C O N F L I C T (MAY NLE 2015)

Is a disagreement among two or more individual groups, or

organizations.
It is present when an inner or outer struggle occurs regarding ideas,
feelings or actions.

4 TYPES OF CONFLICT
1. Intrapersonal
Conflict within an individual
Confronted with 2 or more compatible demands.
2. Conflict between health organizations
Issues that pertains to competition for buildings, types of facilities,
funding, and business.
3. Conflict within health organizations
Interpersonal and inter-group.
4. Conflict in a multi-cultural environment
nurse manager must not assume that everyone has a similar behavior,
beliefs, &
values.
CONSEQUENCES OF CONFLICT
1. Issues are recognized & brought out in the open.
2. There is a rise in group cohesion and performance.
3. Poor performance
4. Constructive or destructive results
5. There may be a rise of leaders.
DELEGATION
Defined as sharing responsibility and authority with subordinates and
holding them accountable for their performance.
It is a skill that relies on trust that the subordinates have the necessary
skills and knowledge to know how to do the assigned tasks.
It is a tool that the nurse managers uses to build morale among the
staff which involves:
a. giving assignments to subordinates
b. motivating them to perform their
job efficiently and effectively.

 Is a major element of the directing function of the nursing

management competency by which nurse managers get the work done
through their employees.

PURPOSES OF DELEGATION
Saves time and can help develop others.
Maximizes the use of the talents of staff associates
Uses latent abilities in personnel that contribute to their growth and development.

When NOT to Delegate

Do not delegate the power to discipline

Do not delegate responsibility for maintaining morale
Do not delegate overall control
A Hot potato jobs that are too technical
Do not delegate duties involving a trust or confidence.

FIVE REASONS FOR DELEGATING

Assigning routine task

Assigning tasks for which the nurse manager does not have time
Problem solving
Changes in nurse managers own job emphasis
Capability building

FUNCTIONS OF LEADER

Creates connection among an organization members

Achieve concensus within the group about its goal
Supply necessary information that helps provide direction & clarification.
Maintain group satisfaction cohesion, & performance
Focus on :
a. communicating
b. motivating
c. initiating
d. facilitating
e. integrating

FUNCTIONS OF MANAGERS
Coordinates and integrate resources using the functions of :
A. Planning
B. Organizing
C. Supervising
D. Staffing
E. Evaluating
F. Negotiating
G. Representing
* Interpersonal skill is important, but a manager also has the authority, responsibility,
power defined by the organization

NURSING AUDIT

a method of assuring documentation of the quality of nursing care in keeping with

established standards
official examination of nursing records for purposes of evaluation, verification and
betterment
provides the inspection method that compares results with predetermined criteria
Documenting the level of care delivered will not, in and of itself, improve the
quality of care. Nursing audit raises the level of awareness of the need for
accurate and concise documentation.
This is to prove that nursing care has been given effectively; and,
the patients progress resulted from that care

7 STEPS AND PROCEDURE OF NURSING AUDIT

1. Establish / create a nursing audit committee represented by department / unit
heads responsible for providing nursing care.
-Tasks include developing purposes and objectives, and maintaining implementation of
the audit procedure.
A. Establish standards and criteria
B .establish guidelines for conducting the audit
C. decide on the use of necessary forms

D. Initiate the auditing process

E. Practice the process for proficiency
2. Establish standards and criteria specific to the area of evaluation (structure, process,
outcome).
3. Measure actual practice against set criteria.
4. Evaluate results observe variations and decide which are justifiable in terms of
acceptable nursing practice, and identify actual deficiencies, indicating the probable
reasons for such.
5. Take corrective action.
6. Follow-up and reassess done on a quarterly or bi-annual basis. The committee may
be justified to make a follow-up a month after feedback was given. This will provide solid
evidences of improved documentation or achievement of quality care.
7. Report prepare and distribute summary reports to nursing service, hospital
administrators, and to the executive committee of the medical staff.

