out unscheduled and rarely was supervised
21. Discharge planning is only carried out when the patient is leaving.
22. The hospital had not yet provided leaflets for patients to take home
23. The documentation is detailed but incomplete
24. Docoumentation is not neatly organized
25. Many medical records that have no stamps that are read back for messages via electronic

media and have not
26. It was found that 3 out of 10 medical records had no date and signature
27. PPB sheet 2 out of 10 medical records were not filled
28. Inpatient assessment sheets 3 out of 10 medical records obtained 2 medical records. not filled
in and 1 medical record does not exist
29. Patient safety goals are implemented occasionally
30. AvLos not ideal 5 days
31. Some patients who were not attached to fall identification wristbands
32. The bed fence was not attached
33. Identifies the patient but immediately mentions the name without confirming the patient's
wristband
34. Nurses do not wash their hands prior to the patient but always wash their hands after leaving
the patient
2.4 Prioritize Problem

Prioritize the problem based on specific area on kite diagram.Example:
No PROBLEM SCORE OF SWOT ANALYSIS AREA
IFAS EFAS
1. M1 -0.3 +0.4 Turn around
2. Discharge Planning -1.4 +1 Turn around
3. M4 +1.7 +2 Aggressive
4. NR +1 +1 Aggressive
5. M2 +0.6 +0.5 Aggressive
6. Handover +0.6 +1 Aggressive
7. M5 +0.6 +1 Aggressive
8. NP +0.5 +1 Aggressive
9. SUP +0.5 +2 Aggressive
10. MAKP +0.5 +1 Aggressive
11. DOC +0.3 +1 Aggressive
12. SO +0.15 +1 Aggressive

CHAPTER 3
STRATEGIC PLANNING
3.1 Organizing The Group Management
Organizational Structure
Head : Noverianti
Vice : Natalia Chrismonika
Secretary : Yeni Pangestika
Exchequer : Meidiana
PIC Activities : Inka Kristina
Editor : Devita Sherly
Inventory : Carlin KImang
Job description:
1. Head
a. Dividing roles and tasks for each member

b. Directing members
c. Lead discussions with group members
d. Responsible for all activities carried out
e. Set up the schedule of service
f. Interview the sources
2. Vice
a. Assist the head in carrying out his duties

b. Replace the position of chairman if the head is unable to
3. Secretary
a. Record all the results of assessments and interviews

b. Report all results to the head
4. Exchequer
a. Manage all group finances

b. Record and report all financial results
5. PIC Activities
a. Responsible for the running of activities

b. Buy all the items needed in the activity
c. Pay attention to the schedule of activities and coordinate activities
6. Editor
a. Edit all data that has been typed

b. Create leaflets and forms activities
7. Inventory
a. Record all the items the group has needed

b. Report the list of items needed to the treasurer
c. Inspection of completeness of goods

