SHAIRUZ CAESAR B. DUGAY RN MSN NA 202 HUMAN AND FINANCIAL RESOURCE MANAGEMENT MIDTERM EXAMINATION 1. The Civil Se vi!

!e C"##i$$i"% &ive$ '()li*i!)+i"%$ $+)%,) ,$ i% +he hi i%& "* e#-l".ee$ i% +he &"ve %#e%+. H"/eve 0 +he e)li+. i$ -"li+i!)l i%*l(e%!e1 2l"", el)+i"%$hi- )%, e%," $e#e%+ "* hi&h3 )%4i%& "**i!i)l$ !"#e i%+" +he -i!+( e. Di$!($$ +hi$ e)li+. )%, !i+e $-e!i*i! e5)#-le$ i* )%. /hi!h #). h)ve h)--e%e, i% ."( /" 4-l)!e " i% "+he &"ve %#e%+ "**i!e $. While the professionalizations policies currently place have institutionalized the minimum standards for appointment in the civil service, those standards do not sufficiently guarantee the quality of civil servants. Citizen demand for better public service requires a shift in focus from standards determined through paper credentials to the desired value orientation of civil servants. The values of prompt and courteous service to the public, the pursuit of excellence in the performance of ones wor and clear awareness of ethical conduct should be accorded greater premium than is presently obtaining in the recruitment of personnel. !alue dimensions shall therefore be factored into the testing processes for recruitment into the service. The present system that upholds the exercise by the president of discretionary powers in the appointment of career executives has exacerbated the politization of the career executive service and perpetuated the "spoil system# in the appointment process. $uch exercise of presidential prerogative must be limited to choices determined through an open, competitive process of selection and promotion based on merit and expertise. The vision in the long term is to transfer the appointing power from the president to the C$C as a constitutional and non%partisan body. &romotion within the C'$ is envisioned to be based on three ma(or dimensions) character, competence and potentials. Character will include integrity, credibility and reputation. Competence encompasses not only managerial but technical s ills as well. &otential is the capacity to develop and learn new s ills and ideas. This would transform the C'$ into a real pool of professional experts beholden to no one and unencumbered by political compromises. The predominant thin ing that the bureaucracy does not thin for itself and follows directions or merely implements orders emanating from the other power centers of government has to be replaced with a mental set that it can and should set its own directions. The essence of a career civil service is its autonomy from the dictates of political authorities, and its reliance on its own expertise to develop policies and programs pertaining to the dispensation of public service. * professional, career bureaucracy should be able to stand up to the regime of the day, set its own vision and road map for the organization, and deflect political importuning that will set its course astray. +ut in reality, Civil $ervice Commission is influenced by the dictates of political authorities. ,n most countries today there are increasing expectations

from ordinary citizens, business leaders and Civil $ociety that -overnments will establish and deliver higher standards of ethicality and integrity in the Civil $ervice, agencies of government, and -overnment itself. ,n part this expectation is the result of better%focused media attention and public scrutiny, and increasing impatience by ordinary citizens and Civil $ociety, whose members want to see an end to the corrupt practices and systems of the past. +earing in mind the significant progress made in recent years in developing effective Civil $ervice 'thics, Codes of Conduct, transparency measures, 'thics and ,ntegrity systems, and *nti%corruption agencies, there is now a need to concentrate on three areas of concern in particular, which are directly relevant to the problems of internalizing integrity and 'thics in democratic governments and the Civil $ervice. .ost Civil $ervice regimes still equate "&ublic $ector 'thics# with anti% corruption efforts, and limit their engagement with professional practice issues to a minimalist written Code of Conduct or Code of 'thics, which is usually concerned with prohibiting conflict of interests and self%dealing, and encouraging political and other forms of impartiality, and /increasingly0 service to the community. ,t may be fairly said that a civil service organization which fails to implement, /through adequate and effective training and management leadership0 and enforce /through effective leadership, disciplinary and management action0 its Code of 'thics in practice, can expect to be ineffective in controlling corruption, and inefficient or incapable of providing services to the public. ,n most established civil services, traditionally &romotion and recruitment to the civil service has been based on merit, not political or family connections, and is protected by law. &atronage and favoritism in public employment is generally prohibited by law, and protected by effective independent appeals mechanisms. ,ncreasingly, attempts to employ friends, relatives and cronies contrary to merit%based procedures required by such laws are being treated as a serious form of corruption, and have led to dismissals and prosecution for public officials /including .inisters0 who engaged in such practices. *rbitrary dismissal from the Civil $ervice 1iscipline and management practices must be ob(ective, fair, and reasonable. .anagers are expected to be trained able to deal with such matters as providing adverse assessments on performance, enforcing required wor processes, requiring punctuality, and dealing with employee grievances, effectively and fairly, to ensure that the efficiency of the wor place is not compromised unnecessarily. &erhaps most important of all, Civil $ervice salaries must reflect the cost of an adequate standard of living, both to minimize individuals2 temptation to corruption, and to maximize the Civil $ervices ability to attract and retain talented employees who can ma e a contribution to their community. &erformance may be ta en into account in setting pay, increment, or bonus levels, but must be based on actual performance, ob(ectively assessed, and properly documented.