2 TYPES OF NURSING AUDIT

1. Retrospective (Closed Chart) Audit
-An inspection of a closed chart to examine its DOCUMENTARY RELIABILITY,
COMPLETENESS, and COMPLIANCE with established standards
-Attempts to determine the DEGREE to which the patients chart
accurately reflects the quality of nursing care; and,
whether or not the care given is clinically sound
- it MAY FOCUS on : OUTCOME and PROCESS AUDIT
2.Concurrent (Open Chart) Audit
An inspection of the nursing process, as evidenced by the open chart, patient feedback,
and staff input.

QUALITY ASSURANCE
the estimation of the degree of excellence in patient health outcomes, activity,
and other resource outcomes
QUALITY the degree of excellence
- doing the right thing right, the first time, all the time
ASSURANCE formal guarantee of a degree of excellence
The term quality assurance is gradually being replaced with terms that better
define the process, such as total quality management (TQM), and continuous
quality improvement (CQI).

Quality assurance requires evaluation of three Components of care: (SPO)

1. Structure Evaluation- focuses on the setting in which care is given.
Structural standards describe desirable environmental and organizational
characteristics that influence care: Equipment and staffing
2. Process Evaluation-focuses on how the care was given process standards
focus on the manner in which the nurse uses the NURSING PROCESS
3. Outcome Evaluation- focuses on demonstrable changes in the clients
health status as a result of nursing care. Outcome criteria written in terms of
clients responses or health status, just as they are for evaluation WITHIN
the NURSING PROCESS
QUALITY CONTROL

assessment of the level of nursing care provided and its effects on the patient
organizational functions
inputs and outputs

PERFORMANCE APPRAISAL
a method of acquiring and processing the information needed to improve work
performance (Douglass)

a periodic formal evaluation of how well personnel have performed their duties
during a specific period (Tomey)
a control process in which actual performance is evaluated against standards
(Venzon)
the most valuable tool in controlling human resources and productivity
PURPOSES OF PERFORMANCE APPRAISAL (MAY nle2015)
1. To determine job competence
2. inform employees where they stand
3. To establish performance standards
4. To enhance staff development and motivate personnel toward higher
achievement
5. To discover the employees aspirations and recognize accomplishments

6. To improve communication between managers and staff and reach an

understanding on the objectives of the job
7. To improve performance by developing good interpersonal relationships among
and between members
8. To determine training and developmental needs of employees
9. To make inventories of talents within the organization and reassess assignments
10. To generate information for salary adjustments, promotions and transfers,
disciplinary actions, and terminations (Marquis)

-determine salary standards and merit increases

select qualified personnel for promotion or transfer

-identify unsatisfactory employees for demotion or termination

11. To provide employee recognition for accomplishments

COMPONENTS of an EFFECTIVE PERFORMANCE APPRAISAL SYSTEM

1. Compatibility between criteria for individual evaluation and organizational
goals.
2. Direct application of the appraisal to the performance standards and
objectives expected of the worker.
3. Development of behavioral objectives mutually agreed upon by both parties.
4. Understanding of the appraisal process and its effective utilization by the
rater.
5. Rating of each individual by the immediate supervisor.
6. Reinforcement of strengths in performance; and noting weaknesses only
when:
-They
pose
a
threat
to
client
safety
-They provide a significant deterrent to goal accomplishment
7. Encouragement of feedback regarding performance, needs, and interests
8. Provision for initiating preventive and corrective actions, and making
adjustments to improve performance
GUIDELINES FOR DNR
When to be ordered:
Unreceptivity or Unresponsiveness
No movement or breathing
No reflexes

A flat ECG

DNR PRINCIPLES
DNR order should be written in Medical Record MR.
DNR orders should specify the exact nature of the treatment to be withheld.
If able, patient should participate in DNR decision. Their involvement & wishes
should be documented in the MR.
Decisions to withhold CPR should be discussed w/ the health team.
DNR status should be reviewed on a regular basis.
DNR is not equivalent to medical or psychological abandonment.