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• …or evaluating is an on-going function of management which occurs during planning, organizing and directing activities. • …is the management function in which performance is measured and corrective action is taken to ensure the accomplishments of organizational goals CONTROL MEASURES Standards …general guide to provide a framework for nurse managers or administrators. The responsibilities and expectations of the nurse are embodied in these standards. Standard I …the division of nursing has a philosophy and structure that ensure the delivery of high-quality nursing care. Standard II …the division of nursing is administered by a qualified nurse executive who is a member of a corporate administration. Standard III …policies and practices of the division of nursing provide for equality and continuity of nursing services that recognize cultural, economic, and social differences among patients of health care organization. Standard IV …the division of nursing ensures that the nursing process is used to design and to provide nursing care to meet the individual needs of patients/clients in the context of their families. Standard V …the division of nursing ensures the development of educational programs to support the delivery of high-quality nursing care. Standard VI …the division of nursing initiates, utilizes, and participates in research studies or projects for the improvement of patient care. Reasons for conducting Evaluation 1. Ensures that quality nursing care is provided. 2. Allows for the setting of sensible objectives and ensures compliance with them. 3. Provides standards for establishing comparisons. 4. Promotes visibility and a means for employees to monitor their own performance. 5. Highlights problems related to quality care and determines the areas that require priority attention. 6. Provides an indication of the costs of poor quality. 7. Justifies the use of resources 8. Provides feedback for improvement. Evaluation Principles 1. Must be based on the behavioral standards of performance which the position requires. 2. Enough time should be spent to observe employee’s behavior. Usual and consistent behavior should be evaluated. 3. Employee should be given a copy of the job description, performance standards and evaluation form before the scheduled evaluation conference. 4. Performance appraisal should include both satisfactory and unsatisfactory results with specific behavioral instances.
Establishment of standards. 2. 1. PRINCIPLES OF CONTROL Controlling aims to verify whether activities and performances of employees are in conformity with the plans of the organization. 3. sound implementation strategy. measurement and evaluation. In attempting to control others. individuals themselves provide their superior with the information that will be used to evaluate their performance. an individual may impose new requirements on them. an individual may drive out “unmeasured (and unrewarded) behavior 3. Focusing on specific and measurable aspects of the job in giving feedback to . to modify the information. control and Improvement. 7. In this situation. good planning. Validity – refers to the relevancy of the measurement to the performance of the employee. principles and practices. Doing so leads to counter measures by the controllee. Principle of “measured behavior” drives out “unmeasured behavior” . or even to seek substitute for the desired action. Principle of “setting the fox to watch the henhouse”. either to avoid this control. Comparison of results of performance with standards and objectives and identifying strengths and areas for correction and / or improvement. The means of good performance and management includes leadership and commitment. Measurement of actual performance. The controlling process opens opportunities for improvement and comparing performance against set standards. 3. and methods for measuring performance. full employee involvement. 6. Basic components of the Control Process 1. and 5.a control process in which employee’s performance is evaluated against standards. Action to reinforce strengths or successes. Structure evaluation report and conference in such a way that it is perceived and accepted positively as a means of improving job performance. Characteristics of an evaluation tool: 1. Prioritize areas needing improvement to help the worker upgrade his performance.5. Sensitivity – means that the instrument can measure fine lines of differences among the criteria being measured. PERFORMANCE APPRAISAL . 2. Objectivity – means that the evaluation tool is free from bias. Principle of “paradox of control”. It provides information about how well processes and people function so they can be motivated to perform better in the future. 2. 4. Scheduled and conduct evaluation conference at a convenient time for the rater and the employee under evaluation. and the achievement and sustenance of standards of excellence. Reliability – refers to the accuracy or precision of the tool such that it will produce the same results if administered twice. Implementation of corrective action as necessary. objectives. 4.
