Islamic University – Gaza

Faculty of Nursing

2011
Management and Leadership in Nursing
(Clinically)
Faculty of nursing

:Prepared By

Dr. AbdAlKarim Radwan

2011
 The Islamic University of Gaza
Faculty of Nursing

Course Syllabus:
Course title : Management and Leadership in Nursing (Clinical)
Course Number : NURS 4334
Placement : Fourth year
Lecturer : Dr. AbdAlkarim Radwan

Goal: By the end of this semester the student should be able to integrate administrative
theory with clinical nursing.

Objectives : Upon satisfactory completion of this course the student will be able to:
Distinguish the differing roles of various nurse administrators.
Competently perform routine nursing tasks expected of staff nurses .
All routine nursing procedures for assigned area.
Receive and give a change of shift status report on all patients in their care.
Know, understand, and be able to explain the diagnosis and patho-physiology involved
for patients in their care.
Understand and be able to explain pertinent information about prescribed medications
for patients in their care.
Properly complete a kardex (or its equivalent).
Transcribe medical orders and insure their completion.
Properly admit and discharge patients.
Participate in medical and nursing rounds.
Properly order and account for supplies.
Display communicative competence with both patients and the health care team.
Properly supervise and evaluate subordinate workers (students).
Show competence in completing selected hospital forms.
Document patient's care correctly by utilizing nursing notes for the assigned patients.
Observe and accurately identify leadership styles in selected nurse administrators.
Complete a one month staffing schedule (plan) for a theoretical unit when given
pertinent data.
Observe nursing care given to a group of patients and critically evaluate that care.
Resolve conflict when given pertinent data.
Effectively evaluate and make positive suggestions for improving nursing services in
your assigned unit.
Understand the organizational structure of the hospital and ward where assigned and
objectives, and draw organizational hierarchy perfectly.
Read and understand the philosophy and objectives of the ward and hospital where
assigned, and make a new philosophy for the assigned clinical area.
Read and understand hospital policies as they apply to nursing.
Write self management report which must include:
First & last impression about management role.

2
Strong & weak points for assigned department including (Instructor, students, nurses,
doctors, visitors, other professionals, & administration of Hospital) and how to resolve
weak points.

Instructional Strategies :
- Lectures, lecture/discussion
- Assignments
- Case studies/conferences

Evaluation Methods

- Clinical Performance 30%

- Assignments 30%
- Attendance & presentation 10%
- Final clinical exam 30%
Total 100%

3
 ‫األهداف العملية لمقرر اإلدارة والقيادة في التمريض‬
‫قدرة التفريق بني كل مستوى من مستويات اإلدارة‬
‫األدوار الكاملة لألعمال اليومية يف القسم واملهام املوكلة للحكماء‪.‬‬
‫األعمال الروتينية يف املكان احملدد‪.‬‬
‫القدرة على تلقي وإعطاء تقرير عن كل حالة يف القسم على حدة يف حالة تغري دوريات العمل‪.‬‬
‫أن يعرف ويفهم> ويكون> قادر على توضيح التشخيص الطيب واألعراض املرضية املرتتبة عليه للمرضى‪.‬‬
‫أن يفهم> ويكون> قادر على تفهيم املعلومات اخلاصة مبريض ما عن عالجاته اخلاصة‪.‬‬
‫أن يكون قادر على التعامل مع> الكارديكس بشكل مرتب أو مع ما يعادله إن مل يوجد‪>.‬‬
‫أن يستطيع نقل العالجات املدونة يف ورقة الدخول يف مكاهنا الصحيح وبالطريقة الصحيحة‪.‬‬
‫أن يقدر على عمل إدخال وإخراج للمريض بشكل مناسب‪.‬‬
‫املشاركة الفعالة يف املرور> الطيب والتمريضي اليومي‪.‬‬
‫القدرة على طلب املعدات والقيام بعدها بالشكل املناسب‪.‬‬
‫أن يتمتع بالكفاءة عند االتصال والتواصل مع املرضى وأعضاء الفريق الصحي‬
‫)‪(Communication Skills‬‬
‫أن يكون قادر على اإلشراف الكامل على القسم وأن يستطيع تقييم من يعملون> لديه‪.‬‬
‫أن يستطيع أن يتعامل ويكمل النماذج اخلاصة باملستشفى (املوافقة على العملية‪ ،‬طلب األدوية‪ >،‬طلب األدوات‪ >...‬اخل)‬
‫التوثيق اجليد لألعمال اخلاصة برعاية املريض‪.‬‬
‫أن يراقب وحيدد> بدقة أساليب القيادة لدى املمرضني املسئولني‪.‬‬
‫أن يكون قادراً على عمل جدول شهري> للعمل ‪ 24‬ساعة يومياً لوحدة معينة‪.‬‬
‫متابعة عمل الطلبة واملمرضني يف القسم ويبدي اقرتاحاته االجيابية‪.‬‬
‫أن يكون قادراً على إزالة املشاحنات فيما خيص الطلبة واملمرضني داخل القسم‪.‬‬
‫أن يستطيع تقييم اخلدمة التمريضية لوحدته اخلاصة بشكل مناسب‪.‬‬
‫أن يتعرف على نظام وفلسفة املستشفى ووحداته اخلاصة (إن وجدت)‪.‬‬
‫أن يكون قادراً على عمل فلسفة خاصة واضحة املعامل للمستشفى أو للقسم املعين‬
‫)‪(Bio-psycho-social &spiritual Environment –Nursing –Health – Person‬‬
‫أن يقرأ ويفهم> قوانني وأنظمة املستشفى وخاصة يف جمال التمريض‪.‬‬

‫‪4‬‬
 ‫مهمات واجبة لطالب اإلدارة‪:‬‬
‫التواجد قبل ساعة استالم الوردية تقريباً ‪ 7:20‬صباحاً‪.‬‬
‫استالم القسم بشكل مناسب وخاصة حاالت الدخول اجلديدة‪.‬‬
‫استالم األدوات والتتميم عليها‪.‬‬
‫عمل توزيع للعمل وحماولة سد العجزان وجد‪.‬‬
‫فحص األدوات يف القسم والتتميم عليها وفحص عربة الطوارئ وإمتام النقص فيها حبيث تكون جاهزة لالستعمال يف كل زمان‪.‬‬
‫ترتيب املكاتب وتنظيمها‪.‬‬
‫جتهيز الطلبات اخلاصة بالقسم مثل أدوية‪ ،‬كشف غذاء‪ >،‬تعقيم‪ ،‬طلب غسيل‪ ..‬اخل‪.‬‬
‫مراجعة ملفات املرضى والتقرير> التمريضي‪.‬‬
‫تفقد طلبية األدوية قبل توزيعها على القسم‪.‬‬
‫تبليغ املشرف عن أي مشاكل خاصة بالعمل مثل عجز> متريض‪ ،‬غياب‪ ،‬تأخري‪ ،‬فقدان أدوات‪. ،‬اخل‪.‬‬
‫القدرة على تسليم القسم بشكل كامل للممرضني يف الوردية الثانية‪.‬‬
‫على طالب اإلدارة مالحظة الطلبة اآلخرين في الجوانب التالية‪:‬‬
‫االنضباط – حضور‪ >،‬انصراف‪ ،‬التزام بوقت االسرتاحة‪ ،‬وااللتزام املكاين‪.‬‬
‫متابعة االلتزام بالزي الرمسي شامالً ‪.Tag name‬‬
‫التواصل اجليد مع املرضى‪ ،‬املوظفني‪ ،‬املدرس‪ >،‬مع> البعض‪ ،‬الزوار‪ ،‬الطبيب‪ ،‬واملسئولني‪.‬‬
‫عدم> الرد على التليفون‪ >،‬وعدم> التجمع على مكتب التمريض‪ ،‬وعدم> التجمع يف مناطق القسم‪.‬‬
‫ضرورة معرفة كل طالب احلالة الكاملة ملريضه اخلاص منذ الدخول حىت تارخيه وعمل> تقرير الزم> عنه‪.‬‬
‫التشديد على عدم إعطاء عالج بدون أمر طيب أو لوحده إال بوجود> املشرف‪.‬‬
‫حتديد مواضيع علمية حمددة للطلبة ليتم حتضريها وإلقائها على الطلبة‪.‬‬
‫طرح> أسئلة علمية‪ ،‬ورياضية خمتلفة على الطلبة مع عدم> تأثريها على جمريات العمل التمريضي‪.‬‬

‫‪5‬‬
 PHILOSOPHY OF NURSING

The philosophy is the second steps of planning, and it is one of five steps of planning, it
includes (mission statement, philosophy, goal and objectives, policies and procedure and
rules or regulation).