2. H"$-i+)l "-e )+i"%$ ) e !)+e&" i6e, )$ he)l+h $e vi!e$. The $e vi!e - "vi,e li4e %( $e$ )%, ,"!+" $ $h"(l, )l/).$ )2i,e !($+"#e !) e )%, !($+"#e $)+i$*)!+i"%. Give% +hi$ $i+()+i"%7 ). H"/ $h"(l, +he $e vi!e - "vi,e h)%,le )2($ive -)+ie%+$ )%, *)#il.8 &ersonal space is the area around us that we consider an extension of ourselves. 3ow much space each of us requires to feel comfortable varies considerably4 What is almost universally true, however, is that anxiety rises when personal space is invaded. This heightened anxiety ma es it more li ely a person will act out in a more serious way. To avoid such a response, maintain at least an arm2s%length distance from a person whose behavior is escalating. ,n this way, you will be less li ely to increase the person2s anxiety. 5ou will also reduce danger to yourself by maintaining a margin of safety that allows you time to react. ,f you must touch an anxious person to provide medical care, explain what you are about to do before you begin. ,f the person ob(ects, decide if) 60 the procedure can wait until the person is less anxious7 80 someone else might be better suited to provide the care, e.g. someone who has established stronger rapport with the person7 or 90 the procedure must be done by you at this very moment. This third alternative should be a last resort, chosen only due to medical necessity. ,f this is your decision, be prepared for the possibility of the patient reacting negatively. ,n addition to maintaining adequate space between you and an anxious person, avoid eye%to%eye, toe%to%toe positions, as they might be interpreted as challenging. &ositions perceived as challenging can evo e a :fight or flight: response from the other person, and neither of those reactions is li ely to be helpful. $tanding at an angle to the person and off to the side is much less li ely to escalate an agitated person2s behavior. Try not to (udge or discount the feelings of others. Whether or not you thin their feelings are (ustified, those feelings are real to the other person. &ay attention to them, and don2t be afraid of silence. 5our supportive presence is often more important than what could be conveyed with any words you might say. *s a person begins to lose control of rational thought, the person becomes more tuned into your body language and less tuned into your words. ;onverbal communication < including gestures, facial expressions, movements and tone of voice < becomes paramount in conveying a calm, respectful attitude. ,f patients or family members become belligerent, defensive or disruptive, establish limits and directives clearly and concisely. When setting limits, offer simple, clear choices and consequences to the acting% out individual. +e sure the consequences are reasonable and enforceable. =or example, you might tell a family member who is insistent about entering an emergency treatment room, :&lease come bac to the waiting area with me, and ,2ll be sure the doctor spea s with you about your husband as soon as possible. ,f you try to enter the treatment room again,