Concentration on the strengths and 7.1. 4. 8. Essay – the appraiser writes a paragraph or more about the worker’s strengths. Understanding the process and effective utilization of procedure by the rater. 2. Determine training and development needs of employees. 3. 2. Checklist –a compilation of all nursing performances expected of a worker. Provision for initiating preventive and corrective action and making adjustments to improve performance. and 11. Rating Scale – includes a series of items representing the different tasks or activities in the nurse’s job description or the absence or presence of desired behaviors and the extent to which these are possessed. 7. Select qualified individuals for promotion or transfer. Direct application of the rated performance to performance standards and objectives expected of the worker. 5. Improve communication between supervisors and employees and reach an understanding on the objectives of the job. 4. Identify unsatisfactory employees for demotion or termination. Determine salary standards and merit increases. Discover the aspirations of employees and reconcile these with the goals of the institution. 6. improving. 3. 5. Improve the performance of work groups by examining. Anecdotal Recording – describes the nurse’s experience with a group or a person. 3. Rating of each individual by the immediate supervisor . 4. weakness and potentials 2. correcting interrelationships between members. 10. 5. Encouragement of feedback from the rated employees about their performance needs and interests. and how. The Anecdotal record should include: – A description of the particular occasion. mark appropriate column whether the worker does or does not show the desired behavior. Forced-Choice Comparison – the evaluator is asked to choose the statement that best describes the nurse being evaluated. 8. Make inventories of talents within the institution. Compatibility between the criteria for individual evaluation and organization goals. Methods of Measuring Performance 1. – A delineation of the behavior noted including answers to the questions who. Ranking – the evaluator ranks the employees according to how he fared with co-workers with respect to certain aspects of performance or qualifications. what. Factors contributing to an Effective Performance Appraisal System 6. Provide “employee recognition” for accomplishment. when. Establish standards of supervisory performance. 6. why. weaknesses to improve individual performance. and – The evaluator’s opinion or assessment of the incident or behavior 1. 9. Inform employees “where they stand”. Development of behavioral expectations which have been mutually agreed upon by both the rater and the worker. or in validating technical skills and interpersonal relationships.
The performance appraisal information should be shared with the employee who should have the opportunity to respond in writing.). evaluated through review of charts and questionnaires sent to patients Peer Review • Peer evaluates the performance of job based on accepted standards Quality Circles • Group of workers meet voluntarily to identify. 3. observation of patient care given is done and observation of the effect of nursing care done • Retrospective Patient Care Audit: for discharged patients. There should be a mechanism by which an employee can appeal the results of the performance appraisal. maintenance and assurance of high quality care for patients which includes assessment of patient care and correction of problems identified. • Describes all activities related to the establishment. NURSING AUDIT COMMITTEE • Patient Care Audits • Peer Review • Quality Circles Patient Care Audits • A day of observation of the activities in the ward based on process or outcome criteria • Concurrent Patient Care Audit: done while patient is still in the unit. The appraisal should be in writing and carried out at least once a year. CENTRAL TENDENCY – occurs when the evaluator is reluctant to give a true appraisal. HORNS – are essentially the opposite of the halo error and occurs when the evaluator is overly critical CONTRAST – occurs when the evaluator rates the employee opposite from the way they perceive their own abilities RECENCY – is the tendency to base the performance appraisal on recent events rather than on performance over the entire evaluation period. attitude. The evaluators should be trained on how to carry out the performance appraisal process. 5. The supervisor should have adequate opportunity to observe the employee’s job performance. . analyze and solve work related problems and recommend solutions to management QUALITY ASSURANCE • The estimation of the degree of excellence in patient health outcomes and in activity and other resource outcomes. etc. 6. Notes (critical incidents) on the employee’s performance should be kept during the entire evaluation period. COMMON ERRORS in performance evaluation HALO – results when the evaluator allows one trait to influence evaluation of other characteristics. 7. The performance appraisal process should be behaviorally-based (focusing on what the person did) rather than trait-based (focusing on personality characteristics such as initiative. 2. 4. rating all employees as average.GUIDELINES ON APPRAISING PERFORMANCE 1.