Definitions of philosophy:
There is a multiple or several meaning for philosophy as the following:
1. The philosophy define as (love of wisdom ‫)حكمة‬
2. The science which investigate the facts and principle of reality and of human
nature and conduct.
3. It is statements of beliefs and value that direct ones practice.
It's generally accepted that philosophy encompasses three areas: concern with….
- Knowledge.
- Values
- Being or one's beliefs about existence.
*The nursing philosophy will defined as the following "the intellectual and effective
outcomes of the professional nurses effort to ". Understand the ultimate relationship
between human and their environment.
- Approach nursing as a scientific discipline.
- Integrate a personal belief system about human being.
- Articulate a personal belief system about human being environment, health, and
nursing as a process.
In all three areas, intellectual processes underlie the method of philosophy.
The concern with knowledge: is important to nursing because nursing is a science, and
the nursing process Is based on logic and the scientific method
 The intellectual and affective outcomes of professional nurse effort to:
1. Understand the ultimate relationship between human and their environment.
2. Approach nursing as a scientific discipline.
3. Integrate a sense of values.
4. Articulate a personal belief system about human being, environment, health and
nursing.
:‫كلمة فلسفة‬
‫هي كلمة يونانية معناها اللغوي " حب احلكمة أو املعرفة " وكل نظام يستند على فكر فلسفي يوجد مسريته ويضبط توقيعاته‬
.ً‫ويساير أداءه إىل النشاط الذي حيقق غرضا‬
‫ لقوله‬.‫البد من وجود> مرجعية حتدد> السبب من وجود> هذه املؤسسة وبالتايل حتدد> وظائفه املستقبلية وكل مؤسسة تفتح يف هذه البالد‬
)14:‫َأسلَ ْمنَا َولَ َّما يَ ْد ُخ ِل اِأْل ميَا ُن يِف ُقلُوبِ ُك ْم)> (احلجرات‬ ِ ِ ِ َ‫تعالى (قَال‬
ْ ‫اب َآمنَّا قُ ْل مَلْ تُْؤ منُوا َولَك ْن قُولُوا‬
ُ ‫اَأْلعَر‬
ْ ‫ت‬

Goal and Objectives:

6
Goal and objectives state actions for achieving the purpose and philosophy.
 All philosophy must be translated into specific goals and objectives if they are to
result in action.
 Thus goals and objectives considered operational definition of the philosophy.
 A goal may be defined as the desired result toward which effort is directed it's the
aim of the philosophy.

Objectives:
Are more specific and measurable than goals because they identify "how" and "when"
the goal is to be accomplished so, they motivate individual to a specific end, and are
explicit, measurable, observable and obtainable.
Writing good objectives requires time and practice.
Many ch.ch must be present in objectives it written in short word that every letter leads
to word as the following:
S = specific
M = measurable.
A = attainable
R = reliable.
T = time limited.
 The following format is suggested in writing clear objective:
1. Who will do the work.
2. Write the word " to" followed by an action verb.
3. Write a single key result to be achieved.
4. Write the word " by" and state the target date for accomplishment.
5. Write the maximum cost in terms of money or time.
Example:
Goal " All registered nurses will be proficient in the administration for hospital z might
include the follows:
1. All Registered nurses in the hospital, "X" must enter Training Course on
intravenous therapy skills for a month
2. Registered nurse Should get on the rate of more than 70% and shall be given
another chance to pass the test within two weeks
3. Failed nurses will not be allowed to give IV therapy to the patients. (An
individual plan will be established by the unit manager and employee).
NOTE:
The philosophy must not be vague, abstract term and the philosophy should be written,
placed in appropriate document, and reviewed periodically.
*When critiquing any philosophy we must look for four elements.
1. Persons
2. Health
3. Nursing
4. Environmental

The purposes of philosophy:

7
 It has been suggested that philosophy is distinguished from all other sciences by
its purpose – the quest for all ultimate reason for all that is knowable.
1. To be concerned with the theory and limits of knowledge.
2. To study the purpose of life, specifically human life.
3. To be concerned about the nature being of reality.

The importance of philosophy to human system:

To achieve intellectual enlightenment is consider better protection against
calamitous mistakes than ignorance.
Thus over time, the study of philosophy has accrued great benefits for individuals,
societies and particularly the specific sciences.

The importance of philosophy to nurse:

Because nursing has been intensely involved with the development of its theory
and belief system in the past decade its evident that nursing is committed to the
clarification of philosophy – knowledge values and existence can be related to the
nursing process as:
 Knowledge ----- Based on logical thinking and the scientific method.
 Value ----- covered by a code of ethics.
 Existence ----- concerned with the nurse and client as human beings and the
evaluation of theory based practice.

Criteria of philosophy
Nursing;
Is the process of human caring which facilitates health and healing in persons and
society. The essence of nursing practice is the caring behaviors in which the nurse
engages within the context of the nurse – client relationship. Nursing practice is firmly
grounded in fundamental clinical and technological competence as well as the sciences
and humanities.

Person:
Possess three spheres three spheres: mind, body, soul, together these entities
comprise a unique, integrated human being. Persons have human needs which must be
met in order to relieve distress or to improve well being. These needs exist in a
hierarchical fashion. As identified by Maslow. Through the life cycle, nursing assists
persons with satisfying human needs in order to promote health and facilitate growth
and development.
*Basic human needs can be understood by organizing them into a structural system
based on functional Health Patterns.
They dignity and worth of all person is recognized.
Their right to autonomy of all freedom of choice in the process of human caring and
healing is acknowledged.

Health:

8
 Is unity and harmony within the mind, body and soul health does not presume the
absence of disease and illness is not necessarily disease. Since health is considered.
Harmony illness is disharmony within the person health is determined by a person's
perception of well being (harmony) with others and the environment.

Environment:
The health – healing includes the physical, mental, socio-cultural, and spiritual
aspects of a person's domain.
Persons are affected by the environment and by their unique responses to that
environment.
Society is made up of persons with various values, beliefs, traditions, norms and rules
which reflect their respective cultures. Culturally diverse persons are part of and
interrelate with society at large.
In order to interact effectively with all persons, nursing care must be in harmony with
individual cultures.

 Some points related to hospital philosophies:

Why there must be a clear philosophy for each hospital?
Because each hospital has established a specific goal to achieve, for example: a commercial
purpose to earn money, while others are aimed at healthy, and some of her other goals

- Is the philosophy of the hospital fixed or variable?

Are generally fixed but may change depending on the circumstances, and philosophy
must be flexible and continue for several years until you can achieve goals, "the only
philosophy that remains constant is the Islamic faith."
- Why does each institution have a different philosophy from the other?
Because each institution varies according to approach, for example: Ministry of Health
philosophy is different from the Ministry of Commerce or the Ministry of Education.
• Why do some hospitals do not have a philosophy?
It all goes to administrative neglect may be some hospitals have been built in times of
emergency and crisis

NB: Examples of Gaza hospitals philosophies (appendix 1)

ASSERTIVENESS

9
  Do you often find that others coerce you into thinking their way?
 Is it difficult for you to express your positive or negative feelings openly and honestly?
 Do you sometimes lose control and become angry at others who don't warrant it?
 A ' yes ' answer to any of the above questions may be an expression of a common
problem known as "lack of assertiveness".

What is Assertiveness?
Assertiveness is the ability to express yourself and your rights without violating the
rights of others.
Assertiveness basically means the ability to express your thoughts and feelings in a way
that clearly states your needs and keeps the lines of communication open with the other.

Characteristics of assertive behavior:

1. Openness
2. Directness
3. Spontaneity
4. Appropriateness

Selfishness and Aggressiveness:

Aggressiveness means that you express your rights but at the expense, degradation, or
humiliation of another. It involves being so emotionally or physically forceful that the
rights of others are not allowed to surface. Aggressiveness usually results in others
becoming angry or vengeful, and as such, it can work against your intentions and cause
people to lose respect for you. You may feel self-righteous or superior at a particular
time, but after thinking things through, you may feel guilty later.

What Assertiveness will not do?

Asserting yourself will not necessarily guarantee you happiness or fair treatment
by others, not will it solve all your personal problems or guarantee that others will be
assertive and not aggressive. Just because you assert yourself does not mean you will
always get what you want; however, lack of assertiveness is most certainly one of the
reasons why conflicts occur in relationships.

Specific Techniques for Assertiveness (Skills):

1. Be as specific and clear as possible about what you want, think, and feel. The
following statements project this preciseness:
- "I want to ..."
- "I don't want you to ...'
- "I would you …?"
- "I liked it when you did that."
- "I have a different opinion, I think that… "
- "I have mixed reactions. I agree with these aspects for these reasons, but I am
disturbed about these aspects for these reasons. "
It can be helpful to explain exactly what you mean and exactly what you don't mean,
such as "I don't want to break up over this, but I'd like to talk it through and see if we can
prevent it from happening again.

10
Be direct, & deliver your message to the person for whom it is intended. If you want to
tell Jane something, tell Jane; do not tell everyone except Jane; do not tell a group, of
which Jane happens to be a member.

2. "Own" your message: Acknowledge that your message comes form your frame
of reference, your conception of good vs. bad or right vs. wrong, your
perceptions. You can acknowledge ownership with personalized "I" statements
such as " I don’t' agree with you" (as compared to " You're wrong") or "I'd like
you to do that" (as compared to " Your really should do that, you know").
Suggesting that someone is wrong or bad and should change for his or her own
benefit when, in fact, it would please you will only foster resentment and
resistance rather than understanding and cooperation.

3. Ask for feedback: "Am I being clear? How do you see this situation? What do
you want to do?" asking for feedback can encourage others to correct any
misperception you may have as well as help others realize that you are expressing
an opinion, feeling, or desire rather than a demand. Encourage others to be clear,
direct, and specific in their feedback to you.
Learning to Become more Assertive:
As you learn to become more assertive, remember to use your assertive
"skills" selectively. It is not just what you say to someone verbally, but also how you
communicate nonverbally with voice tone, gestures, eye contact, facial expression and
posture that will influence your impact on others. You must remember that it takes time
and practice, as well as a willingness to accept yourself as you make mistakes, to reach
the goal of acting assertively. As you practice your techniques, it is often helpful to have
accepting relationships and a supportive environment. People who understand and care
about you are your strongest assets.
Non assertive behavior:
People who are non assertive in a given situation typically deny their true feelings
and inhibit actions that will would reflect these feeling.