,2ll have to call security, and then it will be even longer before you can tal to the doctor.: ,t is often the safest and best alternative to let the person shout, removing others from the area when feasible. *llow the person to release as much energy as possible by venting verbally. *s a person is venting, there will be pea s and valleys in the outburst, as the person2s energy expenditure rises and falls. ,f you cannot allow the person to continue venting, state the directives and reasonable limits during the :valleys: in the venting process. 'ven in the midst of an angry tirade, there is useful information to be gained about what a person is thin ing and feeling. The real reason for a person2s outburst is often not what it seems to be. *nxious patients and family members can be highly critical of hospital staff for reasons that are much more related to the fear and helplessness they are experiencing than to the ways staff members are performing their duties. Try to listen for the real message < the feelings behind the facts. >estate the message you thin you have received in order to determine if you correctly understood the person2s intent. &hysical restraint should be used only when people2s behaviors are dangerous to themselves or others. &hysical intervention itself always carries some ris of in(ury to staff or to the person being restrained. $uch interventions should be used, therefore, only when it is more dangerous ;?T to intervene. =urthermore, physical interventions should be used only by competent staff members who are trained to use the safest, least restrictive methods of intervention possible and who are well versed in any applicable regulations or laws pertaining to restraint use in their facilities. 2. H"/ $h"(l, -)+ie%+$ ,e)l /i+h ,e)l /i+h )2($ive ,"!+" $ )%, %( $e$8 .ost of these cases are that, the service health care providers are sexually abusive. =emale patients are much more li ely than male patients to be sexually abused in medical settings, but that does not mean that male patients are not at ris of being sexually abused too. .en are less li ely than women to report sexual abuse. $exual abuse in medical settings is more common than many people realize. ?ne health outcomes researcher did a survey with a group of men and 6@A of them reported inappropriate touching and comments during a physical exam at some point in their lives. ,n this survey, the most common groups to be exploited were /60 young naBve teenagers, followed by /80 guys in their 8@s getting their first required physical for employment, followed by /90 men getting their 9rd or Cth 1igital >ectal 'xam /1>'0. 1octors use female nurses or assistants as chaperones during exams that are unnecessary and cause embarrassment for male patients. ,n some cases, a female assistant stays around to observe or ta e notes while the male patient is undressed. $pea up and as for a private exam with the doctor without the female medical personnel.

,t is prudent for a male patient to find a good male doctor for intimate male health issues. Try to find a male doctor who is very sensitive to patient modesty and protecting your privacy as much as possible. Consider interviewing a doctor to see where he stands on patient modesty before allowing him to do intimate examinations on you. ,t would also be prudent to have a male doctor perform your colonoscopy if you must have the procedure. 1o not allow yourself to be pressured into having a genital or rectal exam at any doctor appointments. $ome male patients have gone to the doctor for other health concerns and were pressured into having unnecessary examinations. =or instance if you go in for a sore throat and you thin you may have strep throat, don2t spend time listening to a lecture by the doctor about how important it is to have a genital, prostate, or rectal exam and that you need one today. ,f something li e that happens, tell the doctor you are not interested and you only want to tal about the reason you came in /ex) your throat is sore0. Deep in mind that genital exams are often unnecessary unless you have urological symptoms or a genital in(ury. 5ou have the right to refuse genital or rectal exams at any time. Ta e along a trusted person /preferably your wife0 for doctor appointments that require genital or rectal exams if possible % not only for protection from potential sexual abuse, but to act as another set of eyes and ears to help listen and remember everything you need to now regarding the reason you actually are there. 3aving a nurse or an assistant present in the room with the doctor doesn2t guarantee that nothing inappropriate would happen to you. >emember that the nurse or assistant is present to :protect: the doctor and will often be on the doctor2s side. ,f the doctor refuses to allow the person of your choice to be present, wal away. ,f you are uncomfortable or frightened with something that is happening during an exam or procedure, spea up and stop the exam or procedure. 1on2t undress or put on a medical gown when it is unnecessary andEor you feel uncomfortable. There are so many procedures and tests that doctors can do on you without you having to change your clothes. =or example, there2s no need to change into a medical gown for a strep throat test. 5ou should thin in advance about what parts of your body the doctor should examine and dress accordingly. =or instance if you have a nee problem that you want the doctor to chec out, you should put shorts instead of pants on so you would not have to ta e any of your clothes off in the doctor2s office. ,f you are going to be put under anesthesia, you should insist that you have a family member or a friend present for your procedure to protect you. &atients who are under anesthesia are very vulnerable because they have no control over what happens. .any patients are unnecessarily stripped na ed for surgeries. ?ne male hand surgery

patient had his gown and underwear removed after he was put under anesthesia. The only reason he found out was because he wo e up in middle of the surgery. ,f you must be hospitalized, it would be best if you could have someone not employed by the hospital present with you at least most of the time especially when you are asleep or drowsy. ,nsist that no urinary catheter be inserted unless it is absolutely necessary. Too many unnecessary urinary catheterizations are done. ,f you must be catheterized, it would be prudent to as that a male nurse or doctor do it.