5. Principles Underlying Quality Assurance Efforts 1. • Document. Peer pressure provides the impetus to effect prescribed changes based on the results of assessment and needed improvements on the quality of care. • Treat staff members as you’d want to be treated. sharing relationships among workers instead of a feeling of threat when observed or evaluated. Peer Review 3. not favoritism. Coordinatio n is essential in planning a comprehensive quality assurance program. It perpetuates good performance and replaces unsatisfactory interventions with more effective methods. Reorganiza tion in the formal organization structure may be required if assessment reveals the need for a different pattern of health care. Factors influencing Discipline: 1. be your guide • Make staff members aware of policies and revise them as needed • Turn negative events into positive learning experience Discipline: • Rigid obedience to rules and regulations. 10. the limits and the actions and . 8. There should be focus on critical factors such as functions and activities that promise to yield the greatest health and financial benefit to reveal significant findings. The ability to achieve nursing objectives depends upon the optimal functioning of the entire nursing process and its effective monitoring. Purpose of Quality Assurance . Quality circle 4. Feedback to practitioners is essential to improve practice.• It should promote collegial and 9. • A constructive and effective means by which employees take personal responsibility for their own performance and behavior. the violation of which results in punitive actions. Collection and analysis of data should be utilized to motivate remedial action. document. Also known as self-discipline. Resource expenditure for quality assurance activities is appropriate. document! • Keep confidential information confidential. 6. approach. 2. Utilization of results 10 Tips for Success as a Nurse Manager • Take an active. Concurrent and retrospective patient care audits. All health professionals should collaborate in the effort to measure and improve care. Understanding of requirementsknow and understand ground rules. 7. • Hold employees accountable for their actions. 2. not reactive. 4. Quality patient care is accurately evaluated through adequate documentation. • Let equal treatment. Quality Assurance Methods 1. 3. • Maintain a balance between being a manager and being a friend.to assure the consumer of a specified degree of excellence through continuous measurement and evaluation. • Seek support from many sources.
conducted in an informal atmosphere to encourage employee his view of the problem. Suspension • Given after oral and written warnings • Applied when management feels that the employee can still be rehabilitated. Dismissal • Invoked only when all other disciplinary efforts have failed • Make sure that the cause for dismissal conforms with the criteria of a major discipline violation as contained in the policy manual. 3. policies. cohesion and moralestrong commitment to the objectives. • For government employees. Problem solving • Aid employees in analyzing work problems. important to obtain all relevant facts • Written warning.authority is used to enforce discipline Goals.through …More on Disciplinary Approaches Any employee charged for breach of the rules and regulations. • A review is usually done by higher management. 4. Disciplinary action • Oral warning. acceptance of approved standards of conduct. • For government employees. DISCIPLINARY APPROACHES . those contained in the Civil Service Rules and Regulations and the code of conduct. 4. positive attitudes and behavior 1.social pressures generate within a group or organization Formal sanctions. serve as counselor to personal problems 2.rests on a foundation of mutual trust and confidence (confidence of managers in their subordinates. are necessary evidences of due process. 4. Note: Accurate documentation of oral and written warnings including suspension. norms of conduct shall be given due process. identification of the rule which was violated – Consequences of continued deviant behavior – Employee's commitment to make correction – Follow up action to be taken 3. behavior that are approved and disapproved Atmosphere of confidence.2. Characteristics of Disciplinary approaches • Impartiality • Consistency • Promptness • Non. subordinates in the decisions and actions of their supervisors) Informal sanctions. this is further reviewed by respective departments and final affirmation is done by the Civil Service Commission. • There must be existing rules of conduct governing his behavior • Documentation of actual violation of such rule must support charges • Employee must be notified in writing about the violation and given the right to counsel. if done. obtain information not readily available to employees.includes: – statement of the problem.punitivenes • Fairness • Advance warning • Follow.