Characteristics of non assertive behavior:

1. Hide their true feelings and inhibit action that would reflect their feelings.
2. They often feel hurt, because they allow others to choose for them.
3. They rarely achieve their goals
4. Often they have difficulty giving and receiving complaints.
The areas of assertive communication:
1. Feeling talk: ‫ حبيث نعرب عن مشاعرنا اإلجيابية واليت قد ختتلف مع> كثريين‬:‫التعبري عن الذات‬
2. Contradictory opinions: ‫ عند خمالفة الرأي ألحد> جيب احرتام رأي اآلخرين‬:‫اآلراء املتناقضة‬
3. Setting limits: ‫وضع احلدود بني الرئيس واالحرتام املتبادل‬
4. Self-Initiation: ‫املبادرة الذاتية‬

Components of assertive behaviors:

1. Verbal and non verbal expression:
2. Timing

11
 3. Content of communication:
- Say what you are feeling and be honest.
- Accept responsibility for your feeling instead of putting some one else down.
- Emphasize the person's behavior, not his or her character is specific in your
comments.
4. The appropriateness of response

Barriers of assertiveness:
1. The most pervasive barrier is female sex role socialization, but men are
characterized as aggressive.
2. The nursing socialization process and the nature of nursing.
3. In addition to these male-female role competition problems: men are more
competitive with women than with men. And women are more competitive with
women than with men.

Ethical Decision Making

Introduction:
The traditional decision making model taught in most ethics programs is beyond the
reading comprehension level of an estimated 25% of the employee population. We need
an alternative model capable of ensuring that the ethical issues inherent in routine
business situations could be effectively surfaced while making the model easy to use by
people who were functionally semi-illiterate.
While developing this alternative model we kept two overriding conations in mind:
Every employee is called upon to make decisions in the normal course of doing his/her
job. Organizations cannot function effectively if employees are not empowered to make
decisions consistent with their positions and responsibilities.
For the decision maker to be confident in the decision's efficacy, every decision should
be tested against the organization's policies and values, applicable laws and regulations
as well as the individual employee's definition of what is right, fair, good and
acceptable. What we were looking for was a simple set of guidelines that would make it
easier for the individual employee, regardless of position or level, to be confident that
his/her decisions meet all of the competing standards for effective and ethical decision-
making used by the organization.
The decision making process we adopted was carefully constructed to meet several
criteria. It had to be:
- Fundamentally sound based on current theories and understandings of both
decision making processes and ethics.
- Simple and straightforward enough that it could be easily integrated into every
employee's thought processes.
- Descriptive (detailing how ethical decision are made naturally) rather than.
*To make it easy to understand and apply these ethics filters we have adapted to
mnemonic word PLUS.
P = Policies
Is it consistent with my organization's policies, procedures and guidelines?
L= Legal
Is it acceptable under the applicable laws and regulations?

12
U = Universal
Does it conform to the universal principles/values my organization has adopted?
S= Self
Does it satisfy my personal definition of right, good and fair?
PLUS presumes effective communication with all employees so there is a common
understanding of:
-The organization's policies and procedures as they apply to the situation.
-The applicable laws and regulations.
-The agreed to set of "universal" values - in this case Empathy, Patience, Integrity,
Courage (EPIC)
- E - Empathy - understanding the thoughts and needs of others
- P - Patience - taking the time to understand before we act
- I - Integrity - honesty and truth in all situations
- C - Courage - doing what is right even when it is difficult.
*The individual's sense of right, fair and good springing from their personal values set.

 PLUS also presumes a formal mechanism, provided by the organization, to allow

employees access to a definitive interpretation of the policies, laws and universal
values when their own knowledge of these PLUS factors is insufficient for them
to make the decision with a high level of confidence.
Six Steps to Ethical Decision Making
- Step 1: Define the problem PLUS
- Step 2: Identify alternatives
- Step 3: Evaluate the alternatives PLUS
- Step 4: Make the decision
- Step 5: Implement the decision
- Step 6: Evaluate the decision PLUS

Step 1: Define the problem:

The most significant step in any decision making process is describing why a decision is
called for and identifying the most desired outcome(s) of the decision making process.
One way of deciding if a problem exists is to couch the problem in terms of what one
wanted or expected and the actual situation. In this way a problem is defined as the
difference between expected and/or desired outcomes and actual outcomes.
This careful attention to definition in terms of outcomes allows one to clearly state the
problem. This is a critical consideration because how one defines a problem determines
how one defines causes and where one searches for solutions.
The limiting aspect of the problem definition step is not widely appreciated. Consider
this example.
Your company owns an old, downtown office building. Tenants are complaining that
their employees are getting angry and frustrated because there is always a long delay
getting an elevator to the lobby at rush hour.
You are asked for a reaction on how to solve this problem. As with most problem
situations there are several ways to define the situation and several solutions that suggest
themselves.

13
  This scenario has been presented to over 200 groups in a training environment.
The most common alternatives these groups offered were:
- Flexible hours- so all the tenants' employees wouldn't be at the elevators at the
same time.
- Faster elevators - so each elevator could carry more people in a given time period.
- Bigger elevators - so each elevator could carry more people per trip.
- Elevator banks- so each elevator would only stop on certain floors, increasing
efficiency.
- Better elevator controls - so each eltor would be used more efficiently.
- More elevators - so that overall carrying capacity could be increased.
- Improved elevator maintenance - so each elevator would be more efficient.
- Encourage employees to use the stairs - so fewer people would use the elevators.
If you examine each alternative you will see that several different definitions of the
problem must have existed.
- If the solution is "flexible hours" the problem must have been defined as, "Too
many people getting off work at a given time." No other problem makes sense for
that solution.
- "Faster elevators" comes from, "The elevators are too slow."
- "Bigger elevators" comes from, "The elevators are not carrying enough people."
- "More elevators" comes from, "Too few elevators."
The real life decision makers defined the problem as "people coming about having to
wait". Their solution was to make the wait less frustrating by piping music into the
elevator lobbies. The complaints stopped.
There is no way that the eventual solution could have been reached if, for example, the
problem had been defined as "too few elevators".
As you can see, how you define the problem determines where you go to look for
alternatives/solutions, so define the problem carefully.

Step 2: Identify available alternative solutions to the problem

The key to this step is to not limit yourself to obvious alternatives or what has worked in
the past but to be open to new and better alternatives. How many alternatives should you
identify? Ideally, all of them. Realistically, we teach that the decision maker should
consider more than five in most cases, more than three at the barest minimum. This gets
away from the trap of seeing "both sides of the situation" and limiting one's alternatives
to two opposing choices; either this or that.

Step 3: Evaluate the identified alternatives

As you evaluate each alternative, you should be looking at the likely positive and
negative cones for each. It is unusual to find one alternative that would completely
resolve the problem and is heads and shoulders better than all others. Differences in the
"value" of respective alternatives are typically small, relative and a function of the
decision maker's personal perceptions, biases and predispositions.
As you consider positive and negative cones you must be careful to differentiate
between what you know for a fact and what you believe might be the case.

14
The decision maker will only have all the facts in trivial cases. People always
supplement what facts they have with assumptions and beliefs.
This distinction between fact-based evaluation and non-fact -based evaluation is
included to assist the decision maker in developing a "confidence score" for each
alternative. The decision maker needs to determine not just what results each alternative
could yield, but how probable it is that those results will be realized. The more the
evaluation is fact-based, the more confident he/she can be that the expected outcome
will occur.

Step 4: Make the decision

When acting alone this is the natural next step after selecting the best alternative. When
the decision maker is working in a team environment, this is where a proposal is made to
the team, complete with a clear definition of the problem, a clear list of the alternatives
that were considered and a clear rationale for the proposed solution.

Step 5: Implement the decision

While this might seem obvious, it is necessary to make the point that deciding on the
best alternative is not the same as doing something. The action itself is the first real,
tangible step in changing the situation. It is not enough to think about it or talk about it
or even decide to do it. A decision only counts when it is implemented. As Lou Gerstner
(CEO of IBM) said, "There are no more prizes for predicting rain. There are only prizes
for building arks."

Step 6: Evaluate the decision

Every decision is intended to fix a problem. The final test of any decision is whether or
not the problem was fixed. Did it go away? Did it change appreciably? Is it better now,
or worse, or the same? What new problems did the solution create?
Ethics Filters
Until now we have been discussing a generic decision model similar to those taught in
every business school and management training program. But our concern is not just
decision making; it is ethical decision making.
The ethical component of the decision making process takes the form of a set of
"filters". Their purpose is to separate the sought after elements from their containing
environment.
At key steps in the process the decision maker can stop and run his/her considerations
through these filters and thereby separate the ethical conations from the remainder of the
decision. This ensures that the ethical issues imbedded in the decision can be given
consideration.
In their academic form, the language for these filters is too complex and academic for
most employees. In simplifying the process we risked losing some of the finer points but
dramatically increased the utility of the ethics filters process.

The user should realize that the PLUS filters do not guarantee an ethical decision. They
merely ensure that the ethical components of the situation will be surfaced so that they
might be considered.

15
While PLUS suggests a process for assessing the ethical impact of a decision, ultimately
whether or not the decision meets the ethical standards of the organization or the
individual decision maker is a matter of personal responsibility. After all, ethics is about
choices.