3.2 Strategic Planning
Plan of Action (POA)
NO DATA PROBLEM GOALS ACTIVITIES INDICATOR TIME PIC

1. SUPERVISION Supervision in this Short term 1. Create 1. There is a 1 month Natalia
1. The nurse stated that room is not going goals : standards / standards / guidelines
supervision had not well and is not Nurses are guidelines format format for the
been carried out by the optimal because able to carry for the implementation of
nurse supervision activities out implementation of supervision in the
2. There was no are not scheduled and supervision in supervision in the room
standard format for have not been carried accordance room according 2. There is a training
supervision of every out by nurses with theory with theory or socialization
action Long term 2. Propose to regarding
3. Had never received goals : NUM for training supervision
training and Implement of or socialization 3. There is a
socialization on supervision regarding supervision
Supervision properly and supervision so scheduling
4. Some nurses stated optimally in that nurses know 4. Implement
that they did not know the room the flow of supervision roleplay
the flow of supervision supervision and 5. Supervision
and there was no can carry out roleplay can run well
supervision format that supervision
properly
was in accordance with 3. Make
nursing standards. supervision
5. The nurse stated that scheduling
supervision was carried 4. Implementing
out unscheduled and supervision
rarely was supervised roleplay in
accordance with
the theory
5. Evaluating the
supervision that is
applied
2. DOCUMENTATION Nursing Short term 1. Complete 1. There is complete 2 weeks Yeni
1. The documentation is documentation in the goals : nursing and detailed nursing
detailed but incomplete room has not been Nurses can do documentation in documentation
2. Docoumentation is carried out properly complete accordance with 2. NUM / PN check
not neatly organized and there are still nursing the theory the completeness of
3. Many medical many incomplete documentatio 2. Proposing the documents
records that have no documents n NUM / PN to 3. Implement nursing
stamps that are read Long term always check the documentations
back for messages via goals : completeness of roleplay
electronic media and Nurses can documentss 4. Nursing
have not implement 3. Implementing documentations
4. It was found that 3 nursing nursing roleplay can run well
out of 10 medical documentatio documentations
records had no date and n optimally roleplay in
signature accordance with
5. PPB sheet 2 out of 10 the theory
medical records were 4. Evaluating the
not filled nursing
6. Inpatient assessment documentations
sheets 3 out of 10 that is applied
medical records
obtained 2 medical
records. not filled in and
1 medical record does
not exist
3. MAKP This room has used Short term 1. Creating a clear 1. There is a clear 3 month Carlin
1. Sometimes they are the primary MAKP goals : Organizational organizational
still confused with their but it has not been Able to apply structure in the structure board in the
job disc especially when running optimally the Primary Primary MAKP room
the primary nurse is not due to lack of MAKP 2. Create clear 2. There is a clear
in service knowledge about the method well guidelines for the record of the division
2. The medical ward has application of this division of tasks of duties and
4 primary nurses model Long term and responsibilities
3. The organizational goals : responsibilities 3. Increased number
structure is there, but it Able to 3. Propose to of PN
still looks like the implement NUM to provide 4. Implement
combined structure of and run the training to Primary MAKP
the Primary-Team primary increase the roleplay
model MAKP number of PN 5. Primary MAKP
method 4. Implementing can run well and
properly and the Primary efficiently
correctly MAKP roleplay
according to according to the
the guidelines theory
5. Evaluating the
Primary MAKP
method that is
applied
4. NEW PATIENT The admission of Short term 1. Creating 1. There is a 1 month Devita
ADMISSION new patients to the goals : guidelines or guidelines or
1. The room does not room has not been Nurses are standards in new standards in new
yet have standards / going well and able to apply patient admissions patient admissions
guidelines in providing optimally because it the process of according to 2. There is a sheets
new patient admissions does not have admitting theory for a new patients
services. adequate guidance new patients 2. Making such as giving a
2. Some patients do not properly completeness bracelet according to
wear the risk bracelet to according to sheets for new the patient’s
the guidelines patients such as 3. Implement new
fall even though the that have giving a bracelet patient admissions
patient is weak. been given according to the roleplay
Long term patient's condition 4. New patients
goals : 3. Implementing admission roleplay
Nurses are new patient can run well
able to run admissions
and roleplay in
implement accordance with
new patient the theory
admissions in 4. Evaluating the
the room new patient
oprimally admission that is
applied
5. NURSING ROUND Nursing rounds have Short term 1. Create format 1. There is a format 3 month Inka
1. The nursing round is not been going well goals : of round of of nursing round
carried out incidentally because there are still The nurse nursing 2. There is an
according to the a number of cases wants to do 2. Propose to increase spesialist
patient's condition due that occur and there the nursing NUM for increase and experience
to the limited number of is a shortage of round the number of 3. Implement nursing
specialists and specialists and according to specialists and round roleplay
experience experience the theory also increase 4. Nursing round
2. Long hospitalization Long term experience so that roleplay can run well
time and have not goals : nursing rounds are
shown improvement in Nurses are not carried out
their condition or in a able to incidentally
death case perform and 3. Implementing
implement nursing round
nursing roleplay in
rounds accordance with
properly and the theory
correctly 4. Evaluate
nursing round that
is applied
6. DISCHARGE Discharge planning Short term 1. Make leaflet 1. There is a leaflet 1 month Meidiana
PLANNING has been going well, goals : 2. Providing 2. There is validation
1. Discharge planning is but there are some The nurse health educations sheets about giving
only carried out when things that have not gave the HE to patients before HE
the patient is leaving. been fulfilled, leaflet to the going home 3. Implement
2. The hospital had not namely the absence patient who 3. Carry out discharge roleplay
yet provided leaflets for of a memorandum in went home roleplay discharge 4. Discharge
patients to take home the room Long term planning planning roleplay can
goals : according to the run well
Nurses can format
implementati 4. Evaluate
ons optimal discharge
discharge planning that is
planning applied
7. HANDOVER Handover in the Short term 1. Carry out 1. Implement 2 weeks Nove
1. The handover has room has used the goals : handovers handover roleplay
been communicated by SBAR The nurse roleplay in accordance with
SBAR but the time for communication weighs accordance with existing guidelines
the receipt is quite long. method but has not acceptance existing and the time used is
2. The validation run optimally according to guidelines and are not too long
process for patients at because there is still the guidelines carried out in an 2. Handover roleplay
the change of evening to no complete with time efficient time and can run well
night shifts is not carried validation from the effective and validate to
out. patient always patients
validates the 2. Evaluate
status for the handover that is
patient applied
Long term
goals :
Weigh accept
can be
optimally
implemented
in the room
8. DRUG The implementation Short term 1. Complete the 1. Completeness of 1 month Natalia
CENTRALIZATION of drug centralization goals: drug the flow of drug
1. There is no written is still not optimal 1. The nurse centralization centralization
flow regarding drug because the flow of has a drug flow 2. Demonstrate a
centralization. drug centralization is centralized 2. practice carry theory-appropriate
2. There are demands only spoken and not flow out the role play drug-centralized
from the community for written format of drug roleplay
professional service 2. The nurse centralization appropriately
centralizes well
the drug
according
to the
groove that
has been
made
Long term
goals:
Drug
centralization
activities can
run well so
that it is
optimal
CHAPTER 4
CLOSING
Explain about thinks are expected during clinical practice