their dependents and authorized civilians 7. neighborhood clinics • BSN • Participates in all phases of patient care of the acutely ill. 3. Nurse is an independent contractor 4. Hospital/ Institutional Nursingnursing in hospitals and related health facilities Ex.career ladder starts with a Clinical Instructor position up to the dean of a College of Nursing 6.responsible for the school’s activities in the areas of health service. protection and supervision of workers’ health within the context of a safe and healthy work environment 5. Public Health/ Community Health Nursing. DPT.provides and delivers health care services to workers.of. health education and environmental health and safety 8.nurse acts as a receptionist. and . Nursing homes. Function is to provide comprehensive and quality nursing care to all military personnel.Nurse Corps. Occupational Health Nursing/ Industrial Nursing.undertakes to give comprehensive care to a client on a one-on-one ratio. breach of contract COLLECTIVE BARGAINING AGREEMENT DOCUMENTATION IN NURSING • • • • • • Charting Incident Report Memorandum Hospital manual Endorsement & end. Practice focuses on promotion. convalescing and ambulatory patients 2. AFP.shift report Referral of health & prevention of disease rather than care of the sick.emphasis is on promotion STAFF DEVELOPMENT THE NURSE SHOULD ENGAGE IN ACTIVITIES SUCH AS: * attending conferences seminar-workshops * in-service training programs * reading professional publications. does the billing. Nursing Education. answers phone calls. Private Duty Nursing.Reasons for dismissal from a position • Negligence • Incompetence • Malpractice • Unprofessional behavior. gives injections (BCG. School Health Nursing. Military Nursing. changes dressings. measles) & assists in physical examination Computer & Information Management • Implication to nursing education and practice Current Issues and Trends in Nursing Management CAREER PLANNING Career Path/ Classification of Field of Nursing 1. Clinic Nursing.
national & international agencies 2. Plan courses and design learning experiences – Schedules should be flexible enough that changes and additions can be made 4.composed of nursing service administrators both in government and private agencies – Initiated development of Standards of Nursing Service & Nursing Practice in 1976 4. Association of Deans of Colleges of Nursing in the Philippines.organize nurses in industrial & commercial enterprises into an Industrial Nursing Unit 7.dedicated to maintenance of high standards of objectives to standardize & broaden instruction in Public Health Nursing & to undertake that which will enhance professional growth 6.& posttests of knowledge • Professional Associations 1. Implement plans – Design curriculum – Select committee for each activity 6. Occupational Health Nurses Association of the Philippines. Set goals and define specific objectives – Should express expected outcomes 3. tapes. pre. Philippine Association of Public Health Nursing Faculty. participant satisfaction ratings. reaction sheets. elevate & maintain the standards of clinical instruction program of nursing students & to improve nursing service & facilities of the clinical fields in hospitals & public health agencies 5. Evaluate program – Did the educational activity make a difference in the knowledge. skills and attitudes of the participants – Includes diaries. Philippine Nurses’ Association – To attain level of professional standards – To work for the welfare of member nurses – To respond to the changing health needs of the Philippine society – To establish linkages with government. patient load 2. Assess needs – Changes in technology.SERVICE EDUCATION Steps in Planning: 1.unite government nurses so they can be presented well in the government 3.*engaging in other activities that will enhance his or her competencies as a nurse IN. Select resource people – Expertise & clinical competence – Model for learners – Knowledgeable about concepts of adult learning – Relates well with adult learners – Able to communicate knowledge – Starts where learners are and let them progress at their own pace – Willing to assist in evaluation process – Accepting and listening person 5. research. The National League of Government Nurses. Military Nurses Association of the Philippines (MNAP). legislation. Association of Nursing Service Administrators of the Philippines (ANSAP). inactive Membership in Professional Organizations • Alumni Associations .promote.for active.
insure maximum service to patients. maternity leaves are given? • Other benefits . promote professional development. his family & the community & assist them to use their own resources to maintain health & to acquire a healthy state of adaptation when mental illness occurs 11. RETAINING. personal growth and well. Operating Room Nurses Association of the Philippines.being of its members 10. Private Duty Nurses Association of the Philippines. Integrated Registered Nurses of the Philippines – the nurse can exercise a positive voice & be influential in addressing & articulating for a better & improved health care services & in maintaining nursing integrity CHOOSING.addresses issues of increasing private duty nurses in hospitals.does it fit the job you are applying for? • Years of experience & training– are your experiences and training relevant to what you are applying for? – Consider your age & physical condition • Emotional stability & goals in life– can you be calm under severe stress? – Do you get along well with people? – What is your primary aim in taking up nursing: for money or the satisfaction in helping people? Factors in Selecting a Job • Kind of work to be performed – Are you prepared for the job? – Can you work under stress – Do you get along well with people? • Availability of the work – Is there a shortage of workers? GUIDELINES IN CHOOSING A JOB • Hours of work – Are you rotated on shifts? – How many hours a day or week do you go on duty? • Qualifications – What are the requirements in terms of educational qualifications? – Experience? – Training? Factors in Selecting a Job • Opportunities for advancement – What chances do you have of being promoted after several years of employment? – Will be allowed to pursue continuing education? • Method of entering – Do you need an examination to enter? – Do you need someone to recommend you? • Earnings – How much is the initial salary? – Is salary paid weekly or every 15 days? • Fringe benefits – How many days of vacation & sick.a nurse can interact & assist the individual. Psychiatric Nursing Specialists Foundation of the Philippines. provision of definite policy guidelines in employment.and retired Nurse Corps officers of the AFP 8.committed to improvement of OR management technique & facilities. uniformity in rate & pay 9. RESIGNING & DISMISSAL FROM A POSITION GUIDELINES IN CHOOSING A JOB • Qualifications. Catholic Nurses Guild – Promote spiritual welfare of nurses & those under their care – strive to advance in professional & technical competence 12.