Conflict resolution in nursing

Introduction:
If you have to deal other people, you will, sooner or later, have to deal with conflict.
Conflict is not inherently bad. In fact, conflict simply stems from differing viewpoints.
Since no two people view the world exactly the same way, disagreement is quite normal.
In fact, anyone who agrees with you all of the times is probably telling you what you
want to hear, not what he or she actually believes.
The reason conflict has received such bad press is because of the emotional aspects that
come along with it. When there is conflict, it means that there is strong disagreement
between two or more individuals. The conflicts are usually in relation to interests or
ideas that are personally meaningful to rather one or both of the parties involved.

Unmanaged conflict can lead to violence and insubordination. Notice I said

"unmanaged". The key to managing conflict effectively is to learn the skills necessary to
become a good conflict manager.

We are going to examine three main areas where conflicts occur . in interpersonal one-
no-one relationships ; and in negotiations . Although there are similarities between all of
these areas, each one take a slightly different slant depending on the setting the conflict
occurs in. Let's take a look at each one in a little more details and I will show you what I
mean.

Definition in conflict:
1. Webster’s dictionary (1983) defines conflict as: sharp disagreement or opposition
of interest or ideas.
2. In other words, what I want does not match what you want.

Conflict resolution can be defined as:

The process of resolving a dispute or a conflict, by providing each side’s needs, and
adequately addressing their interest so that they are satisfied with the outcome
Conflict resolution aims to end conflicts before they start or lead to physical fighting.
This usually involves two or more groups with opposing views regarding specific issue,
and another group or individual who is considered to be neutral in their opinion on the
subject .this last bit through is quote often not entirely demand if the "outside" group is
well respected by all opposing parties. Resolution methods can include conciliation,
mediation, arbitration or litigation.

Conflict resolution strategies:

There are many ways to solve conflicts. Listed below m you will find several
examples of conflict resolution strategies:

16
-Say "I'm sorry": sorry can mean different things .one reason to say sorry is when you
are wrong. It can also be a way of saying, "I feel bad we’re having this conflict."
-Build trust: sometimes one person doesn’t believe what the other says .people need to
trust each other.
-Work together: sometimes a conflict can be solved by agreeing to work together on a
project or an idea.
-Solve the problem: conflicts are problems. Are the people solving the problem to work
together on a project or an idea?
-Put it off: sometimes people are too angry to talk it out or solve the problem, they may
need to take a break and work on it later.
-Skip it: some conflicts aren’t worth bothering with. Just forget about it.
-Get help: sometimes you can't come to a solution by yourself, and you need to ask a
grown-up or another one to help you.
-Talk it out: many conflicts can be solved by sitting down and talking about the problem.
*Listen to each other: people in the conflict need to be willing to listen to each other.
Good listening helps each person understand what the other is thinking and feeling.
* Share: if people are having a conflict about who gets to use sometimes, there may be
away to use the object at the same time.
* Take turns: one way to share is to decide that one person uses it , and then the other
person has a turn .
* Compromise: if both people give in a little, they compromise.
* make a peace offering: one person gives a little gift or something that shows he or
she wants to solve the conflict.
* Chance: one way to solve a conflict is by flipping a coin.

Advantage:
The pt will have the best care when all nurses have no any conflicts.
Some relationships will be stronger after conflicts.
Every person will know the personality of others, so it may prevent them from conflicts
in the future.
The other people (even themselves) may learn their mistakes.

Disadvantage:
One of the two groups may have to leave some of their rights or principle for resolution.
As a conflict resolution (third group) I must deal with or work with person I don’t like to
deal with.
Some events may have to be mentioned but one of the two groups doesn't like this event.
Some resolutions are not fair-some a group but they must deal with it.
Some conflict appears to be solved between them it's not.

Conflict in meetings:
Conflict in meetings can be very disruptive. But they can also very helpful. Remember,
conflict, are disagreement. If the person who is disagreeing with you is raising valid
question, it may benefit the group to address the issue they are presenting. In fact, by
listening to them, you may gain valuable insight into what is not working within your
organization. However, if the person continues past the point of disagreement to the

17
point of disruptiveness, specific steps should be taken. Below is a list of conflict
resolution tactics that you can use for meeting that get "out of control".

Conflict in negotiations:
When you are negotiation with your clients, vendors, or even your employees, it is
important to always keep in- mind the idea that both parties are seeking a win/win
situation. No one wants to feel like they are giving away something for nothing. in fact,
most conflicts arise because one party feels like the other party is taking advantage of
them . In order to avoid these types of situation, there are certain principles you can
apply to increase your chances of a successful negotiation.
- Avoid defend –attack interaction: non-productive every time!
- Seek more information: ask a lot of question.
- Check understanding and summarize: make sure that you understanding
everything!
- Try to understand the other person’s perspective: communication is more than
just listening; try to see it their way.
Rules for disagreeing diplomatically:
Regardless of the type of conflict you are dealing with, there are several general rules of
thumb you should follow whenever you are trying to bring harmony to a volatile
situation. Here they are.
- Reflect your understanding of the other’s position or opinion. "I feel, think, want,
etc." this says, "I am listening to your opinion and I take your opinion into
account before I state mine."
- Let the other person know that you value him/ her person even through his /her
opinion is different from yours."I understand (appreciate, respect, see how you
feel that way, etc.). this says," I hear you and respect your opinion"
- State your position or opinion."I feel, think, want, etc, ".this says, "I don’t agree,
but I value you – so let's exchange ideas comfortably, not as a contest for
superiority."
To become a good conflict manager requires a lot of practice. Just remember that the
goal is to reach a compromise that both of you can live with as well as be happy with. In
other words, find a way that both of you can walk away feeling like a winner!

Role model of manager:

Student managers must be role model for subordinates by the followings:
 Punctual (on time, in work, uniform, tag name, hygiene)
 Assertive: (openness, directness, spontaneity, appropriateness)
 Stable emotionally.
 (Be simply with anxious person, be interested with depressed ones)
 Is initiative: going to the tasks and not waiting for them to come for you.
 Quick motion (responsive for all events present in the assigned are all the time of
his duty.
 sharp vision ( has power to percept any problem may exist in any time and try to
avoid or prevent it )
 Expert in science and practice especially when dealing with subordinate.
 Don’t be ego centric.

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  has unique personality (not follower )
 Respect other's opinion tell the degree permit it by roles of in situation.

Nursing occupational distress

In most instance nurses respond and adapt without becoming exhausted,

occupational distress occurs because of persistent, chronic stressors that cause
exhaustion.

Causes of stress:
1. The need to perform numerous physical and psychological tasks quickly and in
time constricted setting.
2. Practice in space constricted environment.
3. Major responsibilities for the lives of the patient.
4. Nurses are women and mothers (few authorities , multi roles)
5. Workload with understaffing salary.
6. Physicians.
7. Dying patient or their family, working with cancer patient.
8. Making medication error.
9. Lack of authority and lake to born decision making.

Effects of stress:
Anxiety , aggression , frustration , low self – steam , fatigue , emotional outburst ,
excessive drinking , smoking , or eating , loss of appetite , inability to make decision ,
psychosomatic complaints , family problems , job dissatisfaction , disorientation ,
disorganization , depression , burn out , bizarre behaviors , psychosis .

Support factors:
1. Higher income.
2. Prestige residence and strong lasting, interpersonal relationship, identifying
supported family and friend, religious belief and vacation days.

Coping:
The perception , definition of the situation , commitment motivation , intelligence , and
problem solving ability all to do with individual internal resources to deal with stress .
- Experience
- Defenses.
- Beliefs about the self and level of self- steam.

Intervention for nursing occupational distress:

1) Administration and organizational intervention:
- 4 days, 40 hours schedules with long weekends.
- Rotation of presumably high stress nursing units.
- 1:2 nurse- patient ratios in critical care areas.

19
 - Humanistic support training for head nurse and supervisor, staff group meeting to
provide opportunities for emotional catharsis.
- Increase auxiliary personal for non- nursing functions.
- Psychiatric nursing consultation to staff nurses on regular basis.
- Motivation, increase team member, nurse's rotation, team conference, education,
rotating shift.
- Reward promotions.
- 40 hours a week.
- Off week ends
- Patient nurse ratio.
- Job description.
- Increase axially nurse.

2) Individual intervention:
- There nurse should know his limitation.
- Nurse must accept their inability to meet some patients needs, their irritation at certain
patients, decrease realistic self expectations, and use their work group as a support
group.
- Humor, money prestige, autonomy, the ability to effect change, power, and adventure
may all be considered.
- External reward.
- Increase motivation level.
- Increase nursing salaries, the actual costs for categorized nursing care.
-Increase power, control and autonomy.
- Nursing education.

Staffing scheduling
Definition:
Staffing is the process of assigning competent people to fill the roles designed for the
organizational structure through, recruitment, selection and development of personal.
- Staffing is the third managerial function.
- Staffing involves the selection of personal and assignment system and the
determination of staffing schedules.
- The health care industry requires many employees to accomplish its goals.
- This large work force must be composed of highly skilled, competent
professionals.
- Staffing is an important part of management because its concerned with placing
the right person in the right jobs & position. An organizational structure may be
designed on paper, but to come to life & practical application it must be staffed
with people. These efforts are referred to as staffing, which is a separation &
fundamental function to management

Purpose of staffing:
1. Assigning qualified people to appropriate jobs.
2. Assuring the adequacy of skilled staff.
3. Facilitates the achievement of organizational goals.