REFERENCES
Huber, D., L. 2010. Leadership and Nursing Care Management, 4th edition.Elsevier Health
Sciences
Kelly, Patricia. 2012. Nursing Leadership & Management; third edition. Canada:Cengange Learning
Nursalam. 2015. Manajemen Keperawatan: Aplikasi dalam Praktik Keperawatan Profesional.

Jakarta: Salemba Medika

APPRAISAL OF ASSESSMENT REPORT
Score
No Description Assessment aspect Max Score
score obtained
1. Material report 1. Accuracy of data presented 15
2. Accuracy of SWOT analysis 15
3. Accuracy of problem identification 20
4. Accuracy of strategic planning 20
5. Writing system 10
6. Language grammar 10
7. References 10
Total score A (SA)
2. Presentation 1. Timelines of presentation 15
2. Presentation method 20
3. Mastery of material 25
4. Presentation performance 20
5. Media 20
Total score B (SB)
3. Discussion 1. Answer correctly 20
2. Appropriate argumentation 20
3. Active discussion 20
4. Team work 20
5. Use of good language 20
Total score C (SC)
TOTAL SCORE = (0,4 X SA) + (0,3 X SB) + (0,3 X SC) =…………….
PRECEPTOR

Management Nursing Step 3 (Second Period)

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FORM ASSESSMENT REPORT

MANAGEMENT ASSESSMENT REPORT

1. Natalia Chrismonika (9103018002)

2. Yeni Pangestika (9103018003)

3. Carlin Kimang (9103018004)

4. Devita Serly (9103018016)

5. Inka Kristina (9103018039)

Nursing Management Practice | 1

Management Assessment Report in Irna Ward Floor 3 Gotong Royong Hospital

Approved on 10 May 2021

Acaademic preceptor Clinical Preceptor

(Made Indra Ayu.,S.Kep.,Ns.,M.Kep) (………………….)

Nursing Management Practice | 2

Surabaya May 11, 2021

Nursing Management Practice | 3

1.2 Purpose ............................................................................................................... 6

1.2.1 General purpose .......................................................................................... 6

1.2.2 Specific purpose .......................................................................................... 6

1.3 Benefits .............................................................................................................. 7

1.3.1 For Hospital and Nurse ............................................................................... 7

1.3.2 For college student ...................................................................................... 7

1.3.3 For patients and families ............................................................................. 7

2.2.1 Vision of hospital ........................................................................................ 8

2.2.2 Mission of hospital ...................................................................................... 8

2.2.3 Motto of hospital/ ward ............................................................................... 8

2.2 Data Collection ................................................................................................... 8

2.2.1 Employee and patient (M1/ Man) .................................................................... 9

1. Organization structure ................................................................................. 9

2.2.2 Building and facilities (M2/ Material) ...................................................... 19

1. Location and ward plan ............................................................................. 19

2. Number of bed .......................................................................................... 20

3. Equipment and facilities............................................................................ 20

4. Administration of nursing support ............................................................ 22

2.2.3 Method of nursing care (M3/ Method) ................................................. 22

Nursing Management Practice | 4

2. Handover Method ..................................................................................... 23

3. Drug Centralization Method ..................................................................... 24

4. Nursing Round Data.................................................................................. 27

5. New Patient Admission Methods .............................................................. 28

6. Supervision methods ................................................................................. 28

7. Discharge planning method ...................................................................... 30

8. Nursing documentation methods .............................................................. 32

2.2.4 Hospital financing (M4/ Money) .......................................................... 35

2.2.5 Hospital Marketing and quality (M5/ Market) ..................................... 35

1. Bed Occupation Rate (BOR)..................................................................... 35

2. Level of patient satisfaction ...................................................................... 36

3. Average Length of Stay (AvLOS) ............................................................ 38

4. Patient safety applied at Irna Ward ........................................................... 38

2.3 Data Analysis ................................................................................................... 40

2.4 Problem Identification ............................................................................................. 50

2.5 Prioritize Problem .................................................................................................... 51

3.2 Strategic Planning .................................................................................................... 54

Plan of Action (POA) .................................................................................... 54

Nursing Management Practice | 5

Nursing Management Practice | 6

Nursing Management Practice | 7

2.2.3 Motto of hospital/ ward

Nursing Management Practice | 8

Nursing Management Practice | 9

Nursing Management Practice | 10

Nursing Management Practice | 11

2) Non nursing staff