retirement benefits provided for? LETTER OF APPLICATION Pointers in making a Letter of Application • Use clean. unlined paper • Use ink or ball pen in writing • Use proper salutation • Write in a courteous manner • Enclose return postage Contents of Letter of Application • 1st paragraph. regulations and job descriptions are communicated to the newly employed nurse. medicare. potential as a working place – Philosophy & objectives – Working conditions 1. try to fit the job to a promising client 3. ball pen) • Ask questions about the job • Thank interviewer for giving you some of his time • Give yourself time to think about the position • Write a follow. ORIENTATION --.up letter if prospective employer does not answer your call 3.process of enlisting personnel for employment METHODS: • advertising • word of mouth • employee recommendation 2. SCREENING. RECRUITMENT --. experience & training • Reference – 3 names • Last paragraph. year of graduation. etc) & other things needed (ID pictures.recruiter uses data about the applicants to determine if he/ she is qualified and meets the minimum requirement PHILOSOPHIES: 1. when policies. .process of becoming familiar with a new environment and adapting well to it • Part of staff development. TIN.– Are insurances.Qualifications – College from where he/ she graduated. INTERVIEW • Face to face conference between two people about something • Employer– assess applicant’s personality – Alertness in answering questions – Poise – Command of the spoken language • Applicant– Background of institution.Request for personal interview SELECTION OF PERSONNEL 3.Source & purpose – Source of info concerning vacancy & nurse’s intent to apply • 2nd & 3rd paragraphs. screen out applicants who do not fit the image of the agency 2. white. uncertainties are diminished. residence certificate. try to fit the applicant to the job Pointers in preparing for an Interview • Make appointment either by mail or phone • Be at the place at the appointed time • Know something about the institution where you are applying • Be at your best • Knock before you enter • Bring credentials (PRC card.
important & applicable patientreported.anxiety is reduced and misunderstandings are prevented. interpretation & integration of valid. • Unmet Information Needs Practitioner information needs are currently not being met. etc Points in writing a Letter of Resignation • Give date of resignation • State reason for resigning • Express gratitude for kindness & consideration given during period of employment • Attach clearance for money. Cullum N. marriage.CONCERNS AND FUTURE DIRECTIONS INNURSING EVIDENCED-BASED NURSING An important concept to grasp when talking about new approaches to practice is “understanding reality while imagining other possibilities. their clinical expertise and patient preferences. in the context of available resources”.derived evidence .observed & research. • Implementation Delays . Ciliska D (1998)) Why we need EBN • Explosion of Literature . policies and standards of the institution • functions of the members of the health team RESIGNING FROM THE JOB Reasons for Resigning from the Job • Seek better positions locally or abroad • Inability to adjust to work situation.To provide the highest quality & most cost efficient nursing care possible • Founded on the collection. work & property responsibilities ISSUES. A well-defined orientation program would include: • a tour to the physical facilities • introductio n to co-workers • description of the organizational structure of the institution • information on the philosophy. children. clinician.Difficult to keep up with health care literature.Average of 17 years before research findings are fully integrated into clinical practice • Goal.” “Evidence based nursing is the process by which nurses make clinical decisions using the best available research evidence. (DiCenso A. goals.