20
 4. Fulfill the need to supply enough staff according to standards & organizational
structure.
5. Increase job satisfaction.
6. Decrease burn – out of staff &possibility of staff turn – over & frustration.
7. Improving & maintaining the quality of care.
8. Providing for cost- effectiveness of work.

Standards for scheduling:

1. Sorting of staff:
Staff can be organized either by name or by staff type & by level of study.
2. Staff skill menageries: can run reports through the staffing & scheduling
application to list all staff whose certificates will expire soon.
3. Numbers of staff – available.
4. Budgeting capabilities: managers can compare the cost of their proposed
schedules to the funds they have in their budget.
5. Quality of services required.
6. The work load (maximum hrs).
7. Legal constraints: might include agreements about hrs, specific days of the week,
holidays weekend.
8. Setting schedules: scheduling can be centralized or decentralized for the entire
health care organization.

Methods of staffing schedules:

A. Decentralized staffing :
Definition: schedule done by manager units.
** In organizations with de-centralized staffing the unite manager is responsible for:
- Covering all scheduled staff absences.
- Reducing staff during period of decreased pt. census or acuity.
- Adding staff during high patient census.
- Preparing monthly unite schedules.
- Preparing holiday & vacation schedule.
** The advantages are:
1. Personnel feel that they get more personalized attention.
2. Mutual trust – head nurse & employee
3. Supervisors & charge nurses are freed from staffing responsibilities & have more
time for other tasks.
4. Nurse Manager learns their responsibilities of staff.
5. Staffing is easier & less complicated when done for a small area.
6. Nurse Manager can better respond to the needs of the unit & her staff.

** The disadvantages are:

- Work schedules can be used as a reward - punishment system by nurse manager.
- Time consuming for nurse manager.
- Employees will be treated unequally or inconsistently which may result in a
negative staff reaction.

21
 B. Centralized scheduling:
Definition: organization with centralized staffing use one individual or a computer to do
the staffing and scheduling duties for all units.
** The advantage:
1. Better utilization of human resources.
2. Fairness to employee's impartial application of policies.
3. Relieves nurse managers from time consuming duties.
** The disadvantages are:
- Lack of individual RX of employees.
- Confusion over responsibility & authority when staffing officer make decisions
for which nurse manager is accountable.
Scheduling options:
1. Alternating or rotating work shifts:
- Creates stress for staff nurses.
- Change in a sleep cycle.
- Affect the social & reaction activities.
- Affect quality of their work & their health.

Permanent skills:
- Relieve nurses from stress & health related problems associated with alternating
& rotating shifts.
- They also provide social, educational, psychological advantage.
- Sense of belonging to their shifts is developed.
- Good work & good feeling … job satisfaction.
- Easier to evaluate.

C. Block or cyclical scheduling:

Uses the same schedule repeatedly personal are scheduled repeatedly, personal are
scheduled to work 6 successive days followed by at least 2 day off. The schedules
repeated every 6 wk.
** Advantage:
1. Personal can plan for their life.
2. Decrease absence due to social events.
3. Stable work groups, decrease floating, thus promoting team spirit & continuity of
care.

Variables affecting staffing:

- The type of pt., their expectations, fluctuation in admission, length of stay , &
complexity of care complicate staffing .
- Personal policies, educational & experiential level of staff, job description, the
mix of work titles or leveling, hr & rotation policies, absenteeism & the
competitive market also affect staffing.
- Environmental factors, such as, numbers of pt .s beds, availability of supplies &
equipments the organizational structure & support service from other departments
& agencies are also considered when planning staffing patterns.

22
* Staff development:
- The better trained the staff, the less numbers required.
- Staff development then is cost-effectiveness in increasing productivity.
- Education & training are two component of staff development that & may occur
either within or outside the organization.

You must make assignment according to:

1. Primary method schedule.
2. Functional method.
3. Team method.
4. Case method.

A. Primary method:
One nurse assigned for one to three patient. (new cases ) , and make care plan for 24
hour for them and still responsibility about them in the home and follow any changes in
this cases .
*disadvantages:
- Economical.
- Under stress.
** Advantages:
- Each nurse responsible about all care of the patient.
Head nurse makes delegations

B. Functional method:
Distribution student according to the task present in the assigned department for e.g. IV
therapy for Mosa, supplies for Akram , & X ray for Layla .
* Advantages:
- Specific tasks for specific nurse
- Everyone have the same chance.
* Disadvantage: No experience.

C. Team method :
Distribution the student according in team groups to work together in the assigned area
and assigned task.

D. Case method :
Distribute every for student for one case responsible about this on duty only. This may
be used in closed area closed areas e.g. ICU, nursery, cardiac surgery…etc.

(Shifting report)
1_ General report method:
On duty Nurse together with coming nurse are talking about the department and the
patients in general statements.

23
 2-Case report method:
On duty nurse with coming nurses go to assigned room &patients and discusses every
case separately.
3- Group report method:
All nurses in the assigned department make a conversation about department, patients,
admissions, & discharge patients...etc. , and this may be done in corridors.

Important points regarding shifting report (be alert for the following patient's information):
1. General notes about the dept.
2. Name of patients in the department.
3. Diagnosis of patients.
4. Medication of patients.
5. Date of admission.
6. Important Changes of case.
7. Operations or surgical interventions.
8. If there is specific procedures or not.
9. Type of diet.
10.Laboratory tests done (normal or abnormal)
11.Present of allergies or not.
12.Prognosis of specific cases.
13.Specific Past history.

Clinical hospital forms needed for a management nurse in clinical area (appendix: 8)
1. Graphic sheet.
2. Order sheet.
3. Follow up sheet.
4. Medication sheet.
5. Nursing note sheet.
6. Consent form for operations and others procedure like CT , MRI
7. Preparation for operation sheet.
8. Cardex.
9. Medication tickets. (Yellow 2 time green 3 times blue 4 times, red for IV)
10.Laboratory test form. (CBC, chemistry, serology, cultures)
11.X ray sheet, ultrasound sheet, CT sheet, MRI sheet.
12.Culture and sensitivity sheet (urine, blood, pus.. etc .)
13.Biopsy sheet, autopsy sheet.
14.Milk order sheet.
15.Medication order sheet.
16.Diet order sheet.( liquid, soft , regular)
17.Blood order sheet. (Whole blood, plasma, packed RBCs).
18.Admission sheet.
19.Central supply sheet.
20.Report sheet (regular or incidence).
21.Laundry sheet.
22.Repair of errors sheet.
23.Death certificate sheet.

24
 24.Triage form sheet. (green, yellow , red, & black)

Daily orders for a department:

1. central supply (bandage , catheter , gauze )
2. Laundry supply.
3. medications (daily use)
4. Intravenous fluids.
5. Laboratory orders (urine cups, blood tubes, cultural tubes )
6. Diet order (soft, planed, diabetic...etc )
7. Miscellaneous orders.

Important points when doing monthly schedule:

1. Be alert for the following items to do correct schedule fairly.
2. "Head nurse is the top manager must be straight morning with one vacation
weekly
3. Every nurse must have one vacation day in the week at least.
4. Register nurse must not work together without practical nurse.
5. Don’t let practical nurse to work alone.
6. You may increase the number of staff in the morning shift daily except in Friday.
7. Every nurse can work night duty from one to three times weekly.
8. Nurse must take off day after night duties.
9. It is preferred for a nurse to work evening shift return after night days
10.When return from off days after night duties preferred to work evening duty and
not morning duty.
11.Be fair when distributing the vacations between nurses especially Friday.
12.Night duties must be equal for all nurses in the schedule.
13.It is preferred that’s night duties are between 6 to 8 times monthly.
14.Total hours by the end of schedule for all nurses may be between around (170
hours.
15.You can use two days as feast days when emergency exist.
16.Double shift is prohibited.
17.Registered or practical nurses must not work separately without other levels of
nurses
18.A symbol = Morning
19.B symbol = Evening
20.C or N symbol = Night

Manager student considered a role model:

Manager student must be a role model for other students by the following:
1. Punctual (on time , in work ,tag name , uniform …etc )
2. Assertive: (openness, directness, spontaneous, appropriateness).
3. Emotionally stable: must be quite calm with angry ones and simple with anxious
ones and interested with depressed ones.
4. Be initiative: go to tasks and not waiting for it to come.
5. Quick motion "responsive for all events" present in the assigned areas all the time
of hid duty.

25
6. Has a Sharp vision: Expert in science practice "especially when dealing with
subordinators.
7. Not to be ego centric.
8. Has a unique personality. " not to be a follower "
9. Respect other's opinions, until the degree permitted by legislations of the
institution.

26
 APPENDICES

No. Appendix Subject

1. Appendix ( 1) Examples of Gaza hospitals philosophies

2. Appendix (2) Clinical Assignment Sheet
3. Appendix (3) Monthly schedule
4. Appendix (4) Some Hierarchies of Hospitals
5. Appendix (5) Daily Nursing Report
6. Appendix (6) Management Report
7. Appendix: (7) INCIDENCE REPORT
8. Appendix (8) Clinical Hospital Forms

27
 Appendix (1)
Examples of Gaza hospitals philosophies

Philosophy of El-Awda Hospital

Union of health work committees deeply believes in basic human value and the
individual's right to live in dignity and safety.
Our slogan "is health services and an essential right of whoever needs them".
We hold this to be true for all, regardless of religion, race at political affiliation. Every
aspect of our work is aimed at developing a comprehensive Palestinian health system
based on primary health care principles and concentrating on promoting community
awareness. As an organization we cooperate and coordinate with other health services
providers whether it is governmental or nongovernmental. In addition we stress the vital
role of institutional development in the technical and administrative field so that we can
have a democratic Palestinian state based on the principles of equality and social justice.

Critiquing of El-Awda Hospital:

El-Awda Hospital deeply believes that human being are unique, due to deferent
genetic endowment, personal experiences in social and physical environmental, and the
ability to adapt biophysical, psychosocial, and spiritual stressor, thus each clients are
considered to be a unique individuals with unique needs, and believes in basic human
values and the individual's right to live dignity and safety.
The institution believes that the health services are an essential right of whoever needs
them, and we hold this to be true for all regardless of religion, race of political
affiliation.

Every department in the institution aimed to developing a comprehensive Palestinian

and concentrating on promoting community awareness.
And we believes that necessarily to giving a care for every client from northern of Gaza
strip transferred from governmental or nongovernmental institution and to take other
medical and surgical services to any one need it.
This institution believes that the nursing is the diagnosis and treatment of human
response to actual or potential health problems, and believes to giving a chance for
student and volunteers to practice part of studying and the institution believes that the
nursing are represent an important occupation in hospital.

28
 ‫فلسفة مستشفى األطفال ( النصـــر)‬

‫إن فلسفة مستشفى النصر لألطفال تنسجم مع فلسفة المؤسسة المنبثقة عن فلسفة وزارة الصحة وتنص على تقديم‬
‫رعاية صحية لجميع األطفال المرضى بما يتناسب مع القيم والمبادئ اإلسالمية واالجتماعية وبما يتماشي مع‬
‫القوانين واألعراف الدولية وبما يتناسب مع اإلمكانيات المتاحة‪.‬‬

‫تعديل فلسفة مستشفى النصر لألطفال‪:‬‬

‫تؤمن إدارة مستشفى النصر لألطفال بقيمة اإلنسان وبحقه في العيش بكرامة وأمان وكما تؤمن بالمساواة‬
‫وعدم التمييز بين اإلنسان ال على أساس اللون أو الدين أو الجنس وغن الخدمة الصحية حق لكل طفل يحتاج لهذه‬
‫الخدمة بما يتناسب مع القيم والمبادئ اإلسالمية واالجتماعية وبما يتناسب مع اإلمكانيات المتاحة‪.‬‬
‫كما تؤمن هذه المؤسسة أنه من حق أي طفل ما بين عمر صفر إلى ‪ 12‬سنة من سكان قطاع غزة بتلقي خدمة‬
‫طبية وتمريضية حسنة وجيدة بأعلى المستويات التي تستطيع أن تقدمها المستشفى للمرضى أو الزوار والسعي‬
‫كذلك على االتصال والتواصل مع المؤسسات األخرى لتقديم أعلى وأجود أنواع الخدمات الصحية المقدمة‬
‫للمرضى والسعي إلى تطوير الكوادر الطبية الموجودة في داخل المستشفى للوصول بهم إلى أعلى مستويات‬
‫الكفاءات لتقديم أفضل عناية ممكنة للمرضى‪.‬‬
‫كما تؤمن المستشفى بأن الخدمات المقدمة من قبل الطاقم الطبي والتمريضي تعكس بشكل مباشر مدى جودة‬
‫العناية المقدمة للفئة المستهدفة من األطفال للوصول بهم إلى أفضل وضع صحي ممكن وفي حدود اإلمكانيات‬
‫المتاحة وكذلك في حدود التخصصات المتوفرة لدنيا وكما نؤمن بأن التمريض هو العمود الفقري لهذه المؤسسة‬
‫الصحية ونؤمن أن التمريض هو الذي يقدم لألطفال بغرض مساعدتهم على االحتفاظ بحالتهم الطبيعية بأكمل وجه‬
‫أو مساعدتهم لتخفيف اآلالم والمشاكل الصحية والعضوية أو وقايتهم من المرض والمصادر المؤدية إلى‬
‫األمراض أو المساعدة في التشخيص والعالج والوقاية من حدوث مضاعفات‪.‬‬
‫كما وتؤمن بلزوم توفير فرص لتعليم الطلبة من كال الجنسين نتيجة االطراد المتزايد في النقص في الطواقم‬
‫الطبية بقطاع غزة نتيجة األوضاع السياسية التي نعيش بها وتوفير فرص عمل مناسبة لهم نتيجة ذلك‪.‬‬

‫‪29‬‬
Philosophy of governmental European Gaza hospital:

The philosophy of European Gaza hospital was derived from its mission
statement & it's based upon respect for the individual's dignity, worth and we believe
that each patient admitted to the EGH is unique with unique needs and should be respect
at all times.

Person:
All patients at any age and complain of any problem (medical, surgical, obstetric,
pediatric … etc.. ) have the right to admitted to EGH to receive treatment and effective
nursing care to help restore patients to the best possible state of physical, mental and
emotional health. We believe that each patient is unique with unique needs due to
differing endowment, personal experiences in social and the ability to adapt to
biophysical, psychological and spiritual stressors.

Health:
We believe that the health is state of complete physical, psychological, spiritual and
social well being that not means absence of disease (WHO).

Environment:
We believe that environment is all circumstances surrounding and interact with it and it
should be free from hazards, quite and provide recreational state.

Nursing:
We believe that nursing is the diagnosis and treatment of human response to actual and
potential health problems, so the nursing should have scientific rational for nay care
provided to any patients and utilizing the skills of assessment, planning, implementation
and evaluation when deal with patient.

El – Wafa medical rehabilitation hospital philosophy:

30
The philosophy of El – Wafa hospital consists of:
Nursing:
We believe that nursing profession is a humanistic job. They provide rehabilitation
services for all people from all ages who needs rehabilitation care.
They deal with as a team and collaborate with other departments as physiotherapy,
occupational therapy and others.
They offer rehabilitation care to patient and family training to prevent complications.
Nursing team works as educator, researcher and provide learning and training to students
nursing from nursing collages in Palestine and physiotherapy and occupational therapy
students from Islamic, Azhar, Aqsa universities.

Health:
We believes that health of human being is very important so the hospital teams sacrifice
to protect the human and the patients physical-psychological state and prevent
deterioration in it and care for all aspects of health so if the patient is having motor or
physical disability his health to be maintained needs provision of psychotherapy, social
support., environmental adaptation and job which is suitable for his case.

Human:
We believe that individual is a human being his regarded sex, age, religion, life style or
economic status.
All human has rights to have the rehabilitation care when he is in need, El-Wafa hospital
offers rehabilitation services to Aqsa injured people without fund or financial coverage
in Aqsa intifada because human being is valuable.

Environment:
We believe that the safety of environment is very important so it provides special
containers for garbage and for sharp objects to provide safety to people.
Provide and established El-wafa garden for patients and their families to have fresh air
and good scene in the day time and during visiting hours.
Keep areas around the hospital clean to prevent accumulation of flies and contamination.

31
 Appendix (2)
‫الجامعة اإلسالمية – كلية التمريض‬

Clinical Assignment Sheet

2/5/2006 :‫التاريخ‬ Women word :‫القسم‬.Ophthalmic H :‫ المستشفى‬Third level :‫المستوى‬

No Student name Patient name & number Break time Other

assignment

1. Ahmed Ahmed Team Leader 10:30 – 11:00 am Leading dept.

2. Mohammad yaser O.P.C (examination room) 10:30 – 11:00 am Admission

3. Mazen Ateya R2/B1,Raed Doghmosh, 10:30 – 11:00 am Presentation

4. Yousef Naser O.P.C (minor Op room) 10:30 – 11:00 am Medication 12
5. Khaled Nabil R4/B3,Tarek Ashi 10:30 – 11:30 am Admission
6. Sami Waleed O.P.C (examination room) 10:30 – 11:30 am Post op. care
Feras Ahmad R4/ B2,Hadi Abo kasem 10:30 – 11:30 am Medication 12
Sami Samara R3/B2, Mazen Salama 10:30 – 11:30 am Surgeries
preparation
Each student must do holistic care and making a report for assigned clients.

Manager student: ------------------- Clinical instructor: ---------------------

32
33
appendix(3)

34
35
 Appendix (4)
Some Hierarchies of Hospitals

36
37
‫هيكلية مستشفى غزة األوروبي‬

‫‪38‬‬
 Appendix (5)
Daily Nursing Report
20\20\20 :‫ التاريخ‬....................:‫ القسم‬......................:‫ المستشفى‬.).................‫الجامعة اإلسالمية (طالب كلية التمريض المستوى‬
Client initials: …………………………. No.:…………………… Age ……………………. Sex : male. Address:
…………………………. Occupation: …………………………. Social Status: Married, Single.
Date of admission: ……………………….…….. Via: ……………………………………………………
Source of data: …………………………… Condition of arrival: Wheelchair, Walking, Stretcher.
Reason for hospitalization: ……………………………………………..…………………………………………
Confirmed diagnosis: …………………………………… Final Diagnosis: ……………………………….…………..
Past medical history
………………………………………………………………………………………………………………..
Family history
……………………………………………………………………………………………………………………….…
Allergies ( Drug , food , dyes ) : No , Yes , ( Specify ) ………………………………………………………...
Diet : Typical diet at home:………………… Prescribed diet:……………….. No. of meals: …………….
Activity:
…………………………………………………………………………………………………………………………………….
Special Nursing Notes:
……………………………………………………………………………………………………………..……………...
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………….……
Vital Signs:
Temperature
Pulse
Respiration
Blood Pressure
Other
Medications:
Date Medications Amount Route Frequency Time P.R.N. M.