In some areas of clinical practice the proportion of researchbased evidence will be high compared to other areas where experiential evidence will be paramount (physiological v.The scale shows Research and “Knowledge” – the specific type of knowledge required in a given situation will depend upon the context of that situation. physical) The idea of RCTs. meta-analyses and systematic reviews as the ’gold standard’ methods of assessing the effectiveness of treatment methods and nursing interventions is based on the assumption that rigorous systematic reviews provide nurses with a summary of all the methodologically sound STUDIES RELATED TO A PARTICULAR TOPIC .
unchangeable • Is not focused only on randomized controlled trials (RCTs) 5-Step EBN Process Step 1: Asking and formulating an answerable question Step 2: Database/ resource searching .o. male with chronic venous ulcer Best Available Research Evidence 1st line: High Compression Bandaging 2nd line: Graduated compression hosiery Judgment and Expertise of the Nurse Nurse is inexperienced in compression bandage application Patient has arthritic hands and is unable to apply the bandage No facility for washing stocking Patient Preference and Circumstances Judgment and Expertise of the Nurse Patient Preference and Circumstances Available Resources = Available Resources CLINICAL DECISION = CLINICAL DECISION Best Available Research Evidence 1st line: High Compression Bandaging 2nd line: Graduated compression hosiery What EBN is NOT • Is not a recipe or cookbook • Does not eliminate clinical judgment/reasoning • Does not ignore patient preferences • Is not rigid.Case Study 74 y.
Does the use of pain diaries in the palliative care of patient with cancers lead to improved pain control compared with not using diaries? 2. is Paracetamol more effective than Ibuprofen in achieving apyrexia within 1 hour of administration? Types of Clinical Questions • Health Care Interventions – Does compression bandaging increase the healing of venous leg ulcers compared with no compression? • Causation and Harm – Does the combined MMR childhood vaccine lead to an increased risk of autism compared with separate vaccines at different times? • Prognosis – Does having a stroke increase the risk of dementia in older people? • Diagnosis or Assessment – Is audiometry more accurate than the whispered voice test in diagnosing hearing impairment in older people? • Meaning – What are the experiences of using pain diaries in people with cancer receiving palliative care? • Economics – Are four-layer elastic bandages more cost-effective than multilayer inelastic bandages for healing venous ulcers? Step 2: Database/Resource Searching • General Information (Background) Resources • Filtered Resources • Unfiltered Resources EG: Background Filtered Resources Unfiltered Resources . In children with pyrexia.Step 3: Critically appraising the evidence Step 4: Applying the evidence Step 5: Re-evaluating the evidence Step 1: Formulating the Question P Population I Intervention C Comparison O Outcome T Time Frame EG: 1.
cinahl.tripdatabase.cochrane.bmjjournals.com www.com www. and accurate in my hospital? • Is my patient so different from those in the study group that the results cannot be applied? • According to the study results. how much would my patient benefit from the intervention or treatment? • Can the study results be applied to my patient? • What is my patient’s risk for side effects? • Are there alternative therapies? • Is my patient similar to those in the study group? • How will the evidence influence my choice of intervention? Step 5: Re-evaluating the Evidence • Was the diagnosis correct and the intervention successful? • Is there new information in the literature? • How can I improve/update my clinical decisions? So what’s the difference between research and EBN? RESEARCH EBN Discovery Research Utilization Usually single study Several studies critically appraised Research results are Research results presented are used to change practice EBN will change nursing practice from ‘think and feel’ to ‘knowledge and documentation’ .com www.uptodate.pubmed. affordable.ebn.com www.clinicalevidence.com Electronic textbooks www.com www.com National Guideline Clearinghouse Step 3: Critical Appraisal ? Diagnosis ? Therapy ? Harm ? Prognosis • Did the patient sample include an appropriate spectrum of patients similar to the general population? • Was the assignment of patients to groups randomized? • Were all the assigned patients accounted for at the end of the study? • Were the treatment groups similar at the start of the study? • Were exposures and outcomes measured similarly in the groups compared? • Were the comparison groups similar in outcome except for the variable studied? • Was the follow-up adequate? • Was the patient sample representative at a well-defined point in the course of the disease or disorder? • Was the length of follow-up adequate? • Was the follow-up complete? Step 4: Applying the Evidence ? Diagnosis ? Therapy ? Harm ? Prognosis • Is the test available.Information www.
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