Laboratory Test:
Test Patient value Test Patient value

Student Name: ……………………………………. Student Manager :……………………………………………

39
 ‫)‪Appendix (6‬‬
‫‪Management Report‬‬
‫الموضوع‪ :‬تقرير إداري عن الفترة التدريبية لطلبة المستوى الرابع من كلية التمريض بالجامعة اإلسالمية في‬
‫المرافق الصحية المختلفة‪.‬‬
‫الانطباع عن دور اإلدارة‪-:‬‬
‫اإلدارة تعتبر مجال جديد وشيء لم يسبق لنا التدريب فيها وال نعرف المزيد عنها لذا كان يتملكني شعور بالقلق‬
‫حول التدريب اإلداري على الرغم من أنني المجموعة الثالثة وأخذت انطباع من المجموعات السابقة إال أنها‬
‫طبيعة األشياء كل شيء جديد خوف يشعر به اإلنسان لكن الحمد اهلل تغلبت على هذه المرحلة االنتقالية في‬
‫حياتنا العملية وأعطيت كل ما عندي من مجهود الستفيد وأفيد وما ساعدني على تخطي هذه المرحلة أنني قمت‬
‫باالستفسار من الفرق السابقة عن طبيعة العمل‪ ,‬مما خفف من خوفي وقلقي‪ ,‬فأعطيت المجهود والتفكير نحو‬
‫األفضل‪.‬‬
‫المرشد‪-:‬‬ ‫‪.1‬‬
‫النقاط اإليجابية‬
‫يتيح لنا الفرصة في نقد الطلبة‪.‬‬
‫متعاون في بعض األحيان ‪.‬‬
‫يدع لنا المجال للتعليق على محاضرات الطلبة ثم يبدي رأيه‪.‬‬
‫ترك لنا المجال في اليوم األول من التدريب لطرح منهجية العمل‪.‬‬
‫بين لنا بعض المسائل اإلدارية على سبيل المثال وضح لنا ماهية مهام اإلدارة ومهام القيادة‪.‬‬
‫كان يشاركنا في اتخاذ القرار على سبيل المثال‪ ,‬في اختيار المحاضرات‪.‬‬
‫كان يتعامل معنا كأنه أخاً لنا ويستمع لنا في حل مشاكلنا‪.‬‬
‫النقاط السلبية‬
‫كان يتدخل في مهامنا اإلدارية ‪,‬مثال ذلك االعتراض على توزيع العمل على الرغم من صحته‪.‬‬
‫كان يوجه لنا انتقاده أمام الطلبة مما كان يسبب اإلحراج لنا‪.‬‬
‫منعنا من عمل ‪ orientation‬للطلبة وادعى أن هذا مضيعة للوقت‪.‬‬
‫كان يعطي إذن للطلبة من دون الرجوع لنا كطلبة إدارة‪.‬‬
‫الطلبة‪-:‬‬ ‫‪.2‬‬
‫*محمد‪-:‬‬
‫النقاط اإليجابية‬
‫كان ملتزم بالزي العملي وميعاد الحضور واالنصراف‪.‬‬
‫متعاون معنا كطالب إدارة‪.‬‬
‫لديه معلومات جيدة بحيث أنه يجيب عند السؤال‪.‬‬
‫يسأل عن تشخيص بعض األمراض الغامضة‪.‬‬

‫‪40‬‬
 ‫يحفظ المعلومات الخاصة عن حالة معينه حتى لو مر عليها فتره من التدريب‪.‬‬
‫النقاط السلبية‬
‫يخاف من التعامل مع بعض الحاالت الصعبة (المعدية)‪.‬‬ ‫‪-‬‬
‫بطيء جدا في أداء العمل المطلوب منه‪.‬‬ ‫‪-‬‬
‫ليس لديه دوافع لتعليم الرجال حول طرق الوقاية من المرض‪.‬‬ ‫‪-‬‬
‫الحلول المقترحة‪-:‬‬
‫نحاول الوقوف معه ونذكره بتعليم الرجال دائما أينما ذهب بطرق الوقاية من المرض ونتيح له الفرصة في‬
‫تطبيق العمل‪.‬‬
‫محاولة تحفيزه وتشجيعه لتقوم بزيادة نشاطه‪.‬‬
‫محاولة متابعته وسؤاله في كل مرة عن إرشاداته‪.‬‬
‫إعطائه دوافع وحوافز حتى يحاول انجاز عمله بنفسه في كل مره بزيادة عنصر مكتوم داخله‪.‬‬
‫*ياسر‪-:‬‬
‫النقاط اإليجابية‬
‫متعاون إلى حد ما‪.‬‬
‫كان يكتب مالحظات التمريض بشكل جيد‪.‬‬
‫كان يعطي تقرير كامل عن المريض الموكل له‪.‬‬
‫النقاط السلبية‬
‫كان يتأخر بالحضور صباحاً‪.‬‬
‫يتهرب من أداء العمل المطلوب منه‪.‬‬
‫كان ال يتقبل النقد والنصائح في بعض األحيان‪.‬‬
‫يعترض على توزيع العمل أحيانا‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫تنبيهه إلى ضرورة عدم التأخير في المرة القادمة والعقوبة المترتبة على تأخره أكثر من مرة‪.‬‬
‫مراقبته بحيث نشعره بمراقبتنا والتأكيد على ضرورة انجاز عمله بأكمل وجه‪.‬‬
‫إذا وجدنا أي طريقه من االعتراض والمقاومة نترك المسؤولية إلى المعلم‪.‬‬
‫*خالد‪-:‬‬
‫النقاط اإليجابية‬
‫ملتزم بالزي العام‪.‬‬
‫متعاون إلى حد ضئيل جدا‪.‬‬
‫بجيب عن السؤال عند استفساره في بعض األحيان‪.‬‬
‫بطلب المساعدة منا إذا واجه صعوبة في انجاز عمل ما‪.‬‬
‫النقاط السلبية‬

‫‪41‬‬
 ‫كان غالبا يتأخر في ميعاد الحضور صباحا‪.‬‬
‫يعترض على توزيع العمل في بعض األحيان‪.‬‬
‫ال يتقبل النقد بشكل ايجابي‪.‬‬
‫ال يؤدي ما يطلب منه على أكمل وجه‪.‬‬
‫غير متعاون مع زمالئه‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫تنبيهه إلى ضرورة عدم التأخير في المرة القادمة وأخباره بالعقوبة المترتبة على تأخره أكثر من مرة‪.‬‬
‫معاملته دبلوماسيا بحيث إخباره أن توزيع العمل من واجبه تطبيقه وان هذا يكسبه مهارات وال يضر به‪.‬‬
‫مناقشته حول أهمية التعاون مع زمالئه وحل مشكلته‪.‬‬
‫*سامي‪-:‬‬
‫النقاط اإليجابية‬
‫يلتزم بميعاد الحضور واالنصراف‪.‬‬
‫ملتزم بالزي العام‪.‬‬
‫متعاون في بعض األحيان‪.‬‬
‫نشيط في أداء العمل المطلوب منه‪.‬‬
‫النقاط السلبية‬
‫يتعصب لرأيه أحيانا‪.‬‬
‫كان ال يتقبل النقد‪.‬‬
‫ال يتقبل إلقاء عليه واجب عملي في حين يعتقد انه أمر‪.‬‬
‫يضع نفسه أحيانا موضع القائد على زمالئه‪ ،‬مما كان يسبب بعض الحساسية لدى الطالب‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫إعالمه أن ما نقوم به هو من واجبنا كما أنه سيمر بهذه المرحلة وسيرى الواجبات ومصداقية العمل‪.‬‬
‫نترك له المجال لتمييز بين واجبنا وواجبه ثم نخبره عن واجباتنا وواجباته‪.‬‬
‫رئيس القسم ‪-:‬‬ ‫‪.3‬‬
‫النقاط اإليجابية‬
‫متعاون إلى حد ما‪.‬‬
‫قام بشرح الطلبيات مثل طلبية األدوية والحليب والغذاء ‪ ...‬الخ‪.‬‬
‫كان يترك لنا المجال لتطبيق الجانب العملي من اإلدارة‪.‬‬
‫كان يجيب عن استفساراتنا حول ما نجهله‪.‬‬
‫النقاط السلبية‬
‫كان يؤكد لنا على حبه العمل بما يقوم به لوحده في الطلبيات الخاصة بالقسم‪.‬‬
‫الحلول المقترحة‪-:‬‬

‫‪42‬‬
 ‫نؤكد له على ضرورة اخذ حقنا وواجبنا كطالبات إدارة وقيادة‪.‬‬
‫معاملته بأسلوب لبق بحيث يكون تعلمي تحت إشرافه‪.‬‬
‫تمريض القسم‪-:‬‬
‫النقاط اإليجابية‬ ‫‪.4‬‬
‫متعاونين ويحاولوا مساعدتنا في األمور التي نجهلها‪.‬‬
‫يحترموا بعضهم البعض أحيانا‪.‬‬
‫كان بينهم روح األخوة والزمالة‪.‬‬
‫كانوا يتعاملون بيدا واحد وروح واحده‪.‬‬
‫النقاط السلبية‬
‫كان الممرضين ال يهتموا بغسل اليدين بين كل مريض خاصة في قسم الحضانة‪.‬‬
‫كانوا ال يهتموا بالتعقيم عند التعامل مع المريض‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫إعطاء نشرات ملزمة لكل الممرضين من الجهات العليا الستخدام التعقيم وغسل اليدين والمحافظة على النظافة‬
‫بإلزام من رئيس القسم لتطبيقها‪.‬‬
‫األطبـاء‪-:‬‬ ‫‪.5‬‬
‫النقاط اإليجابية‬
‫يقوموا بشرح التشخيص والعالج للطلبة في اغلب األوقات‪.‬‬
‫كانوا يلتزموا في موعد المرور الطبي‪.‬‬
‫يقدموا االستشارة لبعضهم البعض في بعض األحيان‪.‬‬
‫النقاط السلبية‬
‫يقوموا بالتدخين داخل القسم وحول المرضى بالرغم من أن المرضى أطفال‪.‬‬
‫ليقوموا بتوضيح طبيعة المرض لألهل المرضى‪.‬‬
‫األمر الذي يعطيه الطبيب ال يكون واضحا خطيا لذلك يصعب قراءته‪.‬‬
‫متابعة المرضى يكون غير دقيق ويفضلوا عمل خروج للمريض‪.‬‬
‫الحظت عدم انسجام بين بعض الطبيبات والطاقم التمريضي‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫تذكير األطباء بضرورة عدم التدخين وتعزيز فكرة انه قدوة وبصفة مهنته يجب عليه أن يمتنع عن التدخين‪.‬‬
‫لعل الذكرى تنفع المؤمنين لذلك يجب علينا تذكير األطباء بضرورة اإلخالص بالعمل ومراقبة اهلل وان مابين‬
‫أيديهم هي أرواح خلقها اهلل ووضعها بأيديهم وأيدينا أمانه لنرعاها والراعي هو اهلل‪.‬‬
‫المرضى‪-:‬‬ ‫‪.6‬‬
‫كان تدريبي العملي في مستشفى النصر لألطفال لذلك تعاملت مع أمهات المرضى مباشرة‪.‬‬
‫النقاط اإليجابية‬

‫‪43‬‬
 ‫متعاونات أثناء العمل التمريضي‪.‬‬
‫يثنون على العمل التمريضي‪.‬‬
‫يحبون معرفة طبيعة مرض ابنهم‪.‬‬
‫يتقبلون النصائح التمريضية ويستفسروا عما يجهلن‪.‬‬
‫النقاط السلبية‬
‫كان بعضهن يعترض على عمل الطالبات‪.‬‬
‫يفتقرون إلى عنصر الترتيب مثال ذلك كثرة تراكم األغراض على سرير الطفل وعلى الخزانة المجاورة ‪.‬‬
‫يقوموا بغسل مالبس أطفالهن ووضعها في أماكن غير الئقة لتنشيفها‪.‬مثل وضع المالبس على شباك الغرفة وعلى‬
‫شجر المستشفى عند ممر الناس مما يبدي منظر غير الئق‪.‬‬
‫ال يهتمون بنظافة أطفالهن مما يؤدي إلى ظهور رائحة لألطفال وتكون غير مستساغة‪.‬‬
‫غالبا ما يطلبن من األطباء بإخراج الحالة على عاتقهن الشخصي‪.‬‬
‫بعضهن يجهلن طرق التغذية السليمة لطفل وطرق الوقاية من المرض‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫توجيه السيدات إلى ضرورة المحافظة على نظافة المكان وذكر ايجابيات النظافة وتأثيرها إيجابا على صحة‬
‫أطفالهن‪.‬‬
‫أنصح السيدات بعدم غسل المالبس ووضعها في أماكن من الممكن أن تؤثر على صحة الطفل وخاصة من ذوي‬
‫األمراض الصدرية‪.‬‬
‫عمل حملة تثقيف صحية عن طرق التغذية السليمة وطرق الوقاية من األمراض‪.‬‬
‫عمل لوحات تثقيفية داخل كل غرفة مريض لزيادة ثقافة السيدات‪.‬‬
‫إعطاء فكرة لكل سيدة حول أهمية التمريض وتغير النظرة حول الطالبات بعمل ‪ teaching‬لكل سيده من قبل‬
‫الطالبات‪.‬‬
‫نصح السيدات بعدم إهمال نظافة أطفالهن‪.‬‬

‫الزوار‪-:‬‬ ‫‪.7‬‬
‫النقاط اإليجابية‬
‫يلتزمون بميعاد الزيارة والمغادرة‪.‬‬
‫يهتمون بالسؤال عن أطفالهم وعن حالتهم الصحية‪.‬‬
‫النقاط السلبية‬
‫*لم أالحظ أي نقاط سلبية‪.‬‬
‫إدارة المستشفى‪-:‬‬ ‫‪.8‬‬
‫النقاط اإليجابية‬
‫النظافة ‪-:‬‬

‫‪44‬‬
 ‫النظافة في المستشفى بشكل عام جيدة‪.‬‬
‫كان عامل النظافة باستمرار يقوم بتنظيف القسم‪.‬‬
‫رئيس قسم الحضانة قام بطلب تنظيف شامل للحضانة الداخلية‪.‬‬
‫الكهرباء‪-:‬‬
‫اإلضاءة جيدة في جميع األقسام‪.‬‬
‫المياه‪-:‬‬
‫وجود المياه بشكل مستمر في القسم‪.‬‬
‫وجود جهاز تحليه للمياه صحية في كل قسم يستخدمه كال من الطاقم الصحي والمرضى‪.‬‬
‫النقاط السلبية‬
‫النظافة‪-:‬‬
‫غالبا تكون مواد التنظيف لها رائحة كريها وغير مقبولة‪.‬‬
‫وجود ظاهرة الصراصير بالقسم وفي ‪ incubator‬الخاص بالطفل‪.‬‬
‫تناول الممرضون طعام اإلفطار على مكتب التمريض وعلى أوراق تابعة للقسم‪.‬‬
‫الكهرباء‪-:‬‬
‫تحتاج بعض مصابيح اإلضاءة إلى صيانة‪.‬‬
‫الحلول المقترحة‪-:‬‬
‫طلب صيانة من الجهات العليا‪.‬‬
‫مناقشة موضوع تناول طعام في اإلفطار في مكان خاص للطعام بحيث يتم توفير كافي خاص للتمريض لتناول‬
‫الطعام في كل قسم‪.‬‬
‫إعادة صيانة لبعض المناطق التي تكون هدفا لمخبأ الحشرات‪.‬‬
‫طلب مبيدات حشرية تكون فعالة في حالة عدم وجود مرضى بالقسم وإ عادة ترميم وتنظيف المكان‪.‬‬
‫تنبيه العاملين وتشجيعهم على أن يحافظوا على استمرارية نظافة المكان‪.‬‬
‫طلب مواد تنظيف ذات رائحة جيدة ووجود معطر لتنظيف القسم وانتقائه بحيث ال يضر بصحة األطفال‪.‬‬
‫إدارة األقسام‪-:‬‬ ‫‪.9‬‬
‫النقاط اإليجابية‬
‫يوجد تعاون بين األقسام بشكل مستمر‬
‫يوجد عالقة بين التمريض واألطباء مبنية على أساس المحبة والتفاهم‬
‫متوفر بالقسم جميع األوراق األزمة للعمل‬
‫يوجد مشاورة مابين التمريض ورئيس القسم واتفاق مابين تبادل األدوار في تقسيم العمل‬
‫النقاط السلبية‬
‫قلة عدد الشراشف المتوفرة باألقسام‬
‫بعض األدوات باألقسام تحتاج إلى صيانة وتغيير‬

‫‪45‬‬
 ‫عدم توفر عدد كافي من الممرضين‬
‫عدم توفر عدد كافي من أدوات الغيار ومستلزماته‬
‫قلة وجود غرف خاصة للغيار وللطعام‬
‫عدم نظافة غرفة الغيار‬
‫تناول الطعام في غرف الغيار‬
‫الحلول المقترحة‪-:‬‬
‫طلب توظيف عدد من التمريض يناسب احتياج المستشفى او القسم‬
‫توفير غرف خاصة للطعام والغيار‪.‬‬
‫توفير إمكانية وجود عدد كافي من األدوات خاصة عند الطوارئ‬
‫طلب ملح للنظافة وتخصيص المكان المناسب للطعام‬

‫انتهى التقرير‬

‫‪46‬‬
 Appendix: (7)
INCIDENCE REPORT

Master / head nurse of pediatric department in El. Naser hospital

By clinical instructor y y

From manager student nursing in four level.

Name: x x

Student nurse in the Islamic university

El.Naser hospital

Department III

Date: Wednesday- 25/3/2009

Time: 12:00 pm

47
Topic: mistake when preparing medication
At 12 pm in the el Naser hospital in III department student in the third level prepare the
medication for patient in room (6) the student prepare IV medication after preparing
aspirated with syringe label and write name of patient and room and dosage of
medication, after that I checked the medication in the chart and what the student prepare
I found the doctor order is oral medication for a patient not IV medication and ask the
head nurse about type of medication she sell me this order tablet medication after take
the medication and throw it .
Take the student to distribution the medicine without affect of student during give to
patient medication after finish of distribution the medication talk with student about
event and teaching it should be reading the other in the chart and when not sure for order
should ask the head nurse about it .
The occurrence of these events was in front of student M. & student L. (witnesses
persons)
Decision: the student who made the mistake converted to clinical department in
the faculty of nursing

Manager student: xx clinical instructor: yy

Signature: ------------------- Signature: -------------------

1. Appendix (8) Clinical Hospital Forms

The end
February 2011

48